Review Article

An educational strategy for the implementation of a delirium assessment tool

Beatriz Bonaga*, Elena Ruiz-Escribano Taravilla, Carmen Carrilero-López, María Dolores Castillo-Lag, Leanne M Boehm, Ángela Prado Mira, María Joaquina Piqueras Diaz and E Wesley Ely

Published: 10 August, 2021 | Volume 6 - Issue 1 | Pages: 015-020

Background: Delirium is an acute syndrome of organ dysfunction with long-term consequences which commonly occurs in the Intensive Care Unit (ICU). The incidence of delirium ranges from 30% - 50% in low severity ICU patients and up to 80% in mechanically ventilated patients. This condition is frequently under-recognized and daily routine screening is a key strategy to early intervention. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the most recommended assessment tools for detecting delirium in the critical ill patient.

Objective: The main objective of this study is to educate ICU staff about delirium. In addition, nurses were trained to use the CAM-ICU as a standard screening tool. The intervention was evaluated through a survey aimed at ICU staff.

Methods: An educational intervention was started in 2014 in our ICU. An educational package for ICU staff consisted of a didactic brochure and explanatory videos. One-on-one teaching, case based scenarios and didactic teaching were strategies used in the implementation process. The entire intervention was evaluated by means of a survey directed to the professionals.

Results: The structure of the didactic brochure was simple in order to have an easy understanding of the CAM-ICU tool. We also created 10-minute videos. According to the results of the satisfaction survey (N=62), disorganized thinking was the most difficult feature of CAM-ICU to interpret. When in doubt, consultation between co-workers was the primary resource selected by unit staff.

Conclusion: This initiative achieved the objective of training health care professionals in the application of the CAM-ICU tool with a good level of satisfaction from them. Therefore, ICU staff consider delirium management in the broader picture of critically ill patient care as a major activity of daily practice.

Read Full Article HTML DOI: 10.29328/journal.jcicm.1001035 Cite this Article Read Full Article PDF


  1. Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Crit Care Clin. 2013; 29: 51-65. PubMed: https://pubmed.ncbi.nlm.nih.gov/23182527/
  2. Van Rompaey B, Elseviers MM, Schuurmans MJ, Shortridge – Baggett LM, Truijen S, et al. Risks factors for delirium in intensive care patients: a prospective cohort study. Crit Care. 2009; 13: R77. PubMed: https://pubmed.ncbi.nlm.nih.gov/19457226/
  3. Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, et al. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care. 2005; 9: 375-381. PubMed: https://pubmed.ncbi.nlm.nih.gov/16137350/
  4. Salluh JI, Soares M, Teles JM, Ceraso D, Raimondi N, et al. Delirium Epidemiology in Critical Care Study Group. Delirium epidemiology in critical care (DECCA): an international study. Crit Care. 2010; 14: R210. PubMed: https://pubmed.ncbi.nlm.nih.gov/21092264/
  5. Ely W, Shintani A, Truman B, Speroff T, Gordon  SM, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. 2004; 291: 1753-1762. PubMed: https://pubmed.ncbi.nlm.nih.gov/15082703/
  6. Brummel NE, Vasilevskis EE, Han JH, Boehm L, Pun BT, et al. Implemeting delirium screening in the UCI: secrets to success. Crit Care Med. 2013; 41: 2196-2208. PubMed: https://pubmed.ncbi.nlm.nih.gov/23896832/
  7. Guenther MD, Popp J, Koecher L, Muders T, Wrigge H, et al. Validity and reliability of the CAM-ICU flowsheet to diagnose delirium in surgical ICU patients. J Crit Care. 2010; 25: 144-151. PubMed: https://pubmed.ncbi.nlm.nih.gov/19828283/
  8. Van Rompaey B, Elseviers MM, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, et al. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care. 2009; 13: R77. PubMed: https://pubmed.ncbi.nlm.nih.gov/19457226/
  9. Dewlin JW, Marquis F, Riker RR, Robbins T, Garpestad E, et al. Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside. Crit Care. 2008; 12: R19. PubMed: https://pubmed.ncbi.nlm.nih.gov/18291021/
  10. Boehm LM, Pun BT, Stollings JL, Girard TD, Rock P, et al. A multisite study of nurse-reported perceptions and practice of ABCDEF bundle components. Intensive Crit Care Nurs. 2020; 60: 102872. PubMed: https://pubmed.ncbi.nlm.nih.gov/32389395/
  11. Barr J, Fraser GL, Puntillo K et al. American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41: 263-306. PubMed: https://pubmed.ncbi.nlm.nih.gov/23269131/
  12. Ely EW, Margolin R, Francis J, Ely EW, Gélinas C, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assesment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001; 29: 1370-1379. PubMed: https://pubmed.ncbi.nlm.nih.gov/11445689/
  13. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screnning Checklist: evaluation of a new screening tool. Intensive Care Med. 2001; 27: 859-864. PubMed: https://pubmed.ncbi.nlm.nih.gov/11430542/
  14. Chen TJ, Chung YW, Chang HR, Chen PY, Wu CR, et al. Diagnostic accuracy of the CAM-ICU and ICDSC in detecting intensive care unit delirium: A bivariate meta-analysis. Int J Nurs Stud. 2021; 113: 103782. PubMed: https://pubmed.ncbi.nlm.nih.gov/33120134/
  15. Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018; 46: e825–e873. PubMed: https://pubmed.ncbi.nlm.nih.gov/30113379/
  16. Christensen M. An exploratory study of staff nurses ́ knowledge of delirium in the medical ICU: an Asian perspective. Intensive Crit Care Nurs. 2014; 30: 54-60. PubMed: https://pubmed.ncbi.nlm.nih.gov/24042089/
  17. Boot R. Delirium: a review of the nurses role in the intensive care unit. Intensive Crit Care Nurs. 2012; 28: 185-189. PubMed: https://pubmed.ncbi.nlm.nih.gov/22245104/
  18. Luetz A, Balzer F, Radtke FM, Jones C, Citerio G, et al. Delirium, sedation and analgesia in the Intensive Care Unit: a multinational, two part survey among intensivists. PLoS One. 2014; 9: e11935. PubMed: https://pubmed.ncbi.nlm.nih.gov/25398099/
  19. Page VJ, Navarange S, Gama S, McAuley DF. Routine delirium monitoring in a UK critical care unit. Crit Care Med. 2009; 13: R16. PubMed: https://pubmed.ncbi.nlm.nih.gov/19203391/
  20. Devlin JW, Fong JJ, Howard EP, Skrobik Y, McCoy N, et al. Assesment of delirium in the intensive care unit: nursing practices and perceptions. Am J Crit Care. 2008; 17: 555-565. PubMed: https://pubmed.ncbi.nlm.nih.gov/18978240/
  21. Elliot SR. ICU Delirium: A Survey into nursing and medical staff knowledge of current practices and perceived barriers towards ICU delirium in the intensive care unit. Intensive Crit Care Nurs. 2014; 30: 333-338. PubMed: https://pubmed.ncbi.nlm.nih.gov/25201699/
  22. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and health care outcomes (update). Cochrane DatabaseSyst Rev. 2013; 28: CD002213. PubMed: https://pubmed.ncbi.nlm.nih.gov/23543515/
  23. Marino J, Bucher D, Beach M, Yegneswaran B, Cooper B. Implementation of an Intensive Care Unit Delirium Protocol: An interdisciplinary quality improvement project. Crit Care Nurse. 2015; 34: 273-284. PubMed: https://pubmed.ncbi.nlm.nih.gov/26244242/
  24. Swan JT. Decreasing inappropriate unable-to-assess ratings for the confusion assessment method for the intensive care unit. Am J Crit Care. 2014; 23: 60-69. PubMed: https://pubmed.ncbi.nlm.nih.gov/24382618/
  25. Riekerk B, Pen EJ, Hofhuis JG, Rommes JH, Schultz MJ, et al. Limitations and practicalities of CAM-ICU implementation, a delirium scoring system, in a Dutch intensive care unit. Intensive Crit Care Nurs. 2009; 25: 242-24PubMed: https://pubmed.ncbi.nlm.nih.gov/19540761/
  26. Pun BT, Gordon SM, Peterson JF, Shintani AK, Jackson JC, et al. Large – scale implementation of sedation and delirium monitoring in the intensive care unit: a report from two medical centres. Crit Care Med. 2005; 33: 1199-2205. PubMed: https://pubmed.ncbi.nlm.nih.gov/15942331/
  27. Soja SL, Pandharipande PP, Fleming SB, Cotton BA, Miller LR, et al. Implementation, reliability testing, and compliance monitoring of the Confusion Assessment method for the Intensive Care Unit in trauma patients. Intensive Care Med. 2008; 34: 1263-1268. PubMed: https://pubmed.ncbi.nlm.nih.gov/18297270/
  28. Detroyer E, Dobbels F, Debonnaire D, Irving K, Teodorczuk A, et al. The effect of an interactive delirium e-learning tool on healthcare workers´ delirium recognition, knowledge, and strain in caring for delirious patients: a pilot pre-test/post-test study. BMC Med Educ. 2016; 16: 17. PubMed: https://pubmed.ncbi.nlm.nih.gov/26768589/


Figure 1

Figure 1

Figure 1

Figure 2

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More