Screening and assessment of delirium in adult intensive care unit patients: a best practice implementation project.

Abstract

Introduction: Delirium affects up to 80% of adult intensive care unit (ICU) patients, resulting in a significant impact on clinical outcomes.

Objectives: This evidence implementation project evaluated and improved adherence to best practice guidelines for delirium screening and assessment in a specialized ICU setting.

Methods: This project used the JBI Evidence Implementation Framework and was conducted in a 10-bed adult neurological ICU in São Paulo, Brazil. Compliance was assessed across seven best practice audit criteria measured at baseline (n = 27) and at follow-up (n = 27). Using JBI's Getting Research into Practice (GRiP) analysis, two primary barriers were identified: nurse knowledge deficits and operational time constraints due to documentation complexity. To address these barriers, micro-learning sessions were conducted using gamification, quick-access electronic health record templates, and visual huddle reminders.

Results: The follow-up audit demonstrated increased compliance across five criteria: daily observation, formal assessment (CAM-ICU), nurse training, clinical prioritization, and complete documentation. Compliance remained unchanged for two criteria: initial risk screening upon ICU admission and immediate observation following a positive screening.

Conclusions: Strategic implementation using gamified education and streamlined workflows successfully bridged knowledge and operational gaps in a high-acuity neurological ICU. Combining active-learning strategies with workflow simplification proved essential for driving sustainable improvements in clinical delirium assessment.

Spanish abstract: https://links.lww.com/IJEBH/A723.