Non-Pharmacological Treatment/Prevention Options
Non-Pharmacological interventions are key to preventing and treating ICU delirium.
- Repeated re-orientation of patients - It is important that patients are spoken to calmly when the room is entered and reminding them that they are in the hospital and that they are being taken care of. The ICU can be quite a scary place and since most patients are somewhat sedated and do tend to sleep frequently it is sometimes difficult to distinguish what is reality and what is a dream. Continuous re-orientation will help reassure the patient.
- Non-Pharmacological Sleep Protocol - Ensure that a patient's room is as dark as possible at night and that they are encouraged to sleep during the night hours. Also it is important to try and keep them awake during the day so as to help promote a healthy sleep wake cycle. (For a detailed Sleep Protocol created by the Regional Geriatric Program of Toronto click here.)
- Cognitively stimulating activities - such as reading a book, watching TV or listening to the radio.
- Early mobilization exercises - Getting the patient up and moving or simply having physio do exercises at the bed is beneficial. This not only helps with the prevention of any clots or bed sores, it can help improve pain symptoms and improve the mood of the patient.
- Timely removal of catheters and restraints - Removal of catheters helps to decrease the irritation the patient may be experiencing and the potential for infection. The use of restraints have been highly discouraged as it has been shown to worsen patient fear. Several patients reported thoughts of "being crucified" during delirious episodes while restrained.
- Use of eye glasses and hearing aids - Often times patients impaired sensory input can lead to symptoms that appear to present like delirium. Therefore a patient should be encouraged to wear their eye glasses and hearing aids so they can get a clearer understanding of their surroundings.
- Early correction of dehydration - Re-hydration therapy is an essential component of delirium management.
- Pain Management - Inadequate pain control can be a risk factor for delirium. It is important that a patient is comfortable. However, it is imperative to keep in mind that
Reference:
United States Department of Veteran Affairs. Vanderbilt University Medical Centre. http://www.mc.vanderbilt.edu/icudelirium/overview.html. Accessed March 2012.
United States Department of Veteran Affairs. Vanderbilt University Medical Centre. http://www.mc.vanderbilt.edu/icudelirium/overview.html. Accessed March 2012.