title: Determination of the feasibility of a multicomponent intervention program to prevent delirium in the Intensive Care Unit: A modified RAND Delphi study.
abstract: BACKGROUND
  Delirium is common in Intensive Care Unit (ICU) patients and associated with poor outcome. In non-ICU patients a multicomponent intervention program with non-pharmacological interventions has shown to reduce delirium. Currently, there is insufficient evidence regarding the effects of such a program in ICU patients. We developed a draft program based on a review. As most studies were conducted in non-ICU patients, the feasibility of the program in ICU patients needs to be assessed before investigating its effectiveness.
  
  
  OBJECTIVE
  To determine experts' opinion and to achieve group consensus on the feasibility and completeness of the multicomponent intervention program for ICU patients.
  
  
  METHODS
  A modified RAND/UCLA Appropriateness Method Delphi study was used. A total of 38 experts were selected following purposive sampling. Round one informed the experts about the draft program and asked for their opinion about its feasibility and completeness. In round two the experts were asked to reconsider their opinion based on changes made, and to rank the interventions in order of importance. The feasibility was scored using a 9-point Likert scale. A disagreement index (DI) and panel median were calculated to determine the level of agreement.
  
  
  RESULTS
  During Delphi round one 100% of the questionnaires was completed, during round two 79%. After two rounds the experts agreed on the feasibility of the interventions targeting sleep deprivation (panel median 7.00, DI 0.26), immobility (panel median 8.00, DI 0.22), visual and hearing impairment (panel median 8.00, DI 0.19), and cognitive impairment (panel median 8.00, DI 0.23), except for cognitive training (panel median 5.00, DI 0.52).
  
  
  CONCLUSIONS
  During this study a feasible multicomponent intervention program to prevent ICU delirium was developed based on expert consensus. As no consensus was reached on cognitive training, a pilot study is planned to determine the feasibility of cognitive training in the ICU.
authors.affiliation: Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: annelies.wassenaar@radboudumc.nl.
authors.forename: Annelies
authors.initials: A
authors.lastname: Wassenaar
authors.affiliation: Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: van den Boogaard
authors.affiliation: Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Research Department of Anesthesiology & Intensive Care, Isala, Zwolle, The Netherlands; Department of Intensive Care Medicine, Maxima Medical Center, Veldhoven, The Netherlands; Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Department of Intensive Care Medicine, Medical Center Haaglanden-Bronovo, The Hague, The Netherlands; Department of Intensive Care, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands; Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care Medicine, Hospital Gelderse Vallei, Ede, The Netherlands; Department of Geriatric Medicine, Spaarne Gasthuis, Haarlem, The Netherlands; Department of Intensive Care, Zuyderland Medical Center, Heerlen, The Netherlands.
authors.lastname: Underpin-Icu Study Group
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, UK; Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.affiliation: Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Pickkers
mesh_terms: D000328:Adult; D003693:Delirium / Q000517:prevention & control*; D003697:Delphi Technique; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male
keywords: Delirium; Delphi technique; Intensive Care Unit; Nursing interventions; Program development