Clinical Pearls

Abstract

Complications of delirium are widely known and can contribute to significant morbidity and mortality. However, delirium is under-recognized and undetected in 30% to 75% of cases. Further, studies have shown that nurses have inadequate knowledge of delirium risk factors and consequences and that some nurses believe delirium screening is unnecessary.Blevins and colleagues tested the effectiveness of an educational intervention on nurses’ knowledge of delirium and delirium risk factors. The intervention included a video, didactic instruction, case study analyses, and bedside screening instruction with return demonstration. They found the following:Although further research on various instructional methods is needed to determine the best strategies, the authors recommend ongoing education to maintain accurate screening.See Article, pp 270–278Items that are often touched in the hospital setting may contain microbes that contribute to nosocomial infections. Most surfaces can be effectively disinfected following standards set by the manufacturer. However, items with complex, intricate surfaces are more difficult to clean and may serve as reservoirs for bacteria.Risteen and colleagues studied the effectiveness of 0.5% hydrogen peroxide wipes on blood pressure cuffs and electrocardiographic telemetry leads, as compared with the cleaning of hard, smooth surfaces. They found the following:The hydrogen peroxide wipes were adequate for blood pressure cuffs but not for telemetry leads. The authors advocate an emphasis on thorough cleaning of all surfaces, including ones that are smooth and hard.See Article, pp 322–327Mortality rates of adult patients in the intensive care unit (ICU) are high. Most families recover from their bereavement, but some experience complicated grief. Research on bereavement experiences has identified some family issues with the experience, but most studies were done outside of the United States and may present differences.Jones and colleagues interviewed families of patients who had died in the medical-surgical or cardiac ICU within the past 13 months. They found the following 3 main themes:Although bereavement care needs to be individualized, findings show that patients’ families would like support both during and after the ICU experience. The authors remind practitioners to be aware of the impact they have on patients’ families.See Article, pp 312–321Alcohol withdrawal syndrome (AWS) is a medical condition with significant symptoms. The 2 most commonly used AWS assessment tools are The Clinical Institute Withdrawal Assessment (CIWA-Ar) and the Minnesota Detoxification Scale (MINDS). The MINDS has been validated with patients in the intensive care unit (ICU) but the CIWA-Ar has not, and this has led to mismanagement of AWS treatment when transitioning a patient from the ICU to a non-ICU setting.Littlefield and colleagues compared the CIWA-Ar and a modified MINDS tool in order to compare the similarities and found the following:The authors state that the results of this study can advance the care of patients with AWS and be used to improve protocols for patients’ transition from the ICU to other hospital units.See Article, pp 280–286