The document discusses implementing a Confusion Assessment Method (CAM) project intervention to assess delirium in older hospitalized patients. Key barriers to implementation include nursing workload and potential patient/family stigma. The DNP student will address barriers by integrating the CAM tool into electronic records, conducting daily staff meetings, and training nurses to champion the project. Project outcomes will be measured using the valid and reliable CAM tool over 10 weeks to assess benefits of early delirium identification and management.

1. Peer post, coherence, staff engagement, transparency, open
communication, and leadership
Peer post, coherence, staff engagement, transparency, open communication, and leadership
engagement are paramount for a successful intervention implementation (Giazik et al.,
2021). The DNP student will be readily available to address any potential barriers during
the implementation phase. Such barriers that may interrupt the implementation of the
Confusion Assessment Method (CAM) project intervention is the lack of nursing support for
the intervention. The nursing shortage crisis and the additional workload due to the
ongoing coronavirus pandemic may cause the staff to resist the additional burden of
implementing the CAM intervention. To alleviate such a burden, the DNP student, with the
help of the IT department, will integrate the confusion assessment tool into the electronic
medical record. Patients and their families may also be hesitant to participate due to the
potential stigma related to a diagnosis of delirium. This kind of barrier can be overcome by
explaining the benefit of the CAM intervention.Implementation depends largely on the
acceptance and the ease of the measuring tool by team members (Waltz et al., 2019). The
DNP project manager will continue to facilitate open communication with the nurse leader
and nursing staff on the unit and maintain guidelines that align with the organization’s
values. The DNP student will arrange a daily huddle with staff at the beginning of each shift
during the implementation phase to address staff concerns. There will be ongoing staff
training through observation and auditing of the CAM. The DNP project manager invites
interested nurses to be champions for the project. Waltz et al. (2019) indicated that persons
who act as champions would market, support, and drive the implementation process to
overcome resistance. The implementation of the intervention aligns with the organization’s
goal of patient safety. The DNP student will capitalize on the evidence-based practice
project to secure cooperation with key stakeholders by discussing the benefits of the CAM
intervention on best patient outcomes, decrease in mortality, safe discharge, and quality
assurance.OutcomesThe benefit of early identification and management of delirium in
hospitalized adults age 65 and older will be measured using the Confusion Assessment
Method (CAM) [Inouye et al., 2009] (Appendix A). The 9- item questionnaire is used to
detect delirium in high-risk individuals based on the observation made by trained
registered nurses; questionnaire # 2 has two additional questions that assist the examiner
in determining inattentiveness. A nominal measurement scale is used. The diagnosis of
delirium requires the presence of the first two criteria and either the third or fourth

2. criterion [Appendix A]. The CAM screening tool has shown high consistency – Cronbach’s
Alpha of 0.85 and is accepted as a valid and reliable measurement for use by researchers
(Khan et al.,2017; Oh et al., 2017). The tool will be integrated into the electronic medical
record and used as an attachment to the daily patient assessment used on the unit. The
registered nurses will take approximately five minutes to complete the questionnaire. The
implementation will take place over a ten weeks period. The first two weeks will cover the
education and readiness of the implementation team. The data will be collected at the end of
week nine after seven weeks of data collection. The CAM tool is in the public domain, and
permission is not required.ReferencesGlazik, R., Moore, H., Kennedy, D., Bower, H., Rohan,
H., Sharp, A., & Seale, A. C. (2021). A snapshot of the practicality and barriers to COVID-19
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e0260041. https://doi.org/10.1371/journal.pone.0260041 (Links to an external site.)Khan,
B.A., Perkins, A. J., Gao, S., Hui, S. L., Campbell, N. L., Farber, M. O., Chlan, L. L., & Boustani, M.
A. (2017). The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel
Delirium Severity Instrument for Use in the ICU. Critical Care Medicine, 45(5), 851–
857. https://doi.org/10.1097/CCM.0000000000002368 (Links to an external site.) OH, E.S.,
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htttps://doi.org/10.1001/jama.2017.12067Sullivan, M.B., Rentz, A., Mathura, P., Gleddie, M.,
Luthra, T., Thiele, A. T., Kovacs Burns, K., Rich, R., & Sia, W. W. (2022). Establishing an
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to an external site.)Waltz, T.J., Powell, B. J., Fernández, M. E., Abadie, B., & Damschroder, L. J.
(2019). Choosing implementation strategies to address contextual barriers: diversity in
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