Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Elizabeth Burckardt

Committee Member

Dr. Melanie Hardin-Pierce

Abstract

PURPOSE: The goals of this study were to: improve delirium recognition by implementing the Confusion Assessment Method for the ICU (CAM-ICU), evaluate adherence to routine delirium monitoring, measure the incidence of CAM-positive patients, and measure the use of analgesic and sedative medications in ICU patients.

METHODS: This study was a single-center post-implementation retrospective medical record review examining the adherence and incidence of delirium after the introduction of the CAM-ICU assessment on the surgical ICU. Prior to the beginning of the study the surgical ICU nurses were educated on how to assess for delirium using the CAM-ICU instrument. During the six week study the following data were collected: adherence to delirium monitoring through documentation, incidence of CAM-positive patients, and sedation and analgesic medication usage. The sample consisted of seventy-six patients that were admitted to the surgical ICU between September 6, 2016 and October 18, 2016.

RESULTS: Thirty-two (58.1%) patients had the CAM-ICU assessment completed once a shift at the 48-hour evaluation and twenty-two (81.4%) patients during the 96-hour evaluation. Five (9%) patients were CAM-positive at the 48-hour and one (3.7%) at the 96-hour evaluation. The 48-hour time interval had the highest average number of dosages for analgesic medications at 2.3 (29.4%) for CAM-negative patients. CAM-positive analgesic medications usage increased progressively, peaking at the 72-hour interval with the average dose at 3.6 (32.1%). With regards to sedative medications, CAM-negative patients had the highest average number of dosages, 1.9 (30.2%), at the 48-hour interval. For CAM-positive patients the use of sedative medications peaked at the 24-hour interval and then decreased at the 48-hour time frame; after which sedative medication usage rose steadily from the 48 through 96-hour interval.

CONCLUSION: Required routine delirium monitoring should occur per evidence-based practice guidelines for all ICU patients. The incidence of delirium in this study was found to be low, at 9%, when compared to previous studies on delirium. No statistically significant conclusions could be drawn from this study. Factors that could have contributed to this low incidence of delirium in these specific patients could have been the relative young age of the patients (mean age of 53.2) and the possible lower severity of illness, both of these factors influence the risk of delirium development. In conclusion, this single study may have found a low incidence of delirium among these specific ICU patients but many previous studies have determined that the incidence of delirium is much higher.

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