Efficacy of Liaison Education and Environmental Changes on Delirium Incidence in ICU

Abstract

Background: Delirium is a disorder with disturbance of consciousness, cognitive process. The present study's aim is to evaluate the efficacy of liaison educational and environmental changes on the delirium rate in ICU patients. Methods: This is a quasi-experimental study on 148 admitted patients (over 18 years of age) in the general ICU. A total of 69 patients in the group before implementing multidisciplinary interventions and 79 patients in the group after multidisciplinary interventions were evaluated. In the case and control group RASS level of consciousness were measured. Scale ICU-CAM (at morning and evening) is used to check the incidence of delirium in the ICU patient. In addition, the demographic questionnaire has been used and delirium duration and the length of hospitalization are also evaluated in both groups. Multifactorial interventions are included as staff physicians and nurses training through a workshop. It should be noted that a 3-hour workshop is used for training of all staff personnel in the ICU ward. The 2nd part is creating environmental intervention in the ICU to decrease delirium in admitted patients. Results: In this study, 148 patients were studied, 69 patients in the group before implementing multidisciplinary interventions and 79 patients in the group after multidisciplinary interventions were evaluated. Incidence of delirium was 30 (37.97) in intervention

The Effect of Non-Pharmacologic Strategies on Prevention or Management of Intensive Care Unit Delirium: A Systematic Review

“…Of these 27 articles, 24 assessed incidence and/or prevalence within their cohorts [21-40, 42-45, 47], 16 assessed for duration [21-25, 31, 32, 35, 39, 41-43, 45-47], and four for severity [21, 33, 39, 47]. Additionally, 12 focused on the effect of single interventions [21, 26, 28, 29, 31, 35, 38, 39, 41, 42, 44, 45] while 15 considered bundled, multicomponent interventions [22-25, 27, 30, 32-34, 36, 37, 40, 43, 46, 47]. Individual interventions included mobility protocols, distinct family visiting policies, dynamic lighting, music therapy, automated reorientation messages, mindfulness exercises, and the structured use of mirrors in recovery.…”

“…Of the 27 included studies, 11 were RCTs or randomized pilot studies [21, 28, 29, 31-33, 35, 39-41, 45], eight were pre-post prospective studies [23, 25, 36, 37, 43, 44, 46, 47], two were quasi-experimental [22, 27], and the remaining six were a case-matched control study, an evidence based protocol, a mixed-methods pilot study, a prospective cohort study, a retrospective cohort study, and an action research study [24, 26, 30, 34, 38, 42].…”

“…A quasi-experimental study designed by Arbabi et al developed a multi-component delirium management bundle comprised of staff education and environmental and non-pharmacologic care changes [22]. They measured the effectiveness of their bundle by comparing delirium incidence and duration for both groups, finding a significant difference in both outcomes (p = 0.01 and 0.001 respectively; Table 3 & 4).…”

“…The remaining nine bundle studies developed new, unique bundles. They included four pre-post studies [25,43,46,47], three RCTs [32,33,40], one quasi-experimental study [22], and one action research study [30]. Seven assessed delirium incidence and duration using CAM-ICU [22,25,30,32,40,46,47], one used NEECHAM [33], and one used ICDSC [43].…”

“…Sixteen of the reviewed studies evaluated duration of delirium, eight focusing on individual interventions and eight introducing bundled protocols. Of these 16 studies, eight found significant changes overall [21,22,24,25,32,42,43,46], two had significant improvements at select time points [23,41], and five did not have significant results [26,31,35,45,47]; the one remaining study did not assess for statistical significance [39]. Six of the eight successful trials were bundles and both of the two effective individual therapies were mobility-focused (early and intensive OT, and FES) [21,42].…”