American Association of Critical-Care Nurses Encourages Increase Efforts to Assess and Manage Delirium in Critically Ill Patients

ALISO VIEJO, Calif., Feb. 10, 2012 /PRNewswire-USNewswire/ -- Delirium -- an acute change in consciousness characterized by confused thinking and disrupted attention -- affects up to 80 percent of critically ill patients in the United States, with associated annual costs between $4 billion and $16 billion. Implementing early assessment, prevention and detection protocols can reduce delirium risk factors and improve patient outcomes, according to a new evidence-based AACN Practice Alert™.

"For years, delirium was viewed as a fairly benign condition that was often undetected and untreated," says AACN Director of Communications and Strategic Alliances Ramon Lavandero, RN, MA, MSN, FAAN. "However, recent evidence shows that delirium is associated with longer lengths of stay in the ICU, increased use of ventilators, higher mortality rates and increased long-term neuropsychology deficits.

"In addition, treatment is complex because no FDA-approved drug exists to treat delirium," Lavandero says.

This AACN Practice Alert™ is the latest in a series of guidelines to standardize practice and update nurses and other healthcare
professionals on new healthcare advances and trends. All alerts are available on the AACN website, www.aacn.org.

According to AACN, the expected practice for assessing and managing delirium is to:

• Implement delirium assessment for all critically ill patients using validated tools such as the CAM-ICU or ICDSC.
• Create strategies to decrease delirium risk factors including early exercise.
• Administer benzodiazepine cautiously; give only what is needed.
• Consider incorporating multiple evidence-based practice strategies into routine daily care such as the ABCDE Bundle, which includes Awakening and Breathing trial coordination, Careful sedation choice, Delirium monitoring and Early progressive mobility.

Furthermore, the delirium alert lists actions for nursing units to ensure optimal patient outcomes:

• Create and implement a policy for delirium assessment that includes a minimum of once-per-shift assessment for all critically ill patients utilizing a validated tool (i.e., CAM-ICU or ICDSC).
• Perform, document and communicate delirium assessments at least once per shift.
• Evaluate patients for potential risk factors for delirium including a review of medications.
• Consider strategies to decrease benzodiazepine usage, including titration strategies (e.g., sedation scale, targeted sedation protocols and daily awakening trials) or use of an alternative sedative (e.g., dexmedetomidine or propofol).
• Develop a protocol that incorporates early progressive mobility and exercise for all critically ill patients.
• Evaluate patients for causes of delirium, including medications (especially benzodiazepines) and other causes using the THINK pneumonic (identifying Toxic situations; Hypoxemia; Infection/sepsis; Immobilization; Non-pharmacologic interventions; and K+ [ionized potassium] or other electrolyte problems).

Supported by authoritative evidence, AACN's Practice Alerts™ seek to ensure excellence in practice and a safe and humane work environment. The topics address both nursing and interdisciplinary activities of importance to acutely or critically ill patients and their
environments.AACN Practice Alerts™ can be downloaded free of charge from AACN's website.

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, Calif., the American Association of
Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN joins together the interests of more
than 500,000 acute and critical care nurses and claims more than 240 chapters worldwide. The organization's vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. To learn more about AACN, visit www.aacn.org, connect with the organization on Facebook at facebook.com/aacnface and follow AACN on Twitter at twitter.com/aacnme.

This news release was issued on behalf of Newswire™. For more information, visit http://www.newswise.com.

CONTACT: Kristie Aylett, AACN Communications, [email protected]

SOURCE American Association of Critical-Care Nurses

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