Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

Rivosecchi, Ryan; Smithburger, Pamela L.; Svec, Susan; Campbell, Shauna; Kane‐Gill, Sandra L.

doi:10.4037/ccn2015423

Cited by 68 publications

(57 citation statements)

References 28 publications

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“…6 If hospital staff are able to consistently implement preventive measures on an ongoing basis, delirium incidence may decrease, resulting in improved outcomes for patients and hospitals. 17 Although some research has addressed the feasibility of having ICU nurses assess for delirium, little research has tested the feasibility of nurses consistently adhering to all components of a delirium prevention bundle (DPB). 17 The purpose of this article is to report findings from a controlled interventional cohort study that tested the effectiveness of a prescriptive, nonpharmacological, nurse-led DPB in reducing delirium incidence in critically ill patients in medical-surgical ICUs.…”

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confidence: 99%

Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients

Smith

Grami

2017

American Journal of Critical Care

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Background Strategies for preventing delirium include early identification and avoiding or modifying patient, environmental, and iatrogenic factors. Minimal research exists on a prescriptive delirium prevention bundle that details elements or strategies for each bundle component. Even less research has been focused on nurse-driven interventions or components. Objective To evaluate the effectiveness of a delirium prevention bundle in decreasing delirium incidence in 2 medical-surgical intensive care units in a large Texas medical center. Methods Researchers used the Confusion Assessment Method for the Intensive Care Unit to assess delirium incidence by using a controlled interventional cohort design with 447 delirium-negative critically ill patients. Bundle components consist of sedation cessation, pain management, sensory stimulation, early mobilization, and sleep promotion. Results The intervention, analyzed by using a logistic regression model, reduced the odds of delirium by 78% (odds ratio, 0.22; P = .001). Conclusions The delirium prevention bundle was effective in reducing the incidence of delirium in critically ill medical-surgical patients. Further validation studies are under way.

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confidence: 99%

Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients

Smith

Grami

2017

American Journal of Critical Care

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“…16,17 Additional interprofessional strategies include educating members of the health care team about delirium in children, having multidisciplinary rounds focused specifically on delirium monitoring and treatment (eg, brain rounds, pediatric road map), order sets, protocols and practice guidelines for delirium management, and quality ICU rounds checklists to facilitate the consistent assessment and management of pain, sedation, and delirium. 1,4,23,39 Because delirium in infants and children is often unrecognized, education related to the nature and management of delirium is important for the entire pediatric health care team. 2,17,39,55,56 In a study 56 of nurses in one PICU, 11.4% incorrectly identified the Glasgow Coma Scale as the correct screening tool for delirium in children, 38.1% incorrectly indicated that benzodiazepines are helpful in treating delirium, and a majority (62%) incorrectly thought that children generally do not remember the experience of being delirious.…”

Section: Interprofessional Collaboration and Educationmentioning

confidence: 99%

“…17,22,23 Those present and caring for the child should provide frequent reorientation and calm reassurances or explanations. 16,17,21,34,39,40 Nurses and other care providers may need to repeatedly let the patient know, in an ageappropriate manner, who the staff member is, the member's role in caring for the child, what the staff member will be doing and why. 2,39 Table 7 further describes some communication strategies that can be used when engaging with a delirious child.…”

Section: Pharmacological Management Of Deliriummentioning

confidence: 99%

“…16,17,21,34,39,40 Nurses and other care providers may need to repeatedly let the patient know, in an ageappropriate manner, who the staff member is, the member's role in caring for the child, what the staff member will be doing and why. 2,39 Table 7 further describes some communication strategies that can be used when engaging with a delirious child. Children with delirium also benefit from the expertise of child life specialists and QTc assessment at baseline and then at least daily, especially when intravenous haloperidol is used for treatment, which should be avoided in patients at high risk for arrhythmia.…”

Section: Pharmacological Management Of Deliriummentioning

confidence: 99%

“…Use a room with windows with an outside view to cue time of day 11,34,36 Have a calendar and clock for date and time identification 23 Alternate a picture of the sun during the day and the moon at night 19,38 Post a picture identifying what meal is coming next 21,39 Have parents, visitors, and staff actively reorient child to person, place, time, and reason for being in the hospital 14,31,32 Explain where the child is and why he or she is there.…”

Section: Pharmacological Management Of Deliriummentioning

confidence: 99%

See 2 more Smart Citations

Delirium in Children: Identification, Prevention, and Management

Bettencourt

Mullen

2017

Critical Care Nurse

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Delirium in children is an often underrecognized but serious complication of hospitalization. Delirium in this age group has been described as behaviors such as refractory agitation and restlessness, visual or auditory hallucinations, children being "not themselves," and a lethargic state. Often, children with delirium are at risk for harming themselves by dislodging tubes, falling, or refusing care. Pediatric nurses must recognize and intervene to prevent and treat delirium in hospitalized children because the delirium may be an indicator of worsening clinical status and is associated with high mortality and morbidity in children of all ages and with posttraumatic stress disorder. Pediatric nurses are uniquely positioned to design care interventions to both reduce risk for delirium and treat active delirium. Many treatment recommendations are nonpharmacological and are part of excellent nursing care. (Critical Care Nurse. 2017; 37[3]:e9-e18)

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Knowledge of Australian hospital pharmacists regarding delirium in elderly patients

Kassie

Ellett

Nguyen

et al. 2017

Pharmacy Practice and Res

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Background Delirium is a serious condition in which medications are just one of a number of potential predisposing or precipitating factors. Adequate knowledge of delirium among all healthcare professionals, including pharmacists, may assist in effective prevention and management. However, little is known about the knowledge of pharmacists regarding delirium. Aim To assess Australian hospital pharmacists' knowledge of risk factors, symptoms, prevention and treatment of delirium in elderly patients. Method A cross‐sectional survey was conducted via a web‐based questionnaire to collect information on participants' demographics, knowledge of delirium risk factors, symptoms, prevention and treatment. A link to the survey was included in the newsletters of The Society of Hospital Pharmacists of Australia, Australasian Delirium Association and New South Wales Therapeutic Advisory Group and distributed to hospital pharmacists in Australia via email. Results One‐hundred and six responses from hospital pharmacists were available for analysis. Nine of 11 questions assessing basic knowledge were correctly answered by more than half of respondents. Seven of the eight questions related to delirium prevention strategies were correctly answered by more than half of pharmacists. However, only three of the eight questions about risk factors for delirium were answered correctly by more than half of pharmacists. Conclusion Pharmacists' basic knowledge about delirium and prevention strategies was good; however, their knowledge of risk factors and symptoms of delirium needs to be improved. Delirium‐specific educational programs for pharmacists should be considered for improving their knowledge and understanding regarding delirium.

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Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

Cited by 68 publications

References 28 publications

Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients

Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients

Delirium in Children: Identification, Prevention, and Management

Knowledge of Australian hospital pharmacists regarding delirium in elderly patients

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