Delirium prevention and management in an adult intensive care unit through evidence-based nonpharmacological interventions: A scoping review

Abstract

ObjectiveTo map and review current literature to describe evidence-based non-pharmacological interventions for delirium prevention and management in adult critically ill patients. IntroductionPrevious research has demonstrated the efficacy of non-pharmacological interventions for intensive care unit delirium; however, the heterogeneity and complexity of these interventions make it challenging to disseminate and integrate into clinical practice. DesignThis scoping review follows the Joanna Briggs Institute Protocol Guidelines. Data sourcesCumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, PsycINFO, Joanna Briggs Institute, ProQuest, and Excerpta Medica databases were searched until August 2023. Review methodsDouble screening, extraction, and data coding using thematic analysis and frequency counts. Reporting followed the preferred reporting items for systematic reviews and meta-analysis guidelines using the extension for scoping reviews. ResultsThirty-three primary research articles were included; thirty-one were quantitative, and two were qualitative. Four categories of interventions were identified: instrument-based therapeutic interventions (n = 10) consisting of the use of music, light, mirror and occupational therapy; nurse-led interventions (n = 5) consisting of interventions directly delivered by the nurses with mobilisation, orientation and cognitive stimulation being the most common types of intervention. Family-delivered interventions (n = 5) are delivered directly by family members, with extended visitation and orientation being the most utilised. Multicomponent interventions (n = 13) combine different aspects of single interventions into care bundles and programs. ConclusionThis review identified a lack of consistency in applying non-pharmacologic interventions to prevent and manage delirium in adult ICUs. Standardised evidence-based guidelines addressing all aspects of single-component or multi-component non-pharmacological delirium interventions and support for ICU staff utilising these interventions and family member education and support are required. Without consistent involvement from the healthcare team and patient families, opportunities may have been lost to optimise family-centred care practices in critical care settings. Patient or public contributionNo patient or public contribution was necessary for this review. Protocol RegistrationThe protocol registration for this review can be accessed via Open Science Framework at https://doi.org/10.17605/OSF.IO/CMQWG