scholarly journals Protecting Sleep to Reduce Delirium in an Adult Intensive Care Unit

2021 ◽  
Author(s):  
◽  
Heather Thomas
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Standard Of Care ◽  
Practice Change ◽  
Adult Intensive Care Unit ◽  
Project Outcome ◽  
The Hours ◽  
Practice Problem ◽  
Clinically Significant ◽  
Icu Delirium

Practice Problem: Delirium is a common, yet often preventable complication in hospitalized patients. It is often caused by fragmented sleep, medications, environmental stimuli, and treatment therapies. PICOT: The PICOT question that guided this evidence-based practice change project was: For patients in an adult Intensive Care Unit (ICU), does using a nurse-initiated, non-pharmacological sleep-enhancement protocol, versus no sleep-enhancement protocol, reduce the incidence of ICU-delirium over a period of 2 months? Evidence: The reviewed literature supported the evidence for effective use of a nurse-initiated protocol in reducing delirium in the ICU. Sixteen articles met the inclusion criteria for the review of literature that supported the DNP project. Intervention: A nurse-initiated sleep-enhancement protocol was implemented, which reduced interruptions during the hours between midnight and 0400. Outcome: While there was a 50% reduction in delirious patients after the protocol was initiated, the data pool was small and was not proven to be statistically significant. Due to the Covid-19 outbreak, there were far fewer eligible patients than originally anticipated. Conclusion: Although a clinically significant project outcome was not realized, staff felt that the protocol improved patient care and advocated for its use on all patients as a standard of care. Unit-based shared governance councils on other acute care floors have also adopted the sleep enhancement protocol

scholarly journals Clinical Pharmacist Impact on Intensive Care Unit Delirium: Intervention and Monitoring

2018 ◽  
Vol 54 (3) ◽  
pp. 180-185 ◽  
Author(s):  
Myaa Lightfoot ◽  
Adam Sanders ◽  
Christopher Burke ◽  
Jessica Patton
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intervention Group ◽  
Standard Of Care ◽  
Clinical Decision ◽  
Icu Length Of Stay ◽  
Increased Risk ◽  
Before And After ◽  
Icu Delirium ◽  
The Impact

Purpose: The purpose of this study was to determine the impact of pharmacist monitoring with a clinical decision support system (CDSS) on clinical outcomes related to intensive care unit (ICU) delirium. Methods: This was a single-center, before-and-after study. This study compares patient outcomes of the preintervention group, which is the standard of care of pharmacist rounding, and the intervention group of pharmacy rounding with the CDSS rules. Using a CDSS, specific delirium risk factor rules were created to alert pharmacists to patients who have an increased risk of developing ICU delirium. Patients were included in the study if they were ⩾18 years of age, admitted to the trauma intensive care unit (TICU), and had one of the CDSS rule alerts. The CDSS notified pharmacists in real time to patients in the intervention group that met these criteria to provide timely recommendations in an effort to prevent ICU delirium. Results: Compared with the preintervention group receiving the standard of care (n = 28), the intervention CDSS group (n = 33) had a nonsignificant trend in decreased incidence of delirium (33.3% vs 24.1%, P = .45), ICU length of stay (LOS) (10.11 vs 7.55 days, P = .26), and ventilator duration (7.11 vs 5.03 days, P = .26). The intervention group had a significantly shorter hospital LOS (14.74 vs 9.98 days, P = .04). There was a nonsignificant increase in mortality with the intervention group from nondelirium causes (24.2% vs 7%, P = .07). Conclusion: The utilization of a CDSS by clinical pharmacists to monitor for delirium-specific risk factors led to a significantly shorter hospital LOS. Further studies using this model are warranted to see the impact on the ICU population.

Cross-transmission of nosocomial pathogens in an adult intensive care unit: incidence and risk factors

2006 ◽  
Vol 63 (1) ◽  
pp. 39-46 ◽  
Author(s):  
M. Halwani ◽  
M. Solaymani-Dodaran ◽  
H. Grundmann ◽  
C. Coupland ◽  
R. Slack
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Nosocomial Pathogens ◽  
Adult Intensive Care Unit ◽  
Cross Transmission

scholarly journals Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

2021 ◽  
Vol 47 (4) ◽  
pp. 503-520
Author(s):  
Sonia O. Labeau ◽  
◽  
Elsa Afonso ◽  
Julie Benbenishty ◽  
Bronagh Blackwood ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Associated Factors ◽  
Adult Intensive Care Unit

Surgical intensive care unit (ICU) delirium: A “psychosomatic” problem?

2010 ◽  
Vol 8 (2) ◽  
pp. 221-225 ◽  
Author(s):  
Michel Reich ◽  
Regis Rohn ◽  
Daniele Lefevre
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Psychological Factors ◽  
Death Anxiety ◽  
Defense Mechanism ◽  
Cognitive Disorders ◽  
Major Surgery ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Delirium

AbstractObjective:Intensive Care Unit (ICU) delirium is a common complication after major surgery and related among other potential medical precipitants to either pre-existing cognitive impairment or the intensity and length of anesthesiology or the type of surgery. Nevertheless, in some rare situations, an organic etiology is not always found, which can be frustrating for the medical team. Some clinicians working in an intensive care unit have a reluctance to seek another hypothesis in the psychological field.Method:To illustrate this, we report the case of a 59-year-old woman who developed a massive delirium during her intensive care unit stay after being operated on for a left retroperitoneal sarcoma. Interestingly, she had had no previous cognitive disorders and a somatic explanation for her psychiatric disorder could not been found. Just before the surgery, she was grieving the recent loss of a colleague of the same age, and also a close friend, and therefore had a death anxiety.Results:With this case report, we would like to point out the importance of psychological factors that might precipitate delirium in a predominately somatic environment such as an intensive care unit.Significance of results:ICU delirium can sometimes be considered as a “psychosomatic” problem with either a stress response syndrome after surgery or a defense mechanism against death anxiety. Clinicians should be aware of the possibility of such psychological factors even if they always must first rule out potential somatic causes for delirium and encourage thorough investigation and treatment of these medical causes. A collaboration with the psycho-oncologist is recommended to better manage this “psychosomatic” problem.

Staphylococcus epidermidis Bacteremia in Neonates: Further Observations and the Occurrence of Focal Infection

PEDIATRICS ◽  
1984 ◽  
Vol 74 (5) ◽  
pp. 832-837 ◽  
Author(s):  
Gary J. Noel ◽  
Paul J. Edelson
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Staphylococcus Epidermidis ◽  
Neonatal Intensive Care ◽  
Blood Cultures ◽  
Focal Infection ◽  
Clinically Significant ◽  
Vascular Catheters

The frequency and clinical significance of Staphylococcus epidermidis isolates from blood cultures of neonates collected during a 17-month period in The New York Hospital neonatal intensive care unit (NICU) were reviewed. Twenty-three episodes of clinically significant S epidermidis bacteremia were detected using the criteria of isolation from 3/3 blood culture bottles from a single culture, or isolation from two or more blood cultures taken at different times, or simultaneous isolation from blood and fluid, pus or vascular catheter. Of these 23 episodes of S epidermidis bacteremia, ten were associated with colonized vascular catheters, and four episodes occurred in infants with necrotizing enterocolitis. Focal S epidermidis infection occurred in ten episodes, and persistent bacteremia occurred frequently in this setting. S epidermidis was the most frequent cause of bacteremia in the Neonatal Intensive Care Unit during the period reviewed. Of the isolates determined to be clinically significant, 74% were resistant to methicillin and cephalothin and 91% were resistant to gentamicin. All isolates were sensitive to vancomycin. In addition to removing vascular catheters suspected of being colonized and searching for potential sites of focal infection, an antibiotic regimen that includes vancomycin should be initiated once significant S epidermidis bacteremia has been recognized in the neonate.

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