Purpose/Objectives:
To determine the knowledge and awareness of delirium among ICU providers with respect to recognition, impact, and management in order to raise awareness to and improve recognition of ICU delirium among ICU providers.
Significance:
ICU delirium is recognized as a significant contributor to adverse ICU and hospital outcomes. Research in this area has grown over the last 5 years. It has shown the considerable impact of delirium on patient outcomes resulting in the creation of objective ICU delirium assessment tools like the CAM-ICU. Delirium has been correlated as a strong, independent predictor of prolonged length of stay, reintubation, higher mortality, and cost of care.
Background/Rationale:
St Luke's Boise and Meridian Medical Centers and other hospitals nationwide joined together in the Critical Care Innovation Network (CCIN), a coalition of VHA hospitals, to address ICU delirium and improve clinical outcomes by increasing clinician awareness and recognition. A subgroup was formed to create a survey tool designed to evaluate knowledge in 3 areas: recognition, impact, and treatment.
Description:
Retrospective analysis of a multicenter, multidisciplinary, prospectively collected database of 608 respondents based on results from the survey that was distributed to RNs, RTs, MDs, PAs, and NPs in 21 critical care units within 12 hospitals throughout the United States to assess their knowledge awareness of ICU delirium. Survey results were analyzed as both cohort- and unit-specific data.
Outcome:
Providers showed clear deficiencies in their knowledge of the impact of ICU delirium on their patients and often underestimated the impact. Knowledge with respect to recognition and risk factors was limited. Additionally, many responses regarding appropriate management strategies for ICU delirium were incorrect.
Interpretation/Conclusion:
This multicenter, multidisciplinary survey project revealed significant deficiencies in the knowledge of critical care providers with regard to the recognition of ICU delirium, its risk factors, the impact, and appropriate interventions to decrease the incidence and/or duration of ICU delirium.
Implications for Practice:
Working with the interdisciplinary healthcare team, clinical nurse specialists are key in identifying clinical practice improvement opportunities and evaluating applicable evidence-based practice and validated tools in an effort to decrease the incidence and impact of ICU delirium in their organization.
Section Description
The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.
A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.
The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.
Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.