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Implementation of a delirium assessment tool in the ICU and its effect on haloperidol use

Van den Boogaard, M., Pickkers, P., van der Hoeven, H., Roodbol, G., van Achterberg, T. and Schoonhoven, L. (2009) Implementation of a delirium assessment tool in the ICU and its effect on haloperidol use Critical Care, 13, (4) (doi:10.1186/cc7991). (PMID:19664260).

Record type: Article

Abstract

Introduction
In critically ill patients, delirium is a serious and frequent disorder that is associated with a prolonged intensive care and hospital stay and an increased morbidity and mortality. Without the use of a delirium screening instrument, delirium is often missed by ICU nurses and physicians. The effects of implementation of a screening method on haloperidol use is not known. The purpose of this study was to evaluate the implementation of the confusion assessment method-ICU (CAM-ICU) and the effect of its use on frequency and duration of haloperidol use.

Methods
We used a tailored implementation strategy focused on potential barriers. We measured CAM-ICU compliance, interrater reliability, and delirium knowledge, and compared the haloperidol use, as a proxy for delirium incidence, before and after the implementation of the CAM-ICU.

Results
Compliance and delirium knowledge increased from 77% to 92% and from 6.2 to 7.4, respectively (both, P < 0.0001). The interrater reliability increased from 0.78 to 0.89. More patients were treated with haloperidol (9.9% to 14.8%, P < 0.001), however with a lower dose (18 to 6 mg, P = 0.01) and for a shorter time period (5 [IQR:2–9] to 3 [IQR:1–5] days, P = 0.02).

Conclusions
With a tailored implementation strategy, a delirium assessment tool was successfully introduced in the ICU with the main goals achieved within four months. Early detection of delirium in critically ill patients increases the number of patients that receive treatment with haloperidol, however with a lower dose and for a shorter time period.

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More information

Published date: 10 August 2009
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 339232
URI: http://eprints.soton.ac.uk/id/eprint/339232
ISSN: 1364-8535
PURE UUID: 996c68ae-7785-46fc-95c5-602f8f384390
ORCID for L. Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

Catalogue record

Date deposited: 28 May 2012 14:13
Last modified: 18 Jul 2017 05:53

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Contributors

Author: M. Van den Boogaard
Author: P. Pickkers
Author: H. van der Hoeven
Author: G. Roodbol
Author: T. van Achterberg
Author: L. Schoonhoven ORCID iD

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