2017 in Review: Progress toward Delirium Prevention

This post was contributed by Heidi Lindroth, PhD Candidate, RN, University of Wisconsin-Madison, School of Medicine and Public Health, Department of Anesthesiology School of Nursing.

blue circle with brain in background, red text reading "I am delirium aware" in foregroundLet’s ring in the New Year 2018 with a review of research from 2017 focused on delirium prevention. Often, when I talk to others about the confusion and distress experienced by patients in the hospital, people share stories about their close friend, relative, or co-worker who experienced similar distress while hospitalized. Indeed, delirium has touched many lives. Amazingly, one in two cases of delirium can be prevented through early mobilization, cognitive stimulation, sleep hygiene, addressing sensory impairments and ensuring proper hydration and nutrition.1 Delirium is important to prevent because of its associations with hospital complications such as falls, aspiration pneumonia, an increased risk of mortality and an inability to return home following a hospital stay2,3. So, here are the 2017 prevention-focused studies from PubMed. And don’t forget World Delirium Awareness Day is March 14th, 2018!
2017 Prevention Focused Studies from PubMed
  • An increase in delirium free days was observed for an experimental group (p=0.0437) randomized to receive an automated reorientation intervention in the ICU when compared to the control group. These automated reorientation scripted messages were created from a family member’s voice and played every hour from 0900-1600. Messages included phrases designed to help the patients understand their environment.4 PMID: 28606450
  • A modified Hospital Elder Life Program demonstrated a 56% reduction in the odds of developing postoperative delirium in a cluster randomized clinical trial. The intervention consisted of early mobilization, nutritional assistance and orientating communication.5 PMID: 28538964
  • Family members are positioned well to administer delirium prevention measures. A feasibility randomized controlled trial documented family and ICU staff acceptance of a daily intervention administered by family composed of orientation and memory clues, sensory checks and cognitive stimulation.6 PMID: 28254205
  • Comprehensive geriatric assessment was shown to reduce the incidence of postoperative delirium by 13% (p=0.018) when compared to the control group in a randomized clinical trial.7 PMID: 28198997
  • UNDERPIN-ICU (nUrsiNg DEliRium Preventative INterventions in the ICU), a multi-centre, stepped wedge randomized controlled trial, protocol was published. This study will include eight to ten ICUs and test standardized nursing and physical therapy interventions focused on modifiable risk factors for delirium.8 PMID: 28013104
  • Preprinted postoperative orders that included delirium-friendly options addressing pain control, bladder catheter removal, sleep hygiene and dehydration monitoring demonstrated a 18% reduction in postoperative delirium incidence (p=0.001) when compared to the control group in a pragmatic clinical trial targeting individuals with hip fractures.9 PMID: 27874185
  • Occupational therapy twice per day for 5 days along with standard strategies to prevent delirium reduced delirium incidence by 17% (p=0.001) and duration (p=0.000) when compared to the control group in a pilot randomized clinical trial.10 PMID: 27660922
Takeaway: Interprofessional Team Approach
Multicomponent non-pharmacological approaches are best implemented using a multidisciplinary team.11 It may be advantageous for future research, especially implementation studies, to explore the use of ancillary staff such as nursing assistants, sitters, OT, PT, volunteers and family to bolster delirium prevention. Nurses are well-positioned to coordinate and optimize ancillary personnel assistance with delirium prevention.
WORLD DELIRIUM AWARENESS DAY 2018
Delirium science has made progress in 2017 towards preventing delirium using non-pharmacologic approaches and a multidisciplinary approach. Help us spread the word of this great progress on World Delirium Awareness Day, #WDAD2018, March 14th, 2018. I cannot wait to see what new advances in delirium science 2018 has in store!
References
  1. Hshieh TT, Yue J, Oh E, et al. Effectiveness of Multicomponent Nonpharmacological Delirium Interventions: A Meta-analysis. In: Jama Intern Med. ; 2015.
  2. Dasgupta M, Brymer C. Poor functional recovery after delirium is associated with other geriatric syndromes and additional illnesses. Int Psychogeriatr IPA. 2015;27(5):793-802. doi:10.1017/S1041610214002658
  3. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-922. doi:10.1016/s0140-6736(13)60688-1
  4. Munro CL, Cairns P, Ji M, Calero K, Anderson WM, Liang Z. Delirium prevention in critically ill adults through an automated reorientation intervention – A pilot randomized controlled trial. Heart Lung J Crit Care. 2017;46(4):234-238. doi:10.1016/j.hrtlng.2017.05.002
  5. Chen CC-H, Li H-C, Liang J-T, et al. Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery: A Cluster Randomized Clinical Trial. JAMA Surg. 2017;152(9):827-834. doi:10.1001/jamasurg.2017.1083
  6. Mitchell ML, Kean S, Rattray JE, et al. A family intervention to reduce delirium in hospitalised ICU patients: A feasibility randomised controlled trial. Intensive Crit Care Nurs. 2017;40:77-84. doi:10.1016/j.iccn.2017.01.001
  7. Partridge JSL, Harari D, Martin FC, et al. Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. Br J Surg. 2017;104(6):679-687. doi:10.1002/bjs.10459
  8. Wassenaar A, Rood P, Schoonhoven L, et al. The impact of nUrsiNg DEliRium Preventive INnterventions in the Intensive Care Unit (UNDERPIN-ICU): A study protocol for a multi-centre, stepped wedge randomized controlled trial. Int J Nurs Stud. 2017;68:1-8. doi:10.1016/j.ijnurstu.2016.11.018
  9. Freter S, Koller K, Dunbar M, MacKnight C, Rockwood K. Translating Delirium Prevention Strategies for Elderly Adults with Hip Fracture into Routine Clinical Care: A Pragmatic Clinical Trial. J Am Geriatr Soc. 2017;65(3):567-573. doi:10.1111/jgs.14568
  10. Alvarez EA, Garrido MA, Tobar EA, et al. Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial. J Crit Care. 2017;37:85-90. doi:10.1016/j.jcrc.2016.09.002
  11. Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA. 2017;318(12):1161-1174. doi:10.1001/jama.2017.12067
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