Implementation of a validated delirium assessment tool in critically ill adults

To evaluate the feasibility and effectiveness of the validated Confusion Assessment Method-ICU (CAM-ICU) delirium screening tool in a critical care unit.

A single centre service evaluation design was conducted in an 18 bed critical care unit comprising medical and surgical patients. Two self report questionnaires were administered to nursing staff (n=78) one immediately prior to and then three months following delirium education and CAM-ICU practical training.

The response rates of the questionnaires were 92% (72/78) and 60% (47/78) respectively, completed by predominantly females with a similar age range across the two groups. Prior to education and training 54% (39/72) of nurses agreed that delirium was a significantly underdiagnosed problem. Few nurses (6%, 4/72) considered evaluating their patients for it and 69% (50/72) did not feel the need to routinely monitor. Following a simple educational intervention 68% (32/47) believed delirium was a very serious problem, 74.5% (35/47) frequently evaluated their patients and only 31% (15/47) felt that CAM-ICU assessments should not be part of routine nursing care. The majority (85.1%, 40/47) of nurses found the CAM-ICU easy to administer, were confident in using the tool (74.4%, 35/47) and felt it led to a more comprehensive patient assessment (83%, 39/47). Despite this, barriers to undertaking delirium assessment identified at the start of the project remained and included patient intubation (42%, 20/47), sedation level (40%, 19/47) and medical staff inability to act on CAM-ICU assessment data (25%, 12/47).

This service evaluation has shown that implementation of a delirium screening tool into daily nursing practice is achievable within a relatively short time period. A simple, educational intervention incorporating written and video information improved the capacity of critical care nurses to perform delirium assessments in a standardised way and reduced the discordance between the perceived importance of delirium and the practice of its evaluation. Such data is especially important since delirium assessments had not traditionally been part of daily nursing care.