Innovative clinical strategy better manages delirium at Concord Hospital - Laconia

Strategic sensory input ensures patients’ safety and quality care

CONCORD, NH – When an elderly patient was admitted to Concord Hospital – Laconia, their family was distressed by their condition. Once active and sharp-minded, they had become confused, irritable, and largely unresponsive — classic symptoms of delirium. That’s when quality and patient safety nurse Jenny Boulanger, RN stepped in with a groundbreaking approach that changed the patient’s outcome.

Boulanger encountered the patient during multidisciplinary rounds and, upon hearing about the patient’s condition — excessive sleeping, not eating or drinking, and unable to participate in necessary evaluations — recognized an opportunity to employ a new technique on which she’d recently been trained. Within 20 minutes of working with a colleague to apply the Attention and Awareness Through Movement (AATM) method, a systematic movement protocol, the patient’s condition dramatically changed.

“They woke up and were able to have a conversation,” Boulanger recalls, adding that, in a particularly moving moment, the patient looked at their grandson and said, “Hi, I’ve missed you,” followed by a poignant observation: “I was lost.”

Prior to applying AATM, hospital staff had administered what has long been considered the gold standard protocol for patients exhibiting signs of delirium. But that didn’t work. Boulanger credits her training to co-worker Dana Bisson, MSN, RN, who is leading a system-wide interdisciplinary delirium prevention and management initiative at Concord Hospital, partnering with other medical staff to implement innovative clinical strategies for managing the altered state.

Unlike traditional approaches to delirium that rely heavily on medication, AATM uses strategic sensory input through a sequence of head-to-toe movements to reactivate the brain, from face washing to range of motion exercises. 

“Doing it in this systematic order helps engage the brain a specific way,” Boulanger explains, “which is the breakthrough in getting them to clear the cobwebs and respond.”

Beyond the emotional impact of helping patients reconnect with their families, AATM directly addresses quality and safety concerns in hospital settings by offering improved mental status for patients. This, Boulanger adds, means that patients are less likely to fall, can use their call bells effectively, and reduce their risk of blood clots and other complications — and they often recover and go home faster.

After seeing its effectiveness, ICU staff at Laconia are eager to receive training in the technique. The next step, Boulanger says, is to have them, and others system-wide, work with Bisson on a four-hour training that will allow more nurses to perform AATM on patients. The goal is to continue gathering data, refine techniques, and eventually make it a hospital-wide intervention.

For health care professionals like Boulanger who have witnessed its effects, the intervention represents the essence of nursing care. “Knowing that something you can do without medicine can improve a patient’s quality of life is why we became nurses,” she says. “Our goal is to help people get better.”