Delirium Inpatient Care Pathway

VMC is excited to announce the introduction of the Delirium Reduction & Recognition (DRR) Clinical Pathway, which went live on January 9, 2024. Clinical inpatient providers should be aware of this new pathway and expect notification from nursing to initiate the DRR order panel for patients admitted who screen at high risk for development of delirium or for those patients who develop active delirium at any point in their hospital course. 

Utilization of the DRR Pathway

• All patients 65 and older will get a delirium risk screen (AWOL) at the time of admission.
• For those patients who screen at high risk on AWOL, nursing staff will notify providers to initiate the DRR order set (‘Med IP Delirium Focused’).
• This will include a delirium screen (Nu-DESC) per shift to monitor closely for any changes in mentation during their hospitalization stay.
• In addition, the order panel includes a set of nursing interventions (providing reorientation, optimizing fluid status, mobilization, sleep-wake cycle, etc.), in addition to orders for potential consultation of specialists if clinically relevant and indicated (e.g., pharmacy, PT, OT, nutrition, speech, etc.).

Background for Development of this New Pathway at VMC

Due to the high incidence, increased risk of morbidity and mortality, in addition to the increased cost associated with delirium, evidence-based interventions to recognize the syndrome early can help improve overall patient care and outcomes. It is estimated that 30% of delirium cases in the hospital are preventable. The VMC DRR Pathway is an evidence-based, multi-disciplinary, multi-component, nursing led pathway which utilizes a validated delirium risk screen (AWOL) and delirium screen (Nu-DESC). The protocol is a variation of the pathway model created by clinicians and researchers at UCSF.

Further information regarding the DRR Clinical Pathway can be found here.