The Effects of a Delirium Notification Program on the Clinical Outcomes of the Intensive Care Unit: A Preliminary Pilot Study

Abstract

Background Delirium is common among intensive care unit (ICU) patients, so recent clinical guidelines recommended routine delirium monitoring in the ICU. But, its effect on the patient’s clinical outcome is still controversial. In particular, the effect of systems that inform the primary physician of the results of monitoring is largely unknown.Methods The delirium notification program using bedside signs and electronic chart notifications was applied to the pre-existing delirium monitoring protocol. Every patient was routinely evaluated for delirium, pain, and anxiety using validated tools. Clinical outcomes, including duration of delirium, ICU stay, and mortality were reviewed and compared for 3 months before and after the program implementation.Results There was no significant difference between the two periods of delirium, ICU stay, and mortality. However, anxiety, an important prognostic factor in the ICU survivor’s mental health, was significantly reduced and pain tended to decrease.Conclusions Increasing the physician’s awareness of the patient’s mental state by using a notification program could reduce the anxiety of ICU patients even though it may not reduce delirium. The results suggested that the method of delivering the results of monitoring was also an important factor in the success of the delirium monitoring program.

Non-pharmacological Treatment of Intensive Care Unit Delirium

“…Although one of the main limitations for this study was the small sample size making it difficult to establish if indeed music had an effect on the CAM scores, the small trends were clear indications that music can be used in reducing Delirium symptoms among aged patients. The study by Dizon [26] concurred with earlier ones to demonstrate that for surgical patients that listened to music, there were limited confusion episodes as compared to those who did not. Music is part of non-pharmacological intervention which can, therefore, be used to assist patients to manage the condition.…”

“…Music therapy aids in addressing confusion among Delirium patients. This was revealed in a quantitative study by Dizon [26] where some of the respondents had reduced CAM scores when subjected to classical music. Although one of the main limitations for this study was the small sample size making it difficult to establish if indeed music had an effect on the CAM scores, the small trends were clear indications that music can be used in reducing Delirium symptoms among aged patients.…”

“…Current and widely applied non-pharmacological interventions include patient and family awareness through nursing education, addressing dehydration, providing the patient with nutrition supplements, occupational and physical therapy, using hearing aids, providing the patient with visual covers, and reducing the number of visits [5]. Music therapy as a non-pharmacological intervention has also been explored and noted to decrease the level of anxiety and confusion of the patient [26,27]. However, more studies are required to explore the relationship between music therapy further and preventing or treating Delirium.…”

Adaptation and Validation of a Chart‐Based Delirium Detection Tool for the ICU (CHART‐DEL‐ICU)

“…3 Studies report that routine delirium screening is associated with reduced inhospital mortality 4 and reduced patient anxiety. 5 Two validated tools are commonly used for routine delirium screening in the ICU: the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) 6,7 and the Intensive Care Delirium Screening Checklist (ICDSC). 8 However, delirium is a clinical diagnosis and the sensitivity and specificity of these screening tools (compared to clinical diagnosis) vary across studies.…”

“…Regular screening is important for the early recognition of delirium symptoms which may prompt the ICU care team to use nonpharmacological and pharmacological strategies to prevent and manage delirium 3 . Studies report that routine delirium screening is associated with reduced in‐hospital mortality 4 and reduced patient anxiety 5 . Two validated tools are commonly used for routine delirium screening in the ICU: the Confusion Assessment Method for the Intensive Care Unit (CAM‐ICU) 6,7 and the Intensive Care Delirium Screening Checklist (ICDSC) 8 .…”