“Incidence, risk factors and consequences of ICU delirium” discusses the impacts of delirium in the ICU patient (Ouimet, Kavanagh, Gottfried, & Skrobik, 2007). According to this study, 31.8% of patients reviewed suffered from delirium; delirium was linked to increased ICU stay, longer hospitalization, and increased patient mortality. The risk of delirium was increased in patients who received sedatives and analgesics. Delirium was also more highly associated with hypertension, alcoholism, and severity of illness.
It is interesting to note that this article cited a different study that reported delirium in up to 80% of patients. This is significantly higher than the result of this article, which found an occurrence of 31.8%. This demonstrates potential inconsistencies in scoring tools and inclusion/exclusion criteria across various studies.
As an ICU nurse, I find it very frustrating when there is a discrepancy between what evidence-based literature reports and what is practiced clinically. ICU patients are routinely given sedatives and analgesics to manage pain while patients are on highly invasive and painful therapies such as ventilators, balloon pump therapy, hypothermic therapy, etc. Acknowledging the data presented in the articles reviewed for this week’s discussion, I pose the question regarding potential solutions and alternatives to this problem? Yes, of course we want to wean the patient off sedation as soon as possible, but when critical patient warrants such medications, what is the alternative? Is it potential to reduce delirium more beneficial to a patient than managing the risk of extensive pain or self-extubation?
To share a story that happened just this past week, my unit was caring for a post op open heart patient CABG x3 vessels with extensive pulmonary disease. This patient was extremely hemodynamically unstable, on high ventilator support, and extremely agitated. Without going into much more detail, this patient was on two sedative drips, and still his agitation was uncontrolled. This patient ended up pulling out his endotrachael tube and needed to an emergency reintubation. The surgeon was extremely upset and ordered a third sedative for this patient. Knowing the data associated with sedation and delirium, would this order be beneficial to the patient? Lack of adequate sedation led (in part) to the self-extubation from which could have had fatal consequences.
Ouimet, S. , Kavanagh, B. , Gottfried, S. , & Skrobik, Y. (2007). Incidence, risk factors and consequences of icu delirium. Intensive Care Medicine, 33(1), 66-73.
As with any aspect in nursing, technology can be effectively used if utilized in the appropriate manners and can benefit in patient care and safety. I think that healthcare professionals should be open to change and embrace technology, because that is the direction that the healthcare field has already taken. Those who are not flexible to adapt to these changes will be faced with struggles in the future.
An example that comes to mind involves the use of paperless charting and electronic physician orders at the facility that I currently work at. A few years ago, these changes were implemented at my hospital. Yes, it was a struggle to adapt and with any new changes there were hiccups in the process along the way. But eventually, we collectively reached out goal of paperless charting, electronic medication administration, and physician-entered orders. These changes help promote patient safety because of safeguarding against medication errors, and reducing the risks of incorrect orders via telephone or verbal orders. Charting is also more effective and easier to manage.
Another use of technology that promotes patient well-being is the increasing access to their own medical records. Patients can have access to their laboratory values, diagnostic exams, and have electronic methods of contacting their care providers with questions and follow up information.
My name is Vy Do (Pronounced Vee Doe). It’s ok if you still pronounce it wrong, I will respond to anything that sounds close to it. I am an RN at Glendale Adventist Medical Center in Surgical Intensive Care. We care for primarily for open heart, neuro, and surigcal patients. I have been an RN for 2.5 years. I did my ADN at College of the Canyons, and I also have my BA in Communication Studies from CSU Northridge. After I finish my BSN, I plan to take a (long) break from school. In the future, I would like to pursue clinical education.
Outside of work and school (in the whole 2 hours that remain in the week) I like to cook and binge watch Netflix. I also like to travel, and I’m going to Chicago and New York in the next few months.