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Journal

Implementing delirium screening in the ICU: secrets to success

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Published:1st Sep 2013
Author: Brummel NE, Vasilevskis EE, Han JH, Boehm L, Pun BT, Ely EW
Availability: Free full text
Ref.:Crit Care Med. 2013;41(9):2196-208
DOI:10.1097/CCM.0b013e31829a6f1e

OBJECTIVE:

To review delirium screening tools available for use in the adult ICU and PICU, to review evidence-based delirium screening implementation, and to discuss common pitfalls encountered during delirium screening in the ICU.

DATA SOURCES:

Review of delirium screening literature and expert opinion.

RESULTS:

Over the past decade, tools specifically designed for use in critically ill adults and children have been developed and validated. Delirium screening has been effectively implemented across many ICU settings. Keys to effective implementation include addressing barriers to routine screening, multifaceted training such as lectures, case-based scenarios, one-on-one teaching, and real-time feedback of delirium screening, and interdisciplinary communication through discussion of a patient's delirium status during bedside rounds and through documentation systems. If delirium is present, clinicians should search for reversible or treatable causes because it is often multifactorial.

CONCLUSION:

Implementation of effective delirium screening is feasible but requires attention to implementation methods, including a change in the current ICU culture that believes delirium is inevitable or a normal part of a critical illness, to a future culture that views delirium as a dangerous syndrome which portends poor clinical outcomes and which is potentially modifiable depending on the individual patients circumstances.

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