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Keywords

Assessment, Delirium, Dementia, Documentation errors, Family engagement, ICU psychosis, Implications of extended ICU stay, Improved outcomes

 

Authors

  1. Volland, Jennifer DHA, RN, CPHQ, NEA-BC, FACHE
  2. Fisher, Anna DHA, CDP
  3. Drexler, Diane MBA, BSN, RN, FACHE

Abstract

Longer stays in the intensive care unit (ICU) can be an opportunistic battlefield where not only is the length of stay longer, but also there is increased time that lapses with the potential for a patient fall, nosocomial infection, urinary tract infection, and other untoward events (http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf; ASHRM Forum. 2014;Q3:10-14). As such, the push has become for shorter lengths of stay whenever possible. Delirium and dementia are 2 conditions that the ICU clinician must remain diligent in monitoring for status changes. Delirium poses the threat of longer-term undesirable outcomes and is a potential inherent risk in the care delivered. It rises to the level of a medical emergency that can be deadly but, when caught early, can be treated and resolved (Science Daily, September 16, 2013). Setting expectations with families, providing adequate education, and involving them in a holistic view of patient-centered care can help toward the detection of differences that may occur from an ICU stay. Interventions the ICU clinician can take for increasing self, patient, and family awareness to decrease risk and improve outcomes and ways to deepen family engagement in these populations are explored with practical applications.