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Implementing Delirium Screening in the ICU: Secrets to Success

Brummel, Nathan E. MD, MSCI1,2,3,4,5; Vasilevskis, Eduard E. MD, MPH1,2,4,5,6; Han, Jin Ho MD, MSc6,7; Boehm, Leanne MSN, RN, ACNS-BC8; Pun, Brenda T. MSN, RN, ACNP4; Ely, E. Wesley MD, MPH, FCCM1,2,3,4,6

doi: 10.1097/CCM.0b013e31829a6f1e
Concise Definitive Review

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.

1Geriatric Research, Education and Clinical Center, (GRECC) Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN.

2Department of Medicine, Vanderbilt School of Medicine, Nashville, TN.

3Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt School of Medicine, Nashville, TN.

4Center for Health Services Research, Vanderbilt School of Medicine, Nashville, TN.

5Center for Quality Aging, Vanderbilt School of Medicine, Nashville, TN.

6Division of General Internal Medicine and Public Health, Vanderbilt School of Medicine, Nashville, TN.

7Department of Emergency Medicine, Vanderbilt School of Medicine, Nashville, TN.

8School of Nursing, Vanderbilt University, Nashville, TN.

Dr. Brummel is supported by the National Institutes of Health (T32HL087738) and the Vanderbilt Clinical and Translational Scholars Program. Dr. Vasilevskis is supported by the Department of Veterans Affairs-Tennessee Valley Geriatric Research, Education and Clinical Center (GRECC) and by National Institutes of Health (K23AG040157). Dr. Han is supported by the National Institutes of Health (K23AG032355). Ms. Boehm has received honoraria from Hospira. Ms. Pun has received honoraria from Hospira. Dr. Ely is supported by the Department of Veterans Affairs Tennessee Valley GRECC, the VA Clinical Science Research and Development Service (VA Merit Review Award), and the National Institutes of Health (AG027472 and AG035117). He has received research grants and/or honoraria from Hospira, Orion, Abbott, and Masimo. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging, the National Institutes of Health, or the U.S. Department of Veterans Affairs.

For information regarding this article, E-mail: nathan.brummel@vanderbilt.edu

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins