807: melatonin secretion pattern in critically ill patients

Learning Objectives: It is well recognized that delirium screening in the intensive care unit (ICU) is an essential component of care. The use of standardized delirium assessment tools have been validated for use in ICU patients. However, these tools, such as the Confusion Assessment Method for the ICU (CAM-ICU) have not been validated for use in neurocritically ill patients. Baseline daily screening rates in four adult ICUs at a single center identified a need to improve delirium assessments for all ICU patients, including Neuroscience ICU patients.
Methods: A pilot project implementing CAM-ICU assessment in the Neuroscience ICU to increase screening rates and documentation of CAM-ICU screenings in the adult ICUs was conducted at a Midwestern, university affiliated 640-bed medical center. A multi-disciplinary committee met monthly to review implementation steps and educational in-services were provided to ICU staff to reinforce correct use and documentation of the CAM-ICU. A goal of 80% was set for twice daily assessments.
Results: During a 6 month period, improvements were seen in the screening of over 500 patients in all our ICUs, with the Neuroscience ICU increasing documented assessments in over 100 patients from 0% to 54%. The project is ongoing as part of the Society of Critical Care Medicine’s ICU Liberation Collaborative.
Conclusions: A multidisciplinary team based initiative to reinforce education, audit and feedback resulted in increased documentation of CAM-ICU screening rates. However, use of the CAM-ICU with Neuroscience ICU patients presented a challenge due to the need to the difficulty in differentiating delirium and clinical neurological deterioration. Currently, the results of this pilot project indicate that the CAM-ICU can be used in Neuroscience ICU patients, but clinical neurological deterioration may result in false-positive CAM-ICU assessment.