Early Identification of Delirium in Intensive Care Unit Patients: Improving the Quality of Care.

BACKGROUND: Delirium has long-term consequences for intensive care unit patients. The project site, an urban academic hospital, did not previously use a validated delirium screening tool, and patients commonly received sedative medications to treat agitation. OBJECTIVE: To minimize the risk of delirium by implementing the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) as the standard-of-care delirium assessment tool in the intensive care unit and by decreasing use of high-risk medications (ie, opioids and benzodiazepines). METHODS: An observational pretest-posttest design was used to analyze deidentified patient data from electronic health records. The evidence-based practice intervention focused on educating nurses on high-risk medications and CAM-ICU implementation. Control charts, χ2 tests, and mixed regression models were used to evaluate the effectiveness of the intervention in reducing delirium risk by decreasing use of high-risk medications. RESULTS: High-risk medication use significantly decreased after intervention among patients at low risk for delirium (before intervention, 7.37%; after intervention, 3.92%; P \u3c .001) and at high risk for delirium (before intervention, 4.73%; after intervention, 2.99%; P \u3c .001). Hospital stays were significantly shorter in patients at low risk than at high risk for delirium (P \u3c .001) but increased by a mean of 0.13 days with each additional high-risk medication used (P \u3c .001). CONCLUSIONS: The variation of high-risk medication use was significantly controlled with the implementation of CAM-ICU and education. Nurses felt that hands-on training with the CAM-ICU increased their comfort in identifying patients at risk for delirium. Future work will focus on assessment accuracy