Effect Of Confusion Assessment Scores On Identifying Delirium In Intensive Care Patients, Kayla Jacobs

Dissertations

Delirium in intensive care unit (ICU) patients can lead to increased length of stay in the hospital, increased risk of complications, increased polypharmacy, family distress and increased rate of mortality (Vasilevskis et al., 2018). Research has shown that addressing modifiable risk factors can improve survival rate by up to 15%, and routine screening for delirium in ICU patients leads to decreased patient anxiety, reduced in-hospital mortality, early recognition, and treatment of delirium (Krewulak et al., 2021 ; Vasilevskis et al., 2018). This quality improvement project used evidence-based intervention to increase accurate documentation of the confusion assessment method in the ICU …

Delirium And Staff Injury, John Olague Jr

Master's Projects and Capstones

Abstract

Problem: From April 2021 to January 2022 there were 17 cases of reported patient aggression and staff injury due to patients in the hyperactive state of delirium. In a stroke/tele unit, diagnosis of delirium was delayed due to subjective assessment from the confusion assessment method (CAM) tool. This delay allowed patients to reach the hyperactive state of delirium which poses a threat to patient and staff safety. An objective form of assessment for delirium was needed on this stroke/tele unit.

Context: Through a microsystem assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis, stakeholders in this performance improvement plan …

Evaluation Of A Process Change Using An Updated Sedation Protocol, Rachel Allen

Dissertations

Problem: Pediatric delirium is continuing to increase intensive care environments and for patients who require mechanical ventilation and continuous sedative medications. Delirium is harmful to the patient creating lasting neurologic and mental health issues along with prolonged hospitalization and increased healthcare cost

Method: For this quality improvement (QI) project, a descriptive observational study was used to evaluate the implementation of a sedation protocol for patients who are mechanically ventilated and on continuous sedative medications. This was completed with the use of retrospective chart reviews three months prior to implementation and three months after the new protocol was implemented. Nurses were …

Evaluating The Rass And Cap-D In A Pediatric Cardiac Intensive Care Unit, Sarah Anderson

Dissertations

Abstract

Problem: Pediatric delirium is highly prevalent in the intensive care setting, as much as seventy to eighty-seven percent. Kalvas & Harrison (2020) found that sixty-six percent of critically ill children in a pediatric intensive care unit suffered from a diagnosis of delirium. Delirium has been widely linked with increased costs, mortality, and length of stay.

Methods: The quality improvement (QI) project used a descriptive design to collect retrospective and prospective data before and after an individualized bedside education session was completed. The QI project used a purposive convenience sampling to assess the ability to accurately identify the presence of …

Ethical Sensitivity Of Padis Care Among Critical Care Nurses: A Mixed Methods Study, Denise Waterfield

Theses & Dissertations

Critically ill patients often experience distressful and impactful symptoms and conditions that include pain, agitation/sedation, delirium, immobility, and sleep disruption (PADIS). The presence of PADIS can affect recovery and long-term patient outcomes. An integral part of critical care nursing is PADIS prevention, assessment, and management. To better understand the complexities of PADIS care, two reviews of the literature were completed. The first is an integrative review of the use of PADIS assessment tools by critical care nurses. The second is a qualitative systematic review of the literature on the integration of care ethics and nursing workload. Ethical sensitivity of everyday …

The Effect Of The Sleep Promotion Interventions On Incidence Of Delirium In Intensive Care Patients: An Integrative Literature Review, Sarah Lee

Nursing Masters Papers

Sleep is vital to our health, and prolonged sleep deprivation can result in serious health problems. Yet, patients in the intensive care unit (ICU) commonly experience sleep deprivation due to the environment and necessary treatments. High noise levels, bright lights, frequent patient care activities, mechanical ventilator desynchrony, pain, anxiety, and medications are the main factors that disrupt patients’ sleep architecture and affect sleep quality. Sleep deprivation is a significant contributor to the development of delirium, which is associated with poor patient outcomes and added financial burden. Implementation of sleep promotion interventions may decrease the incidence of this detrimental illness. The …

Implementing The Richmond Agitation-Sedation Scale To Assess Delirium In A Pediatric Icu, Leigh Paridy

Dissertations

Purpose: The purpose of this quality improvement project was to establish early identification of delirium in the intensive care setting to reduce the impact of long-term patient outcomes. Description of project: A retrospective-prospective medical chart review was completed. The retrospective chart review looked at fifty-two patients admitted to the pediatric intensive care unit (PICU) between October 1, 2020 and December 1, 2020 for patient demographics and State Behavior Scale (SBS) and the Cornell Assessment for Pediatric Delirium (CAPD) charting compliance especially with children with developmental delay and those with a high susceptibility to delirium. The prospective chart review looked at …

Delirium, Angela Lee

Nursing Student Class Projects (Formerly MSN)

Delirium is a severe neurocognitive syndrome characterized by acute changes in consciousness and cognition (American Psychiatric Association, 2013; Wilson et al., 2020). The syndrome is found to be prevalent within the adult intensive care population resulting from various triggers and stressors in the critical care setting (Wilson et al., 2020). On average, the prevalence of delirium is 23%, but the incidence significantly increases to 50-70% in mechanically ventilated patients (Wilson et al., 2020). As a result of the extension of cognitive deficits, if left untreated, delirium may lead to long-term impairments in cognitive disfunction (Wilson et al., 2020). Current studies …

The Effects Of Dexmedetomidine On Preventing/Decreasing Severity Of Delirium When Given To Surgical Intensive Care Unit Patients: A Systematic Review Of Randomized Control Trials, Lindsey Hettish

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The purpose of this systematic review was to integrate research evidence from studies published from 2010 to 2020 on the relationship between administration of dexmedetomidine and severity/prevalence of postprocedural delirium in patients in the surgical intensive care unit. In this review, clinical trial studies were recovered by searching the MEDLINE Complete and PubMed databases and utilizing MeSH terminology search. The MeSH terms utilized to search for applicable articles on PubMed included: “intensive care units” or “critical care” or “critical care nursing”, and “delirium”, “dexmedetomidine”, and “surgical procedures, operative”. On MEDLINE Complete, the search terms utilized were “ICU or intensive care …

Protecting Sleep To Reduce Delirium In An Adult Intensive Care Unit, Heather Thomas

Student Scholarly Projects

Practice Problem: Delirium is a common, yet often preventable complication in hospitalized patients. It is often caused by fragmented sleep, medications, environmental stimuli, and treatment therapies.

PICOT: The PICOT question that guided this evidence-based practice change project was: For patients in an adult Intensive Care Unit (ICU), does using a nurse-initiated, non-pharmacological sleep-enhancement protocol, versus no sleep-enhancement protocol, reduce the incidence of ICU-delirium over a period of 2 months?

Evidence: The reviewed literature supported the evidence for effective use of a nurse-initiated protocol in reducing delirium in the ICU. Sixteen articles met the inclusion criteria for the review of literature …

A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula

Nursing Masters Papers

Abstract

Delirium is a complex syndrome resulting from compounding effects of acute illness, comorbidities, and the environment. It results in adverse outcomes: elevated mortality rates, length of stay, readmissions, institutionalization, long-term cognitive changes, and diminished quality of life. The rate of iatrogenic delirium is astounding, ranging from 10%-89%. There are no curative treatments; thus, primary prevention is the key. The purpose of this literature review is to identify and critique the research for the accuracy of risk stratification and feasibility in practice. Support for interventions that prevent delirium is mounting; however, interventions are resource-intensive and often not implemented. Researchers have …

Veteran Specific Risk Factors For Delirium, Allison Perkins

Dissertations

Purpose/Aims: This study explored the relationships between military characteristics such as combat experience, mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety and substance use disorder (SUD), physical comorbidities such as coronary artery disease (CAD), other risk factors, and delirium diagnosis among hospitalized veterans.

Background: Delirium is a common disorder experienced by 25% of all hospitalized adults 65 years and older. No published studies to date have examined whether combat, TBI and PTSD are associated with the incidence of delirium in the hospitalized veteran.

Methods: A retrospective cross-sectional cohort design with a sample size …

Evidence Based Practice Implementation Of The Delirium Portion Of The Abcdef Bundle, Jessica Sumner

Graduate Theses, Dissertations, and Capstones

Background: Delirium is a common complication in the ICU setting and has serious long-term consequences. Increased mortality and long-term cognitive issues are associated with under-recognition and lack of treatment for delirium. Nursing staff must identify delirium and manage the event, in addition to providing care to other assigned patients.

Purpose: The purpose of this evidence-based project was twofold. First, the project set out to determine if implementation of the delirium portion of the ABCDEF bundle promoted delirium recognition and decreased ICU length of stay and ventilator days. Second, the project examined if the use of a structured delirium education program …

Pediatric Delirium: Development Of A Standard Of Practice In A Cvicu And Picu Setting, Frances Gililand

DNP Projects

Pediatric delirium remains a significant cause of morbidity in pediatric critical care resulting in longer lengths of stay and increased healthcare costs that may extend beyond critical illness. Prevalence rates of pediatric delirium in pediatric intensive care settings are 20%. Not all children’s hospitals regularly assess for pediatric delirium. At the time of this project, the assessment of pediatric delirium was not a standard of practice at John Hopkins All Children’s Hospital (JHACH). Examining provider’s experience, knowledge and self-efficacy of pediatric delirium was the primary aim of this project. The secondary aim was to use information obtained through the first …

Delirium: A Cnl-Led Protocol To Clear Up The Confusion, Shanda N. Whittle

Master's Projects and Capstones

Project objectives: Delirium is a form of organ failure defined as an acute change in cognition, evidenced by altered consciousness and impaired attention that fluctuates over time, and is associated with increased morbidity, mortality, and healthcare services utilization. In the hospital where this evidence-based practice project took place, there was no formal protocol or guideline for assessing or managing delirium. Therefore, this project focused on improving the practice of identifying patients at risk for developing delirium with the AWOL tool and treating patients with signs and symptoms of delirium found using the Short-CAM assessment. Population and setting: This project took …

Incidence Rate Of Delirium After Cardiac Surgery And Feasibility Of A Delirium Prediction Rule, Kelly Bohl

DNP Projects

Delirium is an acute, temporary cognitive disorder that is characterized by a change in mental status, altered level of judgement, and changes in perception and behavior. Elderly patients who undergo open cardiac surgery are particularly at risk for developing delirium postoperatively. Although it is a temporary disorder, there are many consequences associated with delirium after cardiac surgery, including a longer length of stay in the hospital, long term functional decline, a greater use of health care resources and an increase in mortality risk. The purpose of this project was to identify the one-year incidence of postoperative delirium after cardiac surgery …

Monitoring For Delirium In The Intensive Care Unit Following The Introduction Of The Confusion Assessment Method For The Intensive Care Unit, Charity A. Batman

DNP Projects

PURPOSE: The goals of this study were to: improve delirium recognition by implementing the Confusion Assessment Method for the ICU (CAM-ICU), evaluate adherence to routine delirium monitoring, measure the incidence of CAM-positive patients, and measure the use of analgesic and sedative medications in ICU patients.

METHODS: This study was a single-center post-implementation retrospective medical record review examining the adherence and incidence of delirium after the introduction of the CAM-ICU assessment on the surgical ICU. Prior to the beginning of the study the surgical ICU nurses were educated on how to assess for delirium using the CAM-ICU instrument. During the six …

Preventing Delirium Through The Implementation Of The Abcde Bundle And Pad Guideline Into Everyday Care In A Community Hospital Intensive Care Unit: Opportunities For Practice Improvement, Mary Zody

DNP Projects

This DNP project focuses on the reduction of delirium through improvement of nursing knowledge of delirium and implementation of evidence based bundle ( Awake, Breathing, Coordination, Early Mobility, and Pain, Agitation, Delirium) into a twelve bed intensive care unit located in a 150 bed community hospital. Specifically, this project will review the literature supporting the evidence based bundle and report on a comprehensive gap analysis which was done to determine areas for practice improvement to reduce delirium and improve patient outcomes. The gap analysis included a comparison of current practice to the evidence, a review of administrative policies/ statements of …