A few months ago, I had the opportunity to develop a programme in an Intensive Care Unit (ICU) to help prevent delirium among critically-ill adults. This was perceived as a very common condition among our patients, but no formal data had been gathered to date. The challenge wasn’t easy, but I had the the invaluable support of my Unit’s Chief, colleagues, nurses and staff at my centre. Hopes were high.
We chose to approach this as a formal research project at my hospital’s ICU, which is an 8-bed facility aimed at providing care for naval personnel and their relatives. An interrupted time series (“before & after”) study was started, with its first phase aimed at providing our unit’s baseline statistics, which were unavailable at the time. Our first analyses showed some interesting results: Delirium roughly developed among 40% of our admitted patients, and was significantly associated with prolonged hospital stays, failure to wean from the ventilator, mortality and self-removal of invasive medical devices, including central venous catheters, nasogastric and orotracheal tubes. All of these outcomes were considered highly relevant by our team, and everyone agreed that delirium was a relevant risk factor that needed to be controlled.
That’s when the evidence came in. I had recently finished my dissertation, a systematic review on how to prevent delirium using non-pharmacological, multi-component interventions. Briefly, these strategies are methods aimed at avoiding risk factors that commonly contribute to the development of this condition. Several randomised trials had already shown their effectiveness among inpatients, including the critically-ill (you can find the full text here). Using this information, we developed a tailored multi-component intervention that suited our Unit’s needs and expectations. Several meetings were held, in which everyone was invited to participate and share their views and experiences with delirium. After a few weeks we developed a 10-item intervention whose components were based on current evidence, but also took ideas from these meetings into consideration.
It’s been a few months since our programme started, and we have already applied our strategy to 130 critically-ill patients. Our results have been more than satisfactory so far. The absolute risk to develop delirium has dropped by 15%, which roughly translates in that we avoid one case of delirium per 7 admissions. Furthermore, significant drops in rates of self-removals have also been seen, as a reduction in the mean time on mechanical ventilation. This is likely to result in cost reductions for our Unit, and I plan to conduct formal calculations soon!
I believe that the reason behind our success stems from the proper translation of evidence into practice, which couldn’t be achieved without the constant commitment of everyone involved in the care of our patients. Adherence rates to our programme are always over 90%, which shows how motivated my team is towards preventing incident delirium.
So, what’s the next step? I would love to develop similar strategies for other wards in our hospital. Getting support from the Board of Directors is certainly going to be key to achieve this goal, but I trust that our numbers will speak for themselves.
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