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Routine use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) by bedside nurses may underdiagnose delirium.
Crit Care Resusc. 2011 Dec; 13(4):217-24.CC

Abstract

BACKGROUND

The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is emerging as the most frequently used tool for identifying delirium among critically ill patients.

OBJECTIVE

To determine whether the number of patients and nursing shifts in which delirium was diagnosed would increase after the introduction of the CAM-ICU in our unit.

DESIGN

Before-and-after study. In a 30-day Phase 1, we asked bedside nurses to assess their ICU patients for delirium each shift. We then conducted intensive education on the CAM-ICU for 30 days, including lectures, bedside tutorials, and supervised practice. In Phase 2, for 30 days we asked bedside nurses to record the results of their CAM-ICU assessments.

SETTING

20-bed mixed medical and surgical ICU at the Austin Hospital, Melbourne.

PARTICIPANTS

All patients admitted to the ICU during each phase.

MAIN OUTCOME MEASURES

Diagnosis of delirium by bedside nurses using either the CAM-ICU or an unstructured clinical assessment, by patient and nursing shift.

RESULTS

Compared with unstructured assessments, the CAM-ICU identified a significantly lower proportion of patients (36.7% v 21.3%; P = 0.004) and a significantly lower proportion of shifts (14.7% v 6.4% of shifts, P = 0.002) with delirium. When adjusted for differences in age, sex, Acute Physiology and Chronic Health Evaluation III risk of death and total length of stay between the two periods, assessment type remained a significant predictor of the diagnosis of delirium.

CONCLUSIONS

In our hospital, the CAM-ICU detected delirium less often than unstructured delirium assessments made by qualified intensive care nurses.

Authors+Show Affiliations

Intensive Care Unit, Austin Hospital, Melbourne, VIC, Australia. m.reade@uq.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22129282

Citation

Reade, Michael C., et al. "Routine Use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) By Bedside Nurses May Underdiagnose Delirium." Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine, vol. 13, no. 4, 2011, pp. 217-24.
Reade MC, Eastwood GM, Peck L, et al. Routine use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) by bedside nurses may underdiagnose delirium. Crit Care Resusc. 2011;13(4):217-24.
Reade, M. C., Eastwood, G. M., Peck, L., Bellomo, R., & Baldwin, I. (2011). Routine use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) by bedside nurses may underdiagnose delirium. Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine, 13(4), 217-24.
Reade MC, et al. Routine Use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) By Bedside Nurses May Underdiagnose Delirium. Crit Care Resusc. 2011;13(4):217-24. PubMed PMID: 22129282.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Routine use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) by bedside nurses may underdiagnose delirium. AU - Reade,Michael C, AU - Eastwood,Glenn M, AU - Peck,Leah, AU - Bellomo,Rinaldo, AU - Baldwin,Ian, PY - 2011/12/2/entrez PY - 2011/12/2/pubmed PY - 2012/2/10/medline SP - 217 EP - 24 JF - Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine JO - Crit Care Resusc VL - 13 IS - 4 N2 - BACKGROUND: The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is emerging as the most frequently used tool for identifying delirium among critically ill patients. OBJECTIVE: To determine whether the number of patients and nursing shifts in which delirium was diagnosed would increase after the introduction of the CAM-ICU in our unit. DESIGN: Before-and-after study. In a 30-day Phase 1, we asked bedside nurses to assess their ICU patients for delirium each shift. We then conducted intensive education on the CAM-ICU for 30 days, including lectures, bedside tutorials, and supervised practice. In Phase 2, for 30 days we asked bedside nurses to record the results of their CAM-ICU assessments. SETTING: 20-bed mixed medical and surgical ICU at the Austin Hospital, Melbourne. PARTICIPANTS: All patients admitted to the ICU during each phase. MAIN OUTCOME MEASURES: Diagnosis of delirium by bedside nurses using either the CAM-ICU or an unstructured clinical assessment, by patient and nursing shift. RESULTS: Compared with unstructured assessments, the CAM-ICU identified a significantly lower proportion of patients (36.7% v 21.3%; P = 0.004) and a significantly lower proportion of shifts (14.7% v 6.4% of shifts, P = 0.002) with delirium. When adjusted for differences in age, sex, Acute Physiology and Chronic Health Evaluation III risk of death and total length of stay between the two periods, assessment type remained a significant predictor of the diagnosis of delirium. CONCLUSIONS: In our hospital, the CAM-ICU detected delirium less often than unstructured delirium assessments made by qualified intensive care nurses. SN - 1441-2772 UR - https://www.unboundmedicine.com/medline/citation/22129282/Routine_use_of_the_Confusion_Assessment_Method_for_the_Intensive_Care_Unit__CAM_ICU__by_bedside_nurses_may_underdiagnose_delirium_ L2 - https://medlineplus.gov/delirium.html DB - PRIME DP - Unbound Medicine ER -