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Yes, We CAM!

Understanding the Confusion Assessment Method for the ICU
by

Saera Kim

on 24 November 2012

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Transcript of Yes, We CAM!

Understanding the Confusion
Assessment Method (CAM) in
the ICU Yes, We CAM! What is ICU delirium? Acute and fluctuating impairment of attention, cognition and behavior

3 Types: Hypoactive, Mixed, Hyperactive



Prevalence of delirium 60%-80% in mechanically ventilated patients Impacts CAM-ICU Feature 2 Instruct patient with the following: Bedside assessment tool for nurses to use Yes, you CAM-ICU! Shock-Trauma ICU Feature 1 Acute Onset or Fluctuating Course Feature 3 Altered Level of Consciousness Feature 4 Disorganized Thinking T.H.I.N.K T- Toxic Situations
H- Hypoxemia
I- Infection/Sepsis
N- Nonpharmacologic Interventions
K- K+ or other eletrolyte problems Demonstration of CAM-ICU Only 2 minutes long! Inattention Review patient's pharmacological treatment
Is your pt receiving lorazepam, propofol, morphine, midazolam and/or fentanyl?
Recommend haloperidol Delirium Interventions Increase morbidity
Higher mortality rate
Reintubation
Poor functional recovery
Prolongs length of stay
Long-term cognitive impairment
Higher ICU Costs Revised and adapted to use for mechanically ventilated patients
4 Diagnostic Features First.. Do you need to even use it? Otherwise.. Proceed with CAM-ICU If RASS is -4 or -5, STOP and
REASSESS patient later Has the patient had an acute change from mental status baseline? OR Has the patient's mental status fluctuated during the past 24 hours? NO = STOP. Delirium is NOT present YES= Continue to Feature 2 "Squeeze my hand when I say the
letter 'A'." ERRORS= NO squeeze with "A" &
squeeze on letter OTHER THAN "A" > 2 ERRORS = Continue to Feature 3 <2 ERRORS= STOP. Delirium is NOT present Assess with RASS Must have Feature 3 OR Feature 4 Any score other than 0 on RASS
=
Features 1, 2, & 3 PRESENT
STOP
Delirium is PRESENT
CAM-ICU Positive Must have Feature 3 OR Feature 4 Step 1- Questions
Will a stone float on water?
Are there fish in the sea?
Does 1 pound weigh more than 2 pounds?
Can you use a hammer to pound a nail? Step 2- Commands
"Hold up this many fingers." (Hold up 2 fingers)
"Now do the same thing with the other hand"
OR- "Add one more finger" (If patient cannot move both arms) >1 error in BOTH Questions & Command =
Features 1, 2, & 4 PRESENT

Delirium is PRESENT
CAM-ICU Positive Non-Pharmacological Prevention and Treatment
Early mobilization
Range of motion exercises
Timely removal of restraints and catheters
Reorient patient Pharmacological Prevention and Treatment
Dexmedetomidine (Precedex)
Haloperidol (Haldol)
Atypical antipsychotics
aripiprazole
olanzapine
quetiapine
ziprasidone Assess and adjust environmental factors
Visible clock
Regular reorientation to time, date, and place
Ensuring visible daylight
Attempts to maintain Circadian rhythm $23,000 vs $13,000 Each day pt is delirious = 10% increased risk of death READ: S A V E A H A A R T RASS = 0 Go to Feature 4 STOP Allen, J. & Alexander, E. (2012). Prevention, recognition, and management of delirium in the intensive care unit. American Association of Critical Care Nurses, 23(1), 5-11.

Balas, M.C., Vasilevskis, E.E., Burke, W.J.m Boehm, L., Pun, B.T., Olsen, K.M, Peitz, G.J, & Ely, E.W. (2012). Critical care nurses' role in implementing the "ABCDE Bundle" into practice. Critical Care Nurses, 32(2), 35-57.

Cutler, L.R. & Cutler, J.(2010, October 16).CAM-ICU. Retrieved from http://www.youtube.com/watch?v= fyaQuYnnoZ4

Ely, E. W.(2010). Confusion assessment method for the intensive care unit (CAM-ICU): the complete training manual. Nashville, TN: Vanderbilt University

Nelson, L.S. (2009). Teaching staff nurses the CAM-ICU for delirium screening. Critical Care Nurses Quarterly, 32(2), 137-143.

Pun, B. & Ely, E. W. (2007). The importance of diagnosing and managing intensive care unit delirium. CHEST, 132(2), 624-636.

Soja, S.I., Pandharipande, P.P., Fleming, S.B., Cotton, B.A., Miller, L.R., Weaver, S. G., Lee, B.t., Ely, E. W. (2008). Implementation, reliability testing, and compliance monitoring of the confusion assessment method for the intensive care unit in trauma patients. Intensive Care Medicine, 34,1263-1268. References Trauma Patients Presumed to have fewer predisposing factors for development of delirium-due to lack of comorbidities
IMPORTANT to IDENTIFY to reduce negative consequences!! (in the ICU) Up to 64% of ICU patients have HYPOACTIVE delirium (Balas et al., 2012)
(Lat et al., 2009) (Cutler & Cutler, 2010) (Soja et al., 2012)
(Pun & Ely, 2007) (Ely, 2010) (Allen & Alexander, 2012) (Ely, 2010)
(Soja et al., 2012) Video Demonstration Performing the CAM-ICU To watch video: must STOP autoplay, use MOUSE
on laptop to CLICK PLAY
Full transcript