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The implementation of a nonpharmacologic protocol to prevent intensive care delirium

Ryan M Rivosecchi1, Sandra L Kane-Gill2, Sue Svec1

  • 1University of Pittsburgh Medical Center, Presbyterian Campus, 200 Lothrop St, Pittsburgh, PA, 15213.

Journal of Critical Care
|November 25, 2015
PubMed
Abstract

Insights

Implementing a nonpharmacologic delirium prevention protocol significantly reduced time spent delirious in the medical intensive care unit (MICU). This evidence-based approach also lowered the incidence of delirium development in critically ill patients.

Area of Science:

  • Critical Care Medicine
  • Gerontology
  • Nursing Research

Background:

  • Delirium is a common complication in intensive care units, associated with adverse outcomes.
  • Existing sedation and mobility protocols may not fully address delirium prevention.
  • Nonpharmacologic interventions offer a potential strategy to mitigate delirium.

Purpose of the Study:

  • To evaluate the effectiveness of an evidence-based nonpharmacologic protocol in reducing delirium duration in a medical intensive care unit (MICU).
  • To assess the impact of the protocol on the incidence of delirium development.

Main Methods:

  • A prospective, pre-post quality improvement project involving MICU patients from September 2013 to April 2014.
  • Implementation of a bundled nonpharmacologic protocol including music, light management, reorientation, and sensory care.
  • Nursing education on evidence-based nonpharmacologic interventions was provided.

Main Results:

  • A 50.6% reduction in the percentage of time patients spent delirious was observed (16.1% vs 9.6%, P < .001).
  • The incidence of delirium development decreased significantly (15.7% vs 9.4%, P = .04).
  • The protocol reduced the odds of developing delirium by 57% (OR, 0.43; P = .005), controlling for covariates.

Conclusions:

  • Implementation of the nonpharmacologic delirium prevention protocol led to a significant reduction in delirium time and incidence in the MICU.
  • Further rigorous studies are needed to confirm the efficacy of nonpharmacologic interventions within comprehensive care protocols.
Keywords:
Critical illnessDeliriumIntensive Care Delirium Screening ChecklistIntensive careNonpharmacologic

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