Delirium is a common complication of pediatric and adult patients in hospitals and other settings, estimated up to every fourth till sixth patient can be affected by delirium. The hyperactive form of delirium is well known to most clinicians, but more dangerous is the hypoactive delirium, leading to more serious consequences. The longer a delirium lasts, the more serious are the consequences. Delirium is associated with impaired rehabilitation, cognitive decline, avoidable events such as falls, restraints, pressure sores, and higher mortality: each day in delirium increases the 1-year mortality by 14%.
The experience of delirium is frightening. Patients often experience hallucinations, vivid dreams, feel kidnapped or in other realities and cannot come back; also families are stressed by loved-ones, being delirious: they try to calm them, but don’t know how, they cannot trust them, they experience sudden changes in behavior and hope that the well-known person would come back. It is a very stressing situation for patients, families, and staff. The treatment of delirium often leads to a de-humanization, with sedative drugs, restraints, longer stay in ICU, and others.
Hence, it is essential to screen patients for delirium frequently and educate patients and families. Person-centered interventions are recommended for prevention and treatment, such as family presence, early mobilization, re-orientation, and of course, provision of hearing-, vision- and mobility aids. But the extend often depends on local structures, processes, and team culture. Delirium related structures and processes can have an impact on prevention and treatment of delirium. The worldwide extent of these structures and processes on delirium remains unknown.
Hence, we would like to assess the worldwide delirium practice and organizational characteristics in wards and Units caring for pediatric and adult institutionalized patients.
We are planning a worldwide, cross sectoral prevalence study on March 15th, 2023. March 15th will be the next World Delirium Awareness Day. Attending clinicians will be asked for data of the structures of their hospitals/ICUs or units and performance of delirium related approach to inpatients. Included are all wards and units from hospitals, rehabilitation facilities and nursing homes, excluded are ambulatory care services (home care). We include patients of all age groups and disciplines, ICUs as general wards but exclude operation theatres. The primary outcome is the general prevalence of delirium in present patients at 8 a.m. and 8 p.m. on that day, and the practice of delirium assessment methods. Secondary outcome parameters are the use of pharmacological and non-pharmacological interventions, presence of protocols, interprofessional education, and others.
The survey will be electronically via Survey Monkey, and will take 15 minutes plus assessment of delirium data for each ward/unit. The study is registered and has a first ethic approval in Germany (more approvals are ongoing in different countries).
The survey will explore current practices of delirium management in institutions worldwide. Sub-analysis will be feasible for single countries and other conditions, allowing a bench-marking for quality improvement projects and evaluations.
The study is led by Heidi Lindroth, RN PhD from USA, Keibun Liu, MD PhD from Australia, and Peter Nydahl, RN PhD from Germany. The website is www.wdad-study.center
The study has no funding but a lot of highly motivated professionals. If you are interested, please fill this form (dead line September 30th): https://proyectohuci.com/es/investdelirium/
Raising awareness for delirium supports the humanization of critical care.
By Peter Nydahl
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