Delirium monitoring and patient outcomes in a general intensive care unit.

Abstract

Use of an evidence-based tool for routine assessment for delirium by bedside nurses in the intensive care unit is recommended. However, little is known about patient outcomes after implementation of such a tool. To evaluate the implementation and effects of the Confusion Assessment Method for the Intensive Care Unit as a bedside assessment for delirium in a general intensive care unit in a tertiary care hospital. Charts of patients admitted to the unit during a 3-month period before implementation of the assessment tool and 1 year after implementation were reviewed retrospectively. Patient outcomes were incidence of delirium diagnosis, duration of mechanical ventilation, length of stay in the intensive care unit, and time spent in restraints. The 2 groups of patients did not differ in demographics, clinical characteristics, or predisposing factors. The groups also did not differ significantly in delirium diagnosis, duration of mechanical ventilation, length of stay in the intensive care unit, or time spent in restraints. Barriers to use of the tool included nurses' lack of confidence in performing the assessment, concerns about use of the tool in patients receiving mechanical ventilation, and lack of interdisciplinary response to findings obtained with the tool. No change in patient outcomes or diagnosis of delirium occurred 1 year after implementation of the Confusion Assessment Method for the Intensive Care Unit. Lessons learned and barriers to adoption and use, however, were identified.