An Innovative Approach to Improving the Accuracy of Delirium Assessments Using the Confusion Assessment Method for the Intensive Care Unit

DiLibero, Justin; OʼDonoghue, Sharon C; DeSanto‐Madeya, Susan; Felix, Janice; Ninobla, Annalyn; Woods, Allison

doi:10.1097/dcc.0000000000000167

Cited by 15 publications

(13 citation statements)

References 19 publications

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“…Valid and reliable tools are guideline recommended for the assessment of delirium in hospitalized patients. One hospital that implemented a validated delirium screening tool later identified inaccuracies in nursing assessments, which resulted in unidentified delirium and missed opportunities to treat patients with delirium (DiLibero, DeSanto-Madeya, Dottery, Sullivan, & O'Donoghue, 2018;DiLibero et al, 2016). The subsequent QI project aim was to achieve >80% delirium assessment accuracy by nurses.…”

Section: Is Approachesmentioning

confidence: 99%

Implementation Science Training and Resources for Nurses and Nurse Scientists

Boehm

Stolldorf

Jeffery

2019

J of Nursing Scholarship

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The substantial push for enhanced patient safety began with the publication of the National Academy of Medicine's (NAM) groundbreaking report To Err is Human: Building a Safer Health System. This report revealed that numerous patient deaths occur as the result of preventable medical errors (Kohn, Corrigan, & Donaldson, 2000). The NAM's second report, Crossing the Quality Chasm, provided solutions to address the risks to patient safety by proposing six dimensions for healthcare improvement (Institute of Medicine Committee on Quality of Health Care in America, 2001). Specifically, healthcare organizations must improve to provide care that is safe, effective, patient centered, timely, efficient, and equitable. These dimensions provide the focus for implementation of evidencebased practice (EBP), reducing preventable harm in healthcare, and continue to drive quality improvement (QI) initiatives. Considering that half of research evidence relevant to clinical practice never reaches the clinical setting, translating evidence into routine clinical care requires focused interdisciplinary efforts (Balas & Boren, 2000). Implementation science (IS) was established to develop evidence-based strategies to promote the uptake of EBP into clinical care. The purpose of this article is to describe the differences between QI and IS, the

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Section: Is Approachesmentioning

confidence: 99%

Implementation Science Training and Resources for Nurses and Nurse Scientists

Boehm

Stolldorf

Jeffery

2019

J of Nursing Scholarship

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“…Nonetheless, in our study, the raters’ assessments were matched in 83% patients with a kappa of 0.66, which is considered moderate and acceptable inter-rater reliability [ 38 ]. We believe that the accuracy of the CAM-ICU assessment could be further improved by providing proper education about delirium and training for the CAM-ICU [ 33 , 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Psychometric properties of the Arabic version of the confusion assessment method for the intensive care unit (CAM-ICU)

et al. 2018

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BackgroundIt is recommended that critically ill patients undergo routine delirium monitoring with a valid and reliable tool such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). However, the validity and reliability of the Arabic version of the CAM-ICU has not been investigated. Here, we test the validity and reliability of the Arabic CAM-ICU.MethodsWe conducted a psychometric study at ICUs in a tertiary-care hospital in Saudi Arabia. We recruited consecutive adult Arabic-speaking patients, who had stayed in the ICU for at least 24 hours, and had a Richmond Agitation-Sedation Scale (RASS) score ≥ − 2 at examination. Two well-trained examiners (ICU nurse and intensivist) independently assessed delirium in eligible patients with the Arabic CAM-ICU. Evaluations by the two examiners were compared with psychiatrist blind clinical assessment of delirium according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Subgroup analyses were conducted for age, invasive mechanical ventilation, and gender.ResultsWe included 108 patients (mean age: 62.6 ± 17.6; male: 51.9%), of whom 37% were on invasive mechanical ventilation. Delirium was diagnosed in 63% of enrolled patients as per the psychiatrist clinical assessment. The Arabic CAM-ICU sensitivity was 74% (95% confidence interval [CI] = 0.63–0.84) and 56% (95%CI = 0.44–0.68) for the ICU nurse and intensivist, respectively. Specificity was 98% (95%CI = 0.93–1.0) and 92% (95%CI = 0.84–1.0), respectively. Sensitivity was greater for mechanically-ventilated patients, women, and those aged ≥65 years. Specificity was greater for those aged < 65 years, non-mechanically-ventilated patients and men. The median duration to complete the Arabic CAM-ICU was 2 min (interquartile range, 2–3) and 4.5 min (IQR, 3–5) for the ICU nurse and intensivist, respectively. Inter-rater reliability (kappa) was 0.66.ConclusionsThe Arabic CAM-ICU demonstrated acceptable reliability and validity to assess delirium in Arabic-speaking ICU patients.

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“…Similarly, some nurses (Steinseth et al, 2018) reported the Confusion Assessment Method for the ICU (CAM-ICU) for delirium assessment as unbiased and reliable. Barriers associated with use of the tool included perceptions of use as busy work (DiLibero et al, 2016), imperfect but adequate (Jung et al, 2013), unreliable and not trusted (Steinseth et al, 2018;Zamoscik et al, 2017), (Gélinas et al, 2014); clinically useful (Phillips et al, 2019) (−) no correlation between pain level and tool total score (Gélinas et al, 2014;Phillips et al, 2019) Delirium (+) unbiased and reliable (Steinseth et al, 2018); 80% understood tool was valid with ventilated patients (Swan, 2014) (−) "busy work" (DiLibero et al, 2016); imperfect tool but adequate (Jung et al, 2013); tool unreliable/not trusted (Steinseth et al, 2018;Zamoscik et al, 2017); tool inaccurate (Gloger et al, 2019); potentially harmful to patients (Oxenbøll-Collet et al, 2018); questions are too random, questionable reliability and consistency of users (Powell et al, 2019) Pain, agitation/ delirium (+) increases quality, continuity, and consistency (Wøien & Bjørk, 2013) CONSTRUCT: Relative Advantage -Nurses' perceptions of the advantage of using the tool(s) versus an alternative solution.…”

Section: Perception Of Tool Characteristicsmentioning

confidence: 99%

“…Pain (+) increased autonomy and accountability (Mascarenhas et al, 2018) Agitation (+) >90% used tool without protocol in place (Egerod et al, 2013); 68% agreed tool use increased autonomy and enhanced role (Sneyers et al, 2014) (−) more MDs than RNs agreed that tool use increased RN autonomy and enhanced roles (Sneyers et al, 2014) Delirium (+) ownership/engagement/empowerment; meaning and value to work (DiLibero et al, 2016) (−) considered to be "tick-box"/ "cookie-cutter" nursing (Christensen, 2014;LeBlanc et al, 2018); limits autonomy (LeBlanc et al, 2018); incompatible roles of caregiver vs. interrogator; threatens professional integrity (Oxenbøll-Collet et al, 2018); "unable to assess" option as work-around to opt out of documentation (Spiegelberg et al, 2020) Pain, agitation/ sedation, delirium (−) own experience and judgement are being challenged (Wøien & Bjørk, 2013) Note. Data analysis was guided by Consolidated Framework for Implementation Research (CFIR; Damschroder et al, 2009).…”

Section: Symptom Nurses' Evaluation Of Tool Usementioning

confidence: 99%

Use of PADIS Assessment Tools by Critical Care Nurses: An Integrative Review

Waterfield

Barnason

2020

West J Nurs Res

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The purpose of this integrative review was to evaluate the literature from January 2013 to April 2020 and to explore critical care nurses’ perspectives of and intent to use recommended Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) patient assessment tools in adult critical care units. A literature search was performed with a total of 47 studies included in the final analysis for this review. The studies’ data were organized and further reduced based on The Reasoned Action Approach behavioral theory to reflect the extent to which a nurse plans to use a PADIS assessment tool. Extracted themes were related to behavioral beliefs in patient-centered care and critical thinking; normative beliefs about communication and prioritization; and control beliefs concerning autonomy and confidence. Contextualizing the international phenomenon of variation in PADIS assessment tool use by critical care nurses provides a deeper understanding of its complexity for use in the clinical setting.

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An Innovative Approach to Improving the Accuracy of Delirium Assessments Using the Confusion Assessment Method for the Intensive Care Unit

Abstract: The results from this project suggest the effectiveness of the program in improving assessment accuracy among difficult-to-assess patients. Further research is needed to demonstrate the effectiveness of this model across other critical care units, patient populations, and organizations.

Cited by 15 publications

References 19 publications

Implementation Science Training and Resources for Nurses and Nurse Scientists

Implementation Science Training and Resources for Nurses and Nurse Scientists

Psychometric properties of the Arabic version of the confusion assessment method for the intensive care unit (CAM-ICU)

Use of PADIS Assessment Tools by Critical Care Nurses: An Integrative Review

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