AACN Practice Alert:
Delirium Assessment and
Monitoring
Suad Ali, Nicki Croel, Vaughn Lovell & Chelsey Treglia
Objectives
● Review the background of AACN standards and
practice alerts
● Provide an overview of AACN ICU Delirium Practice
Alert
● Define evidence-based nursing interventions for ICU
delirium
● Discuss improving quality and safety and the influence
of standards of care
The AACN
● American Association of Critical-Care
Nurses
○ “Patients and their families rely on nurses at the most vulnerable
times of their lives. Acute and critical care nurses rely on AACN for
expert knowledge and the influence to fulfill their promise to
patients and their families. AACN drives excellence because nothing
less is acceptable” (American Association of Critical-Care Nurses
[AACN], 2014).
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Levels of evidence
o
Level A-E, & M
Practice Alert Summary
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“Delirium is an acute change in consciousness that is
accompanied by inattention and either a change in
cognition or perceptual disturbance” (AACN, 2014).
Expected Practice:
o Implement delirium assessment for all critically ill patients using
validated tools such as the Confusion Assessment Method for the ICU
(CAM-ICU) or Intensive Care Delirium Screening Checklist
(ICDSC) (Level B)
o Create strategies to decrease delirium risk factors, including early
exercise (Level B)
o Be cautious with benzodiazepine use, giving only what is needed
(Level C)
o Consider whether to adopt a core bundle like the ABCDE bundle
(Level E)
Influence on Standards of Care
● Assessment
● Planning
● Interventions
● Collaboration
Improving Quality & Safety of
Healthcare Delivery
● THIINK mnemonic for early recognition of cause
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Toxic Situation
Hypoxia,
Infection / sepsis
Immobilization
Nonpharmacologic Interventions
K+ (Potassium or electrolyte problems)
Reliable and valid assessment tools
Medication precautions and reviews
Implementation of ABCDE bundle
Summary
•
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The complications associated with delirium
are serious and can be debilitating
Practice alerts give guidelines to critical
care nurses by enabling them to use current
recommendations and best practice when
providing care.
References
American Association of Critical Care Nurses. (2013). History of AACN. Retrieved from
http://www.aacn.org/wd/mainpages/content/aboutus.content?menu=AboutUs
American Association of Critical Care Nurses. (2013). Delirium assessment and management. Retrieved from
http://www.aacn.org/wd/practice/content/practicealerts/delirium-practice-alert.pcms?menu=practice