World Delirium Awareness Day 2019, delirium and risk of falls in the hospital setting

Abstract Background Delirium is an acute change in cognition, common among older hospitalized patients, however, patients of all ages are at risk of delirium during a hospital stay. The International Federation of Delirium Societies promotes, each year, a World Delirium Awareness Day, to raise the awareness of, not just recognizing delirium in the hospital setting, but ensuring interventions are in place to prevent the development of delirium. Hospitalized patients with delirium have increased risk of adverse events such as falls, pressure injury, malnutrition, increased length of stay, increased health care costs, and mortality. This clinical audit aimed to estimate the risk of a subsequent fall, following an acute episode of in-hospital delirium, across a broad cross-sectional of clinical settings. Methods Seventeen adult acute inpatient wards across a health district, undertook an audit of the number of admitted patients who had had at least one episode of delirium since being admitted to hospital. Using the hospital-based incident management reporting system, the rates of subsequent falls was compared between delirium and non-delirium patients. Results Fifty of the 473 patients (11.4%) were identified by the nursing staff to have had at least one episode of delirium since admission. The proportion of fallers among the delirium and non-delirium patients were 10% and 2%, respectively (p = 0.004). The rate of falls per 1000 patient days was 6.45 (95% confidence interval (CI) 2.1 to 15.1) among delirium patients, compared to 2.12 (95% CI 1.0 to 4.0) among patients without delirium. The risk of falling among delirium patients was 4.25 higher compared to non-delirium patients (adjusted hazard ratio (HR) = 4.25, 95% CI 1.26 to 14.39). Conclusion This clinical audit has been able to show that an acute episode of delirium increases the risk of an in-hospital fall fourfold. Importantly, these results have highlighted the need for a hospital wide approach, to not just in identifying delirium, but the need to have interventions in place to reduce the risk of delirium. In other words, delirium prevention should be ‘core business’ of all nursing care, across the acute hospital setting.