The role of clinical nurse specialists in the implementation and sustainability of a practice change.
AIM
This project's purpose was to promote and sustain a practice change focusing on delirium utilising the clinical nurse specialist (CNS) in a leadership role.


BACKGROUND
Delirium is an altered state of consciousness accompanied by an acute change in cognition that tends to have a fluctuating course. Delirium is strongly associated with negative outcomes and is often unrecognised.


METHOD
A policy was implemented stating that the RNs will screen patients for delirium with the confusion assessment method (CAM). Interdisciplinary delirium education was offered prior to the practice change and repeated at 3, 6 and 12 months after implementation. The documentation, completion and CAM accuracy screening were determined by the CNS.


RESULTS
The CAM documentation and completion audit goal was met and sustained by week 21, and screenings were accurate 83% of the time.


CONCLUSIONS
The CNS has an opportunity to take a leadership role when instituting an innovative practice change. Successful implementation of a new practice requires that patient care units are divided into cohorts with systematic roll-out of the initiative.


IMPLICATIONS FOR NURSING MANAGEMENT
In addition to leadership, CNS availability on the patient care units is imperative to staff acceptance and sustainability of a practice change.
['Babine|Rhonda L|RL|', 'Honess|Cindy|C|', 'Wierman|Heidi R|HR|', 'Hallen|Sarah|S|']
D003693:Delirium D006801:Humans D007857:Leadership D008403:Mass Screening D009720:Nurse Clinicians D024802:Nurse's Role D009936:Organizational Innovation D063868:Patient Outcome Assessment D011050:Policy Making D015397:Program Evaluation
nursing delirium leadership education continuing staff development