Date of this Version

12-12-2024

Document Type

DNP Project

Rights

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Abstract

Background: Elderly individuals undergoing general anesthesia commonly experience postoperative delirium (POD), which has been linked to increased morbidity and mortality rates. Recent evidence shows that POD is associated with increased complications, prolonged hospital stays, decreased long-term cognitive function, and poor functional recovery. This condition's complex and multifactorial nature contributes to the difficulty in identifying effective preventive or treatment options. To date, emphasis is placed on risk stratification and interventions that may alter the physiological processes associated with POD. While controversial data exists, melatonin and dexmedetomidine remain two common pharmacologic agents utilized for the prevention of postoperative delirium. Hence, this DNP project aimed to inform anesthesia providers of current, evidence-based research that can be utilized to transform clinical practice and improve patient outcomes.

Methods: A comprehensive literature review was conducted to identify randomized controlled trials published within the last 6 years that evaluated the effectiveness of either Melatonin or Dexmedetomidine for preventing POD and compared to a placebo. The relevant evidence obtained was utilized to develop an online educational module comprised of a pre-test to evaluate anesthesia providers’ baseline knowledge and attitudes regarding POD, dexmedetomidine, and melatonin, and a voiceover PowerPoint presentation on current statistics and evidenced-based practices, followed by a post-module assessment to determine the degree of knowledge gained and providers’ inclination to implement these research findings into practice. This educational model was distributed via an anonymous link with randomized identifiers. Qualtrics software was used to collect data and generate the study’s results.

Results: The results indicated a statistical difference between the pre- and post-survey responses. The average number of correct responses on the pre-test was 59.5%, and an average of 87.63% correct responses were reflected on the post-test. The calculated percent change of these results, 47.28%, signifies the knowledge improvement acquired from this module. The average amount of anesthesia providers inclined to utilize melatonin for POD prevention in high-risk patients was 22% in the pre-test and 63% in the post-test. A drastic increase in the inclination to use melatonin for POD prevention was observed, with a percent change of 186.36%.

Discussion: The higher means for the post-test survey showed that the educational module improved knowledge regarding POD and effective interventions to prevent or mitigate its occurrence among elderly patients. Participants’ attitudes and inclinations toward implementing melatonin to prevent POD also improved after completing this educational module. The number of respondents and the module's delivery were 2 major limitations of this study. While this study does not distinctly point to a superior agent for this condition, the positive results obtained offer hope for a transformation of clinical practice. Anesthesia providers are at the forefront of this condition and can reduce the incidence of POD and improve patient outcomes. As advanced practice nurses, certified registered nurse anesthetists (CRNAs) are responsible for generating new research findings and translating them into clinical practice to improve patient care. The information obtained from this project will hopefully spark interest in this topic and provide a foundation for future research.

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