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Am J Crit Care. 2014 Jan;23(1):60-9. doi: 10.4037/ajcc2014567.

Decreasing inappropriate unable-to-assess ratings for the confusion assessment method for the intensive care unit.

Author information

  • 1Joshua T. Swan is an assistant professor of pharmacy practice at the College of Pharmacy and Health Sciences, Texas Southern University, a clinical pharmacist specialist at Houston Methodist Hospital, and a clinical research scholar in the Center for Outcomes Research in the Department of Surgery at Houston Methodist Research Institute, Houston, Texas.

Abstract

BACKGROUND:

The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a validated tool for diagnosing delirium in the ICU and yields 1 of 3 ratings: positive, negative, and unable to assess (UTA). It was hypothesized that an educational campaign focused on establishing patients' arousal as comatose versus noncomatose before initiating the CAM-ICU would decrease the incidence of inappropriate UTA ratings.

OBJECTIVES:

To compare the incidence of inappropriate UTA ratings before and after an educational campaign.

METHODS:

An interventional, quasi-experimental study was conducted in a surgical ICU at a tertiary academic medical center. A nursing educational campaign was conducted from March 1 to March 7, 2012. Patients admitted to the surgical ICU from December 25, 2011 through January 25, 2012 were included in the baseline cohort, and patients admitted from March 9 through April 9, 2012 were included in the posteducation cohort. Inclusion criteria were admission to the surgical ICU for at least 24 hours and at least 1 CAM-ICU assessment.

RESULTS:

The baseline cohort included 93 patients and the posteducation cohort included 96 patients. Patients were 41% less likely to receive an inappropriate UTA rating after the educational campaign (32% [30 of 93] baseline vs 19% [18 of 96], P = .03). Patients with concurrent mechanical ventilation were more likely to receive an inappropriate UTA rating in the baseline cohort (odds ratio, 30.7; 95% CI, 8.9-105.9; P < .001) and the posteducation cohort (odds ratio, 15.5; 95% CI, 4.1-59.5; P < .001).

CONCLUSION:

The educational campaign decreased the incidence of inappropriate UTA ratings.

PMID:
24382618
[PubMed - indexed for MEDLINE]
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