Management of postoperative delirium for geriatric patients with hip fracture: A quasi-experimental study

Abstract

Introduction: Delirium is one of the postoperative complications in the group of geriatric patients with hip fracture. A variety of measures were addressed on prevention of postoperative delirium but the prevalence of it remains high over the world. Postoperative delirium surely disturbs rehabilitative processes of patients and adds emotional burden to nurses. As a result, an effective postoperative delirium management is important to this group of patients and healthcare providers. Aim: This studywas to determine the effectiveness of the modified Risk Assessment and Management of Postoperative delirium (RAMP) care plan on the management of delirious patients receiving hip fractures operation in two comparable groups.

Methods: A quasi-experimental sampling using a time-series design was carried out to assign subjects to the conventional and protocol care group according to the inclusion and exclusion criteria. The incident rate of postoperative delirium was determined. The length of hospital stay, the duration of the postoperative delirium and the mean of delirious day after operation in the two groups were compared using ANOVA analysis.

Results: Of 303 participants, 62 subjects were eligible for conventional group and 49 subjects were eligible for protocol group. The duration of patients developing delirium postoperatively in the protocol care group (mean days = 2.33) was significantly different from that in the conventional care group (mean days = 3.5). Further, the length of stay which was recorded from patients receiving operation to discharge or transfer was found significantly different between the conventional group (9.06 days) and the protocol group (8.17 days). The mean days of the development of delirium after operation in the conventional care group was 2.13 whereas that in the protocol care group were 1.17.

Conclusion: The RAMP care plan was proved its effectiveness on shortening the duration of postoperative delirium by 1.17 days. In spite of the inspired results, it was suggested that the modified RAMP care plan should be used for screening and assessment before patients receiving hip surgery.