Delirium Prevention Guideline for Intensive Care Patients

NCT06403410 | Not Yet Recruiting

• 1 other identifier: Delirium Prevention Guideline
• Study Type: interventional
• Target: 160
• Locations: 1 country
• Sites: 1

Brief Summary

Delirium is a complication characterized by fluctuations in orientation, memory, thinking, or behavior, with sudden onset of these changes. Studies have shown that pharmacological agents are the most significant risk factors for delirium in intensive care units. In recent years, the impact of non-pharmacological interventions in preventing delirium development has started to be discussed.

Conditions

Delirium; Nurse's Role

Keywords

delirium; non-pharmacologic; nursing intervention

Outcome Measures

Primary Outcomes (1)

• In patients receiving Delirium Prevention Guidelines, the rate of delirium development is change compared to the control group at the end of one week.

  prevent delirium

  3 weeks

Study Arms (2)

Experimental

EXPERIMENTAL

In the intervention group, initially, the Patient Identification Form, RASS, and Nu-DESC will be administered. The RASS and Nu-DESC forms will continue to be applied once a day throughout the patient's follow-up period in the intensive care unit, every 12 hours. Each intervention group patient randomized will receive the Delirium Prevention Guideline. The guideline includes standard practices used by intensive care nurses in patient monitoring. In addition to routine follow-ups, eye masks and earplugs will be applied to patients in the intervention group between 24:00 and 06:00. It is expected that the guideline will be used once every 24 hours, in the morning, to ensure standardization

Other: Delirium Prevention Guideline

Control

NO INTERVENTION

Routine delirium monitoring conducted in the intensive care clinic will be performed for patients in this group. There is no standard form used for delirium in the unit where the study is conducted. At the beginning of data collection, the Control group patients will undergo the Patient Identification Form, RASS, and Nu-DESC (once every 12 hours). The RASS and Nu-DESC forms will continue to be applied once a day throughout the patient's follow-up period in the intensive care unit. Data collection will be terminated in case of delirium development in patients.

Interventions

Delirium Prevention Guideline OTHER

Each intervention group patient randomized will receive the Delirium Prevention Guideline. The guideline is designed to be followed by nurses. However, collaboration with the physician is required for some aspects of the guideline (pain control, ordering/follow-up of laboratory tests, etc.). Support will be obtained from the intensive care physician, who is a member of the research team, for these steps. The guideline includes standard practices used by intensive care nurses in patient monitoring. In addition to routine follow-ups, eye masks and earplugs will be applied to patients in the intervention group between 24:00 and 06:00.

Experimental

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged 18 and above,
• Without motor, sensory, or hearing impairment,
• Able to communicate,
• Admitted to the intensive care unit within the first 24 hours of admission,
• Without chronic cerebral damage,
• Richmond Agitation Sedation Scale value between -1 and +1 at the beginning of the study,
• Nursing Delirium Screening Scale (Nu-DESC) score \<2,
• No wounds or infections in the ears or eyes,
• Patients who have given consent to participate in the study.

You may not qualify if:

• Patients who receive sedation or require sedation during the data collection process, those who are unable to communicate due to intubation, those with diagnosed psychiatric disorders, those with profound hearing loss affecting communication, and those who do not wish to use eye masks and earplugs will be excluded from the study.

Sponsors & Collaborators

• Istanbul Demiroglu Bilim University: lead

Study Sites (1)

Demiroğlu Bilim University

Istanbul, Şişli, 34394, Turkey (Türkiye)

Location

Related Publications (14)

• Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the Intensive Care Unit: executive summary. Am J Health Syst Pharm. 2013 Jan 1;70(1):53-8. doi: 10.1093/ajhp/70.1.53.

  PMID: 23261901 BACKGROUND

• Christensen M. What knowledge do ICU nurses have with regard to the effects of noise exposure in the Intensive Care Unit? Intensive Crit Care Nurs. 2005 Aug;21(4):199-207. doi: 10.1016/j.iccn.2005.01.003. Epub 2005 Feb 25.

  PMID: 16039957 BACKGROUND

• Cinar F, Eti Aslan F. Evaluation of Postoperative Delirium: Validity and Reliability of the Nursing Delirium Screening Scale in the Turkish Language. Dement Geriatr Cogn Dis Extra. 2019 Dec 5;9(3):362-373. doi: 10.1159/000501903. eCollection 2019 Sep-Dec.

  PMID: 31911787 BACKGROUND

• Deng LX, Cao L, Zhang LN, Peng XB, Zhang L. Non-pharmacological interventions to reduce the incidence and duration of delirium in critically ill patients: A systematic review and network meta-analysis. J Crit Care. 2020 Dec;60:241-248. doi: 10.1016/j.jcrc.2020.08.019. Epub 2020 Aug 31.

  PMID: 32919363 BACKGROUND

• Duning T, Ilting-Reuke K, Beckhuis M, Oswald D. Postoperative delirium - treatment and prevention. Curr Opin Anaesthesiol. 2021 Feb 1;34(1):27-32. doi: 10.1097/ACO.0000000000000939.

  PMID: 33315641 BACKGROUND

• Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage. 2005 Apr;29(4):368-75. doi: 10.1016/j.jpainsymman.2004.07.009.

  PMID: 15857740 BACKGROUND

• Litton E, Carnegie V, Elliott R, Webb SA. The Efficacy of Earplugs as a Sleep Hygiene Strategy for Reducing Delirium in the ICU: A Systematic Review and Meta-Analysis. Crit Care Med. 2016 May;44(5):992-9. doi: 10.1097/CCM.0000000000001557.

  PMID: 26741578 BACKGROUND

• McManus J, Pathansali R, Stewart R, Macdonald A, Jackson S. Delirium post-stroke. Age Ageing. 2007 Nov;36(6):613-8. doi: 10.1093/ageing/afm140. Epub 2007 Oct 25.

  PMID: 17965033 BACKGROUND

• McGuire BE, Basten CJ, Ryan CJ, Gallagher J. Intensive care unit syndrome: a dangerous misnomer. Arch Intern Med. 2000 Apr 10;160(7):906-9. doi: 10.1001/archinte.160.7.906.

  PMID: 10761954 BACKGROUND

• Morandi A, Jackson JC, Ely EW. Delirium in the intensive care unit. Int Rev Psychiatry. 2009 Feb;21(1):43-58. doi: 10.1080/09540260802675296.

  PMID: 19219712 BACKGROUND

• Delirium: prevention, diagnosis and management in hospital and long-term care. London: National Institute for Health and Care Excellence (NICE); 2023 Jan 18. Available from http://www.ncbi.nlm.nih.gov/books/NBK553009/

  PMID: 31971702 BACKGROUND

• Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP, Elswick RK. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002 Nov 15;166(10):1338-44. doi: 10.1164/rccm.2107138.

  PMID: 12421743 BACKGROUND

• Shi Q, Presutti R, Selchen D, Saposnik G. Delirium in acute stroke: a systematic review and meta-analysis. Stroke. 2012 Mar;43(3):645-9. doi: 10.1161/STROKEAHA.111.643726. Epub 2012 Jan 19.

  PMID: 22267831 BACKGROUND

• Van Rompaey B, Elseviers MM, Van Drom W, Fromont V, Jorens PG. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care. 2012 May 4;16(3):R73. doi: 10.1186/cc11330.

  PMID: 22559080 BACKGROUND

MeSH Terms

Conditions

Delirium

Condition Hierarchy (Ancestors)

Confusion; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Neurocognitive Disorders; Mental Disorders

Central Study Contacts

Serpil Topçu, 1

CONTACT

05324676179; serpilakkustopcu@gmail.com

Merve Kıymaç Sarı, 2

CONTACT

05348204991; merve.sari@fbu.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR
• Masking Details: The study will utilize single-blind masking
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: randomized controlled quasi-experimental study

Study Record Dates

• First Submitted: April 26, 2024
• First Posted: May 7, 2024
• Study Start: June 15, 2024
• Primary Completion: September 15, 2024
• Study Completion: December 15, 2024
• Last Updated: May 7, 2024

Record last verified: 2024-05

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)