Graduation Year

2021

Document Type

Capstone

Degree Type

Open Access Capstone

Degree Name

Doctor of Occupational Therapy (OTD)

Department

Occupational Therapy

Abstract

Executive Summary

Background: The onset of delirium during a stay in the intensive care unit (ICU) is considered a sign of complication and is associated with increased risk of mortality and longer stays. Monitoring for delirium and incorporating early rehabilitation services (occupational therapy and physical therapy) are considered promising, evidence-based strategies to manage delirium.

Purpose: The purpose of this study was to assess current practices for 1) delirium monitoring and 2) rehabilitation intervention as part of delirium management. The study verified the rate of delirium monitoring using standardized assessments, prevalence of delirium, the interval between admission to the ICU and first rehabilitation intervention (“early engagement”), the length of stay in the ICU, the number of days of therapy (occupational and physical), the reasons for delay of therapy, the content of therapy services (mobility, cognitive and/or ADLs), in a 12-bed intensive care unit in a community hospital in Lexington, Kentucky.

Theoretical Framework. This project utilized strategies and tools from the Quality Improvement Model as well as principles of evidence-based practice.

Methods. For this retrospective chart review, patient data was extracted from medical charts. Participants included all individuals admitted in the ICU from September 1st, until the maximum number of 100 participants was reached. Institutional Review Board approval was obtained until 6/1/2021. For the purpose of this report, data from the first 35 charts were analyzed to describe rate of monitoring, prevalence of delirium, length of stay, amount and content of rehabilitation services (occupational and physical therapy), reasons for delay in rehabilitation service delivery.

Results. For the initial sample (n=35), delirium monitoring was completed in the ICU at a rate slightly lower than recent studies document (94% versus 100%). Both delirium and subsyndromal delirium were associated with a longer hospital length of stay (26, 17 respectively versus 10 days for patients with normal consciousness). The prevalence of delirium was lower than expected for this sample (20% versus 30%), which could suggest insufficient monitoring and/or wrong categorization. The rate of subsyndromal delirium was higher than expected (46% versus 36%). The mean interval between admission into the ICU and first attempt by an occupational or physical therapist was 5 days, within the interval recommended in systematic reviews (4 to 7 days). The content of occupational therapy sessions does not specifically address delirium or cognition, but did address mobility and self-care.

Conclusions: Occupational therapy could increase its role in monitoring and managing delirium, to assist with proper categorization, provide specialized treatment, and possibly decreasing duration of delirium as well as length of stay.

Faculty Mentor

Dr Dana Howell, PhD

Department Affiliation

Occupational Therapy

Committee Member

Dr Renee Causey-Upton, PhD

Department Affiliation

Occupational Therapy

Department Affiliation

Occupational Therapy

IRB Approval Number (if applicable)

4269

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