Esteban Heniquez, RN, DNP, CRNA

DNP Nurse Anesthesia 

Project Golden Eagle: Reducing Postoperative Emergence Delirium in the Veteran Population at the Zablocki VA Medical Center

Project Category: Evidence Implementation

Project Team:  Esteban Henriquez, DNP, CRNA, Catherine Martzke, DNP, CRNA Peter Kallio, DNP, CRNA, APNP, FAANA (Advisor)

Abstract

Background: Created at the Pittsburgh Veteran Affairs (VA) Medical Center, Project Golden Eagle is a program that intentionally utilizes and avoids various medications that may influence the rate of emergence delirium (ED) within the veteran population with posttraumatic stress disorder (PTSD). ED is an acute alteration in mental status that places the patient at risk for potential injury to self or staff. In addition, no validated tool for measuring ED existed for the adult population. This project aimed to implement a protocol to reduce ED in the veteran population with known PTSD and validate a novel tool for identifying ED in adults. 

Methods: Building on the work of prior students, a comprehensive protocol was implemented at the Zablocki VA February 2023 through July 2023. Evidence-based in-services were provided to anesthesia clinicians and perioperative nursing staff. Validation of the adult ED scale was attempted using concurrent validity with the pediatric tool and analyzed using statistical tests.  

Results: Fifty-one patients received the protocol. There was a significant increase in use of dexmedetomidine after project implementation (8.2% vs 29.4%, p=0.004). The administration of ketamine nearly doubled, but was not statistically significant (9.8% to 17.6%, p=0.227). The use of midazolam did decrease, but was not statistically significant (26.2% vs 17.6%, p=0.277). Adult Anesthesia Emergence Delirium and Pediatric Anesthesia Emergence Delirium tools demonstrated a very high degree of correlation (r=0.977, p<0.001). 

Conclusions: Implementation of the Project Golden Eagle protocol is important for reducing ED among patients with PTSD. The use of dexmedetomidine and ketamine, along with environmental changes, may be associated with reductions in adult ED among veterans. The use of a novel tool developed for adults to detect ED should be adopted due to its correlation with existing tools.

Full Manuscript