Shaping the future of Nursing Screening for Delirium ...

1 Screening for Delirium ,Dementia and Depression in Older AdultsNursing Best Practice GuidelineShaping the future of NursingNovember 2003 Greetings fromDoris Grinspun Executive DirectorRegistered Nurses Association of Ontario It is with great excitement that the Registered Nurses Association of Ontario (RNAO)disseminates this Nursing best practice guideline to you. Evidence-based practice supportsthe excellence in service that nurses are committed to deliver in our day-to-day practice. We offer our endless thanks to the many institutions and individuals that are makingRNAO s vision for Nursing Best Practice guidelines (NBPGs) a reality. The Ontario Ministryof Health and Long-Term Care recognized RNAO s ability to lead this project and is providing multi-yearfunding. Tazim Virani NBPG project director with her fearless determination and skills, is moving the projectforward faster and stronger than ever imagined.

2 The Nursing community, with its commitment and passionfor excellence in Nursing care, is providing the knowledge and countless hours essential to the creation andevaluation of each guideline. Employers have responded enthusiastically to the request for proposals (RFP),and are opening their organizations to pilot test the NBPGs. Now comes the true test in this phenomenal journey: will nurses utilize the guidelines in their day-to-day practice? Successful uptake of these NBPGs requires a concerted effort of four groups: nurses themselves, otherhealthcare colleagues, nurse educators in academic and practice settings, and employers. After lodgingthese guidelines into their minds and hearts, knowledgeable and skillful nurses and Nursing students needhealthy and supportive work environments to help bring these guidelines to life.

3 We ask that you share this NBPG, and others, with members of the interdisciplinary team. There is much tolearn from one another. Together, we can ensure that Ontarians receive the best possible care every time theycome in contact with us. Let s make them the real winners of this important effort!RNAO will continue to work hard at developing and evaluating future guidelines . We wish you the best for a successful implementation!Doris Grinspun, RN, MScN, PhD (candidate)Executive DirectorRegistered Nurses Association of OntarioHow to Use this DocumentThis Nursing best practice guidelineis a comprehensive document providingresources necessary for the support of evidence-based Nursing practice. The documentneeds to be reviewed and applied based on the specific needs of the organization or practicesetting/environment, as well as the needs and wishes of the client.

4 guidelines should not beapplied in a cookbook fashion but used as a tool to assist in decision making for individualizedclient care, as well as ensuring that appropriate structures and supports are in place to providethe best possible , other healthcare professionals and administrators who are leading and facilitatingpractice changes will find this document valuable for the development of policies, procedures,protocols, educational programs, assessment and documentation tools. It is recommendedthat the Nursing best practice guidelines be used as a resource tool. It is not necessary, norpractical that every nurse have a copy of the entire guideline. Nurses providing direct clientcare will benefit from reviewing the recommendations, the evidence in support of therecommendations and the process that was used to develop the guidelines .

5 However, it ishighly recommended that practice settings/environments adapt these guidelines in formatsthat would be user-friendly for daily use. This guideline has some suggested formats for suchlocal adaptation and wishing to use this guideline may decide to do so in a number of ways: Assess current Nursing and healthcare practices using the recommendations in the guideline. Identify recommendations that will address identified needs or gaps in services. Systematically develop a plan to implement the recommendations using associated tools and is interested in hearing how you have implemented this guideline. Please contactus to share your story. Implementation resources will be made available through the RNAO website at assist individuals and organizations to implementbest practice guidelines . 1 Nursing Best Practice Guideline2 Screening for Delirium , Dementia and Depression in Older AdultsNancy Bol, RN, BScN, MScNTeam LeaderClinical Nurse SpecialistGeriatric PsychiatryRegional Mental Healthcare LondonSt.

6 Joseph s Healthcare LondonLondon, OntarioMadeline Edwards, RN, BA(Sociology),Certificate in Dispute ResolutionCanada Pension Plan Disability TribunalToronto, OntarioMarielle Heuvelmans, RN, HBScN, GNC(C)Client Services LeaderCommunity Care Access Centre forEastern CountiesCornwall, OntarioNadine Janes, RN, BScN, MSc, ACNP,GNC(C)Doctoral StudentFaculty of NursingUniversity of TorontoToronto, OntarioLinda Kessler, RN, BScN, MHScAdministrative Director Geriatric Psychiatry ServicePCCC-Mental Health ServicesKingston, OntarioElizabeth Phoenix, RN, MScN, CPMHN(C)Nurse Practitioner/Clinical Nurse SpecialistChild and Adolescent CentreMental Healthcare ProgramLondon, OntarioTiziana Rivera, RN, BScN, MSc, ACNP, GNC(C)Clinical Nurse Specialist/Nurse PractitionerBaycrest Centre for Geriatric CareToronto, OntarioDianne Rossy, RN, BN, MScN, GNC(C)Advanced Practice Nurse, GeriatricsThe Ottawa Hospital & The RegionalGeriatric Assessment ProgramOttawa, OntarioGuideline Development Panel Members3 Nursing Best Practice GuidelineJosephine Santos, RN, MNFacilitator, Project CoordinatorNursing Best Practice guidelines ProjectRegistered Nurses Association of OntarioToronto, OntarioKathleen Sayle, RPNR egistered Practical Nurses Association of OntarioSupervisor, Occupational Health andSafety ProgramsCentre for Addiction and Mental HealthToronto, OntarioAgnes Scott, RN, CPMHN(C), BSN, MACommunity Nurse ClinicianWhitby Mental Health CentreSeniors Mental Health ProgramWhitby, OntarioSelinah Sogbein, RN, BScN, BA, MHA,MEd, CHE, CPMNH(C)

7 Assistant Administrator/Chief Nursing OfficerNorth Bay Psychiatric HospitalNorth Bay, OntarioAnne Stephens, RN, BScN, MEd, GNC(C)Coordinator, Geriatric Outreach ServicesNorth York General HospitalToronto, OntarioAnn Tassonyi, RN, BScNPsychogeriatric Resource ConsultantAlzheimer Society and Niagara GeriatricMental Health OutreachSt. Catharines, OntarioCatherine Wallis-Smith, RN, CPMNH(C)Supervisor of Nursing and Home SupportParamed Home HealthcareInstructor Palliative Care, Georgian CollegeBarrie, OntarioKevin Woo, RN, BScN, MSc, PhD(cand),ACNP, GNC(C)Nurse Practitioner/Clinical Nurse SpecialistMount Sinai HospitalToronto, OntarioScreening for Delirium ,Dementia and Depression in Older AdultsProject team:Tazim Virani,RN, MScNProject DirectorJosephine Santos,RN, MNProject CoordinatorHeather McConnell,RN, BScN, MA(Ed) Project ManagerMyrna Mason,RN, MN, GNC(C)Coordinator Best Practice Champions NetworkCarrie ScottAdministrative AssistantElaine Gergolas,BAProject Coordinator Advanced Clinical/Practice FellowshipsKeith Powell,BA, AITWeb EditorRegistered Nurses Association of OntarioNursing Best Practice guidelines Project111 Richmond Street West, Suite 1208 Toronto, Ontario M5H 2G4 Website.

8 Best Practice Guideline5 Nursing Best Practice GuidelineFaranak AminzadehResearch Associate/Geriatric AssessorRegional Geriatric Assessment ProgramNepean, OntarioGail AncillNurse ClinicianNeuropsychiatry ProgramRiverview HospitalPort Coquitlam, British ColumbiaTeri BeggNurse Case ManagerNiagara Geriatric Mental HealthOutreach ProgramSt. Catharines, OntarioDiane BuchananClinical Nurse Specialist/ResearcherBaycrest Centre for Geriatric CareToronto, OntarioMargaret BuckEtobicoke, OntarioDr. William DalzielChief, Regional Geriatric AssessmentProgram of Ottawa CarletonAssociate Professor, Division of GeriatricMedicine, University of OttawaOttawa HospitalOttawa, OntarioPamela DawsonDawson Gerontabilities Toronto, OntarioDenise DodmanPsychogeriatric Resource Consultant Chatham/Kent Community Care Access CentreChatham, OntarioAnne EvansClinical Nurse SpecialistRegional Psychogeriatric ProgramSt.

9 Joseph s HealthcareLondon, OntarioBonnie HallAdvanced Practice Resource NurseSCO Health ServiceSt. Vincent HospitalOttawa, OntarioElaine PalmerGeriatric Case ManagerGrey Bruce Community Care Access CentrePort Elgin, OntarioJackie RobertsProfessor, School of NursingMcMaster UniversityHamilton, OntarioStakeholder AcknowledgmentStakeholders representing diverse perspectives were solicited for their feedbackand the Registered Nurses Association of Ontario wishes to acknowledge thefollowing for their contribution in reviewing this Nursing Best Practice for Delirium , Dementia and Depression in Older AdultsPatricia StilesClinical Nurse SpecialistHomewood Health CentreGuelph, OntarioDr. Lisa Van BusselGeriatric PsychiatristRegional Psychogeriatric ProgramSt. Joseph s HealthcareLondon, OntarioDonna WellsAssociate ProfessorFaculty of NursingUniversity of TorontoToronto, OntarioSpecial acknowledgment also goes to Barb Willson, RN, MSc and Anne Tait,RN, BScN,who served as ProjectCoordinators at the onset of the Best Practice GuidelinePrincipal Investigators:Nancy Edwards, RN, PhDBarbara Davies, RN, PhDUniversity of OttawaEvaluation Team:Maureen Dobbins, RN, PhDJenny Ploeg, RN, PhDJennifer Skelly, RN, PhDMcMaster UniversityPatricia Griffin, RN, PhDUniversity of OttawaProject Staff:University of OttawaBarbara Helliwell, BA(Hons); Marilynn Kuhn, MHA; Diana Ehlers, MA(SW), MA(Dem);Christy-Ann Drouin, BBA; Sabrina Farmer, BA; Mandy Fisher, BN, MSc(cand); Lian Kitts, RN.

10 Elana Ptack, BAAs well, RNAO sincerely acknowledges the leadership and dedication of theresearchers who have directed the evaluation phase of the Nursing Best PracticeGuidelines Project. The Evaluation Team is comprised of:Contact Information Registered Nurses Association of OntarioNursing Best Practice guidelines Project111 Richmond Street West, Suite 1208To r o n t o, O n t a r i oM5H 2G4 Registered Nurses Association of OntarioHead Office438 University Avenue, Suite 1600To r o n t o, O n t a r i oM5G 2K8 RNAO also wishes to acknowledge the following organizations in Toronto,Ontario for their role in pilot testing this guideline:Pilot Project Sites Toronto Rehabilitation Institute University Health Network Mount Sinai Hospital8 DisclaimerThese best practice guidelines are related only to Nursing practice and not intended to take intoaccount fiscal efficiencies.