Increasing Awareness for Decreasing Risk
Increasing Awareness for Decreasing Risk
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04/11/2020
Downloadedfromhttps://journals.lww.com/dccnjournalbyBhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD31kf1ZzWr4Xt4spjeLaFW09K6PmSZRH+Gi5FFF1n9fjo=on04/11/2020
Delirium and Dementia in the Intensive Care Unit Increasing Awareness for Decreasing Risk, Improving Outcomes, and Family Engagement
Jennifer Volland, DHA, RN, CPHQ, NEA-BC, FACHE; Anna Fisher, DHA, CDP; Diane Drexler, MBA, BSN, RN, FACHE
Longer stays in the intensive care unit (ICU) can be an opportunistic
battlefield where not only is the length of stay longer, but also there is
increased time that lapses with the potential for a patient fall, nosocomial
infection, urinary tract infection, and other untoward events (http://
oig.hhs.gov/oei/reports/oei-06-09-00090.pdf ; ASHRM Forum.
2014;Q3:10-14). As such, the push has become for shorter lengths of
stay whenever possible. Delirium and dementia are 2 conditions that the
ICU clinician must remain diligent in monitoring for status changes.
Delirium poses the threat of longer-term undesirable outcomes and is a
potential inherent risk in the care delivered. It rises to the level of a medical
emergency that can be deadly but, when caught early, can be treated and
resolved (Science Daily, September 16, 2013). Setting expectations with
families, providing adequate education, and involving them in a holistic
view of patient-centered care can help toward the detection of differences
that may occur from an ICU stay. Interventions the ICU clinician can take
for increasing self, patient, and family awareness to decrease risk and
improve outcomes and ways to deepen family engagement in these
populations are explored with practical applications.
Keywords: Assessment, Delirium, Dementia, Documentation errors,
Family engagement, ICU psychosis, Implications of extended ICU stay,
Improved outcomes
[DIMENS CRIT CARE NURS. 2015;34(5):259/264]
An intensive care unit (ICU) visit is a stressful time for patients and families. Added to the depersonalization of a hospital gown, unpredictability through changing of routines, and uncertainty of self-preservation, a patient is
tossed into a state of disempowerment. Medications become administered by a nurse that had been independently taken at home, privacy can become compromised with changing from a home-like setting to a group environment, and often
DOI: 10.1097/DCC.0000000000000133 September/October 2015 259
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