(1242) Assessing the Prevalence of ICU Delirium Risk Factors in SICU Patients With a Novel Monitoring Form

Introduction: Delirium is a clinical syndrome identified by changes in mental status, inability to focus, or altered level of consciousness. Studies have shown an incidence rate of nearly 80% in intensive care unit (ICU) patients leading to an increase in morbidity, death, length of hospital stay, and cost. Several modifiable and nonmodifiable risk factors (RFs) for ICU delirium have been identified in the literature. An initiative was started by critical care pharmacists to characterize the prevalence of ICU delirium RFs and opportunities for intervention in surgical ICU (SICU) patients.

Methods: An ICU delirium monitoring form was created including the following modifiable RFs: daytime environment (lights off, blinds closed, television off), mobility (restraints on, physical therapy (PT) not consulted), and continuous intravenous medications (dexmedetomidine, fentanyl, ketamine, midazolam, propofol). These specific RFs were selected for their ability to be easily assessed at the bedside or with minimal chart review. All patients admitted to the SICU during January 2023 were included. RFs were assessed on weekdays during morning multidisciplinary rounds throughout the patients’ ICU stay. A retrospective analysis of the first seven days of RF assessment was performed.

Results: A total of 181 patients were included in this analysis. The number of patients assessed on days 1 to 7 are as follows: 181, 100, 61, 41, 31, 22, and 19. The prevalence of each RF on days 1 and 7 respectively are as follows: lights off 35%, 21%; blinds closed 38%, 16%; television off 35%, 14%; restraints on 30%, 47%; PT not consulted 59%, 47%; dexmedetomidine 12%, 38%; fentanyl 10%, 5%; ketamine 1%, 0%; midazolam 2%, 0%; and propofol 9%, 16%.

Conclusions: The prevalence of all RFs decreased from day 1 to 7 except for restraints on, dexmedetomidine, and propofol. This simple monitoring form was a useful tool that aided critical care pharmacists in being more purposeful and consistent in performing daily assessments of common ICU delirium RFs. Future work will capture patient demographics and severity of illness and will focus on further reducing the prevalence of these RFs throughout a patient’s ICU stay, particularly those that either increased in prevalence or those with a higher prevalence than expected.