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Learning Objective 1: Describe the components of a prevention bundle that was designed to decrease the incidence and duration of delirium in hospitalized critically ill patients.
Learning Objective 2: Discuss findings of a study that tested the use of a delirium prevention bundle in hospitalized critical care patients.
Methods: A prospective, interventional cohort study was conducted in two similar medical surgical ICU units in a large, tertiary care facility in southeast Texas. Data collection included use of: the RASS 1, a dichotomous scoring system that ranges from +4 agitation to -4 sedation; the CAM-ICU2-6 , a bedside test that assesses for delirium; and a researcher-generated Delirium Data Collection Tool.
Results: Sample size consisted of n=668 patients and 2687 observations. In the control unit, the odds of developing delirium increased 2.5% for every day hospitalized in the unit. In the intervention unit, the odds of developing delirium decreased 4.8%/day. The overall treatment effect reduced the odds of delirium by 7.1% (p=0.021). When adjusting for age, co-morbidities, and LOS, the overall significance of the adjusted model is p< 0.0001. Patients in the control unit have a 1.7% chance of developing delirium each day, while patients in the intervention unit are 6.1% less likely to develop delirium. The overall treatment effect reduced the odds of delirium by 7.7% (p= 0.012). While gender was not associated with delirium, females are 13.7% more treatable, and the treatment effect reduced the odds of developing delirium by 10.7%. Patients in the intervention group, age 65-74, were 13.7% less likely to develop delirium; treatment effect was 21.9% (p=0.001).
Conclusion: The intervention bundle significantly reduced the incidence of delirium in certain critically care patients. Hospitals should consider implementing a core model of delirium prevention care that combines evidence-based strategies with nursing interventions that are integrated into routine ICU care.
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