The Feasibility of Implementing a Tailored Delirium Prevention Bundle for Intensive Care Units (ICU) from Registered Nurses Perspective.

Abstract

Background: Delirium is a clinical mental disturbance characterized as a transient, often reversible, alteration in consciousness, cognition, or perception. Delirium and sleep deprivation are two clinical syndromes commonly encountered in intensive care Units (ICU). Given the complexity of the shared mechanism and the interactions of the previously mentioned conditions, the relationship between these two phenomena has never been fully understood. While sleep deprivation is thought to be a risk factor for delirium, it is also likely that delirium itself contributes to sleep deprivation (Watson et al., 2012). The feasibility of implementing a non-pharmacological delirium prevention has never been studied in Lebanon. Aim: The aim of this study was to assess the feasibility and barriers of implementing a tailored delirium prevention bundle into nurses' day-to-day practice from a nurse's perspective. Methods: A descriptive correlational study design was used. The study was conducted at the intensive care, neuro-intensive care, coronary care and respiratory care units of the American University of Beirut Medical Center (AUBMC). The target population included all critical care nurses working at the previously mentioned units at AUBMC. The institutional review board (IRB) and AUBMC administration approvals to conduct the study were secured. An online survey was sent to the nurses, including demographic questions, and delirium knowledge questions. In addition, we asked the nurses about their perceived feasibility and barriers to implement the sleep assessment tool and our proposed delirium prevention bundle. Analysis: Statistical analysis included descriptive statistics (means and standard deviations, and frequencies and percentages, depending on the level of measurement). Bivariate analyses included Mann Whitney and Kruskal Wallis tests to examine associations between variables. Results: Our total sample size was 31 with a response rate of 40%. Our sample consisted more of males than females, and were aged mainly between 26-30 and 36 to 40, 60% of our nurses were ICU staff, most of our responder had a bachelor degree in nursing. As for years of experience most of the nurses had between 4 to 6 or 10 to 13 2 years of experience. Almost three forth of the nurses stated that they currently not using any tool to assess sleep. The total feasibility score of this sleep assessment tool was 3.82(0.13) indicating that it’s somewhat feasible as perceived by the nurses. Total feasibility score for the delirium prevention bundle was 3.6 indicating its feasibility as perceived by the critical care nurses. Inadequate staffing, lack of time, and lack of resources were predominant throughout the study. Conclusion: Delirium is a very serious and, most importantly, preventable syndrome. It has been proven to increase morbidity, mortality, and length of hospitalization. This study highlighted the possibility of implementing a delirium prevention bundle at AUBMC and provided baseline data for setting the ground for implementing the sleep targeted delirium prevention bundle. A positive attitude of nurses toward the implementation of the bundle was noted despite some hesitancy manifested by lower perceived feasibility for some of the tested interventions. This study revealed some barriers that should be tackled before implementation to ensure our critical care nurse’s proper and successful execution and positive outcome