The Use Of Non-ICU Confusion Assessment Method (CAM) for the Management of Delirium

Research Objectives: The purpose of this study was to determine the effect the use of the non-intensive care unit confusion assessment method (non ICU CAM) as an early screening tool for delirium on the nursing practice of medical surgical nurses.

Design: This quasi-experimental study focused on early screening and prevention training of inpatient nurses caring for adult inpatients to proactively reduce episodes of delirium.

Setting: The study site is a 258-bed acute care hospital that has been designated as a level 1 trauma center in Phoenix, Arizona.

Participants: No actual patients were enrolled in this study. The participants consisted of the inpatient nurses working in units outside the Emergency Department and Intensive Care Units.

Interventions: The intervention for this study was the training for how to perform, complete, and document the non-ICU CAM assessment for the early detection screening for delirium. The training consisted of an online learning module and four scenarios, walking rounds for understanding and 1:1 education, and auditing for compliance of documentation of the assessment using the non-ICU CAM in Epic.

Main Outcome Measures: 1. Measure the baseline knowledge of nursing staff with questionnaire. 2. Measure attitude, PSE, PSN, intent and utility using a validated self-efficacy tool prior to delirium prevention training. 3. Engage participants in delirium prevention training and utilize non-ICU CAM for early detection and screening of delirium for patients; and 4. After six weeks from the completion of
education, re-measure knowledge, attitude, PSE, PSN, intent and utility using the same survey.

Results: The training and use of non-ICU CAM for medical surgical nurses had a positive impact on their ability to manage overall identification of delirium in their patients and management of their care. The results of this study were statistically improved in areas of knowledge (p =.048), attitude (p=.012), belief (p=.02), PSN (p=.02), PSE (p=.007), and intention (p=.006).

Conclusions: This study contributed to the advancement in the practice of nurses in identifying delirium through patient symptom analysis and improve nurses’ management of challenging patient behaviors.

Author(s) Disclosures: None