Large-scale implementation of sedation and delirium monitoring in the intensive care unit: A report from two medical centers

Critical Care Medicine

Volumn 33, Issue 6, 2005, Pages 1199-1205

  Pun, Brenda Truman ^a,c   Gordon, Sharon M ^a,b,d   Peterson, Josh F ^f   Shintani, Ayumi K ^b   Jackson, James C ^a   Foss, Julie ^a   Harding, Sharon D ^e   Bernard, Gordon R ^a   Dittos, Robert S ^a,d   Ely, E Wesley ^a,d  

^a VANDERBILT UNIVERSITY MEDICAL CENTER   (United States)

^b VANDERBILT UNIVERSITY SCHOOL OF MEDICINE   (United States)

^c VANDERBILT UNIVERSITY SCHOOL OF NURSING   (United States)

^d VA Tennessee Valley Geriatric Research Education and Clinical Center   (United States)

^e VETERANS AFFAIRS MEDICAL CENTER   (United States)

^f VA Tennessee Valley Healthcare System ^*

Author keywords

Clinical practice guidelines; Delirium; Implementation; Intensive care; Mechanical ventilation; Monitoring; Nursing; Process improvement; Protocols; Quality improvement; Sedation

Indexed keywords

ADULT; AGED; AGITATION; ARTICLE; CONFUSION; CONTROLLED STUDY; DELIRIUM; FEMALE; HUMAN; INTENSIVE CARE UNIT; MALE; MEDICAL DOCUMENTATION; MEDICAL PRACTICE; MENTAL PERFORMANCE; MONITORING; NURSE; PATIENT COMPLIANCE; PRACTICE GUIDELINE; PRIORITY JOURNAL; PSYCHOLOGIC ASSESSMENT; RATING SCALE; SEDATION;

ADULT; AGED; CRITICAL CARE; DELIRIUM; DRUG UTILIZATION REVIEW; FEMALE; GUIDELINE ADHERENCE; HOSPITALS, UNIVERSITY; HOSPITALS, VETERANS; HUMANS; HYPNOTICS AND SEDATIVES; INTENSIVE CARE UNITS; MALE; MIDDLE AGED; NURSING ASSESSMENT; OUTCOME AND PROCESS ASSESSMENT (HEALTH CARE); PROSPECTIVE STUDIES; RESPIRATION, ARTIFICIAL; TENNESSEE;

EID: 20444502983     PISSN: 00903493     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.CCM.0000166867.78320.AC     Document Type: Article

References (46)

1. Jacobi J, Fraser GL, Coursin DB, et al: Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002; 30:119-141
2. Brook AD, Ahrens TS, Schaiff R, et al: Effect of a nursing implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 1999; 27:2609-2615
3. Kress JP, Pohlman AS, O'Connor MF, et al: Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342: 1471-1477
4. Mascia MF, Koch M, Medicis JJ: Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care. Crit Care Med 2000; 28:2300-2306
5. Payne JP, Bru O, Bosson JL, et al: Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001; 29:2258-2263
6. Ramsay M, Savege TM, Simpson ER, et al: Controlled sedation with aphaxalone-alphadolone. BMJ 1974; 2:656-659
7. Riker R, Fraser G, Cox P: Continuous infusion of haloperidol controls agitation in critically ill patients. Crit Care Med 1994; 22:433-440
8. Riker R, Picard JT, Fraser G: Prospective evaluation of the sedation-agitation scale for adult critically ill patients. Crit Care Med 1999; 27:1325-1329
9. Sessler CN, Gosnell M, Grap MJ, et al: The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care patients. Am J Respir Crit Care Med 2002; 166:1338-1344
10. Ely EW, Truman B, Shintani A, et al: Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003; 289:2983-2991
11. University Hospital Consortium. Adult ICU 2003 Benchmark Study: Findings and Conclusions Presentation. 2003
12. Ely EW, Siegel MD, Inouye S: Delirium in the intensive care unit: an under-recognized syndrome of organ dysfunction. Semin Respir Crit Care Med 2001; 22:115-126
13. McNicoll L, Pisani MA, Zhang Y, et al: Delirium in the intensive care unit: Occurrence and clinical course in older patients. J Am Geriatr Soc 2003; 51:591-598
14. Ely EW, Inouye SK, Bernard GR, et al: Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001; 286:2703-2710
15. Inouye SK: The dilemma of delirium: Clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 1994; 97:278-288
16. Gustafson Y, Brannstorm B, Norberg G, et al: Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients. J Am Geriatr Soc 1991; 39:760-765
17. Inouye SK, Foreman MD, Mion LC, et al: Nurses' recognition of delirium and its symptoms. Arch Intern Med 2001; 161:2467-73
18. Sanders AB: Missed delirium in older emergency department patients: A quality-of-care problem. Ann Emerg Med 2002; 39:338-341
19. McCusker J, Cole M, Abrahamowicz M, et al: Delirium predicts 12 month mortality. Arch Mem Med 2002; 162:457-463
20. Rockwood K, Cosway S, Carver D: The risk of dementia and death after delirium. Age Ageing 1999; 28:551-556
21. Ely EW, Shintani A, Truman B, et al: Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291:1753-1762
22. Milbrandt EB, Deppen S, Harrison PL, et al: Costs associated with delirium in mechanically ventilated patients. Crit Care Med 2004; 32:955-962
23. Ely EW, Gautam S, Margolin R, et al: The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001; 27:1892-900
24. Ely EW, Margolin R, Francis J, et al: Evaluation of delirium in critically ill patients: Validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med 2001; 29:1370-1379
25. Bergeron N, Dubois MJ, Dumont M, et al: Intensive Care Delirium Screening Checklist: Evaluation of a new screening tool. Intensive Care Med 2001; 27:859-864
26. Hart RP, Levenson JL, Sessler CN, et al: Validation of a cognitive test for delirium in medical ICU patients. Psychosomatics 1996; 37:533-546
27. Hart RP, Best AM, Sessler CN, et al: Abbreviated cognitive test for delirium. J Psychosom Res 1997; 43:417-423
28. Tanios MA, Epstein SK, Teres D: Are we ready to monitor for delirium in the intensive care unit? Crit Care Med 2004; 32: 295-296
29. Bowton D: Delirium: The cost of inattention. Crit Care Med 2004; 32:1080-1081
30. Ely EW, Stephens RK, Jackson JC, et al: Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: A survey of 912 healthcare professionals. Crit Care Med 2004; 32:106-12
31. Ely EW, Baker AM, Dunagan DP, et al: Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996; 335:1864-1869
32. Ely EW, Bennett PA, Bowton DL, et al: Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning. Am J Respir Crit Care Med 1999; 159:439-446
33. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington, DC, American Psychiatric Association, 1994, pp 123-133
34. Smyrnios NA, Connolly A, Wilson MM, et al: Effects of a multifaceted, multidisciplinary, hospital-wide quality improvement program on weaning from mechanical ventilation. Crit Care Med 2002; 30:1256-1260
35. Grol R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care 2001; 39:II-46-II-54
36. Grol R, Jones R: Twenty years of implementation research. Family Practice. 2000; 17:S32-S35
37. Bair N, Bobek MB, Hoffman-Hogg L, et al: Introduction of sedative, analgesic, and neuromuscular blocking agent guidelines in a medical intensive care unit: Physician and nurse adherence. Crit Care Med 2000; 28:707-713
38. Davis N, Pohlman A, Gehlbach B, et al: Improving the process of informed consent in the critically ill. JAMA 2003; 289:1963-1968
39. Inouye SK, Bogardus ST Jr, Charpentier PA, et al: A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340:669-676
40. Skrobik Y, Bergeron N, Dumont M, et al: Olanzapine vs haloperidol: Treating delirium in a critical care setting. Intensive Care Med 2004; 30:444-449
41. Meagher DJ, Hanlon DO, Mahony EO, et al: Relationship between symptoms and motoric subtype of delirium. J Neuropsychiatry Clin Neurosci 2000; 12:51-56
42. Meagher DJ: Delirium: optimising management. BMJ 2001; 322:144-149
43. Truman B, Ely EW: Monitoring delirium in critically ill patients: Using the Confusion Assessment Method for the ICU. Crit Care Nurse 2003; 23:25-36
44. Camus V, Burtin B, Simeone I, et al: Factor analysis supports the evidence of existing hyperactive and hypoactive subtypes of delirium. Int J Geriatr Psychiatry 2000; 15:313-316
45. Peterson JF, Truman BL, Shintani A, et al: The prevalence of hypoactive, hyperactive, and mixed type delirium in medical ICU patients. J Am Geriatr Soc 2003; 51:S174
46. Knaus WA, Draper EA, Wagner DP, et al: APACHE II: A severity of disease classification system. Crit Care Med 1985; 13: 818-829