Research

Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside

John W Devlin^1,2 , Francois Marquis³ , Richard R Riker⁴ , Tracey Robbins⁴ , Erik Garpestad⁵ , Jeffrey J Fong^1,2 , Dorothy Didomenico⁶ and Yoanna Skrobik³

¹  School of Pharmacy, Northeastern University, 360 Huntington Avenue, Boston, MA 02118, USA

²  Department of Pharmacy, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, USA

³  Department of Critical Care Medicine, Maisoneuve-Rosemont Hospital, 5415 de l'Assomption, Montreal, QC H1T 2M4, Canada

⁴  Department of Critical Care Medicine, Maine Medical Center, Portland, ME 04102, USA

⁵  Division of Pulmonary, Critical Care and Sleep Medicine, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, USA

⁶  Department of Nursing, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, USA

author email corresponding author email

Critical Care 2008, 12:R19doi:10.1186/cc6793

Published:	21 February 2008

Abstract

Background

While nurses play a key role in identifying delirium, several authors have noted variability in their ability to recognize delirium. We sought to measure the impact of a simple educational intervention on the ability of intensive care unit (ICU) nurses to clinically identify delirium and to use a standardized delirium scale correctly.

Methods

Fifty ICU nurses from two different hospitals (university medical and community teaching) evaluated an ICU patient for pain, level of sedation and presence of delirium before and after an educational intervention. The same patient was concomitantly, but independently, evaluated by a validated judge (ρ = 0.98) who acted as the reference standard in all cases. The education consisted of two script concordance case scenarios, a slide presentation regarding scale-based delirium assessment, and two further cases.

Results

Nurses' clinical recognition of delirium was poor in the before-education period as only 24% of nurses reported the presence or absence of delirium and only 16% were correct compared with the judge. After education, the number of nurses able to evaluate delirium using any scale (12% vs 82%, P < 0.0005) and use it correctly (8% vs 62%, P < 0.0005) increased significantly. While judge-nurse agreement (Spearman ρ) for the presence of delirium was relatively high for both the before-education period (r = 0.74, P = 0.262) and after-education period (r = 0.71, P < 0.0005), the low number of nurses evaluating delirium before education lead to statistical significance only after education. Education did not alter nurses' self-reported evaluation of delirium (before 76% vs after 100%, P = 0.125).

Conclusion

A simple composite educational intervention incorporating script concordance theory improves the capacity for ICU nurses to screen for delirium nearly as well as experts. Self-reporting by nurses of completion of delirium screening may not constitute an adequate quality assurance process.