Published on January 02, 2020

Leading the Way – An Innovative Delirium Care Initiative Emerges

Delirium Patient with Nurses

Dana Bisson, MSN, RN (right)

For centuries, the medical world has known that many seriously ill patients suffer from delirium — a reversible brain failure brought on by illness, surgery or some medications.

For years, as a nurse caring for seriously ill patients, Dana Bisson felt helpless when delirium caused patients to hallucinate and become less aware of themselves, their bodies and their surroundings.

“It’s like a storm going on in the brain,” she said. “I didn’t know there was anything really that we could do about it until I came to Concord Hospital.”

After arriving in 2011, Bisson quickly learned there were ways to ease patients out of delirium. Concord Hospital established a Delirium Program in 2012, recognizing that the first steps in preventing delirium or helping patients return to normal were making sure they had uninterrupted sleep at night, were mobile during the day with lights on, wore their glasses and hearing aids, were on a toileting schedule and were having their pain managed.

“There weren’t many hospitals that were doing such a big program like that for delirium,” Bisson said. “We were an innovator for that.”

In 2017, with funding from Concord Hospital Trust, Bisson focused on studying delirium and helped solidify the Hospital’s leadership role. She learned the condition could lead to permanent dysfunction and that there was much more that could be done. After devoting many hours at the bedside, Bisson discovered other simple techniques that can help return patients to an attentive state.

Now, as Concord Hospital’s delirium nurse specialist, Bisson trains providers and bedside staff to recognize delirium and how to help.

Bisson found that face washing and oral care was essential in promoting attention and awareness."

“It’s not for hygiene,” she said. “It makes someone aware of themselves.”

Bisson also encourages techniques designed to bring about mental clarity, such as coloring, painting, doing puzzles and listening to familiar music.

Bisson delights in knowing the Hospital and its caregivers now are much better equipped to help patients with delirium.

“After working with a patient for several minutes, you can bring about a point where they can eat, take their medications, work with therapy,” she said. “Having techniques and real tools available to do that brings joy like I’ve never seen before in my career.”

Patient care teams also develop complex care plans for patients who experience delirium in hopes that procedures or medications that might have contributed can be avoided in future hospitalizations. The plans work. A patient who previously had become combative and had to be restrained while suffering a days’long bout of delirium came out of delirium within hours in a subsequent hospitalization because the Emergency Department physician who read the care plan alerted the care team, who made appropriate changes.