Delirium Bibliography

Reference Information

Title

Improving the Accuracy of Delirium Assessments in Neuroscience Patients: Scaling a Quality Improvement Program to Improve Nurses' Skill, Compliance, and Accuracy in the Use of the Confusion Assessment Method in the Intensive Care Unit Tool.

Authors

DiLibero, Justin

Year

2018

Journal

Dimensions of Critical Care Nursing

Abstract

Background: Delirium affects up to 80% of critically ill patients; however, many cases of delirium go unrecognized because of inaccurate assessments. The effectiveness of interventions to improve assessment accuracy among the general population has been established, but assessments among neuroscience patients are uniquely complicated due to the presence of structural neurologic changes. Objectives: The purposes of this quality improvement project were to improve the accuracy of nurse’s delirium assessments among neuroscience patients and to determine the comparative effectiveness of the intervention between medical and neuroscience patients. Methods: A multifaceted nurse-led intervention was implemented, and a retrospective analysis of preintervention and postintervention data on assessment accuracy was completed. Results were stratified by population, level of sedation, and level of care. Differences were analyzed using Fisher exact test. Results: Data from 1052 delirium assessments were analyzed and demonstrated improvement in assessment accuracy from 56.82% to 95.07% among all patients and from 29.79% to 92.98% among sedate or agitated patients. Although baseline accuracy was significantly lower among neuroscience patients versus medical intensive care unit patients, no significant differences in postintervention accuracy were noted between groups. Conclusion: Results from this project demonstrate the effectiveness of the nurse-led intervention among neuroscience patients. Future research is needed to explore the effectiveness of this nurse-led intervention across other institutions and to describe the effectiveness of new interventions to improve outcomes at the patient and organizational levels.

PMID

29194171

Keywords

Delirium — Evaluation
Critical Care Nursing
Neurologic Examination
Clinical Assessment Tools — Utilization
Nursing Assessment
Human
Quality Improvement
Validity
Nursing Skills
Professional Compliance
Comparative Studies
Fisher’s Exact Test
Sedation
Secondary Analysis
Pretest-Posttest Design
Clinical Assessment Tools
Scales
Odds Ratio
Confidence Intervals
Inpatients
Sensitivity and Specificity

Page(s)

26-34

Volume

37

Issue

1