ENHANCING SCREENING AND MANAGEMENT OF DELIRIUM IN CRITICAL CARE

Delirium is a major health issue for critically ill patients. Delirium is characterized by a change in level of cognition with disorganized thinking, and can result in cognitive impairment if undiagnosed and treated. Without screening, greater than 66% of patients with delirium may go undiagnosed, and cognitive impairment upon discharge is 10-fold higher for undiagnosed patients. Use of the Confusion Assessment Method in Intensive Care Unit (CAM-ICU) is known to optimize identification of delirium among critically ill patients. Despite staff training and adoption of the CAM-ICU tool in 2014 in critical care units of a southwestern Magnet-accredited faith-based community hospital, chart audits found that unit staff was inconsistently screening and managing delirium. Nurses stated that the tool was complicated and time-consuming. Following a literature review, an educational program was developed to address the problem. The program is composed of a self-learning module (SLM) with pre- and post-test to be followed by supervised bedside application of the tool, and skills evaluation using a competency checklist. Also developed was a reference and resource manual to be kept on the unit. The program has been approved by the unit manager and clinical nurse specialist (CNS), and will be piloted on five nurses during summer 2018. The five nurses will become the nurse champions for this program. The program will be given to the remaining nurses of the unit after the pilot. A post-program assessment will iv determine the prevalence of delirium in the unit, data which has not been available to date. Enhancing nurses’ skill in identifying presence of delirium will optimize the management of delirium in critical care. This educational program for staff should improve patient care for critically ill patients