Impacting the Global Problem of Delirium in Critically Ill Patients with a Clinical Nurse Specialist (CNS)-Led Prevention Protocol

Foster, Janet G. Whetstone

Monday, 31 October 2011

Janet G. Whetstone Foster, PhD, APRN, CNS
College of Nursing, Texas Woman's University, Houston, TX
Miranda Kelly, BSN, MSN, ACNP, CNS
Critical Care, Memorial Hermann The Woodlands Hospital, The Woodlands, TX

Learning Objective 1: Define delirium and implications for practice in the intensive care unit.

Learning Objective 2: Describe the process and preliminary outcomes for a CNS-led pilot research study for identification and prevention of delirium in the ICU.

Delirium reportedly occurs in 32.3% of critically ill patients in North and South America and Europe and is associated with increased morbidity, mortality, length of stay, and healthcare costs. Delirium is characterized by acute changes in mental status, fluctuations in cognitive functioning, inattention, and either disorganized thinking or an altered level of consciousness. Patient, environmental, and iatrogenic factors contribute to delirium onset, many of which are modifiable. The overall purpose of this multi-phase study is to evaluate the effectiveness of a multi-component intervention in preventing delirium in critically ill adult patients beginning with this pilot study.

This study is taking place in a community hospital, using a prospective, descriptive, comparative cohort, interrupted time series design. Proportion of patients with delirium in one medical intensive care unit (ICU) will be established. Next a multi-component preventative intervention will be implemented, followed by determination of post-intervention delirium rates. The intervention consists of five items: 1) sedation cessation 2) pain control 3) sleep facilitation 4) patient mobility, and 5) meaningful sensory stimulation.

Descriptive statistics will be used to report demographic data, barriers to and success with the intervention; frequency statistics will be used to report proportion of delirium in the pre-intervention group and in the cohort following the intervention. Proportion of delirium during the pre- and post-intervention cohorts will be compared using the binomial test; logistic regression analysis will be used to determine the relative risk of developing delirium with implementation of the prevention intervention. Barriers and successes with the intervention will be recorded during focus groups and reported qualitatively. A power analysis will be calculated to determine sample size for a larger, randomized study. This poster presentation will describe the process for a clinical nurse specialist-led pilot study to improve clinical care through detection and prevention of delirium in ICU patients.

See more of: Poster Session II
See more of: Oral Paper & Poster: Clinical Sessions