Finding new ways to address delirium

“Imagine this,” posits Nadine. “You’re going about your normal, busy life. Type A, incredibly organized, mother of two, small business owner. Your days are structured and well organized: work, volunteer, children’s activities—you’re the ultimate multi-tasker. Then one day, you wake up with no idea where you are or how you got there. You can barely speak, you’re in pain from head to toe and you’re completely exhausted. Everyone seems happy, and you’re dumbfounded to learn that you spent the last five weeks in intensive care, fighting to survive.”

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Nadine was a patient in an Alberta ICU in December 2012. In May 2017, she shared her experience with front-line ICU staff—a story describing her battles with delirium in the ICU, and the devastating long-term effects it had on her personal and professional life after her survival.

According to the Mayo Clinic, delirium is “a serious disturbance in mental abilities that results in confused thinking and reduced awareness of your environment. The start of delirium is usually rapid—within hours or a few days.”

Stories like Nadine’s are helping 22 hospitals across the province learn more about delirium and more important, how to help combat it.

Following a federal clinical study initiated in 2011, the Misericordia Community Hospital has been on the forefront of this issue. 

Trish O’Toole, Program Manager at the Misericordia for Critical Care, Cardiac Science and EEG, succinctly summarizes it as “the altered state of your being. It could be visual, emotional, physical.” 

Trish O'Toole, Program Manager, Critical Care, Cardiac Science and EEG at the Misericordia Community Hospital

“It affects everyone that comes into the ICU,” says Trish. “We used to think [delirium] was limited to just our older patients, but that’s not true. It’s all patients.” 

Intensive care patients are in a more medically critical state than patients on other units. The constant sounds, lights and activity provide the ideal breeding ground for delirium.

After the effects had been noticed, the Misericordia ICU began work to combat the issue.

“Delirium has been there all along; we just haven’t recognized it and the long-term effects it can have,” says Trish.

Several years ago, they joined a Canadian collaboration on delirium. It was a one-year collaborative effort that defined what delirium in an ICU is, the things that contributed to it and how they could be addressed. This year begins the provincial collaboration, led by the provincial Strategic Clinical Networks, with the Misericordia and the Royal Alexandra leading the cause.

“We’re putting in measures to intervene as much as we can,” says Trish. “Reducing light and noise are simple ways to help patients sleep better. We’ve also asked the manufacturers to introduce a night mode to our monitors so they automatically quiet at 22:00. We still hear the alarms but it’s less disruptive to patients.”

These changes have had a marked impact. Jodi Normandeau, Unit Manager of Medicine at the Misericordia, has noticed that as patients are transferred to her unit from the ICU, they’re much more conscious and better able to walk and talk. This change makes the recovery process and hospital stay much easier.

"The strategies that our ICU colleagues have put into practice have improved patient outcomes dramatically,” says Jodi.

“Once patients are stable enough to transfer out of ICU, our focus moves toward successful discharge planning," says Jodi. "Patients are coming to the unit considerably less confused and have a higher level of physical function; we find that we are more efficiently rehabilitating them and returning them to their families sooner."

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