title: Decreasing inappropriate unable-to-assess ratings for the confusion assessment method for the intensive care unit.
abstract: BACKGROUND
  The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a validated tool for diagnosing delirium in the ICU and yields 1 of 3 ratings: positive, negative, and unable to assess (UTA). It was hypothesized that an educational campaign focused on establishing patients' arousal as comatose versus noncomatose before initiating the CAM-ICU would decrease the incidence of inappropriate UTA ratings.
  
  
  OBJECTIVE
  To compare the incidence of inappropriate UTA ratings before and after an educational campaign.
  
  
  METHODS
  An interventional, quasi-experimental study was conducted in a surgical ICU at a tertiary academic medical center. A nursing educational campaign was conducted from March 1 to March 7, 2012. Patients admitted to the surgical ICU from December 25, 2011 through January 25, 2012 were included in the baseline cohort, and patients admitted from March 9 through April 9, 2012 were included in the posteducation cohort. Inclusion criteria were admission to the surgical ICU for at least 24 hours and at least 1 CAM-ICU assessment.
  
  
  RESULTS
  The baseline cohort included 93 patients and the posteducation cohort included 96 patients. Patients were 41% less likely to receive an inappropriate UTA rating after the educational campaign (32% [30 of 93] baseline vs 19% [18 of 96], P = .03). Patients with concurrent mechanical ventilation were more likely to receive an inappropriate UTA rating in the baseline cohort (odds ratio, 30.7; 95% CI, 8.9-105.9; P < .001) and the posteducation cohort (odds ratio, 15.5; 95% CI, 4.1-59.5; P < .001).
  
  
  CONCLUSIONS
  The educational campaign decreased the incidence of inappropriate UTA ratings.
authors.affiliation: Joshua T. Swan is an assistant professor of pharmacy practice at the College of Pharmacy and Health Sciences, Texas Southern University, a clinical pharmacist specialist at Houston Methodist Hospital, and a clinical research scholar in the Center for Outcomes Research in the Department of Surgery at Houston Methodist Research Institute, Houston, Texas.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Swan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D064648:Critical Care Nursing / Q000193:education*; D003693:Delirium / Q000145:classification / Q000175:diagnosis* / Q000451:nursing; D005260:Female; D006801:Humans; D007318:Inservice Training; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009730:Nursing Assessment / Q000379:methods / Q000592:standards*; D015397:Program Evaluation; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000451:nursing / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D062606:Tertiary Care Centers