Date of Award


Document Type


Degree Name

Doctor of Nursing Practice (DNP)

School Name

Donna and Allan Lansing School of Nursing and Health Sciences



Major Advisor

Dr. Nancy York

Second Advisor

Dr. Sherill Cronin


Delirium is the most frequent complication associated with hospitalizations of older adults and is responsible for 17.5 million hospital days at a cost of more than $6 billion each year. It is estimated delirium occurs in approximately 14 – 56% of all hospitalized elderly patients. Outcomes associated with delirium in the adult population are prolonged hospital lengths of stay, increased mortality, and post-hospitalization cognitive impairment. Hospitalized patients diagnosed with delirium may be discharged to rehabilitation centers or nursing homes for recuperation, and/or for permanent residence.

Delirium is often misdiagnosed because the presentation of signs and symptoms mimic other medical conditions or can be mistaken as an adverse medication reaction. The purpose of the project was to implement an evidence-based delirium protocol addressing non-pharmacological interventions for treatment. The project began with a baseline questionnaire completed by Registered Nurses (RNs) to determine educational opportunities for delirium recognition and assessment for patients in a short and long stay unit. An educational in-service was provided for RNs and included early recognition and assessment of delirium. Registered nurses were also re-educated on the use of the Brief Confusion Assessment Method and the Richmond Agitation-Sedation Scale. Finally, practice changes were initiated and the Initial Delirium Assessment in the electronic record was modified.