Assessment and Management of Delirium in Critically Ill Veterans.

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  • Additional Information
    • Affiliation:
      Denise M. Kresevic is a US Department of Veterans Affairs nurse researcher and advanced practice nurse at VA Northeast Ohio Healthcare System, Cleveland, Ohio, and University Hospitals of Cleveland.
      Donna Miller is a clinical nurse specialist and professional nursing practice program manager, Carole W. Fuseck is a clinical nurse specialist, Mia Wade and Laura Whitney are collaborative care case managers, Mary Conley is a licensed physical therapist, Joanne Rimac is a nurse informaticist, and Heather L. O'Leary-Wilson is a registered nurse, VA Northeast Ohio Healthcare System.
      Frank Jacono is an intensive care unit attending physician at VA Northeast Ohio Healthcare System and University Hospitals of Cleveland.
      Christopher J. Burant is the director of the Geriatric Research Education Clinical Center, VA Northeast Ohio Healthcare System, and an associate professor at the Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Background: Delirium is a complex syndrome prevalent in the intensive care unit. It has been associated with significant morbidity including distress, longer hospital stays, prolonged cognitive impairment, and increased mortality. Objective: To describe a nurse-led interdisciplinary quality improvement initiative to increase nurses' knowledge of delirium, documentation of delirium assessment, and patient mobility. Methods: Sixty-seven nurses in medical and surgical intensive care units were required to attend an interactive education program on delirium assessment and management. Scores on tests taken before and after the education program were used to evaluate knowledge. Medical records and bedside rounds were used to validate Confusion Assessment Method for the Intensive Care Unit documentation and interventions. Descriptive statistics were used to describe changes over time. A delirium resource team composed of nurses, physicians, and therapists provided didactic education paired with simulation training and bedside coaching. Mobility screening tests and computer templates guided assessments and interventions. Results: Documentation of the Confusion Assessment Method improved from less than 50% to consistently 99%. Mobilization in the surgical intensive care unit increased from 90% to 98% after intervention. Days of delirium significantly decreased from 51% before intervention to 31% after intervention ( χ 1 2 = 7.01 , P =.008). Conclusions: The success of this quality improvement project to enhance recognition of delirium and increase mobility (critical components of the pain assessment, breathing, sedation choice, delirium, early mobility, and family education bundle) was contingent on nursing leaders hip, interdisciplinary team collaboration, and interactive education.
    • Journal Subset:
      Blind Peer Reviewed; Core Nursing; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Nursing; Peer Reviewed; USA
    • Instrumentation:
      Confusion Assessment Method (CAM)
      Mobility Screening Test
    • ISSN:
      0279-5442
    • MEDLINE Info:
      NLM UID: 8207799
    • Notes:
      For CE see www.ccnonline.org
    • Publication Date:
      20201005
    • Publication Date:
      20201005
    • DOI:
      10.4037/ccn2020137
    • Accession Number:
      146029029
  • Citations
    • ABNT:
      KRESEVIC, D. M. et al. Assessment and Management of Delirium in Critically Ill Veterans. Critical Care Nurse, [s. l.], v. 40, n. 4, p. 42–52, 2020. DOI 10.4037/ccn2020137. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=146029029. Acesso em: 1 dez. 2020.
    • AMA:
      Kresevic DM, Miller D, Fuseck CW, et al. Assessment and Management of Delirium in Critically Ill Veterans. Critical Care Nurse. 2020;40(4):42-52. doi:10.4037/ccn2020137
    • APA:
      Kresevic, D. M., Miller, D., Fuseck, C. W., Wade, M., Whitney, L., Conley, M., Rimac, J., Jacono, F., O’Leary-Wilson, H. L., & Burant, C. J. (2020). Assessment and Management of Delirium in Critically Ill Veterans. Critical Care Nurse, 40(4), 42–52. https://doi.org/10.4037/ccn2020137
    • Chicago/Turabian: Author-Date:
      Kresevic, Denise M., Donna Miller, Carole W. Fuseck, Mia Wade, Laura Whitney, Mary Conley, Joanne Rimac, Frank Jacono, Heather L. O’Leary-Wilson, and Christopher J. Burant. 2020. “Assessment and Management of Delirium in Critically Ill Veterans.” Critical Care Nurse 40 (4): 42–52. doi:10.4037/ccn2020137.
    • Harvard:
      Kresevic, D. M. et al. (2020) ‘Assessment and Management of Delirium in Critically Ill Veterans’, Critical Care Nurse, 40(4), pp. 42–52. doi: 10.4037/ccn2020137.
    • Harvard: Australian:
      Kresevic, DM, Miller, D, Fuseck, CW, Wade, M, Whitney, L, Conley, M, Rimac, J, Jacono, F, O’Leary-Wilson, HL & Burant, CJ 2020, ‘Assessment and Management of Delirium in Critically Ill Veterans’, Critical Care Nurse, vol. 40, no. 4, pp. 42–52, viewed 1 December 2020, .
    • MLA:
      Kresevic, Denise M., et al. “Assessment and Management of Delirium in Critically Ill Veterans.” Critical Care Nurse, vol. 40, no. 4, Aug. 2020, pp. 42–52. EBSCOhost, doi:10.4037/ccn2020137.
    • Chicago/Turabian: Humanities:
      Kresevic, Denise M., Donna Miller, Carole W. Fuseck, Mia Wade, Laura Whitney, Mary Conley, Joanne Rimac, Frank Jacono, Heather L. O’Leary-Wilson, and Christopher J. Burant. “Assessment and Management of Delirium in Critically Ill Veterans.” Critical Care Nurse 40, no. 4 (August 2020): 42–52. doi:10.4037/ccn2020137.
    • Vancouver/ICMJE:
      Kresevic DM, Miller D, Fuseck CW, Wade M, Whitney L, Conley M, et al. Assessment and Management of Delirium in Critically Ill Veterans. Critical Care Nurse [Internet]. 2020 Aug [cited 2020 Dec 1];40(4):42–52. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=146029029