Use of a validated delirium assessment tool improves the ability of physicians to identify delirium in medical intensive care unit patients

Devlin, John W.; Fong, Jeffrey; Schumaker, Greg; OʼConnor, Heidi; Ruthazer, Robin; Garpestad, Erik

doi:10.1097/01.ccm.0000292011.93074.82

Cited by 111 publications

(66 citation statements)

References 10 publications

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“…However, we feel that a single evaluator increased the consistency among the expert CAM-ICU assessments. As clinical pharmacists are now playing a leading role in delirium-related guideline development and educational efforts [6,[19][20][21], a pharmacist successfully served as the expert evaluator in this study. Second, as some evaluations were likely performed in the same patients by the same nurses, the 1011 evaluations may not have been completely independent, thereby affecting the kappa estimations.…”

Section: Discussionmentioning

confidence: 99%

Implementation, reliability testing, and compliance monitoring of the Confusion Assessment Method for the Intensive Care Unit in trauma patients

et al. 2008

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Objective-To implement delirium monitoring, test reliability, and monitor compliance of performing the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in trauma patients.Design and setting-Prospective, observational study in a Level 1 trauma unit of a tertiary care, university-based medical center. Measurements and Results-Following web-based teaching modules and group in-services, bedside nurses evaluated patients daily for depth of sedation with the Richmond AgitationSedation Scale (RASS) and for the presence of delirium with the CAM-ICU. On randomly assigned days over a 10-week period, evaluations by nursing staff were followed by evaluations by an expert evaluator of the RASS and the CAM-ICU, in order to assess compliance and reliability of the CAM-ICU in trauma patients. Following the audit period, the nurses completed a post-implementation survey. Patients-AcutelyOne thousand and eleven random CAM-ICU assessments were performed by the expert evaluator, within 1 hour of the bedside nurses' assessments. Nurses completed the CAM-ICU assessments in 84% (849 of 1011) of evaluations. Overall agreement ( ) between nurses and the expert evaluator was 0.77 (0.721, 0.822; p<0.0001). In TBI patients was 0.75 (0.667, 0.829; p<0.0001), while in mechanically-ventilated patients was 0.62 (0.534, 0.704; p<0.0001). The survey revealed nurses were confident in performing the CAM-ICU, realized the importance of delirium, and were satisfied with the training they received. The survey also acknowledged obstacles to Conclusions-The CAM-ICU can be successfully implemented in a university-based trauma unit with high compliance and reliability. Quality improvement projects seeking to implement delirium monitoring would be wise to address potential pitfalls including time complaints and the negative impact of physician indifference regarding this form of organ dysfunction.

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Section: Discussionmentioning

confidence: 99%

Implementation, reliability testing, and compliance monitoring of the Confusion Assessment Method for the Intensive Care Unit in trauma patients

et al. 2008

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“…This only confirms the notion that delirium and acute brain dysfunction are emerging areas of knowledge where much effort is needed to unify the present definitions [21] and increase the data on pathophysiology [22][23][24], epidemiology [9,17,18], and possible interventions [7,25].…”

Section: Discussionmentioning

confidence: 81%

Mechanical Ventilation

Krüger

Ludman

2014

Core Knowledge in Critical Care Medicine

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Purpose: The aim of the study was to characterize the practices of Brazilian ICU physicians toward sedation and delirium. Materials and Methods: A cross-sectional survey was conducted among a convenience sample of critical care physicians between April and June 2008. Results: One thousand fifteen critical care physicians responded. Sedation scoring systems were used by 893 (88.3%) of the respondents. The Ramsay and Richmond Agitation-Sedation Scale were used by 81.9% and 6.8% of the respondents, respectively. Most respondents did not discuss sedation targets (62.8%) or practice daily sedative interruption (68.3%) in most patients. More than half of the respondents (52.7%) used a sedation protocol, and the most used sedatives were midazolam (97.8%), fentanyl (91.5%), and propofol (55%). A significant rate of the respondents (42.7%) estimated that more than 25% of

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“…In the article written by Devlin and John W. it was shown that after physician education, agreement validated their judge for delirium identifying is more increased (22). In the article written by Gesin et al, (23) it is demonstrated that a multifaceted education program can affect the nurses' knowledge and their ability for screening of delirium.…”

Section: Discussionmentioning

confidence: 99%

“…One of the best programs for education is educating the intensive care delirium screening checklist (ICDSC) (22,24). It seems that it is more important to educate delirium detecting to medical teams (such as doctors and nurses).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Liaison Education and Environmental Changes on Delirium Incidence in ICU

et al. 2018

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Background: Delirium is a disorder with disturbance of consciousness, cognitive process. The present study's aim is to evaluate the efficacy of liaison educational and environmental changes on the delirium rate in ICU patients. Methods: This is a quasi-experimental study on 148 admitted patients (over 18 years of age) in the general ICU. A total of 69 patients in the group before implementing multidisciplinary interventions and 79 patients in the group after multidisciplinary interventions were evaluated. In the case and control group RASS level of consciousness were measured. Scale ICU-CAM (at morning and evening) is used to check the incidence of delirium in the ICU patient. In addition, the demographic questionnaire has been used and delirium duration and the length of hospitalization are also evaluated in both groups. Multifactorial interventions are included as staff physicians and nurses training through a workshop. It should be noted that a 3-hour workshop is used for training of all staff personnel in the ICU ward. The 2nd part is creating environmental intervention in the ICU to decrease delirium in admitted patients. Results: In this study, 148 patients were studied, 69 patients in the group before implementing multidisciplinary interventions and 79 patients in the group after multidisciplinary interventions were evaluated. Incidence of delirium was 30 (37.97) in intervention

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Use of a validated delirium assessment tool improves the ability of physicians to identify delirium in medical intensive care unit patients

Abstract: Use of the ICDSC, along with education supporting its use, improves the ability of physicians to detect delirium in the medical intensive care unit.

Cited by 111 publications

References 10 publications

Implementation, reliability testing, and compliance monitoring of the Confusion Assessment Method for the Intensive Care Unit in trauma patients

Implementation, reliability testing, and compliance monitoring of the Confusion Assessment Method for the Intensive Care Unit in trauma patients

Mechanical Ventilation

Efficacy of Liaison Education and Environmental Changes on Delirium Incidence in ICU

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