Date of this Version

11-6-2024

Document Type

DNP Project

Abstract

Background: Postoperative delirium (POD) is the most common postoperative complication experienced by patients aged 65 and above and is considered both life-threatening and preventable. Elderly patients who present with preexisting cognitive impairment have a significantly higher risk of developing POD; however, cognitive impairment is not always recognized in the elderly patient. Research has suggested that as many as 37% of the elderly surgical population presents with undiagnosed cognitive impairment, indicating that anesthesia providers are unaware of the baseline cognitive status of a large portion of their patients. Preoperative cognitive screening of all elderly patients has been recommended as a critical first step in identifying cognitive impairment and preventing POD. While the Mini Mental State Examination (MMSE) is considered the gold standard screening tool for cognitive impairment, the Mini-Cog is a superior tool for use in the preoperative setting due to its rapid administration time and simple instructions.

Method: A literature review was conducted via the EMBASE, CINAHL, and Cochrane databases to gather evidence for the use of the Mini-Cog for the prediction of POD risk. Following a review and synthesis of the evidence, an educational module was created to explain the benefits of the use of the Mini-Cog in the preoperative setting; the instructions for administration, scoring, and interpretation; and potential interventions for use in patients who are identified as cognitively impaired. The module was distributed to 33 Certified Registered Nurse Anesthetists (CRNAs) employed at an academic medical center, along with a pretest/posttest survey. The results of the surveys were compared to determine the effectiveness of the educational module in increasing provider knowledge and enacting evidence-based practice.

Results: A total of 10 CRNAs from the target facility participated in the study. The pre- and posttests gauged participants’ knowledge of preoperative cognitive testing of elderly patients using the Mini-Cog tool. The average accuracy score on the pretest was 67.5%, compared to 96.25% on the posttest, representing a statistically significant increase in accuracy following completion of the educational module (p < 0.001). Results on the subjective measures improved slightly, indicating an increased belief that a screening tool is necessary for accurate cognitive assessment and a slightly increased likelihood of implementing the Mini-Cog into practice.

Discussion: The educational module was successful in increasing CRNA knowledge of the prediction of POD risk using the Mini-Cog as a preoperative screening tool. CRNA beliefs about the usefulness of such a tool and the likelihood of implementing it into practice were somewhat less affected. Further research is needed to determine if this educational module can successfully influence the way CRNAs at the target facility assess the preoperative cognitive status of elderly patients presenting for surgery. Further research may also help determine if specific policy changes are needed to increase compliance with the recommended intervention.

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