Teaching staff nurses the CAM-ICU for delirium screening

The confusion assessment method for the intensive care unit (CAM-ICU) is a tool for screening for delirium in ventilated patients that with proper training can be administered quickly by staff nurses in the ICU. Unrecognized delirium can have a range of negative consequences, and in the elderly patients, it may be the first sign of an acute illness that, if left untreated, could result in death. Appropriate and early recognition is therefore imperative. Training staff to use the CAM-ICU requires not only a basic understanding of delirium and a firm orientation to the tool's features but also some preparatory decisions about tool usage and a defined approach to integrate the tool into the physical assessment process. Preparatory decisions include (1) how the tool will be used, (2) defining the process for identifying and recording baseline mental status, and (3) defining how documentation will occur. On the basis of the experience of teaching this tool to staff nurses, a 6-step process is explicated to facilitate integration: (1) putting it in context, (2) defining the features, (3) talking about tough cases, (4) doing the assessment, (5) documenting the assessment, and (6) continuing to discuss.