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Delirium Prevention in the ICU: A Literature Review

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Date Issued:
2018
Summary:
Patients admitted to the intensive care unit have been identified as having a predisposition to states of delirium, placing them at high risk for negative outcomes. Delirium within this setting has a direct correlation with adverse occurrences such as prolonged duration of mechanical ventilation, increased length of hospital stays, higher mortality rates, and greater overall cost. Additionally, delirium has both short and long-term effects on patients’ levels of functioning and cognition, deleterious effects that may or may not ever fully resolve. Poor outcomes such as these should be avoided at all costs considering that delirium is indeed a preventable condition. It is the duty of those working in health care to provide both safe and patient-centered care practices. Nurses, in particular, spend a great amount of time with their patients and have the utmost advantage in their position at the bedside to both detect and prevent delirium in the ICU. For this literature review, a pursuit of knowledge and interventions surrounding delirium prevention have been sought after and recommended to be incorporated into practice in order to better care for these patient populations during this vulnerable time. Upon review, the following prevention strategies have been identified: early mobilization, physical therapy, reorientation, cognitive stimulation, drug reviews, awakening and breathing coordination, environmental stimulation and avoidance of sensory deprivation, pain control, restraint use avoidance, family participation, early participation of the health care team, shared leadership, providing adequate nutrition, fluid and electrolyte monitoring, use of the patient’s glasses or hearing aids, prevention of infection, promotion of family visits, use of the “THINK” pneumonic, minimizing the use of sedative medications, avoiding benzodiazepines, adequate oxygenation, sleep promotion, use of observational screening tools, and frequent status checks. We should also remain cognizant of the predisposing and non-modifiable risk factors of delirium such as alcohol or substance abuse, smoking, hypertension, dementia, mental illness, severity of illness, and older age. It has been concluded that by raising awareness through education and implementation of the items discussed, nurses can in fact better prevent delirium through quality improvement and patient-centered care practices in order to decrease mortality rates, reduce incidences of long term cognitive impairment, avoid prolonged length of stays, and mitigate sustained mechanical ventilation.
Title: Delirium Prevention in the ICU: A Literature Review.
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Name(s): Chakonas, Stephanie, author
Mandell, Aubree, author
German, Brianna, author
Regan, Ana, author
Rosa, Yesenia, author
FGCU Research Day
Type of Resource: text
Issuance: single unit
Date Issued: 2018
Physical Form: PDF
Language(s): English
eng
Summary: Patients admitted to the intensive care unit have been identified as having a predisposition to states of delirium, placing them at high risk for negative outcomes. Delirium within this setting has a direct correlation with adverse occurrences such as prolonged duration of mechanical ventilation, increased length of hospital stays, higher mortality rates, and greater overall cost. Additionally, delirium has both short and long-term effects on patients’ levels of functioning and cognition, deleterious effects that may or may not ever fully resolve. Poor outcomes such as these should be avoided at all costs considering that delirium is indeed a preventable condition. It is the duty of those working in health care to provide both safe and patient-centered care practices. Nurses, in particular, spend a great amount of time with their patients and have the utmost advantage in their position at the bedside to both detect and prevent delirium in the ICU. For this literature review, a pursuit of knowledge and interventions surrounding delirium prevention have been sought after and recommended to be incorporated into practice in order to better care for these patient populations during this vulnerable time. Upon review, the following prevention strategies have been identified: early mobilization, physical therapy, reorientation, cognitive stimulation, drug reviews, awakening and breathing coordination, environmental stimulation and avoidance of sensory deprivation, pain control, restraint use avoidance, family participation, early participation of the health care team, shared leadership, providing adequate nutrition, fluid and electrolyte monitoring, use of the patient’s glasses or hearing aids, prevention of infection, promotion of family visits, use of the “THINK” pneumonic, minimizing the use of sedative medications, avoiding benzodiazepines, adequate oxygenation, sleep promotion, use of observational screening tools, and frequent status checks. We should also remain cognizant of the predisposing and non-modifiable risk factors of delirium such as alcohol or substance abuse, smoking, hypertension, dementia, mental illness, severity of illness, and older age. It has been concluded that by raising awareness through education and implementation of the items discussed, nurses can in fact better prevent delirium through quality improvement and patient-centered care practices in order to decrease mortality rates, reduce incidences of long term cognitive impairment, avoid prolonged length of stays, and mitigate sustained mechanical ventilation.
Identifier: fgcu_UGR_0014 (IID)
Note(s): Poster from the Spring 2018 Research Day. Research Mentor: Paula Davis-Huffman
Subject(s): prevention
nurse
outcomes
practices
patient-centered
screening
predisposing
modifiable
effects
Delirium
Critical Care
ICU
Quality Improvement
Morality.
Impairment
Ventilation
Cost.
Cognition.
Safety.
Leadership.
Mobility
Therapy.
Monitoring
Environment
Awareness.
Education.
Persistent Link to This Record: http://purl.flvc.org/fgcu/fd/fgcu_UGR_0014
Use and Reproduction: In Copyright - Educational Use Permitted In Copyright - Educational Use Permitted
Owner Institution: FGCU

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