In critically ill patients, delirium is not uncommon. The stress of serious illness or injury has profoundly negative impacts on one’s psychological well-being. According to the University of Maryland Medical Center, delirium consists of rapid changes between emotional or alertness states and an overall sense of confusion. Delirious patients can be dangerous to themselves and others, and they may respond poorly to standard treatments. Previous surveys have indicated that more than half of patients with delirium while in intensive care wards go undiagnosed. Researchers in the Netherlands recently conducted a test to determine if nurses and physicians in an intensive care unit (ICU) could be trained to better identify delirium in their patients. They theorized that better identification of delirious patients might lead to more effective care and less time spent in the ICU.
At the beginning of the study, primary care nurses were given rigorous training in the use of a delirium test called the “confusion assessment method.” This method involved cognitive tasks and interview questions given at regular intervals—typically every 8 hours. Researchers continued providing educational reinforcement until it was clear that all nurses were providing accurate assessments. When delirium was positively identified, Haldol (haloperidol) was administered to ease the symptoms of confusion and agitation. While Haldol does entail some undesirable side effects, such as profound sedation, the clinical benefits are believed to far outweigh the risks for patients with delirium.
The eventual results of the study were very encouraging. Significantly more cases of delirium were identified, leading to equally greater usage of Haldol. However, the implementation of a standard assessment tool meant that patients generally received smaller doses of the medication for shorter periods of time, thus minimizing the unwanted side effects. At the same time, patients who were previously misidentified as delirious did not receive Haldol unnecessarily.
In the past, delirium often went unrecognized and untreated. This problem sometimes severely compromised the overall treatment of patients and almost certainly led to more costly and prolonged stays in ICU. This new protocol allows for a more targeted and effective use of Haldol in managing the ill effects of delirium.
- University of Maryland Medical Center. (n.d.). Delirium. Retrieved March 1, 2012. Available from: http://www.umm.edu/ency/article/000740sym.htm
- Van den Boogaard, M., Pickkers, P., van der Hoeven, H., Roodbol, G., van Achterberg, T., Schoonhoven, L. (2009). Implementation of a delirium assessment tool in the ICU can influence haloperidol use. Critical Care,13(4), R131. Epub 2009 Aug 10.
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