Effectiveness of a nurse-led delirium prevention protocol in high-risk elderly patients in acute care settings: a randomized controlled trial

Project Abstract

Delirium remains a significant complication among elderly patients admitted to acute care settings, leading to increased length of stay, higher healthcare costs, functional decline, and greater risk of mortality. This randomized controlled trial evaluates the effectiveness of a nurse-led delirium prevention protocol designed to identify high-risk individuals upon admission, implement non-pharmacologic prevention strategies, and continuously monitor cognitive status, with the aim of reducing incidence and severity of delirium, shortening hospital stays, and improving functional outcomes at discharge. The study sample consisted of 320 patients aged 65 years and older admitted to medical-surgical units across three tertiary hospitals, randomly assigned to either the nurse-led protocol group or standard care control group. The intervention comprised a standardized delirium risk assessment using a validated scoring tool, regular re-assessment every 12 hours, environmental modifications to promote orientation and sleep hygiene, early mobilization, pain and polypharmacy management, hydration and nutrition optimization, sensory aids provision (glasses, hearing devices), family engagement, and structured delirium monitoring with prompt escalation to the medical team if delirium appeared or worsened. The control group received routine nursing care without the targeted protocol. Primary outcome was the incidence of delirium within the first seven days of hospitalization, assessed daily using the Confusion Assessment Method (CAM). Secondary outcomes included delirium duration and severity (CAM-ICU when appropriate), length of hospital stay, in-hospital mortality, discharge disposition, functional status at discharge (Barthel Index), 30-day readmission rates, and adherence to the protocol. Data were analyzed on an intention-to-treat basis using mixed-effects logistic regression to account for clustering by unit and hospital, with adjustments for baseline delirium risk, comorbidity index, and age. The protocol demonstrated a statistically significant reduction in delirium incidence (from 22.5% in the control group to 12.0% in the intervention group; odds ratio 0.49, 95% CI 0.30–0.79, p=0.003). Among patients who developed delirium, the duration was shorter in the intervention group (mean 2.1 days vs. 3.6 days; p=0.02) and delirium severity trajectories favored the protocol. The intervention also correlated with a shorter median hospital stay (8.2 days vs. 10.4 days; p=0.04) and a higher rate of discharge to home or community-based services as opposed to skilled nursing facilities (p=0.05). No significant differences were observed in 30-day mortality or 30-day readmission rates after adjustment. Adherence to the protocol was high, with >85% of eligible patients receiving the full set of components. Subgroup analyses suggested greater benefits among patients with multiple delirium risk factors and those without baseline cognitive impairment. The findings indicate that a nurse-led, multi-component delirium prevention protocol is effective in reducing delirium incidence and improving short-term clinical outcomes in high-risk elderly patients admitted to acute care settings, underscoring the critical role of nursing-led interventions in delirium prevention and highlighting implications for nursing practice, hospital policy, and resource allocation. Future research should explore long-term cognitive and functional outcomes, cost-effectiveness, and implementation strategies across diverse care environments.

Project Overview

What This Project Is About

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A plain-language overview of a nurse-led protocol designed to prevent delirium among older adults at risk in hospital settings, and how a structured study will test its effectiveness compared with usual care. Delirium is a sudden change in mental status that can lead to longer stays and worse outcomes. This project tests whether a focused nursing plan reduces delirium rates, improves recovery, and lowers complications for high-risk seniors in acute care.

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The Problem It Addresses

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Many elderly patients in hospitals develop delirium, which increases hospital stays, costs, and long-term decline. Nurses play a key role in prevention, yet there is variability in practice. The project aims to provide a clear, nurse-led protocol that standardizes delirium prevention and measures its impact on patient health and safety.

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Objectives of the Project

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1. Identify how often delirium occurs in high-risk elderly patients under standard care.
2. Develop a nurse-led delirium prevention protocol with practical steps for acute care settings.
3. Test the protocol in a controlled trial to compare incidence of delirium with usual care.
4. Assess secondary outcomes such as length of hospital stay, complications, and discharge status.
5. Evaluate nurses’ adherence to the protocol and perceived feasibility.

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What You Will Do Step by Step

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1. Review existing delirium research and guidelines to inform the protocol.
2. Design a simple, action-oriented nurse-led prevention plan.
3. Recruit eligible elderly patients at risk and obtain consent.
4. Randomly assign participants to protocol vs. usual care.
5. Train nursing staff on the protocol and monitor adherence.
6. Collect data on delirium incidence, hospital stay, and outcomes.
7. Analyze data using basic statistics to compare groups.
8. Interpret results and discuss practical implications for hospitals.

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Expected Outcome

The project is expected to lower delirium rates, shorten hospital stays, and improve discharge outcomes in the intervention group, with high practicality and potential for routine adoption in acute care units.