{"id":1542,"date":"2018-11-26T12:39:33","date_gmt":"2018-11-26T12:39:33","guid":{"rendered":"https:\/\/blogs.bmj.com\/ebn\/?p=1542"},"modified":"2018-11-26T12:39:33","modified_gmt":"2018-11-26T12:39:33","slug":"delirium-in-icu-not-business-as-usual","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/ebn\/2018\/11\/26\/delirium-in-icu-not-business-as-usual\/","title":{"rendered":"Delirium in ICU: Not Business as Usual"},"content":{"rendered":"

Roberta Heale, Associate Editor EBN @robertaheale @EBNursingBMJ\"\"<\/a><\/p>\n

About 25 years ago my Mom underwent a surgical procedure which required her to be in intensive care for several days.\u00a0 She recalls that one night while she was in the ICU, she was surprised to see that all the nurses caring for her were very tiny…far shorter than the height of the mattress on the bed.\u00a0 She protested when the nurses tried to turn her and insisted that they call my father.\u00a0 It was only when he arrived and also appeared to be very tiny, that she realized things weren’t right.\u00a0 We laugh about it now, but delirium in ICU is no laughing matter.\u00a0 Characterized by confusion, hallucinations, unresponsiveness, or agitation, delirium can put patients at risk for longer hospital stays, long-term brain dysfunction or death.1<\/sup><\/p>\n

Unfortunately, delirium is very common.\u00a0 Estimates in ICU range from 30-80 percent, particularly for intubated patients 2<\/sup>Early detection of delirium is imperative for ensuring prompt treatment.3 <\/sup>Several tools can be used to assess patients for delirium in ICU including the RASS (Richmond Agitation-Sedation Scale) and the CAM-ICU (Confusion Assessment Method for the ICU).\u00a0 Both are reliable, validated and simple to use.\u00a0 The RASS, as the name suggests, is a scale of levels of agitation and restlessness.\u00a0 Patients are given a score which prompts for treatment or assessment of delirium. https:\/\/bit.ly\/2QjcpBf<\/a>\u00a0The CAM-ICU incorporates a RASS score of > <\/u>-3 (increasing signs of agitation) along with assessment of change of mental status, attention and response to questions and commands to determine if a patient is suffering from delirium. https:\/\/bit.ly\/2PWw3na<\/a>\u00a0These tests should be administered daily for all ICU patients to determine if they have developed delirium, or to assess the effectiveness of treatment for delirium.<\/p>\n

ICU nurses are ideally suited to implement assessments for delirium in their patients. They have expert knowledge and skills and, because they are with patients for the length of a shift, they are best able to determine if there are changes in the patients’ behaviour or mental status.\u00a0 Nurses collaborate with other health care providers to ensure that delirium is recognized and treated.\u00a0 They are also often the first and most consistent contact of family members.\u00a0As such, nurses can provide education and support for both patients and their families during this difficult time, as they did with my parents many years ago.<\/p>\n

1.\u00a0 Leung, W. (2018). \u2018Like brain failure\u2019: Researchers working to prevent delirium among hospital patients. Globe and Mail, Nov 18, 2018https:\/\/tgam.ca\/2FEWeKp<\/a>
\n<\/a><\/p>\n

2. Cavallazzi, R., Saad, M. & Marik, P.E. (2012). Delirium in the ICU:\u00a0 an overview. Annals of Intensive Care. 2(49).<\/p>\n

3. Harroche, J., St-Louis, L. & Gagnon, M. (2014). The detection of delirium in the ICU:\u00a0 An important aspect of care. Journal of Nursing Education and Practice, 2014 4(9).<\/p>\n

<\/h1>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Roberta Heale, Associate Editor EBN @robertaheale @EBNursingBMJ About 25 years ago my Mom underwent a surgical procedure which required her to be in intensive care for several days.\u00a0 She recalls that one night while she was in the ICU, she was surprised to see that all the nurses caring for her were very tiny…far shorter […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":169,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3664],"tags":[],"class_list":["post-1542","post","type-post","status-publish","format-standard","hentry","category-adult-nursing"],"yoast_head":"\nDelirium in ICU: Not Business as Usual - Evidence-Based Nursing blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/ebn\/2018\/11\/26\/delirium-in-icu-not-business-as-usual\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Delirium in ICU: Not Business as Usual - Evidence-Based Nursing blog\" \/>\n<meta property=\"og:description\" content=\"Roberta Heale, Associate Editor EBN @robertaheale @EBNursingBMJ About 25 years ago my Mom underwent a surgical procedure which required her to be in intensive care for several days.\u00a0 She recalls that one night while she was in the ICU, she was surprised to see that all the nurses caring for her were very tiny…far shorter [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/ebn\/2018\/11\/26\/delirium-in-icu-not-business-as-usual\/\" \/>\n<meta property=\"og:site_name\" content=\"Evidence-Based Nursing blog\" \/>\n<meta property=\"article:published_time\" content=\"2018-11-26T12:39:33+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/ebn\/files\/2018\/11\/Screen-Shot-2018-11-26-at-7.36.06-AM-300x197.png\" \/>\n<meta name=\"author\" content=\"rheale\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"rheale\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2018\\\/11\\\/26\\\/delirium-in-icu-not-business-as-usual\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2018\\\/11\\\/26\\\/delirium-in-icu-not-business-as-usual\\\/\"},\"author\":{\"name\":\"rheale\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/#\\\/schema\\\/person\\\/4d6c0669182b39dd438efb3fe94d7f64\"},\"headline\":\"Delirium in ICU: Not Business as Usual\",\"datePublished\":\"2018-11-26T12:39:33+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2018\\\/11\\\/26\\\/delirium-in-icu-not-business-as-usual\\\/\"},\"wordCount\":471,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2018\\\/11\\\/26\\\/delirium-in-icu-not-business-as-usual\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/files\\\/2018\\\/11\\\/Screen-Shot-2018-11-26-at-7.36.06-AM-300x197.png\",\"articleSection\":[\"Adult Nursing\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2018\\\/11\\\/26\\\/delirium-in-icu-not-business-as-usual\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2018\\\/11\\\/26\\\/delirium-in-icu-not-business-as-usual\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2018\\\/11\\\/26\\\/delirium-in-icu-not-business-as-usual\\\/\",\"name\":\"Delirium in ICU: Not Business as Usual - 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