The Awake and Walking ICU with Kali Dayton

Propofol and Ativan are a nurses best friend, right? WRONG. Kali Dayton, RN, DNP from the podcast Walking Home from the ICU challenges us to rethink delirium in a way that not only produce better patient outcomes but substantially decrease the nurses workload in the long run.

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Types of Delirium

Delirium is not always hyperactive. In fact, it is usually not. According to Kumar et al, the types and frequency of delirium are:

  • Hypoactive 44.5%
  • Hyperactive 33.3%
  • Mixed 22.2%

Important Statistics

  • For every 1mg of Lorazapam given, the risk of delirium goes up by 20% in within the following 24 hours (Pandharipande, 2013)
  • Patient’s who become delirious are
    • 2x as likely to die during admission (Salluh, 2015
    • 3x as likely to die within 6 months after discharge
    • More likely to die 1 year after discharge (Ely, 2004)

Kali’s Call to Action for Nurses

  • Fight for safe staffing ratios with this information. Play out the domino effect and the ultimate $$$ COST of the these consequences
  • Involve families
  • Facilitate physical and occupational therapy
  • Encourage mobility, foleys out, utilize commode/toilet, chair during the day (chair and bed exercises, even with family, are far more effect than inspiratory spirometer)
  • Maintain proper circadian rhythms 
  • AVOID medications like Ativan like the plague
  • Mobility and melatonin at night 
  • Talk patient through it- allow them to discuss their delirium- make sure everyone understands where they are