Provincewide effort lessens patient impact of ICU delirium

Frontline staff in intensive care units (ICUs) around the world are today paying special attention to delirium – a common brain dysfunction among the critically ill that can have long-term negative consequences.

People who have spent time in ICUs sometimes experience lingering memory problems, difficulty in focusing their thoughts, and other challenges with their thinking processes.

Today, World Delirium Awareness Day is being recognized in the Alberta legislature.

“Delirium can be debilitating for patients and their families, leading to longer hospital stays and poorer health outcomes,”says Sarah Hoffman, Minister of Health.“World Delirium Awareness Day is an opportunity to talk about Alberta’s Dementia Strategy and Action Plan and how we’re finding tools to help recognize, prevent and treat delirium earlier.”

Throughout the day, critical care staff with Alberta Health Services (AHS) will be making pledges as part of the #IcanPreventDelirium challenge. They are also nominating and recognizing ‘Delirium Heroes’– those staff members who strive to bring awareness to delirium and its prevention.

“Since late 2016, all 21 of Alberta’s adult ICUs have been focused on making improvements in this area,”says Barbara O’Neill, Senior Provincial Director of AHS’Critical Care Strategic Clinical Network (SCN).“It’s one of the strengths of a single, provincewide health system – that we’re able to initiate and spread quality improvements like these on this scale.”

Since late 2016, the AHS Provincial ICU Delirium Initiative has made significant strides:

• The proportion of patient days where patients were delirious has decreased from

35 per cent to 27 per cent; meaning patients have fewer days in the ICU and fewer days in hospital.

• The length of time patients with delirium were ventilated decreased by 0.53 days; thus reducing a contributing risk factor for delirium.

• Assessments for sedation and agitation increased by 20 per cent; important for preventing delirium and reducing use of restraints (both physical and pharmaceutical).

It’s estimated up to 80 per cent of ICU patients who receive breathing assistance from a ventilator experience delirium, as do roughly half who are not on a ventilator.

After spending five weeks in intensive care – three of them in an induced coma – Nadine Foster of Calgary knows all too well the debilitating consequences of delirium.

“After I was discharged I spent six months more or less bed-ridden, which was the longest six months of my life,”says Foster, 40.

“My previous sharp mental focus was gone and my attention span was very limited. I wasn’t able to read or watch TV. My memory was also impacted. I would forget things that typically I wouldn’t, ranging from something minor, like an item to pick up at the grocery store, to more important things, like people in my life.”

ICU-related delirium can occur because of the type of medications used, the time spent getting breathing assistance from a ventilator, disturbed sleep patterns and being immobilized.

“We used to think delirium was just part of being sick,”says Dr. Chip Doig, Head of the Department of Critical Care Medicine for the Calgary Zone of Alberta Health Services, and co-chair of the Provincial ICU Delirium Initiative. “We know now, however, that ICU delirium is actually a sign of acute brain dysfunction. What the Provincial ICU Delirium Initiative is doing is finding ways to minimize the causes of that dysfunction to improve patient outcomes.”

It’s been a long road back for Foster who, aside from her cognitive challenges, weighed 85 lbs. and couldn’t walk when she left hospital. She has no memory of her time in the ICU but recalls vivid dreams or hallucinations, which are associated with delirium.

Today she’s made nearly a full recovery and shares her experiences with healthcare providers as a Patient Advisor for the Critical Care SCN.

She’s helping create a delirium resource list for patients and families, and she’s also intending to take courses to refresh her registered nursing licence so that can return to the ICU one day – in a professional capacity.

“My goal now is to work with ICU patients or recovering ICU patients. I understand the patient and family perspective and I think I have something to offer in terms of helping people come back – both physically and cognitively,”Foster says.

World Delirium Awareness Day is intended to raise awareness about delirium and to build understanding about its global impacts, advance delirium science, and educate patients, caregivers, professionals and policy-makers about delirium.

Improving the prevention, early identification, and management of delirium, depression and frailty in all care settings is a key action in achieving the vision and outcomes described in the Alberta Dementia Strategy and Action Plan, which was launched last December.