ICU West Bed ____ Patient Initials: _______
Date:________ Shift: Day Night
Was your patient CAM positive this shift? Yes No
If yes, please check off interventions that were tried:
o Provided quiet environment at night/active in day (mobilize/walking)
o Provided glasses/hearing aids
o Checked electrolytes for dehydration
o Assessed for UTI or other infection
o Minimized use of sedatives
o Was an antipsychotic added? (if yes, please specify which one:_________)
o Assessed for medications that worsen delirium, esp. Ativan, dilaudid, gravol;
classes known to increase delirium: opioids, benzos
o Asked family to bring in personal reminders (photos), use of tv/radio/MP3
o Checked for psychiatric meds taken preop and reassess for restarting them
o Checked for history of alcohol/nicotine use and considered possible withdrawal
o Psychiatry consult
o Delirium handbook given to family members (on shelf in charting room)
Additional Comments: (e.g. patient with decreased LOC on-going; sedation on board…)