Routine use of the CAM-ICU by bedside nurses may under-diagnose delirium

Reade, Michael C., Eastwood, Glenn M., Peck, Leah, Bellomo, Rinaldo and Baldwin, Ian (2011) Routine use of the CAM-ICU by bedside nurses may under-diagnose delirium. Critical Care and Resuscitation, 13 4: 217-224.

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Author Reade, Michael C.
Eastwood, Glenn M.
Peck, Leah
Bellomo, Rinaldo
Baldwin, Ian
Title Routine use of the CAM-ICU by bedside nurses may under-diagnose delirium
Journal name Critical Care and Resuscitation   Check publisher's open access policy
ISSN 1441-2772
Publication date 2011-12
Sub-type Article (original research)
Open Access Status
Volume 13
Issue 4
Start page 217
End page 224
Total pages 8
Place of publication Melbourne, Australia
Publisher Australasian Academy of Critical Care Medicine
Collection year 2012
Language eng
Formatted abstract
Background: The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is emerging as the most frequently used tool for identifying delirium among critically ill patients.
Objective: To determine whether the number of patients and nursing shifts in which delirium was diagnosed would increase after the introduction of the CAM-ICU in our unit.
Design: Before-and-after study. In a 30-day Phase 1, we asked bedside nurses to assess their ICU patients for delirium each shift. We then conducted intensive education on the CAM-ICU for 30 days, including lectures, bedside tutorials, and supervised practice. In Phase 2, for 30 days we asked bedside nurses to record the results of their CAM-ICU assessments.
Setting: 20-bed mixed medical and surgical ICU at the Austin Hospital, Melbourne. Participants: All patients admitted to the ICU during each phase.
Main outcome measures: Diagnosis of delirium by bedside nurses using either the CAM-ICU or an unstructured clinical assessment, by patient and nursing shift.
Results: Compared with unstructured assessments, the CAM-ICU identified a significantly lower proportion of patients (36.7% v 21.3%; P = 0.004) and a significantly lower proportion of shifts (14.7% v 6.4% of shifts, P = 0.002) with delirium. When adjusted for differences in age, sex, Acute Physiology and Chronic Health Evaluation III risk of death and total length of stay between the two periods, assessment type remained a significant predictor of the diagnosis of delirium.
Conclusions: In our hospital, the CAM-ICU detected delirium less often than unstructured delirium assessments made by qualified intensive care nurses.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
 
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Created: Wed, 04 Jan 2012, 16:55:57 EST by Michael Reade on behalf of School of Medicine