Effectiveness of a nurse-led delirium prevention protocol on acute postoperative outcomes in elderly orthopedic patients

Project Abstract

Delirium remains a common and costly complication among elderly patients following orthopedic surgery, contributing to prolonged hospital stays, higher mortality, increased risk of long-term cognitive decline, and greater utilization of healthcare resources. This study evaluates the effectiveness of a nurse-led delirium prevention protocol integrated into standard perioperative care for elderly orthopedic patients undergoing hip or knee procedures. A quasi-experimental design with pre- and post-implementation phases was utilized in a tertiary care center, enrolling adults aged 65 years and older admitted for elective orthopedic surgery. The intervention comprises evidence-based, nurse-driven components systematic delirium risk assessment on admission, structured non-pharmacological delirium prevention strategies (sleep optimization, orientation cues, hydration and nutrition optimization, early mobilization, pain control with multimodal analgesia, minimizing polypharmacy, and environmental modifications), routine cognitive screening using validated tools (e.g., CAM or 4AT), staff education workshops, family engagement, and daily multidisciplinary rounds focused on delirium risk and management. The control condition reflected conventional postoperative care without the specialized protocol. Primary outcomes included incidence of postoperative delirium within the first 5 postoperative days, duration and severity of delirium episodes, and length of hospital stay. Secondary outcomes encompassed in-hospital mortality, 30-day readmission rates, discharge disposition (home vs. rehabilitation facility), postoperative complications, and patient/family satisfaction with care. Data were collected from electronic medical records and standardized nursing assessment forms, with delirium diagnosed according to established diagnostic criteria and corroborated by a geriatric consultation when necessary. Multivariate analyses adjusted for confounders such as age, sex, baseline cognitive status, comorbidities, type of surgery, anesthesia method, and perioperative analgesia. The study hypothesizes that the nurse-led protocol will reduce the incidence and duration of delirium, shorten hospital stays, and improve overall postoperative outcomes and patient/family satisfaction compared with standard care. Preliminary results indicate a significant reduction in delirium incidence from X% to Y% (p<0.05) and a decrease in median delirium duration by Z hours, alongside shorter median length of stay and lower rates of discharge to non-home facilities. Secondary outcomes revealed trends toward reduced 30-day readmissions and postoperative complications, with improved patient and family engagement in care plans. Process evaluation demonstrated high fidelity to the protocol, with nurses reporting enhanced confidence in delirium recognition and non-pharmacological management, though barriers included staffing constraints and occasional resistance to practice change. The study contributes to the growing evidence supporting nurse-led, non-pharmacological delirium prevention as a feasible, cost-effective strategy to optimize recovery trajectories in older orthopedic patients. Implications for clinical practice include integration of delirium prevention into standard perioperative pathways, targeted staff education, and policy development to sustain nurse-driven initiatives. Limitations include single-center design and potential selection bias; recommendations for future research emphasize multicenter randomized trials, long-term cognitive outcomes, and economic evaluations to determine cost-effectiveness across diverse healthcare settings.

Project Overview

What This Project Is About

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A straightforward look at how a nurse-led protocol to prevent delirium might change recovery after surgery for older adults with broken bones or joint problems. It focuses on practical steps nurses can take during hospital stays to keep patients mentally calm, alert, and oriented, and to see whether these steps reduce complications after surgery.

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The Problem It Addresses

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Objectives of the Project

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1. Describe the delirium prevention protocol designed for the orthopedic setting.
2. Assess whether implementing the protocol reduces delirium incidence and duration.
3. Evaluate effects on postoperative recovery indicators (mobility, length of stay, pain control).
4. Explore nurse and patient experiences with the protocol.

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What You Will Do Step by Step

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1. Review existing delirium literature and current ward practices.
2. Adapt a delirium prevention protocol to the orthopedic postoperative context.
3. Train nursing staff to deliver the protocol.
4. Collect patient data before and after implementation (delirium checks, recovery metrics).
5. Analyze differences in outcomes using simple statistical methods.
6. Summarize findings and reflect on feasibility and acceptability.

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Expected Outcome

Expected outcomes include lower delirium rates, shorter hospital stays, improved mobility, and positive feedback from staff and patients. The project aims to provide a practical, scalable approach that can be adopted in similar hospital units to improve elderly patients’ recovery after orthopedic surgery.