Validated screening instruments for detecting ICU delirium in acute care

ICU Delirium

Evaluation Table

Author (Year)

Luetz et al. (2014, November). Delirium, Sedation and Analgesia in the Intensive Care Unit: A Multinational, Two-Part Survey among Intensivists. PLOS One, 9(11), 1-6.

Ista et al. (2014, October 2). Improvement of Care for ICU Patients with Delirium by Early Screening and Treatment: Study Protocol of iDECePTIvE Study. Implementation Science, 9(143), 1-10.

Filinson et al. (2016). Adoption of Delirium Assessment in the Acute Care Setting: A Tale of Two Hospitals. Best Practices in Mental Health, 12(2), 81-95.

Friedman et al. (2014). Delirium in Advanced Cancer: Screening for the Incidence on Admission to an Inpatient Hospice Unit. Journal of Palliative Medicine, 17(9), 1045-1048.

Conceptual Framework

ICU delirium is not sufficiently acknowledged by intensivists and nurses providing care on a daily basis. The use of a validated assessment instrument enhances healthcare professionals\' abilities to identify the condition.

ICU delirium management among critically ill patients requires adequate measures including systematic screening.

The adoption of Confusion Assessment Method (CAM) in acute care settings help improve detection of ICU delirium by healthcare professionals.

Delirium screening enhances detection though there is no consensus on the most suitable screening instrument.

Design/Method

A patient survey was carried out through the use of a questionnaire, which was administered to ICU patients.

The researchers conducted an iDECePTIve study through a mixed method research design in 6 ICUs in southwest Netherlands.

The researchers conducted a Plan-Do-Study Act observation and analysis of CAM adoption in two acute care settings.

Two validated delirium screening tools were administered to patients in an acute inpatient hospice unit within 72 hours of admission.

Sample & Setting

The first set of questionnaire for hospital and ICU data was administered to 666 hospitals and ICUs out of which 44% reported using a validated delirium screening instrument.

The second survey involved administering 1004 questionnaire to ICU patients.

The setting for this study was 6 ICUs in southwest Netherlands. These ICUs included university, non-university, and non-educational health facilities. The sample included all ICU physicians and patients aged 18 years and above.

The study was carried in acute care settings in two hospitals i.e. an urban centre hospital and a non-profit general acute care healthcare facility. The researchers utilized a combined total of 44 participants from both hospitals.

The study was conducted on a group of 100 hundred consecutive patients aged 18 or more years admitted in an acute inpatient hospice unit due to advanced cancer.

Major Variables Studied

The survey examined the use of a validated screening tool in hospitals and ICUs and its impact on improved abilities for detecting ICU delirium.

The study examined several variables including current practice of ICU delirium management, barriers and facilitators for utilizing ICU delirium guideline, and implementation of ICU delirium management.

The research examined the effectiveness of training, and administration of CAM during admission and discharge to improve ICU delirium detection.

The study examined the most suitable delirium assessment tool between the Confusion Assessment Method (CAM) and Delirium Rating Scale-Revised 98 (DRS-R-98).

Measurement

The researchers developed two-structured, online anonymous English questionnaires using LimeSurvey as the server-based software.

A survey and in-depth focus group interviews were utilized for data collection.

The researchers conducted observations in experimental units in the facilities within a six-month period.

The researchers conducted a survey on the sample population who were invited to participate through allowing screening using these two tools.

Data Analysis

Statistical analysis was conducted through IBM SPSS Statistics Version 19 and Aabel 3.0.6, Gigawiz Ltd. Co.

Data analyses methods that were utilized include descriptive statistics, multivariate analysis, ANOVA, and IBM SPSS version 21.0.

The obtained data from pre- and post-tests were analyzed using ANOVA analysis.

Statistical analysis using SPSS-20 (SPSS Inc., Armonk, NY) was utilized for data analysis.

Appraisal

The study highlights the significance of using a validated assessment instrument in intensive care units to identify ICU delirium. As shown in the research, the identification of the condition is relatively difficult without the use of such a tool.

This study highlights the significance of a wide approach in addressing ICU delirium beyond screening. It demonstrates that screening is not adequate to deal with the various issues surrounding the management of the condition. In this regard, screening should be followed by prevention and management.

The study demonstrates the role of a validated assessment instrument in detection of ICU delirium to improve patient care delivery. Additionally, it provides recommendations on how to address potential pitfalls to the adoption of a validated assessment instrument through implementation of an education program in the healthcare facility.

The study provides a recommendation of the most suitable delirium assessment instrument given the lack of consensus regarding the best assessment tool for this condition.

Search Tracker

PICOT Question Organizer

PICOT

P

Population

Adults in the ICU i.e. patients aged 18 years or more.

I

Intervention or Issue of interest

A validated delirium assessment instrument.

C

Comparison

Multicomponent interventions.

O

Outcome

Improved delirium detection.

T

Time frame

Six month period.

Search Tracker

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Initial search terms

Database

And/Or?

Added search terms

Title (Ti)

Anywhere, etc.

# of articles found

1

ICU delirium screening

EBSCOHost

ProQuest, Emerald Insight

Detection

How is ICU delirium screening conducted?

10

2

ICU delirium assessment

EBSCOHost

Emerald Insight

Detection

How is ICU delirium assessment and management conducted?

7

3

Assessment tools for ICU delirium

EBSCOHost

CINAHL, ProQuest

Management of ICU delirium and multicomponent interventions

What are the available ICU delirium assessment tools and multicomponent interventions?

8

4

Validated ICU delirium assessment tool

EBSCOHost

JSTOR, Emerald Insight

Evaluation tool and multicomponent interventions.

Does ICU delirium assessment tool enhance detection among adults in ICUs as compared to multicomponent interventions?

4

5

Validated ICU delirium screening instrument

EBSCOHost

ProQuest, JSTOR

Multicomponent interventions

A Validated screening instrument enhances delirium detection among adults in ICUs compared to multicomponent interventions.

5