Delirium Monitoring and Patient Outcomes in a General Intensive Care Unit

Andrews, Lois; Silva, Susan G.; Kaplan, Susan; Zimbro, Kathie S.

doi:10.4037/ajcc2015740

Cited by 53 publications

(62 citation statements)

References 29 publications

(56 reference statements)

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“…This closely corresponds to current data (Elliott, 2014;Luetz et al, 2014;Andrews et al, 2015;Yassin et al, 2015;Mo et al, 2017;Saller et al, 2016). According to the varying prevalence of delirium during day and night (Sandberg et al, 1999;Madrid-Navarro et al, 2015), undiscovered delirium in hypoactive delirium or dementia (Lemiengre et al, 2006) or sedated patients (Svenningsen et al, 2013), screening for only 'suspicious behaviour' may lead to under-recognition of delirium.…”

Section: Professions and Screening Deliriumsupporting

confidence: 92%

Survey among critical care nurses and physicians about delirium management

Nydahl

Dewes

Dubb

et al. 2017

Nursing in Critical Care

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Background: Delirium is a serious complication in patients in intensive care units. Previous surveys on delirium management in daily practice showed low adherence to published guidelines. Aim: To evaluate delirium management in nurses and physicians working in intensive care units in German-speaking countries and to identify related differences between nurses and physicians. Design: The study used an open online survey with multiple-choice responses. Methods: An invitation for participation was spread via journals and electronic resources using a snowball system. Apart from recording socio-demographical characteristics, the survey collected data on delirium assessment, delirium-related processes, non-pharmacological prevention and treatment and barriers for implementation. Differences between nurses and physicians were tested by Fisher's exact test with sequential Bonferroni correction. Results: The survey was conducted in autumn 2016, and 559 clinicians participated. More nurses than physicians reported screening for delirium. The majority of clinicians reported screening for delirium when this was suspected; more than 50% used validated instruments. Half of the clinicians had delirium-related structures implemented, such as two thirds reporting delirium-related processes. Most cited barriers were lack of time and missing knowledge about delirium and its assessment. With significant difference, physicians recommended more than nurses early removal of catheters and daily interprofessional goals for patients. Conclusion: In German-speaking countries, assessment of delirium needs further improvement, leading to accurate assessment. Delirium-related structures and processes appear to be implemented widely, with only a few differences between nurses and physicians. Relevance to clinical practice: Nurses and physicians in this survey reported similar perceptions and attitudes towards management of delirium. Both professions need more knowledge and inter-professional training on when and how to use validated assessment instruments.

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Section: Professions and Screening Deliriumsupporting

confidence: 92%

Survey among critical care nurses and physicians about delirium management

Nydahl

Dewes

Dubb

et al. 2017

Nursing in Critical Care

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“…This is possible because it by determining the causes, care that includes early mobilization, noise reduction and the implementation of routines and protocols to preserve sleep can be adopted (11) . The implementation of delirium assessment by nurses in an ICU, proved to be effective in reducing the use of sedatives, mechanical restraints and better management of issues related to the environment such as luminosity and noise level under the influence of interventions prescribed by nurses (15) . Nurses relate some barriers in delirium assessment that comprise the difficulty of assessing intubated patients, the inability to identify the level of patient sedation, insecurity in the use of instruments, the time spent and the complexity of the instruments (6) .…”

Section: Discussionmentioning

confidence: 99%

Capacitação de enfermeiros na utilização de um instrumento de avaliação de delirium

Souza

Bersaneti

Siqueira

et al. 2017

Rev. Gaúcha Enferm.

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Objective:To narrate the nurses' training experience in the implementation of a systematic delirium screening tool using the Confusion Assessment Method for Intensive Care Unit. Method: Experience report covering the steps of situation diagnosis, planning, staff training and evaluation of the tool's implementation between January and March 2013 with nurses in the ICU of a tertiary hospital in São Paulo. Results: The implementation of the assessment, using the Confusion Assessment Method for Intensive Care Unit, obtained signifi cant nurse adhesion and became a service indicator. Final considerations:The experience has shown that this assessment allows the results of the work process to be analyzed and the consequent transformation of daily initiatives.

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“…In comparison to other studies, Andrews and colleagues implemented a similar CAM didactic in the intensive care unit and found that barriers to CAM use included nursing lack of confidence in performing the assessment, concerns about use of the tool for patients on mechanical ventilation, and lack of interdisciplinary response to findings obtained by the CAM [34]. In our study we were able to evaluate that post-intervention, nurses perceived significant improvement in overall delirium knowledge, specific improvement in identification of delirium risk factors, medications, and non-pharmacological and pharmacological interventions.…”

Section: Discussionmentioning

confidence: 99%