Delirium management in 2024: A status check and evolution in clinical practice since 2016

IF 4.7 2区医学 Q1 NURSING Intensive and Critical Care Nursing Pub Date : 2025-08-01 Epub Date: 2025-03-08 DOI:10.1016/j.iccn.2025.103995

Oliver Coolens , Arnold Kaltwasser , Tobias Melms , Stefanie Monke , Peter Nydahl , Sabrina Pelz , Rebecca von Haken , Wolfgang Hasemann

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Abstract

Background

Delirium in patients on intensive care units (ICU) can lead to prolonged length of stay, cognitive decline and higher mortality. Implementing delirium management is a challenge for healthcare workers. Between 2016 and 2024, several quality improvement projects were performed in German speaking countries. These projects included founding a delirium society, distributing delirium related curricula, awards, surveys, webinars, public materials, and others. The aim was to assess the current state of delirium management in 2024 and identify changes in prevention, detection, and treatment since 2016.

Method

Repetition and comparison of a survey for delirium management from 2016 in 2024. Questions included items for hospital and ICU characteristics, present delirium structures, processes, assessment routines, barriers, and others. The survey was distributed in a snowball system in German speaking countries. Data were analysed statistically.

Results

Participating ICU in both surveys (2016: n = 559, 2024: n = 447) had similar basic characteristics and enabled comparison. Use of validated delirium assessment tools slightly increased from 56.8 % (n = 398) in 2016 to 74.4 % (n = 438) in 2024. Significant improvement rates were identified from 2016 to 2024 in use of validated assessments (56.8 % vs. 72.8 %), prevention programs (34.6 % vs. 44.7 %), information materials for patients and families (18.9 % vs. 33.8 %), and others. Conversely, there was decreased implementation in dementia screening (23.7 vs. 14.8), use of restraints (68.3 % vs. 58.4 %), and others. The top barrier, lack of time and staff, remained in first place.

Conclusions

The comparison of two large surveys in 2016 and 2024 indicate a slightly cultural shift in delirium management in German speaking countries. Open quality improvement projects might increase delirium awareness and contribute to an ongoing cultural change.

Implications for practice

Improvement projects addressing barriers and delirium-specific awareness are essential to improve and sustain delirium management practices in ICU settings.

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2024年谵妄管理：2016年以来临床实践的现状检查与演变

背景：重症监护病房（ICU）患者谵妄可导致住院时间延长、认知能力下降和死亡率升高。实施谵妄管理是医护人员面临的一个挑战。在2016年至2024年期间，在德语国家实施了几个质量改进项目。这些项目包括建立一个谵妄学会，分发谵妄相关的课程、奖项、调查、网络研讨会、公共材料等等。目的是评估2024年谵妄管理的现状，并确定自2016年以来预防、检测和治疗方面的变化。方法对2016年至2024年的谵妄管理调查进行重复与比较。问题包括医院和ICU的特点、目前谵妄的结构、过程、评估程序、障碍等。这项调查在德语国家以滚雪球的方式分发。对数据进行统计学分析。结果两项调查（2016年：n = 559, 2024年：n = 447）参与ICU的患者基本特征相似，可进行比较。经过验证的谵妄评估工具的使用率从2016年的56.8% （n = 398）略微增加到2024年的74.4% （n = 438）。从2016年到2024年，在使用有效评估（56.8%对72.8%）、预防方案（34.6%对44.7%）、患者和家属信息材料（18.9%对33.8%）等方面，发现了显著的改善率。相反，痴呆筛查的实施（23.7%对14.8%）、约束的使用（68.3%对58.4%）等都有所减少。最大的障碍，缺乏时间和人手，仍然排在第一位。结论2016年和2024年两次大型调查的比较表明，德语国家谵妄管理的文化转变略有改变。开放的质量改进项目可能会增加谵妄意识，并有助于正在进行的文化变革。对实践的启示针对障碍和谵妄特异性意识的改进项目对于改善和维持ICU环境中的谵妄管理实践至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Intensive and Critical Care Nursing NURSING-

CiteScore

6.30

自引率

15.10%

发文量

144

审稿时长

57 days

期刊介绍： The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues; to provide an international and interdisciplinary forum for the publication, dissemination and exchange of research findings, experience and ideas; to develop and enhance the knowledge, skills, attitudes and creative thinking essential to good critical care nursing practice. The journal publishes reviews, updates and feature articles in addition to original papers and significant preliminary communications. Articles may deal with any part of practice including relevant clinical, research, educational, psychological and technological aspects.