Delirium Management in the Intensive Care Unit

Delirium is a cognitive impairment that includes an altered level of consciousness, disorganized thinking and inattention. Hospitalized patients, especially those critically ill, are at an increased risk for developing acute delirium during the hospital stay. Delirium in the intensive care unit (ICU) has often been considered an unavoidable aspect of the complex care provided in the ICU setting. However, delirium in the intensive care unit is recognized as an independent contributor to several adverse outcomes. These adverse outcomes include an increase in mortality, hospital length of stay and long-term cognitive impairment following discharge from the hospital. Subsequently, the financial burden associated with the management of delirium in the ICU can be significant. While comprehensive delirium management practice recommendations have been published by the American College of Critical Care Medicine, implementation of these recommendations has been limited in many rural and community hospital settings. The purpose of this scholarly project is to promote the adoption of a delirium management guideline and electronic order set in the adult intensive care unit at a community hospital. Based upon the body of evidence, and incorporating published practice recommendations, the proposal of an ICU delirium management guideline and electronic order set will outline consistent and comprehensive management of delirium for adult intensive care patients. There are four objectives of this scholarly project: 1) Propose an intensive care unit delirium guideline for the management of delirium in the critically ill patient. 2) Propose an electronic order set for intensive care unit delirium treatment. 3) Provide nursing staff with education regarding the clinical significance of intensive care unit delirium. 4) Disseminate information related to the scholarly project. Implementation of the first two objectives included the development and proposal of an ICU delirium management guideline and electronic order set at the site of project implementation. The delirium management guideline included risk factor identification, screening and treatment options pertaining to ICU delirium. The electronic order set was published in the electronic health record test environment and demonstrated at the guideline and electronic order set proposal. Members of the intensive care unit committee at the project site were invited to adopt the guideline and electronic order set. Implementation of objective three and four included the development of an educational module for ICU nursing staff that included a pre- and post-education questionnaire. This educational module helped the nursing staff understand more regarding the clinical implications and significance of intensive care unit delirium. Nursing staff was invited to participate in the education at staff meeting or individually. Objective four of disseminating information related to the scholarly project was implemented through the submission of a poster abstract to a nursing conference.