Monday February 25, 2008
Improving delirium in ICU via education !

In a recent study, Fifty ICU nurses from two different hospitals (university medical and community teaching) evaluated an ICU patient for pain, level of sedation and presence of delirium before-and-after an educational intervention. The same patient was concomitantly, but independently, evaluated by a validated judge who acted as the reference standard in all cases. The education consisted of:

1. two script concordance case scenarios
2. a slide presentation regarding scale-based delirium assessment, and
3. two further cases

Results

• Nurses clinical recognition of delirium was poor in the before education period as only 24% of nurses reported the presence or absence of delirium and only 16% were correct compared to the judge.
• After education, the number of nurses able to evaluate delirium using any scale (12 vs. 82%) and use it correctly (8 vs. 62%) increased significantly
• While judge-nurse agreement (Spearman rho) for the presence of delirium was similar between the pre and post education periods
  

Conclusions: A simple composite educational intervention incorporating script concordance theory improves the capacity for ICU nurses to screen for delirium nearly as well as experts.

Editors' note: Delirium in general is a very common problem; around 20% patients admitted to hospital have delirium. Delirium is commonly occurs in critically ill patient, especially who have other co-morbidities and have prolonged stay in the ICU. The treatment is difficult to provide, although easy to write: treat the underlying cause. Following site has a lot of information about delirium in icu including videos and other links:

www.icudelirium.org

Reference: click to abstract / article

Combined Didactic and Scenario-Based Education Improves the Ability of ICU Staff to Recognize Delirium at the Bedside, Critical Care, 2008 12:R19 ( 21 February 2008) - open access article - pdf file