Deliriumin the ICU setting ‐ a subjective and theoretical survey before the implementation of the Confusion Assessment Method for the ICU in an unit

Bragança, J. P.; Rodrigues, G.; Aragão, I.; Teixeira, C.; Quintaneiro, C.

http://hdl.handle.net/10400.16/1517

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Background and Goal of Study: The current definition of delirium comprises acute change or fluctuation in mental status and inattention, accompanied by either altered level of consciousness or disorganized thinking. It is a frequent condition in the ICU and it is associated with longer hospital stay, increase in mortality at 6 months and long-term cognitive impairment, but remains under diagnosed. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) has been validated and implemented in many ICUs and its use is recommended by the Society of Critical Care Medicine. It is our purpose to evaluate the individual perspective and the objective knowledge of our staf f about delirium before the implementation of the CAM-ICU. Materials and Methods: Anonymous survey to our ICU clinical staf f which contained subjective and ‘true or false’ questions. Data was analised with the sof tware SPSS version 17.0. The Wilcoxon test was used to compare autoperception of knowledge about delirium and the content of answers regarding its definiton. Results: Forty two questionnaires were returned (participation rate of 73%), 11 from physicians and 31 from nurses. Overall, 61,9% of inquiries think they can give a definition for delirium in the ICU and 50% claim to be able to evaluate delirium. 28,6% of the respondents - 63,6% of the physicians and 16,1% of the nurses - know the CAM-ICU. From these only a quarter has received education on this method, 75% think it’s easy to apply and 66% don’t see its use as an increase in the daily workload. We found a high rate of wrong and ‘I don’t know’ answers to questions about operationalization, diagnosis and outcome. The subjects’ auto-perception on their knowledge about delirium [Likert scale] was compared to their ability to answer questions related to its definiton - ‘attention deficit is essencial for diagnosis’ [true], Wilcoxon test Z=-4,699 (p< 0,001); ‘disorganized thinking is essential for diagnosis’ [false], Wilcoxon test Z=-4,437 (p< 0,001). Conclusions: The respondents’ auto perception of knowledge about delirium doesn’t translate in the ability of giving an appropriate definition and making an adequate evaluation. Most of the inquiries don’t know the CAM-ICU, but those who do believe it’s easy to apply and its use won’t increase the workload. We performed educational sessions about delirium and the CAM-ICU in our unit to encourage our clinical staf f to deal properly with this hazardous condition.