Diagnosis, pain management, sedation pause and medications |
Awaken the patient daily (sedation pause: 6:30 am or 7:30 am). |
Awaken the patient and perform ventilation test. |
Assess delirium with CAM-ICU. |
Perform early mobilization. |
Assess pain with validated scales. |
Administer non-opioid analgesics. |
Ensure analgesia before interventions. |
Limit the use of medications associated with delirium. |
Choose sedations that are not a risk factor for delirium. |
administrate haloperidol. |
Cognitive Orientation |
Encourage the team to practice verbal / written orientations whenever possible. |
Call the patient by name when starting an interaction. |
Encourage the patient with predetermined questions, established in protocol. |
Inform the characteristics of the unit, visiting hours, meals and procedures. |
Explain any noise produced by infusion pumps, alarms and / or ventilator. |
Provide information to the patient about their health status, prognosis and treatments. |
Offer means of listening to music and television. From 6 am to 8 pm. |
Provide glasses and hearing aids for personal use as soon as possible. |
Sleep Promotion |
Assess patients for sleep maintenance (Sleep period: 00:00 to 4:00 or 22:00 to 4:00). |
Prevent the patient from sleeping during the day. |
Cluster care for uninterrupted sleep. During the night: bath until 10 pm. |
Avoid administering medication at night - reschedule. Do not interrupt sleep. |
Record vital signs provided by the central monitor during sleep. |
Provide ear plugs and / or eye mask for sleep. |
Individualize the alarm. |
Check the patient's preference for the sleeping environment. |
Inform the benefits of the sleep-wake cycle. |
Assess the risk for PU and the permanence without changing position during sleep. |
Interrupt the sleep period if the patient's clinical status changes / or if there is instabilities. |
Environment and Family Participation |
Orientate using clocks and calendars. |
Allow family members to bring items: magazines, books, etc. |
Reduce light at night. |
Orientate professionals - avoid talking by the bed. |
Control noise at night. |
Make family access more flexible. |
Promote care planning, facilitating family access. |
Perform rounds in visiting hours to offer orientations about delirium. |
Encourage family interaction with the patient. |
Develop educational materials. |
Remove devices early. |
Perform “box glove” mechanical restraint. |
Keep the bed rails high. |
Provide the patient with a means of calling professionals, eg, bell or light. |
Identify the bed of the patient who is in delirium, in order to maintain the care protocol. |