CAM-ICU education

[Leonardsmom,LPN]

Hello all,

Hoping to get some responses from current nurses working in the ICU about current practice of education being received in delirium and training in using delirium screening tools such as the CAM-ICU. A classmate and I are finishing up our PICOT paper and wanted to hear from those working in the ICU what the current practice is and if what is currently being practiced reflects what our research has shown to be the most effective. Thank you for taking the time to respond back.

[Here.I.Stand, BSN, RN]

We use the CAM-ICU screening tool every 4 hrs. The limitations of it that I can see is 1) not everyone can answer the questions and follow commands perfectly if intubated and sedated....certainly not if medically paralyzed, and 2) we get a lot of TBI and stroke pts. Even if they are verbal they may not answer "does a stone float on water?" or squeeze on the letter A, but it's usually because their brain is injured -- not because they are delirious.

More often we detect it by simple ovservation on an ongoing basis. So say a pt was never completely appropriate by the tool, because they had a ruptured aneurysm. They had it coiled, have an EVD in, and being at risk for vasospasm are on strict q 1 hr neuro checks...round the clock. Ten days in, pt who was always confused starts to become withdrawn, and when he does talk makes less sense than ever. He becomes impulsive where before he would stay in bed. Dopplers negative for vasospasm, ICPs fine, HCT is stable. Guess what...he's probably delirious.

What we do is try as best we can to promote sleep and day-night cycles, such as clustering care, designated quiet hours (2 hrs on days, 2 hrs on nocs), giving all non -sedated pts their bath between 0600-2200, getting into chairs, using minimal sedation (unless more medically needed, e.g. ICPs are high, are medically paralyzed etc.), daily wakeups, light appropriate for time of day, putting awake pts in room with a window, etc.