title: Delirium monitoring and patient outcomes in a general intensive care unit.
abstract: BACKGROUND
  Use of an evidence-based tool for routine assessment for delirium by bedside nurses in the intensive care unit is recommended. However, little is known about patient outcomes after implementation of such a tool.
  
  
  OBJECTIVE
  To evaluate the implementation and effects of the Confusion Assessment Method for the Intensive Care Unit as a bedside assessment for delirium in a general intensive care unit in a tertiary care hospital.
  
  
  METHODS
  Charts of patients admitted to the unit during a 3-month period before implementation of the assessment tool and 1 year after implementation were reviewed retrospectively. Patient outcomes were incidence of delirium diagnosis, duration of mechanical ventilation, length of stay in the intensive care unit, and time spent in restraints.
  
  
  RESULTS
  The 2 groups of patients did not differ in demographics, clinical characteristics, or predisposing factors. The groups also did not differ significantly in delirium diagnosis, duration of mechanical ventilation, length of stay in the intensive care unit, or time spent in restraints. Barriers to use of the tool included nurses' lack of confidence in performing the assessment, concerns about use of the tool in patients receiving mechanical ventilation, and lack of interdisciplinary response to findings obtained with the tool.
  
  
  CONCLUSIONS
  No change in patient outcomes or diagnosis of delirium occurred 1 year after implementation of the Confusion Assessment Method for the Intensive Care Unit. Lessons learned and barriers to adoption and use, however, were identified.
authors.affiliation: At the time of this project, Lois Andrews was a clinical nurse specialist in the general intensive care unit at Sentara Norfolk General Hospital, Norfolk, Virginia, and a Doctor of Nursing Practice student at Duke University School of Nursing, Durham, North Carolina. Susan G. Silva is a research associate professor at Duke University School of Nursing. Susan Kaplan is coordinator of nursing research at Sentara Norfolk General Hospital. Kathie Zimbro is director of Clinical Business Intelligence at Sentara Healthcare, Norfolk, Virginia. lkandrew@sentara.com.
authors.forename: Lois
authors.initials: L
authors.lastname: Andrews
authors.affiliation: At the time of this project, Lois Andrews was a clinical nurse specialist in the general intensive care unit at Sentara Norfolk General Hospital, Norfolk, Virginia, and a Doctor of Nursing Practice student at Duke University School of Nursing, Durham, North Carolina. Susan G. Silva is a research associate professor at Duke University School of Nursing. Susan Kaplan is coordinator of nursing research at Sentara Norfolk General Hospital. Kathie Zimbro is director of Clinical Business Intelligence at Sentara Healthcare, Norfolk, Virginia.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Silva
authors.affiliation: At the time of this project, Lois Andrews was a clinical nurse specialist in the general intensive care unit at Sentara Norfolk General Hospital, Norfolk, Virginia, and a Doctor of Nursing Practice student at Duke University School of Nursing, Durham, North Carolina. Susan G. Silva is a research associate professor at Duke University School of Nursing. Susan Kaplan is coordinator of nursing research at Sentara Norfolk General Hospital. Kathie Zimbro is director of Clinical Business Intelligence at Sentara Healthcare, Norfolk, Virginia.
authors.forename: Susan
authors.initials: S
authors.lastname: Kaplan
authors.affiliation: At the time of this project, Lois Andrews was a clinical nurse specialist in the general intensive care unit at Sentara Norfolk General Hospital, Norfolk, Virginia, and a Doctor of Nursing Practice student at Duke University School of Nursing, Durham, North Carolina. Susan G. Silva is a research associate professor at Duke University School of Nursing. Susan Kaplan is coordinator of nursing research at Sentara Norfolk General Hospital. Kathie Zimbro is director of Clinical Business Intelligence at Sentara Healthcare, Norfolk, Virginia.
authors.forename: Kathie
authors.initials: K
authors.lastname: Zimbro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D003693:Delirium / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D009730:Nursing Assessment / Q000379:methods* / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D011795:Surveys and Questionnaires