Delirium is defined as a disturbance of consciousness with inattention accompanied by a change in cognition or perceptual disturbance that develops over a short period of time (hours to days) and fluctuates over time [The Diagnostic and Statistical Manual of Mental Disorders (DSM IV)].
We know that delirium impacts a high proportion of critical care patients, affecting 60-80% of mechanically ventilated patients, and 20-50% of non-mechanically ventilated patients during their stay in an intensive care unit (ICU). (Ely EW, Truman B, Shintani A, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004; 291:1753-1762.)
The negative consequences of delirium in the critical care setting may include lifelong cognitive impairment, with some patients developing Post Traumatic Stress Disorder in relation to their experience in ICU.
Delirious and critically ill patients may also experience increased time on a mechanical ventilator, longer stays in ICU and in-hospital, and higher mortality (in-hospital and post-discharge).
The incidence of delirium in Alberta ICUs remains high. Recent Alberta data shows that 23-38% of adult critical care patients will experience delirium during an ICU stay (Source: eCritical, 2016-2017 TRACER data). Using validated screening tools for delirium, we are now better able to detect patients exhibiting signs and symptoms of ICU delirium in adult and pediatric populations.
One example that has demonstrated effectiveness for ICU delirium is based upon the Society of Critical Care Medicine’s ICU Liberation initiative and the evidence-informed ABCDEF bundle for delirium assessment, prevention, and management (ICU liberation, SCCM)
The Critical Care Strategic Clinical Network™ (CC-SCN) Delirium Initiative has drawn upon the SCCM Liberation ABCDEF bundle to develop a provincial best practice framework for adult and pediatric ICUs across Alberta.
Multidisciplinary healthcare providers caring for critically ill patients can use the following resources to review best practices for preventing and managing ICU delirium. The following links are provided for information purposes only.
Alberta Health Services (AHS) Quality & Patient Safety Education (QPSE) department offers the Institute for Healthcare Improvement’s Open School to AHS staff. The IHI Open School Curriculum brings you engaging training and tools in an online community of more than 250.000 learners from around the world, in building core skills in improvement, safety and leadership.
AHS staff can search Insite for 'IHI Open School Dashboard' for more information.
On May 9, 2017, 22 teams from Intensive Care Units across Alberta gathered to learn, share knowledge, and strategize on how to prevent and manage ICU delirium. That morning, Nadine finally had a chance to tell her story.
In addition, Nadine was a patient in ICU’s in both Edmonton and Calgary. As such she was a patient in Alberta ICUs. She shared her experience with frontline ICU staff – a story describing her battles with delirium in the ICU and the devastating long-term effects it had on her personal and professional life after her survival.