A questionnaire survey of critical care nurses' attitudes to delirium assessment before and after introduction of the CAM-ICU.

Nurses are usually the first to identify delirium in ICU patients. We aimed to assess the attitudes of Australian critical care nurses when we introduced the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We surveyed all 174 nurses in our ICU using two questionnaires: first after a one-month period of mandated but unstructured delirium assessments, and then following one month of CAM-ICU assessments. We also quantified antipsychotic medication usage by inspecting pharmacy records. The first survey response rate was 65/174 (37%). Most nurses (73%) thought active delirium assessment was important, and 93% thought their assessments were worth the time required. These assessments were largely unstructured, as only 20% knew a formal delirium test, and only 7% sometimes used one. The second survey response rate was 45/174 (26%). Most (89%) still thought delirium assessment was important, but only 75% thought the CAM-ICU worth the time required (p=0.01 compared to unstructured assessments). Similar proportions (75% and 73%) were confident in the accuracy of their assessments. Many (33%) found the CAM-ICU 'quite' or 'very' hard to perform, but despite this, 82% wanted to continue to use it. Free-text answers suggested this was because medical staff paid more attention to the CAM-ICU. Supporting this, prescriptions of antipsychotic medications increased significantly in the CAM-ICU period. Critical care nurses in our Australian ICU who responded to our survey think delirium assessment is important. Although they find unstructured assessments easier to perform, they wanted to persist with the CAM-ICU, in part because it facilitated more appropriate pharmacological treatment of delirium for their patients. We recommend the CAM-ICU as a tool to improve communication between nurses and physicians in the management of delirium.

Eastwood GM ，Peck L ，Bellomo R ，Baldwin I ，Reade MC ... -  《Australian Critical Care》

Limitations and practicalities of CAM-ICU implementation, a delirium scoring system, in a Dutch intensive care unit.

Riekerk B ，Pen EJ ，Hofhuis JG ，Rommes JH ，Schultz MJ ，Spronk PE ... -  《-》

Routine use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) by bedside nurses may underdiagnose delirium.

Reade MC ，Eastwood GM ，Peck L ，Bellomo R ，Baldwin I ... -  《-》

Educational intervention on delirium assessment using confusion assessment method-ICU (CAM-ICU) in a general intensive care unit.

To assess intensive care unit nurses' knowledge of intensive care unit delirium and delirium assessment before and after an educational intervention. In addition, nurses' perception on the usefulness of a delirium assessment tool and barriers against delirium assessment were assessed as secondary objectives. Early identification of delirium in intensive care units is crucial for patient care. Hence, nurses require adequate knowledge to enable appropriate evaluation of delirium using standardised practice and assessment tools. This study, performed in Malaysia, used a single-group pretest-posttest study design to assess the effect of educational interventions and hands-on practices on nurses' knowledge of intensive care unit delirium and delirium assessment. Sixty-one nurses participated in educational intervention sessions, including classroom learning, demonstrations and hands-on practices on the Confusion Assessment Method-Intensive Care Unit. Data were collected using self-administered questionnaires for the pre- and postintervention assessments. Analysis to determine the effect of the educational intervention consisted of the repeated-measures analysis of covariance. There were significant differences in the knowledge scores pre- and postintervention, after controlling for demographic characteristics. The two most common perceived barriers to the adoption of the intensive care unit delirium assessment tool were "physicians did not use nurses' delirium assessment in decision-making" and "difficult to interpret delirium in intubated patients". Educational intervention and hands-on practices increased nurses' knowledge of delirium assessment. Teaching and interprofessional involvements are essential for a successful implementation of intensive care unit delirium assessment practice. This study supports existing evidences, indicating that education and training could increase nurses' knowledge of delirium and delirium assessment. Improving nurses' knowledge could potentially lead to better delirium management practice and improve ICU patient care. Thus, continuous efforts to improve and sustain nurses' knowledge become relevant in ICU settings.

Ramoo V ，Abu H ，Rai V ，Surat Singh SK ，Baharudin AA ，Danaee M ，Thinagaran RRR ... -  《-》

Implementation of a validated delirium assessment tool in critically ill adults.

To evaluate the feasibility and effectiveness of the validated Confusion Assessment Method-ICU (CAM-ICU) delirium screening tool in a critical care unit. A single centre service evaluation design was conducted in an 18 bed critical care unit comprising medical and surgical patients. Two self report questionnaires were administered to nursing staff (n=78) one immediately prior to and then three months following delirium education and CAM-ICU practical training. The response rates of the questionnaires were 92% (72/78) and 60% (47/78) respectively, completed by predominantly females with a similar age range across the two groups. Prior to education and training 54% (39/72) of nurses agreed that delirium was a significantly underdiagnosed problem. Few nurses (6%, 4/72) considered evaluating their patients for it and 69% (50/72) did not feel the need to routinely monitor. Following a simple educational intervention 68% (32/47) believed delirium was a very serious problem, 74.5% (35/47) frequently evaluated their patients and only 31% (15/47) felt that CAM-ICU assessments should not be part of routine nursing care. The majority (85.1%, 40/47) of nurses found the CAM-ICU easy to administer, were confident in using the tool (74.4%, 35/47) and felt it led to a more comprehensive patient assessment (83%, 39/47). Despite this, barriers to undertaking delirium assessment identified at the start of the project remained and included patient intubation (42%, 20/47), sedation level (40%, 19/47) and medical staff inability to act on CAM-ICU assessment data (25%, 12/47). This service evaluation has shown that implementation of a delirium screening tool into daily nursing practice is achievable within a relatively short time period. A simple, educational intervention incorporating written and video information improved the capacity of critical care nurses to perform delirium assessments in a standardised way and reduced the discordance between the perceived importance of delirium and the practice of its evaluation. Such data is especially important since delirium assessments had not traditionally been part of daily nursing care.

Scott P ，McIlveney F ，Mallice M 《-》