Our partners at Chesterfield Royal Hospital have been shortlisted for a Nursing Times Award in the Surgical Nursing Category.

The nomination recognised their project concerning ‘preoperative delirium screening for elective orthopaedic patients’ which was supported by the East Midlands Patient Safety Collaborative (EM PSC) - part of the National Patient Safety Improvement Programme that’s improving safety across the NHS. The awards celebrate the exemplary nurses and teams in the profession and highlight excellence.

The nomination is in recognition of a pathway change made by the Surgical Orthopaedic team at Chesterfield Royal Hospital aimed at reducing the effects of delirium for orthopaedic patients undergoing arthroplasty surgery, such as hip or knee replacement surgery. Delirium is a change in the brain that causes confusion and is a common side effect for elderly people following surgery. Delirium can be extremely stressful for patients and families and also delay recovery.

Following an engagement process with East Midlands’ health and care providers, the prevention, diagnosis and management of delirium was identified as a priority area. This project was subsequently selected as a demonstrator by the East Midlands Patient Safety Collaborative (EM PSC), who provided funding, quality improvement and analytics support.

The team recognised that due to the demographic of patients who commonly undergo arthroplasty surgical procedures, a significant number of patients developed delirium following their operation which lead to longer hospital stays. Prior to the change, there were no pre-emptive treatment plans in place to support patients at a high-risk of developing delirium following their surgery.

To combat this, the project was initiated to introduce delirium screening for arthroplasty patients prior to their operation. A vital component of this change was the recruitment of a new clinical nurse specialist, whose role was to plan and activate this strategy. The screening, which consisted of tests related to alertness, attention and other indicators common with the development of delirium, enabled the team to put in place a tailored post-surgery care plan to suit individual patients and their families.

Changes to this pathway have reduced length of stay, saving 1,015 bed days, increased patient safety and improved patient experience. 

“We needed to radically change the care we delivered in order achieve better outcomes for patients. Every patient at risk of developing delirium now has a tailored care plan and staff are easily recognising early signs of delirium and implementing care plans to reduce this developing further. We’re so proud of this nomination which recognises how this project has positively impacted our way of working and the experience our patients have.” Lorraine Sanderson, Arthroplasty Nurse Specialist (formerly Senior Matron)

Chesterfield Royal Hospital are one of the only trusts currently offering delirium screening for arthroplasty patients and are currently planning to scope other groups of patients that would benefit from preoperative delirium screening. The East Midlands PSC are now taking learnings from this project and applying this to other work programmes to benefit patients at high risk of postoperative delirium in the region.

Winners will be announced at an awards ceremony on 30 October 2019, in London.

Delirium – Quality Improvement impacts