CAM-ICU

[bellehill, RN]

Our Neuro Critical Care Unit just started using the CAM-ICU for delirium assessment. We are having a hard time adapting this assessment tool for our neuro patients. Does anyone have any experience with this in a neuro unit? What did you do to help the staff appropriately assess the neuro population?

[CCRNblahblahblahRN]

Our unit recently started using a flowsheet for this assessment. The assessment is done BID 8a and 8p on all patients and has four main steps starting with 'has there been an acute fluctuation in pt mental status from baseline' and then on to can patient perform tests such as squeezing providers hand every time provider says the letter A in HAAVAHART, answer questions such as 'can a stone float in water' and finally is pt's RASS anything other than 0. As you can see I can't remember it completely so each pt's bedside chart has a copy of the flowsheet. It's similar to a pain scale in that we can measure something that is somewhat subjective, but has limitations for the same reasons. But now we can 'prove' to Medicare that we are reasonably trying to measure and prevent ICU delirium.....

[bellehill, RN]

Thanks CCRN. It is nice to know we are having the same problems. In your neuro population, do you consider their baseline to be the way they presented on admission? I have heard that some facilities are using their baseline before the neuro event occurs.

[CCRNblahblahblahRN]

We use baseline before neuro event occurs if the patient already has dementia/alzheimers etc. Otherwise baseline on admission.

[bellehill, RN]

Thanks!