1114: DELIRIUM SCREENING

Abstract

Clinical practice guidelines have shown that multidisciplinary development and implementation of sedation guidelines will reduce drug costs, ventilator times, lengths of stay and mortality. Routine delirium assessment is recommended, and can lead to improved long-term patient outcomes. Our institution modified an existing sedation protocol to include a standard daily screen for delirium, providing an opportunity for early recognition and treatment of this common ICU condition.

With the initiation of the modified sedation protocol, each ICU patient meeting criteria will be given a sedation interruption in conjunction with a delirium screen, to increase early recognition of possible ICU delirium. This will provide an opportunity to further assess the patient and intervene as needed for any positive delirium screen.

All ICU patients were evaluated during multidisciplinary rounds for appropriate sedation interruption and subsequent delirium screen using the CAM-ICU assessment tool, per the sedation protocol. Exclusion criteria for sedation interruption were: active seizures, alcohol withdrawal, extreme agitation with current sedation, paralytic, increased intracranial pressure, or hypothermia protocol in place. Exclusion criteria for CAM-ICU assessment were extreme agitation with current sedation or lack of patient responsiveness with sedation interruption.

A total of 3,959 patient days were identified for this study over a 10 month period. We increased our rate of delirium screening compliance from 65.5% to 91.2% (25.7% improvement). The primary outcome measure was to increase identification of CAM positive patients. This increased from 0% to 14.6%, which resulted in early intervention and treatment of the condition.

We identified that delirium screening compliance was inadequate with our existing sedation interruption protocol. This led to a revised protocol, extensive education and positive reinforcement of current practice guidelines. As compliance increased, so did opportunities to treat patients for ICU delirium both physiologically and pharmacologically, making a difference in our hospital and our community.