Abstract
Background
Delirium is an acute change in behaviour, characterised by a fluctuating course, inattention,
and disorganised thinking. For critically ill adults in the intensive care, the incidence
of delirium has been reported to be at least 30% and is associated with both short-term
and long-term complications, longer hospital stay, increased risk of mortality, and
long-term cognitive problems.
Aim
The objective of this study was to determine the effectiveness of a nurse-led delirium-prevention
protocol in reducing the incidence and duration of delirium among adults admitted
to intensive care.
Methods
A hybrid stepped-wedge cluster randomised controlled trial was conducted to assess
the effectiveness of the implementation and dissemination of the nurse-led intervention
to reduce the incidence and duration of delirium among adults admitted to the four
adults intensive care units in the southwest of Sydney, Australia.
Results
Between May 2019 and February 2020, over a 10-month period, 2618 admissions, among
2566 patients, were included in the study. After an initial 3-month baseline period,
each month there was a random crossover to the nurse-led intervention in one of the
four intensive care units, and by the 7th month of the trial, all units were exposed
to the intervention for at least 3 months. The incidence of acute delirium was observed
to be 10.7% (95% confidence interval [CI] = 9.1–12.4%), compared to 14.1% (95% CI = 12.2–16.2%)
during the preintervention (baseline) period (adjusted rate ratio [adjRR] = 0.78,
95% CI = 0.57–1.08, p = 0.134). The average delirium-free-days for these preintervention and postintervention
periods were 4.1 days (95% CI = 3.9–4.3) and 4.4 days (95% CI = 4.2–4.5), respectively
(adjusted difference = 0.24 days [95% CI = −0.12 to 0.60], p = 0.199).
Conclusion
Following the introduction of a nurse-led, nonpharmacological intervention to reduce
the burden of delirium, among adults admitted to intensive care, we observed no statistically
significant decrease in the incidence of delirium or the duration of delirium.
Keywords
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Article info
Publication history
Published online: September 28, 2022
Accepted:
August 6,
2022
Received in revised form:
July 24,
2022
Received:
April 20,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
