Early recognition of delirium in trauma patients.

OBJECTIVE: Evaluate change in practice and beliefs regarding delirium among nurses, pharmacists, respiratory therapists and physicians in a trauma intensive care unit. METHODOLOGY/DESIGN/SETTING: Descriptive pre and post-design at a Level One Trauma Center. Education on causes of delirium, risk factors, strategies to prevent delirium and routine screening. OUTCOME MEASURES: Change in practice and beliefs regarding delirium. RESULTS: McNemars test measured the differences between pre- and post-questionnaires comparing the proportion of staff changed their responses in one direction to those who went in the opposite direction. Changes in "Delirium is largely preventable", were statistically significant (p=0.035). Haldol was the medication of choice for treating delirium, with an increase in use (p=0.062) post-intervention. The majority of participants believed a high percentage of patients experience delirium in a trauma intensive care. The two most frequent medical complications associated with delirium pre-questionnaire was over sedation 8 (22%) and falls 9 (24%) and in post-questionnaire, over sedation 12 (26%) and falls 13 (28%). CONCLUSIONS: An educational intervention emphasising the importance of screening for delirium, risk factors for delirium and approaches to decrease the incidence of delirium can improve identifying and correctly treating delirium in a critical care setting. An educational program had concrete results in respondents' knowledge about delirium.

A non-pharmacologic approach to decrease restraint use.

AIMS: To evaluate an education intervention to decrease restraint use in patients in a Trauma Intensive Care Unit (TICU) and to evaluate nurses' perceptions regarding restraints. OBJECTIVES: To measure restraint use pre/post-intervention and to measure nurses' perceptions of restraint use. METHODS: Pre/post-intervention design to collate incidences of delirium and restraints pre/post-intervention. Data reporting nurses' views and preferences were collected pre-intervention. MEASURES: Patients were assessed by nursing on admission and every shift with the Confusion Assessment Method for TICU. Restraint use was measured in a 24-hour period. Nurses' perception of restraints was measured using Perceptions of Restraint Use Questionnaire (PRUQ). RESULTS: A statistically significant difference was demonstrated in restraint use before and after the educational intervention. Mean and standard deviation for restraints per 1000 patient days pre-intervention was 314.1 (35.4), post-intervention 237.8 (56.4) (p=0.008). Mean PRUQ overall, 3.57 (range 1-5) indicated that nurses had positive attitudes towards restraints in certain circumstances. The primary reasons for using restraints were: "protecting patients from falling out of bed", 37 (72.5%), and "protecting patients from falling out of chair", 34 (66.7%). CONCLUSION: This study demonstrates that a low risk educational intervention aimed at use of an alternative device use can reduce restraint use.