Delirium in critical Ill patients and association and its and its association with patient factors and factors and outcomes in adult intensive care units

Lekalakala, Azania
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Background: Delirium is a frequent problem in the intensive care unit and associated with increased mortality, prolonged duration of ICU stay and increased cost. Failure by health care professionals to recognise the developing signs of delirium may have an adverse effect of long-term outcomes (quality of life, cognitive decline and independent functionality). Global guidelines have been developed for the early detection and management of delirium. It is argued that routine nurse-led screening for delirium using a validated screening tool will allow early detection and timely implementation of management strategies that reduce severity and/or duration. No studies to date were found in the South African setting on this topic. Without this essential information, appropriate and suitable nursing interventions for delirium will not be able to be developed. Therefore this South African study intended to explore the incidence of delirium in critically ill patients in the adult intensive care units. Setting: The setting for this study was the adult intensive care units of a 1,200 bedded university affiliated public hospital and tertiary level institution in Johannesburg. These intensive care units were: trauma and general intensive care units. Aim: The purpose of this study was to determine the incidence of delirium in critically ill patients in the adult intensive care units of a university-affiliated public hospital in Johannesburg, and to explore the relationships between delirium, patient clinical factors and outcomes. Design and Methods: A quantitative-descriptive and longitudinal design was utilised in this study. The total sample comprised 82 (n = 82) patients from the ICUs between the period 1.07.2017 to 30.9.2017. Random sampling method was utilised. Data was collected by means of a researcher developed checklist built on items from two validated questionnaires: Richmond Agitation and Anxiety Scale (RAAS) and Confusion Assessment Method for ICU (CAM-ICU). Results: Overall 82 (n = 82) patients participated in this study, and more than one-third tested positive for delirium when CAM-ICU method was used during their length of stay in ICU. It should be noted that two-thirds of the sample of patients were surgical cases, and average length of stay in ICU was 6 days. Six patients who had delirium had a death outcome after 218 days in ICU, but these results showed no statistical significance (IR 2.62; CI 0.56 – 16.10; p=0.916). Eight clinical factors in this study were statistically significantly (p<0.000) associated with patients having delirium or not, and most important were medication (p=0.030), physical restraint (p=0.025), and severity of critical illness (p<0.001). Further, the characteristics of >60 years of patients who had tested positive for delirium were mostly male (83.3%), with tertiary level education (50.0%), and on midazolam medication (83.3%). Clinical Implications: These findings have implications for nursing care because they highlight the importance of regular screening for delirium and addressing modifiable factors that contribute to delirium, such as the use of physical restraint and medication titrations. Conclusion: These findings suggest patients are at risk for delirium in these ICUs, and current best practice measures to prevent or combat the incidence of delirium should be put into place.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing
Lekalakala Azania Mpolokeng (2018) 0 Delirium in critically ill patients and its association with patient factors and outcomes in adult intensive care units, University of the Witwatersrand, Johannesburg, <>