Delirium is an underdiagnosed and often untreated health care burden associated with poor outcomes including increased length of stay, increased inpatient mortality, and higher rates of institutionalization. One technique for identifying patients with delirium is the confusion assessment method (CAM), first published by Sharon Inouye, MD This validated tool has been shown to have high sensitivity (97%), specificity (92%), and reliability when administered by nonpsychiatric health care providers. Delirium is present when the CAM criteria shown in Figure 1 are met. The UCSD Medical Center currently does not have a standard approach to assessing, diagnosing, and treating patients with delirium.
To pilot the CAM instrument in various medical‐surgical units as part of a performance improvement project to improve the care of patients with delirium and at risk for developing delirium.
The CAM instrument was used to assess the incidence of delirium over a 3‐day observation period in 5 general medical‐surgical and intermediate care units at UCSD between September 2007 and January 2008. A pharmacy resident and student verbally interviewed nurses of all patients in these units. In addition to the CAM instrument, data regarding other risk factors for delirium were collected, including age, medical diagnoses, functional status, use of restraints or sitter, catheter placement, visual or hearing impairment, nutritional status, and renal dysfunction. Data were also collected regarding medications given to treat these patients.
The CAM instrument was successfully piloted across 5 medical‐surgical units. We demonstrated that the CAM instrument is easy to administer, and as part of their routine patient assessment, nurses are able to answer the CAM questions without additional training. In the future, as part of a performance improvement project, our approach to hospitalized patients with delirium can be standardized by making the CAM instrument part of routine nursing assessment. For patients with a positive CAM score (delirium present), appropriate pharmacological and nonpharmacological therapy can be promptly initiated. Preventive measures for patients at risk for developing delirium can be implemented, and therapies that may increase delirium (eg, catheters, benzodiazepines) can be proactively avoided. A multidisciplinary team of physicians, pharmacists, and nurses will be discussing data from our pilot study to improve early detection and management of patients with delirium and at risk for developing delirium.
B. Huang, UCSD Medical Center, employment; T. Dam, UCSD Medical Center, employment; D. Gin, UCSD Medical Center, employment/resident; G. Maynard, UCSD Medical Center, employment; J. Quartarolo, UCSD Medical Center, employment; K. Tallian, UCSD Medical Center, employment; A. Zeller, UCSD Medical Center, student.