Impacting Outcomes in the Hospitalized Oncology Patient: Evidence-Informed Quality and Safety Project to Implement Routine Screening for Delirium




delirium screening, cancer inpatient, falls, length of stay


Impacting Outcomes in the Hospitalized Oncology Patient: Evidence-Informed Quality and Safety Project to Implement Routine Screening for Delirium Visual Abstract

Background: Delirium can occur in cancer patients during an acute hospitalization or in the terminal stages of cancer. Iatrogenic delirium can complicate hospital stays for over 2.6 million older persons by increasing fall risk, restraint use, length of stay, post-acute placement, and costs. The purpose of this evidence-based quality improvement project was to implement routine screening for delirium with a consistent instrument and adopt an interprofessional plan of care for delirium.

Methods: This project was identified as an interprofessional improvement initiative. The project leader identified a deficiency in the screening for delirium, convened stakeholders, evaluated evidence, reviewed screening instruments, and developed a plan of care for delirium management. Practice changes incorporated routine delirium screening across the inpatient units. A delirium interprofessional plan of care was integrated into the electronic health record for ease of adoption and workflow modification.

Results: Routine screening for delirium and early interprofessional interventions reduced length of stay by 2.27 days for patients screening positive for delirium. The percentage of inpatient falls that were linked to an episode of delirium during hospitalization reduced from 23.4% to 17%.

Discussions: Routine screening and targeted interventions are a first step in prevention and identification of those inpatients at risk of developing delirium. Delirium prevention is the goal for potential associated iatrogenic conditions.

Author Biographies

Cassandra Vonnes, DNP, GNP-BC, APRN, AOCNP, Moffitt Cancer Center

Cassandra Vonnes ( is a geriatric oncology nurse practitioner at H. Lee Moffitt Cancer Center & Research Institute. Her 28 years of NP experience include acute care and outpatient services of internal medicine and cardiovascular medicine; she was inducted as a Fellow of the American Heart Association for her contributions. Under Dr. Vonnes’ leadership as a Nurses Improving Care for Healthsystem Elders (NICHE) coordinator, Moffitt Cancer Center was the first hospital in Florida to be recognized by the Institute for Healthcare Improvement as an Age-Friendly Health System Committed to Care Excellence for the Older Adult. She has taught clinical and didactic courses at the University of South Florida College of Nursing and has presented both nationally and internationally on fall and injury prevention, delirium, and geriatric assessment. She hosts the gerontological advanced practice nurses podcast GAPNA Chat.

Cindy Tofthagen, PhD, APRN, AOCNP, Mayo Clinic Florida

Cindy Tofthagen is a senior associate consultant in the Department of Nursing at Mayo Clinic Florida. Her background as an oncology nurse practitioner guides her research, which focuses on areas of high concern to patients and on symptoms for which there is a limited evidence base to support successful treatment. By focusing on areas in which there are great needs, her research team hopes to offer effective solutions to important clinical problems, including chemotherapy-induced peripheral neuropathy, psychological distress associated with cancer, and cancer treatment–related pain.


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How to Cite

Vonnes, C., & Tofthagen, C. (2022). Impacting Outcomes in the Hospitalized Oncology Patient: Evidence-Informed Quality and Safety Project to Implement Routine Screening for Delirium. Patient Safety, 4(3), 20–29.



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