Delirium identification, prevention and management in intensive care units in England, Wales and Northern Ireland: a survey of practice.

Abstract

INTRODUCTION Delirium is the most common sign of acute brain dysfunction and is prevalent in ICUs. This work is part of a UK National Institute of Health and Social Care Research-funded Programme Development Grant to identify optimal approaches to prevent, identify and manage ICU delirium in the UK. This survey aimed to provide a baseline for contemporary practice. METHODS A structured online survey was designed and sent to all ICUs in England, Wales and Northern Ireland, identified through the Intensive Care National Audit and Research Centre Case Mix Programme. Participants were asked to provide a response that reflected ICU-level care. RESULTS The ICU participant response rate was 249/268 (93%). Of these, 222/249 (89%) ICUs screened for ICU delirium routinely and 208/222 (94%) used the CAM-ICU tool. Delirium care packages were applied by 125/249 (50%) ICUs, but 81/125 (68%) conveyed that this was not consistent for all patients. Both antipsychotics and benzodiazepines are used commonly to manage delirium. All respondents stated that early mobilisation; early removal of invasive catheters; maintenance of hearing aids/glasses; regular mealtimes; and daytime activity were used as non-pharmaceutical delirium management strategies. Enhanced follow-up was reported by 195/249 (79%) respondents, either routinely or for selected cases. DISCUSSION Only half of UK ICUs use a standardised care package to prevent and manage ICU delirium, with inconsistent implementation. Future work should focus on the development and evaluation of an evidence-based and sustainable care package.