According to the article Delirium in Critically Ill Patients, ICU delirium affects 16-89% of all ICU patients, with the wide range attributed to ineffective delirium assessment on admission, lack of training for the medical staff, and the implementation of different sedation and analgesia protocols (Zaal & Slooter, 2012).  Those at a higher risk include the elderly, patients with pre-existing cognitive decline, history of alcohol abuse, sepsis, and immobility.

Although the cause of ICU delirium is unclear, Zaal and Slooter (2012) suggest that an alteration in neurotransmitter activity may be at fault, as patients with ICU delirium show a decrease in acetylcholine activity, resulting in disturbed pathways involving attention, concentration, and learning.  Another hypothesis is that delirium is caused by an aberrant stress response, in which the body releases an excess amount of stress hormones that cross the blood-brain barrier, resulting in cognitive impairment (Zaal & Slooter, 2012).

Early screening of ICU patients—with tools such as the intensive care delirium screening checklist (ICDSC) or the confusion assessment method (CAM-ICU)—results in better prognoses for those suffering with delirium.  Zaal and Slooter (2012) report that repeated re-orientation, early mobilization, noise reduction, and less interruptions during sleep are effective measures that reduce delirium by 40%.  Pharmacologically, intravenous low-dose Haloperidol is the drug of choice, as it has shown to decrease delirium in 23% of ICU patients (Zaal & Slooter, 2012).

Prior to researching this topic, I had no idea ICU delirium existed.  However, after reading the articles and watching Anthony Russo’s video, it is clear that more research is needed to not only prevent ICU delirium, but also to effectively treat and provide adequate ongoing psychological help—long after discharge—to those patients in need.

Reference:

Zaal, I. J., Slooter, A. J. C. (2012). Delirium in critically ill patients: Epidemiology, pathophysiology, diagnosis and management. Drugs, 72(11), 1457-1471. Retrieved from http://eds.a.ebscohost.com.summit.csuci.edu:2048/ehost/detail/detail?

Digital technology is increasingly playing an important role in facilitating the delivery of patient care, with everything from electronic health records to phone applications that allow health care providers to quickly research a disease or look up side effects to a new diabetic medication, for example.  As someone that embraces technology, I have always incorporated it into my nursing career.  As a nursing student, I always had my drug guide, lab book, and Taber’s Encyclopedia—among other applications—on my smart phone for easy access which saved time, especially during clinical rotations, and significantly reduced my stress level.  Currently, I use several mobile applications, including epocrates, to help manage and educate my Hepatitis C patients and ensure my warfarin patients maintain therapeutic INR levels.

There are, however, drawbacks to the new digital era, such as ineffective staff training regarding new electronic health records and equipment. In 2011, a nurse, who misunderstood a confusing pop-up on a new glucometer, accidentally administered insulin to a hypoglycemic patient, causing the patient to go into a diabetic coma (Rice, 2014).  In 2013, a hospitalized patient did not receive his psychiatric medication for three weeks, as the computer system was programmed to discontinue certain medications after a predetermined time (Rice, 2014).   These examples point to the importance of effective staff training, given different individual learning curves and willingness to adapt to change. Rice (2014) suggests the implementation of a national surveillance system for reporting technological problems to help other healthcare providers learn from previous experiences, which would result in better integration of new technologies.  Despite these setbacks, it is crucial to adapt to the digital era, as digital technology will continue to flourish and impact the medical field in the years to come.

Reference:

Rice, S. (2014). New medical technology poses safety problems if users not trained properly. Modern Healthcare. Retrieved   from http://www.modernhealthcare.com/article/20140816

 

 

Hello, my name is Hugo Ortiz and I graduated from Ventura College in 2011 with my ADN.  After passing the boards, I was hired at Sierra Vista Family Medical Clinic, a VCMC-affiliated ambulatory clinic in Simi Valley, as a back office supervisor.  At the time, I supervised a team of thirteen medical assistants, three LVNs, and two phlebotomists for about six months before being promoted to Nursing Supervisor.  As Nursing Supervisor, I headed the new case management program with at team of three registered nurses.  Currently, I case manage all Coumadin and Hepatitis C patients, as well as supervise the RN case managers. Other duties include interviewing, hiring, training, and disciplining staff, as well as providing the nurses and back office supervisor with their yearly evaluations/reviews. Eventually, I’d like to become a Nurse Practitioner and work as a family provider at Sierra Vista Clinic.  My two big hobbies include concerts (I try to catch as many as I can) and electronics (gadgets, phones, tablets, computers, game consoles…yes, I’m pretty nerdy).  I also love spending time with my godson who is currently learning to drive, and my dog who I didn’t want at first but can’t live without now.

 

 

 

 

 

 

 

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