None listed
Conditions
Brief summary
Delirium is an acute neurocognitive disorder that is characterised by a fluctuating level of consciousness with impaired attention and cognition. Delirium has been estimated to occur in approximately 30% of adults admitted the intensive care. Delirium is associated with poor outcomes which include longer stay in intensive care unit, longer stay in hospital by 10 days and experience a prolonged duration of mechanical ventilation. The longer-term outcomes include long-term cognitive impairment, dependency in activities of daily living and 2-3 times higher mortality rates. The restlessness and agitation experienced by patients leads to increasing workload of ICU nurses who need to stay continually by the bedside to ensure the patients safety, thereby requiring one-to-one nursing care. This increases the financial burden of delirium on the Intensive Care unit as well as the hospital. This study will evaluate the impact of a nursing-led delirium-prevention protocol (‘the intervention’) that is aimed at reducing the incidence, severity, and duration of delirium among adults admitted to ICU. The Delirium Prevention Nursing Protocol targets the risk factors for delirium which includes visual and hearing impairment, to prevent or treat sensory deprivation and ultimately the loss of orientation; sleep deprivation, cognitive impairment to (re)orientate patients with regard to time, place and person to prevent or minimize decline; and immobility, to improve patients’ functional mobility in the ICU and to stimulate patients’ cognition.
Interventions
The intervention will incorporate a nurse led delirium prevention protocol, targeting risk factors for delirium: (1) visual and hearing impairment - nurses will ensure that all patient who usually need glasses, or hearing aids will use them during their ICU stay; (2) to prevent and treat sensory deprivation, cognitive impairment, and loss of orientation - all patients will be re-orientated to place, person, and time at the start of nursing shift and during the daily medical round; (3) Sleep dep
The intervention will incorporate a nurse led delirium prevention protocol, targeting risk factors for delirium: (1) visual and hearing impairment - nurses will ensure that all patient who usually need glasses, or hearing aids will use them during their ICU stay; (2) to prevent and treat sensory deprivation, cognitive impairment, and loss of orientation - all patients will be re-orientated to place, person, and time at the start of nursing shift and during the daily medical round; (3) Sleep deprivation will be minimised, and avoided where possible by ensuring minimal nursing care during the night shift (between 10pm and 6am in the morning), and overnight use of lights will be minimised, and noise kept to a level to facilitate/optimise sleeping; and, (4) lack of mobility - staff will attempt to improve functional mobility while in the intensive care, and also stimulate cognition, this will be undertaken in collaboration with the physiotherapy and occupational therapy teams to ensure patient (when able), will sit out of bed and mobilise within the ICU. Nursing staff will use checklists to direct interventions, and regular delirium prevention rounds (one per shift) will be undertaken to ensure application of interventions to reduce the risk of delirium.
Sponsors
Liverpool Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Crossover
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All adults aged 18 years or more admitted to the intensive care during the study period.
Exclusion criteria
(1) patients at the end-of-life, and not expected to survive 24 hours; (2) patients not expected to stay in the ICU for at least 24 hours; (3) patients with acute or chronic neurological conditions that prevented assessment of delirium (traumatic brain injury, intra-cerebral hemorrhage, ischaemic stroke, CNS infection, hypoxic brain injury, hepatic encephalopathy, severe mental disability, serious receptive aphasia, dementia).
Outcome results
None listed