In "Preventing Hospital-Induced Delirium in the ICU" (Viewpoint, September), author Patricia Gavin wrote about her efforts to stave off delirium while she was hospitalized and noted the various factors that helped her stay engaged.

Delirium for some patients may be silent. Nurses may not recognize a patient's subtle changes in behavior, especially if the patient has been on antipsychotics or sedatives. This presents to me as a patient safety culture issue. As nurses, should we assess the issue of delirium as a psychosis, a postoperative complication, or just disorientation?

In order to better assess patients for ICU-related delirium, the use of an assessment scale should be mandated. There are currently five validated screening tools for delirium in adults: Confusion Assessment Method-ICU, Intensive Care Delirium Screening Checklist, Delirium Detection Score, Nursing Delirium Screening Scale, and Neelon and Champagne Confusion Scale.1 Implementing one of these scales with ICU patients may prevent delirium and associated falls, injuries, and even physical or medication restraint. It is my hope that there will be more research in the future to assess the improvement and prevention of delirium in the ICU.

Kerrill J. James, BSN, RN

Youngsville, LA

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