Date of this Version

11-29-2023

Document Type

DNP Project

Abstract

Objective: This quality improvement (QI) project aimed to improve healthcare provider knowledge and attitude regarding exogenous Melatonin to decrease postoperative delirium in the elderly population and determine the effectiveness of an educational intervention.

Background: Postoperative delirium is prevalent in the elderly population. It is associated with increased healthcare costs, functional decline, prolonged hospital stays, and higher morbidity and mortality. The incidence of postoperative delirium in admitted hospitalized patients was projected to be 20% to 29% in geriatrics medicine patients and 11% to 51% in surgical patients. Evidence suggests the use of exogenous Melatonin can decrease the incidence and duration of postoperative delirium.

Methods: A 672-bed acute care hospital in South Florida has a large elderly population requiring anesthetic services. Anesthesia providers were educated on preventative measures to reduce the incidence of postoperative delirium in this facility and the recognition of risk factors increasing the incidence of postoperative delirium. A pretest survey was provided to assess anesthesia providers’ knowledge and attitudes regarding using Melatonin versus Midazolam and postoperative delirium. An educational module included risk factors for developing postoperative delirium, medication classification, and literature findings on Melatonin and Midazolam. At the end of the presentation, a posttest survey containing the same questions as the pretest form was given to the same participants.

Results: After implementing the educational intervention, there was an increase in knowledge and attitudes regarding anesthesia providers in reducing the incidence of postoperative delirium. Most participants reported they were likely to implement Melatonin into their clinical practice.

Discussion: Postoperative delirium is associated with functional and cognitive decline, increased mortality, extended length of stay, and increased costs. Literature displays the benefits of using Melatonin for reducing postoperative delirium in elderly patients. After completing the educational intervention, there was an increased knowledge of Melatonin and its effect on reducing the incidence of postoperative delirium. Participants improved their attitudes and knowledge toward their role and preventative techniques for reducing postoperative delirium. The small sample size is a limitation of this project, as only eight participants completed the module.

Conclusion: An educational intervention can enhance provider knowledge, attitudes, and increase the use of exogenous Melatonin to reduce the incidence of postoperative delirium.

Keywords: Midazolam, Melatonin, elderly, postoperative delirium, postoperative cognitive dysfunction.

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