ICU Nurses Require Training to Spot Delirium

A basic training workshop quickly brings nurses in intensive care units (ICUs) up to the same standard as 'experts' in recognizing the symptoms of delirium.

Researchers at Northeastern University (Boston, MA, USA), the Tufts-New England Medical Center (Boston, MA, USA), and other institutions developed an educational program that consists of a 30-45 minute slide presentation that covers the use of different scales for assessing aspects of delirium. The lecture is placed between two practical exercises to assess delirium, working through questions and using clinical descriptions of patient symptoms. Fifty ICU nurses from two different hospitals evaluated an ICU patient for pain, level of sedation, and presence of delirium before and after an educational intervention. The same patient was concomitantly, but independently, evaluated by a validated judge who acted as the reference standard in all cases. The education consisted of two script case scenarios, a slide presentation regarding scale-based delirium assessment, and two further cases.

The study results showed that the nurses' clinical recognition of delirium was poor in the before-education period, as only 24% of nurses reported the presence or absence of delirium and only 16% were correct compared with the judge. After education, the number of nurses able to evaluate delirium using any scale and use it correctly increased almost eight-fold. While judge–nurse agreement for the presence of delirium was relatively high for both the before-education period and after-education period, the low number of nurses evaluating delirium before education lead to statistical significance only after education. The study was published on February 18, 2008, in the online open access journal Critical Care, a publication of BioMed Central (www.biomedcentral.com).

"Training in the ICU often focuses on how to assess levels of pain and sedation in patients. However, educational initiatives to improve the ability of bedside clinicians to assess delirium are at least as important and should be part of any ICU patient improvement effort,” said lead author John Devlin, Pharm.D., BCPS, of the school of Pharmacy. "A rapid response to delirious patients in the ICU setting is important, as delirium is associated with higher mortality and longer stays in hospital.”

Delirium is an acute and relatively sudden decline in attention-focus, perception, and cognition. It is commonly associated with a disturbance of consciousness. The change in cognition, manifested in memory deficit, disorientation, language disturbance, or the development of a perceptual disturbance, must be one that is not better accounted for by a preexisting, established, or evolving dementia. Without careful assessment, delirium can easily be confused with a number of psychiatric disorders due to many common signs and symptoms present in dementia, depression, and psychosis. Delirium is probably the single most common acute disorder affecting adults in general hospitals, affecting 10-20% of all hospitalized adults, and 30-40% of elderly hospitalized patients.


Related Links:
Northeastern University
Tufts-New England Medical Center