title: Implementing delirium screening in the ICU: secrets to success.
abstract: OBJECTIVE
  To review delirium screening tools available for use in the adult ICU and PICU, to review evidence-based delirium screening implementation, and to discuss common pitfalls encountered during delirium screening in the ICU.
  
  
  METHODS
  Review of delirium screening literature and expert opinion.
  
  
  RESULTS
  Over the past decade, tools specifically designed for use in critically ill adults and children have been developed and validated. Delirium screening has been effectively implemented across many ICU settings. Keys to effective implementation include addressing barriers to routine screening, multifaceted training such as lectures, case-based scenarios, one-on-one teaching, and real-time feedback of delirium screening, and interdisciplinary communication through discussion of a patient's delirium status during bedside rounds and through documentation systems. If delirium is present, clinicians should search for reversible or treatable causes because it is often multifactorial.
  
  
  CONCLUSIONS
  Implementation of effective delirium screening is feasible but requires attention to implementation methods, including a change in the current ICU culture that believes delirium is inevitable or a normal part of a critical illness, to a future culture that views delirium as a dangerous syndrome which portends poor clinical outcomes and which is potentially modifiable depending on the individual patients circumstances.
authors.affiliation: Geriatric Research, Education and Clinical Center, (GRECC) Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA. nathan.brummel@vanderbilt.edu
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Brummel
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Vasilevskis
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Leanne
authors.initials: L
authors.lastname: Boehm
authors.forename: Brenda T
authors.initials: BT
authors.lastname: Pun
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
mesh_terms: D000328:Adult; D057189:Checklist; D002675:Child, Preschool; D003422:Critical Care; D003693:Delirium / Q000175:diagnosis* / Q000451:nursing; D019317:Evidence-Based Medicine; D006801:Humans; D007362:Intensive Care Units; D008403:Mass Screening / Q000295:instrumentation*; D058996:Quality Improvement
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