Incidence of delirium in the Intensive Care Unit before and after implementation of the Confusion Assessment Method for the ICU (CAM-ICU)

Background: Delirium is a serious condition that affects patients in the intensive care unit (ICU) that can lead to worse outcomes and increased length of ICU stay. Delirium was not assessed at Oklahoma State University Medical Center (OSUMC) but the implementation of the Confusion Assessment Method for the ICU (CAM-ICU) has changed that. This study looks to determine the incidence of delirium before and after implementation of the CAM-ICU. The objective of this study is to improve recognition of delirium at this hospital to improve patient outcomes and reduce length of stay in the ICU.Methods: This study has been approved by the institutional review board. It evaluates all patients in the ICU before and after implementation of the CAM-ICU. This four-question assessment will be performed by nurses on their regular shift assessment. The assessment will be modified to fit the institution's use of the Ramsay Score instead of the Richmond Agitation and Sedation Scale. A positive result will be recorded in the patient's electronic medical record (EMR) as well as verbally communicated to the doctor and pharmacist. Diagnosis codes for delirium from January 1st, 2019 through June 30, 2019 will be used to determine the incidence of delirium before the implementation of the CAM-ICU. This study will analyze patients from 10/29/2019 through 3/31/2020 who have undergone the CAM-ICU at least once. Once the study period is complete, a report from the EMR will be performed to identify each patient with a positive CAM-ICU. The patient's age, past medical history, assessment results, medication lists, length of stay in the ICU and hospital will be obtained from the electronic medical record. All data will be maintained and analyzed in a secure database to which only the researchers will have access.Results: From January 1st, 2019 until June 30th, 2019, there were 4 patients in the ICU with a diagnosis code of delirium that was associated with their time in the ICU. From 10/29/19 through 12/31/2019, 153 patients underwent testing by the CAM-ICU. Since then, 19/153 patients (12.4%) have tested positive for delirium. 13/19 (68.4%) of patients were male and 11/19 (57.9%) were older than 65. 10/19 (52.6%) patients had a history of substance abuse. The average length of stay in the intensive care unit was 6 days (1-15). 10/19 (52.6%) patients were on a ventilator. The most common intervention performed in 13/19 (68.4%) was to open the blinds. 9/19 patients were never in a room with a window.Conclusion: This study is currently ongoing. Preliminary results show the CAM-ICU does improve recognition of delirium in patients. Currently it shows that white males >65 who have respiratory failure requiring ventilation have a high incidence of delirium as well as patients with a history of substance abuse