Implementing Delirium Screening in the ICU

Abstract

Objective To review delirium screening tools available for use in the adult and pediatric ICU, review evidence-based delirium screening implementation and to discuss common pitfalls encountered during delirium screening in the ICU. Data Sources Review of delirium screening literature and expert opinion. Results Over the past decade, tools specifically designed for use in critically ill adults and children have been developed and validated. Delirium screening has been effectively implemented across many ICUs settings. Keys to effective implementation include addressing barriers to routine screening, multi-faceted training such as lectures, case-based scenarios, one-on-one teaching and real-time feedback of delirium screening and interdisciplinary communication through discussion of a patient’s delirium status during bedside rounds and through documentation systems. If delirium is present clinicians should search for reversible or treatable causes since it is often multifactorial. Conclusion Implementation of effective delirium screening is feasible but requires attention to implementation methods, including a change in the current ICU culture that believes delirium is inevitable or a normal part of a critical illness, to a future culture that views delirium as a dangerous syndrome which portends poor clinical outcomes and which is potentially modifiable depending on the individual patients circumstances.

Evaluating the Confusion Assessment Method for Intensive Care Unit (CAMICU)Tool: A Comprehensive Literature Review

“…For the adult ICU, there are two delirium-screening tools that have been proven effective in practice: the CAM-ICU and the Intensive Care Delirium Screening Checklist (ICDSC) [26]. Notably, Gusmao-Flores, Salluh, Chalhub, and Quarantini in 2012 [27] conducted a study in which the CAM-ICU and ICDSC were evaluated for their accuracy in diagnosing delirium in critically ill patients.…”

ICU Delirium: Diagnosis, Risk Factors, and Management

“…Both tests have shown significant agreement when compared with one another with good specificity, but operator training can impact the sensitivity to a certain degree. Untrained bedside ICU nurses using these screening tools have demonstrated variability in sensitivity, but with minimal training it appears much of this variability can be minimized [13]. Despite the reproducibility of the results using these tests, clinicians should bear in mind that there will still be a subset of patients for whom the results may be inconclusive, and psychiatric consultation may be warranted for a full DSM-IV-based evaluation.…”

Diagnosis and Management of Delirium in Critically Ill Infants: Case Report and Review

“…1 Adult delirium is increasingly recognized using scales to screen for symptoms and treated with evidence-based milieu interventions, elimination of iatrogenic causes, and antipsychotic medications. 2 How this applies to children has been a subject of much interest and research. [3][4][5][6] The available evidence in children is largely based on case reports/ series and retrospective studies with a lack of prospective trials to assess efficacy of interventions, including medications.…”

“…2,7 Some studies indicate that mortality in children from delirium is comparable to that in adults. [8][9][10][11] A large percentage of children admitted to PICUs are infants.…”