Effectiveness of Implementing Clinical Practice Guidelines for Delirium Prevention and Management in Critically Ill Patients

Abstract

          Delirium, a common condition in critically ill patients, is the cause of more serious illness and delayed recovery of patients. Therefore, this symptom should be prevented and managed properly. The purpose of this implementation research was to determine the effectiveness of clinical practice guidelines (CPGs) for prevention and management of delirium in critically ill patients. The participants were critically ill patients who were admitted to the surgical intensive care unit and medical intensive care unit. The two groups of patients included: 1) 46 critically ill patients who were admitted to the intensive care unit (ICU) before implementation of CPGs, and 2) 43 critically ill patients who were admitted to the ICU during implementation of CPGs. The study framework was based on the CPG implementation and the strategy utilization of clinical practice guidelines of the Australian National Health and Medical Research Council. The study was conducted from December 2021 to April 2022. The data collection instruments were composed of 1) The Process Outcome Evaluation Form and 2) The Patient Outcome Evaluation Record Form. The data were analyzed using descriptive statistics.
          The results revealed that:
          1. The percentage of patients receiving all aspects of preventive care for delirium and patients receiving appropriate and accurate management when experiencing delirium in the CPG implementation group was more than the group before CPG implementation, in terms of: 1) appropriate assessment of the risk factors for acute delirium for the first time within 24 hours of being admitted to the ICU and continued daily assessment (100%), whereas the group before CPG implementation was not assessed at all; 2) appropriate assessment of delirium for the first time within 24 hours of being admitted to the ICU (100%) and receiving continuous assessment at least once per shift (98.37%), whereas the group before CPG implementation was not assessed at all; 3) reorientation (100% and 34.44%); 4) promoting vision and hearing problems in people with disabilities (91.67% and 66.67%); 5) managing sedation (100%), whereas for the group before CPG implementation, this was not implemented at all; 6) early mobilization (97.13% and 43.42%); and 7) early weaning from mechanical ventilation (77.59% and 64.84%).
           2. The percentage of patients receiving appropriate and accurate management when experiencing delirium in the CPG implementation group was more than the group before CPG implementation. In particular, the delirium’ patients were received correctly and physically restrained in an appropriate manner (74.19% and 47.54%).
            3. The incidence rate of delirium in the CPG implementation group was less than that of the group before CPG implementation (18.60% and 23.91%), and the incidence rate of adverse events from delirium in the CPG implementation group was also less than that of the group before CPG implementation (37.50% and 81.82%).
            The findings of this study confirm that implementing CPGs for delirium prevention and management in critically ill patients yields positive patients’ outcomes by decreasing the incidence rate of delirium and adverse events. Therefore, the outcomes of CPGs implementation should be proposed to hospital administrative committees for continued use of these CPGs and for further expansion into other intensive care units.