On a daily basis, 30,000 to 40,000 ICU patients in the United States suffer from delirium. Delirium is an acute brain dysfunction. It is believed the problem will only get bigger due to the increased age of our population. The article written by Maniou states multiple studies concluded delirium in mechanically ventilated patients is seen in 60-80% of ICU patients. The article also states that each day a patient spends in a state of delirium their risk of death is increased by 10%. Hypoactive delirium may be difficult to diagnose but it is important to recognize it because it may be an early sign of a serious medical condition, such as sepsis, pneumonia, MI, or PE. Delirium may also be linked to longer hospital stays and increased cognitive impairment on discharge. Risk factors associated with delirium include: increased age, severity of disease, use of medications such as psychoactive drugs, opiates and benzodiazepines. Other risks include the patient’s loss of control, loss of personal space, and loss of their ability to communicate. For these reasons it is important for nursing staff to be aware of this medical problem. Nurses must know how to recognize it and how to treat it, as delirium is harmful to patients and costly to hospitals. The Confusion Assessment Method-Intensive Care Unit is the most commonly used method to diagnose delirium, other tools include the delirium check list and The Intensive Care Delirium Screening Checklist. Nurses should be educated on effective methods to identify patients at increased risk for delirium, how to asses for delirium and appropriate interventions to manage the medical problem.

I do agree with the article. Medicine has many new advances and people are living longer than before. The older population is more fragile and sensitive, thus increasing their risk for delirium. It also seems that patients admitted to the hospital are more fragile and sick then in past years. It is important for all nurses to identity patients at risk, assess and implement nursing interventions to prevent complications. I think the next step needed to bring about awareness of this issue is staff education. As this is a big problem, nursing staff especially nurses caring for patients in ICU should be educated on the issue. I think nurse education is the most important step to identify and treat these patients. Nurses are the primary caregivers and we are the ones who interact with the patients the most. We are in the perfect position to assess and identify patients at increased risk for delirium. We are also in the perfect position to intervene to prevent long term complications.

As a nurse working in med/surg and acute rehabilitation I often encounter older patients who become disoriented when taking narcotics, sleeping and psychoactive medications. I believe that it is important to for all nursing staff not just ICU staff to get educated on delirium. Often the patients change in LOC is not associated or linked to these medications and it is important to recognize it and to be aware of the possible causes to prevent its reoccurrence. As nurses we are the doctor’s eyes and we are also the patient’s advocate and it is our responsibility to monitor, prevent and intervene in these situations. We must prevent long term complications and limit hospital costs.

Recourses

Maniou, M. (2012). Delirium: A distressing and disturbing clinical event in a intensive care unit. Health Science Journal, 6(2) 587-597.

The article : Changing the Sedation Status Quo in the ICU was very interesting to me because it talks about how hospitals are adopting new policies that limit the amount of time a patient is sedated in the ICU. The new treatment methods would allow patients to be awakened from sedation to assess for pain and removing them from a ventilator as soon as possible.  A growing body of research suggests that patients who are heavily sedated in the ICU are suffering from prolonged delirium. This can have long term effects on cognitive function long after the patient leaves the hospital (Landro, 2011).

Hospitals began rethinking the standard of care in the early 1990s, when patients reported suffering from depression, stress and extreme physical limitations linked to therapy they had received in the ICU (Landro, 2011). Studies conducted by Vanderbilt University show that new monitoring techniques will shorten the duration of delirium by decreasing the amount of potent sedatives a patient receives. Research from John Hopkin’s University shows that getting patients up and moving even when still on a ventilator can also prevent the muscle weakness that results when patients lose conditioning from misuse and the body becomes frail. Hospitals now plan to use milder sedation medication and to wean patients off as soon as possible and not put them back under. This will help patients to go home sooner and avoid having to go to a rehabilitation center.

I agree with this article, I think that it is not healthy to have patients sedated for a prolonged amount of time. If there is a way to get them moving sooner I think this would be beneficial for circulation, skin care, and oxygenation. However the research presented here also shows that in addition to the physical reasons there are also psychological reasons to wean patients from section sooner rather than later. Before reading this article and watching the videos, I had no idea that patients were experiencing delirium while sedated in the ICU. Furthermore it is also very concerning to see how the delirium they experienced in the ICU can affect their lives even months to years afterward. Some patients experience PTSD or depression that interferes with their daily lives. I think that if the amount of time a patient can be sedated can be shortened, and they can be ambulated sooner this will be therapeutic for the patient and will help them to recover sooner.

I think that the next step is to implement this practice in more hospitals by training ICU doctors and nurses. Educating healthcare professionals about delirium will help patients to get the support they need sooner.

References:

Landro, L. (2011, February 15). Informed Patient: Changing the Sedation Status Quo in the ICU. Retrieved September 24, 2015, from http://blogs.wsj.com/health/2011/02/15/changing-the-sedation-status-quo-in-the-icu/

Digital technology is exponentially growing in the healthcare setting, including its increase access into the community. New research studies are pinning down ways to utilize the advance technology available, such as in: mobile device apps detecting health effects on academic performance, EKG ambulatory monitor assessments reducing risk of strokes, to simple ear buds that detect heart rate and calories lost as well as other developing trends.

Raney Linck, MSN instructor from Minnesota school of Nursing, has created a blog based on digital trends occurring in nursing and healthcare. It was unique to view his outlook of creating such a blog, however the most recent post is fairly outdated, October of last year. One of his discussions was on mobile health apps (mHealth), being used in research to gather information on student’s overall health by just having the users cellphone in close proximity. Sensor data was collected and organized by the cellphone app installed known as, “StudentLife.” For example, the camera of a phone was able to tell when the lights were turned off in a room, detect the sleeping duration and amount of time a student was in a particular area. I never heard of such a study but it did intrigue my thoughts wondering how I, as a student, would rate among their study from my mental health effects in my academics and how I can improve it based on the data available. It also made me realize with this research how much work it must take to analyze all the data and who was responsible for that role.

It’s incredible how a software may collect accessible data by using a cellular app, however it takes a humans manual manipulation and labor to analyze. Linck brought up a good point, if we have all the data imaginable with increased use of mHealth apps or EKG ambulatory monitoring and other healthcare related vehicles who will analyze the data? Imagine the changes that can evolve if there was a new job description for this role, possibly RN’s to step up in this changing technologic era and utilize the data for improving outcomes in the community based on the set of identified problem areas.

Nursing will always have a necessity to become socially mindful with using newly updated software’s, applications and programs being used in their facility. Such as with documenting healthcare information in patient care for reimbursements from Medicare and Medicaid. Then there is nursing assessments logged on the computer that allow easy access to trends in patient data such as their labs or imaging, MD/RN progress notes providing a larger picture of the entire patient. It may play a con with documentation say if there is downtime/power outage, I believe not all paper charting should be excluded as we will  eventually need the reliable paper and pen practices in a critical event. The public has become more proactive in their care including the assistance of increased availability to their own medical records from home.

Another interesting study from an Australia, Concord Hospital are participating in this new technology advancement creating wristbands that record the patients vital signs including oxygen saturation which electronically sends to patients medical electronic record instantaneously. They plan to expand their line product to over 27 hospitals over the next three years, allowing benefits for safe and efficient patient care saving time and reducing human error (ANMJ, 2015). The information sought out during this search of the digital trends shows how technology can have meaningful use ensuring quality and safety while improving care communication and management.

References:

ANMJ. (2015). New wristband technology streamlining patient care. Australian Nursing & Midwifery Journal, 23(1), 5.

Piscotty, R. , Kalisch, B. , & Gracey‐Thomas, A. (2015). Impact of healthcare information technology on nursing practice.Journal of Nursing Scholarship, 47(4), 287-293.

Linck, R. (2014, October 8). Digital trends in nursing. Retrieved September 7, 2015,   from http://digitaltrendsinnursing.blogspot.com/