Effectiveness of combined non-pharmacological interventions in the prevention of delirium in critically ill patients: A randomized clinical trial.

PURPOSE: Delirium is a common dysfunction in the intensive care unit (ICU) and it is associated with negative short- and long-term outcomes. This study evaluated the effectiveness of combined non-pharmacological interventions in preventing delirium in critically ill patients. MATERIALS AND METHODS: This is a single-center randomized controlled trial conducted in three Brazilian ICUs from February to September 2019. Patients assigned to the control group received standard care (n = 72) and those assigned to the experimental group (n = 72) received a bundle of non-pharmacological interventions (periodic reorientation, cognitive stimulation, correction of sensory deficits [visual or hearing impairment], environmental management and sleep promotion) throughout the ICU stay. Delirium was monitored twice a day with the Confusion Assessment Method for the Intensive Care Unit Flowsheet. The primary outcome was the incidence density of delirium. RESULTS: The incidence density of delirium was lower in the intervention group (1.3 × 10-2 person-days) than in the control group (2.3 × 10-2 person-days), with a hazard ratio of 0.40 (95% confidence intervals, 0.17-0.95; p = 0.04) after adjustment for Simplified Acute Physiology Score III, surgical admission and alcoholism. CONCLUSIONS: Combined non-pharmacological interventions reduced delirium in critically ill patients, compared to standard care. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC), Identifier RBR-6xq95s, October 03, 2018.

Prevention and monitoring of delirium in older adults: an educational intervention. / Prevenção e monitorização do delirium no idoso: uma intervenção educativa.

OBJECTIVE: to conduct an educational intervention with the nursing team members of an intensive care unit (ICU), aiming to increase knowledge and to introduce improvements in their practices regarding prevention and monitoring of delirium in older patients. METHOD: this is an action research, in which workshops were conducted with eleven nurses and a nursing technician from an ICU unit in Salvador, Bahia, Brazil. RESULTS: ten problems regarding nursing practices for prevention and monitoring of delirium were identified. Educational, practical, technical, and managerial actions were planned, involving cross-sector connections for planning ways to solve these problems. The groups reported significant changes in the practices, with the implementation of drug-free measures for preventing and managing the situation. CONCLUSION: the educational intervention contributed to improve the nursing practices in the ICU unit studied, and it also favored the development of critical thinking about the problems mentioned, thus enabling permanent review of offered treatments.

Prevenção e monitorização do delirium no idoso: uma intervenção educativa / Prevención y monitorización del delirium en personas mayores: intervención educative / Prevention and monitoring of delirium in older adults: an educational intervention

RESUMO Objetivo: realizar uma intervenção educativa com membros da equipe de enfermagem de uma unidade de terapia intensiva (UTI), com vistas a ampliar o conhecimento e introduzir melhorias nas suas práticas de prevenção e monitorização do delirium nos pacientes idosos. Método: pesquisa-ação em que foram realizadas oficinas com onze enfermeiras e uma técnica em enfermagem de uma UTI de Salvador, Bahia-Brasil. Resultados: dez problemas relacionados a práticas de enfermagem para prevenção e monitorização do delirium foram identificados. Planejaram-se ações de caráter educativo, prático, técnico e gerencial, envolvendo a articulação intersetorial para o equacionamento desses problemas. O grupo relatou mudanças significativas nas práticas, com a implementação de medidas não farmacológicas para prevenção e gestão do quadro. Conclusão: a intervenção educativa contribuiu para a melhoria nas práticas da enfermagem da UTI pesquisada, assim como favoreceu o desenvolvimento da consciência crítica acerca da problemática levantada, possibilitando a revisão permanente do cuidado ofertado.

RESUMEN Objetivo: realizar intervención educativa en un personal de enfermería de una unidad de cuidados intensivos (UCI), con el objetivo de ampliarles conocimiento e introducirles mejoras en sus prácticas de prevención y monitorización del delirium al tener a las personas mayores como pacientes. Método: investigación-acción en la que se llevaron a cabo talleres con 11 enfermeras y 1 técnica de enfermería de una UCI de Salvador de Bahía. Resultados: se identificaron diez problemas relacionados a las prácticas de enfermería en la prevención y monitorización del delirium. Se planearon acciones educativas, prácticas, técnicas y de gestión, que implican la articulación intersectorial en la resolución de los problemas. El grupo señaló cambios significativos en las prácticas, con la implementación de medidas no farmacológicas para prevenir y gestionar el cuadro clínico. Conclusión: la intervención educativa contribuyó a la mejora de las prácticas de enfermería en la UCI investigada, así como le permitió desarrollar al personal la consciencia crítica sobre el problema, lo que les posibilita una revisión permanente del cuidado prestado.

ABSTRACT Objective: to conduct an educational intervention with the nursing team members of an intensive care unit (ICU), aiming to increase knowledge and to introduce improvements in their practices regarding prevention and monitoring of delirium in older patients. Method: this is an action research, in which workshops were conducted with eleven nurses and a nursing technician from an ICU unit in Salvador, Bahia, Brazil. Results: ten problems regarding nursing practices for prevention and monitoring of delirium were identified. Educational, practical, technical, and managerial actions were planned, involving cross-sector connections for planning ways to solve these problems. The groups reported significant changes in the practices, with the implementation of drug-free measures for preventing and managing the situation. Conclusion: the educational intervention contributed to improve the nursing practices in the ICU unit studied, and it also favored the development of critical thinking about the problems mentioned, thus enabling permanent review of offered treatments.

Conhecimentos e práticas da equipe de enfermagem para prevenção e monitorização do delirium em idosos / Knowledge and practice of the nursing team for the prevention and monitoring of delirium in the elderly

Objetivo: verificar conhecimentos e práticas da equipe de enfermagem de uma Unidade de Terapia Intensiva(UTI) acerca do cuidado ao idoso para prevenção e monitorização do delirium. Método: pesquisa-ação com noveenfermeiras e uma técnica em enfermagem. Os dados foram coletados em uma oficina pedagógica e utilizou-sea análise de conteúdo. Resultados: as entrevistadas demonstraram conhecimento superficial sobre a manifestaçãodo delirium, expresso por agitação, falas desconexas, alucinações e perda súbita de memória. Informaram apenasa necessidade de medidas de reorientação para prevenir novos episódios e o uso de antipsicóticos/sedativose imobilização no leito para controle do quadro. Na prática, detectam a disfunção exclusivamente mediantesinais clínicos, a previnem com reorientação e promoção do sono e controlam o quadro com contenção físicae medicamentos prescritos. Conclusão: as participantes mostraram conhecimento incipiente sobre a temática,o que repercute diretamente nas práticas efetuadas para prevenção e monitorização do delirium na unidade locus.

Objective: to verify the knowledge and practices of a nursing team from an Intensive Care Unit (ICU) regarding thecare to elderly patients in order to prevent and monitor delirium episodes. Method: this is an action-research, witha sample of nine nurses and one nurse technician. The data was collected in a pedagogical workshop, and theanalysis of content was used. Results: the interviewees demonstrated superficial understanding regarding the eventsof delirium, which can be observed by moments of excitement, disconnected discourse, hallucinations, and suddenmemory loss. They only informed the necessity to take action to bring the patient back to his normal state in order toprevent further events, and the use of antipsychotics/sedatives and immobilization in bed to control the event. Underthe practices described, the authors detected a dysfunction exclusively on the clinical signs, which they prevent in re-orientations and in the promotion of sleep, and control the event by physically restraining the patient and byadministrating the prescribed medication. Conclusion: the participants demonstrated an incipient understanding onthe topic, which reflects directly in the practices performed to prevent and monitor the delirium in the studied location.

Objetivo: verificar conocimientos y prácticas del equipo de enfermería de una unidad de terapia intensiva (UTI)acerca del cuidado al anciano para prevención y monitorización del delirium. Método: investigación-acción connueve enfermeras y una técnica en enfermería. Los datos fueron colectados en un taller pedagógico y se utilizó elanálisis de contenido. Resultados: las entrevistadas demostraron conocimiento superficial sobre la manifestacióndel delirium, expresado por agitación, conversaciones desconectadas, alucinaciones y perdida súbita de memoria.Informaron apenas la necesidad de medidas de reorientación para prevenir nuevos episodios y el uso de antipsicóticos/sedativos e inmovilización en cama para control del cuadro. La práctica, detectan la disfunciónexclusivamente mediante señales clínicas, la previenen con reorientación y promoción del sueño y controlan elcuadro con contención física e medicamentos prescritos. Conclusión: las participantes mostraron conocimientoincipiente sobre la temática, lo que repercute directamente en las prácticas efectuadas para prevención ymonitorización del delirium en la unidad locus.