Educational interventions and guidelines in performing GCS assessment are suggested to maintain and improve knowledge in performing the GCS.

Mentoring and educational interventions are suggested in order to reduce safety risks resulting from lower proficiency in using the GCS.

By creating a regression model for delirium prediction, clinicians may be able to create a checklist to identify patients at risk of developing delirium. This checklist could assist in monitoring patients at higher risk for developing delirium, allowing measures to be implemented for preventing the incidence or reducing the severity of delirium. The use of benzodiazepines should also be avoided if possible, as they are seen to have a significant association with the incidence of delirium.

Background. Delirium is characterized by disturbances of consciousness, attention, cognition, and perception. Delirium is a serious but reversible condition associated with poor clinical outcomes. This has implications for the critically ill patient; the effects of delirium cause long term sequelae, principally cognitive deficits, and functional decline.Objectives. The objective of the paper was to describe risk factors associated with delirium in critically ill adult patients.Methods. Published and unpublished literature from 1990 to 2012, limited to English, was searched using ten databases.Results. Twenty-two studies were included in this paper. A large number of risk factors were presented in the literature; some of these were common across all settings whilst others were exclusive to the type of setting. Benzodiazepines and opioids were shown to be risk factors for delirium independent of setting.Conclusion. With regard to patients admitted to medical and surgical intensive care units, risk factors of older age and comorbidity were common. In the cardiac ICU, older age and lower Mini-Mental Status Examination scores were cited most often as risk factors for delirium, but other risk factors exclusive to the setting were also significant. Benzodiazepines were identified as the most significant pharmacological risk factor for delirium.

Knowledge and experience are the most significant factors on nurses' performance of consciousness level assessment. Implications for nursing management  Formal training is needed on a continual basis to maintain skills in consciousness level assessment, and nurses who are more experienced in the use of assessment should mentor those that are less experienced.