Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients

Am J Crit Care. 2016 Dec;26(1):19-27. doi: 10.4037/ajcc2017374.

Abstract

Background: Strategies for preventing delirium include early identification and avoiding or modifying patient, environmental, and iatrogenic factors. Minimal research exists on a prescriptive delirium prevention bundle that details elements or strategies for each bundle component. Even less research has been focused on nurse-driven interventions or components.

Objective: To evaluate the effectiveness of a delirium prevention bundle in decreasing delirium incidence in 2 medical-surgical intensive care units in a large Texas medical center.

Methods: Researchers used the Confusion Assessment Method for the Intensive Care Unit to assess delirium incidence by using a controlled interventional cohort design with 447 delirium-negative critically ill patients. Bundle components consist of sedation cessation, pain management, sensory stimulation, early mobilization, and sleep promotion.

Results: The intervention, analyzed by using a logistic regression model, reduced the odds of delirium by 78% (odds ratio, 0.22; P = .001).

Conclusions: The delirium prevention bundle was effective in reducing the incidence of delirium in critically ill medical-surgical patients. Further validation studies are under way.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Adult
  • Aged
  • Aged, 80 and over
  • Critical Illness*
  • Delirium / prevention & control*
  • Early Ambulation / nursing
  • Female
  • Humans
  • Intensive Care Units / organization & administration*
  • Male
  • Middle Aged
  • Pain Management / nursing
  • Patient Care Bundles / nursing*
  • Sleep