Factors Influencing CAM-ICU Documentation and Inappropriate "Unable to Assess" Responses.
Omar M Awan, Russell G Buhr, Biren B Kamdar
PMID 34719712WHAT IT FOUND
Nurses documented 66% of CAM-ICU delirium checks in a medical ICU.
Among alert or lightly sedated patients, 16% were recorded as unable to assess. Intubation, sedation, older age, non-White race, night shift, and ICU side were linked to incomplete assessment.
Key findings
01Only 66% of CAM-ICU documentation opportunities were completed.
02Of 15 003 CAM-ICU assessments in alert or lightly sedated patients, 2368 (16%) were recorded as inappropriate unable to assess responses.
03Documentation was higher during day shift, with physical restraints, on side B, and with dexmedetomidine; inappropriate unable to assess responses were higher with age older than 80 years, non-White race, intubation, physical restraints, any sedative infusion, sepsis, and weekday.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in a single academic medical ICU with medically complex nonneurological and nonsurgical patients, so findings may not apply to other ICUs. The retrospective EHR analysis could be affected by unmeasured confounding and missing or inaccurate data. The analysis did not access nursing notes, so it could not explain why assessments were not documented or marked unable to assess. The analysis lacked nursing demographic data, such as years of experience or certifications. The CAM-ICU was conducted only in English. The study reports associations, not tested effects of any intervention.
Declared interests
The supplied text lists NIH extramural and non-U.S. government research support but gives no author conflict declaration.
The easy way to misread this
Do not read the night shift, ICU side, age, race, and sedative associations as proven causes of missed delirium. This retrospective EHR analysis cannot show why nurses documented or marked unable to assess, and it did not test any intervention.