Nurse’ prediction prevention and management on post-operative delirium in geriatric patients with hip fracture: The development of a protocol to guide care

BackgroundA high prevalence for the development of delirium after hip fracture was found in the group of geriatric patients. The National Institute for Health and Clinical Excellence has introduced a guideline for the management delirium (NICE, 2010). Protocols composed of detection, prevention and management of post-operative delirium required some adaptation to meet the needs of local nurses.AimA protocol with a nursing care plan referenced from an international guideline and other literature was developed to predict, prevent and manage post-operative delirium for geriatric patients with hip fracture.MethodsThe literature suggests numerous risk factors are associated with post-operative delirium and its preventive interventions were adopted to develop the protocol and nursing care plan.FindingsSix major risk categories included mental and behavioural influence, sensory impairment, physiological influence, immobility influence, electrolyte disturbance and infection influence. These were used for screening patients, accompanied by various preventive interventions. A protocol was developed to strive for the best management of geriatric patients receiving hip fracture surgery from admission to discharge.ConclusionsThe protocol incorporated with the Risk Assessment for Management of Postoperative delirium (RAMP) care plan was adapted for staff to implement in their local clinical area. Further study is required to determine its effectiveness on the prevention of the development of post operative delirium (POD) in the future.