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A multicentre point prevalence study of delirium assessment and management in patients admitted to Australian and New Zealand intensive care units
Melissa J Ankravs, Andrew A Udy, Kathleen Byrne, Serena Knowles, Naomi Hammond, Manoj K Saxena, Michael C Reade, Michael Bailey, Rinaldo Bellomo, Adam M Deane, On behalf of the George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group
Crit Care Resusc 2020; 22 (4): 355-360
- Melissa J Ankravs 1, 2, 3
- Andrew A Udy 4, 5
- Kathleen Byrne 2
- Serena Knowles 6
- Naomi Hammond 6, 7
- Manoj K Saxena 6, 8
- Michael C Reade 9, 10
- Michael Bailey 1, 5
- Rinaldo Bellomo 1, 2, 5, 11
- Adam M Deane 1, 2
- On behalf of the George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group 12
OBJECTIVE: To characterise the assessment and management of delirium in patients admitted to intensive care units (ICUs) in Australia and New Zealand.
METHODS: We conducted a multicentre observational point prevalence study across 44 adult Australian and New Zealand ICUs. Data were extracted for all patients in the ICU in terms of assessment and treatment of delirium. ICU-level data were collected regarding the use of explicit protocols related to delirium.
RESULTS: We studied 627 patients, with 54% (336/627) having at least one delirium screening assessment performed. The Confusion Assessment Method for the ICU (CAM-ICU) was the most frequently used tool (88%, 296/336). Of patients assessed, 20% (68) were identified to have delirium. Eighteen per cent (111) of patients were administered a drug to manage delirium, with 41% (46) of those receiving a drug having no recorded assessment for delirium on that day. Of the drugs used to treat delirium, quetiapine was the most frequently administered. Physical restraints were applied to 8% (48/626) of patients, but only 17% (8/48) of such patients had been diagnosed with delirium. Most physically restrained patients either did not have delirium diagnosed (31%, 15/48) or had no formal assessment recorded (52%, 25/48) on that day.
CONCLUSIONS: On the study day, more than 50% of patients had a delirium screening assessment performed, with 20% of screened patients deemed to have delirium. Drugs that are prescribed to treat delirium and physical restraints were frequently used in the absence of delirium or the formal assessment for its presence.
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Institution where the work was performed
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Of the patients who had at least one delirium assessment performed on the study day, delirium was present in 20% (68/336), representing 11% of all patients from the study day. For most patients diagnosed as delirious, the type of delirium was not specified, but when specified, hyperactive delirium was the most frequent manifestation recorded (Table 2).