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Delirium and Sedation Recognition Using Validated Instruments: Reliability of Bedside Intensive Care Unit Nursing Assessments from 2007 to 2010
Author(s) -
Vasilevskis Eduard E.,
Morandi Alessandro,
Boehm Leanne,
Pandharipande Pratik P.,
Girard Timothy D.,
Jackson James C,
Thompson Jennifer L.,
Shintani Ayumi,
Gordon Sharon M.,
Pun Brenda T.,
Wesley Ely E.
Publication year - 2011
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2011.03673.x
Subject(s) - delirium , medicine , sedation , intensive care unit , emergency medicine , intensive care , confidence interval , intensive care medicine , anesthesia
Objectives To describe the reliability and sustainability of delirium and sedation measurements of bedside intensive care unit ( ICU ) nurses. Design Prospective cohort study. Setting A tertiary care academic medical center. Participants Five hundred ten ICU patients from 2007 to 2010; 627 bedside nurses. Measurements Bedside nurses and well‐trained reference‐rater research nurses independently measured delirium and sedation levels in routine care. Bedside nurses were instructed to use the Confusion Assessment Method for the Intensive Care Unit ( CAM ‐ ICU ) every 12 hours to measure delirium and the Richmond Agitation‐Sedation Scale ( RASS ) every 4 hours to measure sedation. CAM ‐ ICU and RASS assessment agreement were computed using weighted kappa statistics across the entire population and subgroups (e.g., ICU type). Sensitivity and specificity of bedside nurse identification of delirium were calculated to understand sources of discordance. Results Six thousand one hundred ninety‐eight CAM ‐ ICU and 6,880 RASS measurement pairs obtained on 3,846 patient‐days. For CAM ‐ ICU measurements, agreement between bedside and research nurses was substantial (weighted kappa = 0.67, 95% confidence interval ( CI ) = 0.66–0.70) and stable over 3 years of data collection. RASS measures also demonstrated substantial agreement (weighted kappa = 0.66, 95% CI = 0.64–0.68), which was stable across all years of data collection. The sensitivity of delirium nurse assessments was 0.81 (95% CI = 0.78–0.83), and the specificity was 0.81 (95% CI = 0.78–0.85). Conclusion Bedside nurse measurements of delirium and sedation are sustainable and reliable sources of information. These measures can be used for clinical decision‐making, quality improvement, and quality measurement activities.