Preventing Delirium in Intensive Care Patients
Seriously ill patients in a hospital intensive care unit (ICU) are at high risk for a condition called delirium. Delirium is a state of mental confusion that can be caused by fever, medications, lack of oxygen or injuries to the brain. Delirium affects up to 80 percent of ICU patients and is associated with a higher death rate, depression and post-traumatic stress disorder. Hospital costs for treatment of delirium are estimated between 4 and 16 billion a year. Hospitals can reduce the number of patients that develop delirium by assessing their risk with a list of procedures known as a bundle.
The Washington State Hospital Association, through the LEAPT initiative, is asking participating hospitals to use the bundle with the goal of reducing harm from delirium by 20% by December 9, 2014.
When a patient is admitted to the ICU, hospital staff will check them for their risk of delirium on each shift. They will give them breaks from medications used to keep them sedated and check daily to see if they can breathe on their own without using a ventilator. By the second day, staff will start working with the patient to regain their mobility by having them sit up and do more each day until they are walking again. This prevents complications due to long periods of being bedridden such as falls and pressure ulcers.
Hospitals will measure the results of their efforts by comparing the number of patients who are assessed for the risk and also the number of patients who have delirium but all the elements of the bundle and the number of days the patient stayed in the hospital. Hospitals will submit their results to WSHA each quarter. WSHA will share the results with the hospital and the public to track their progress towards improving survival rates.