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​​​​​Professional Associations and Helpful Websites

*(key resources recommended by Dr. Yoanna Skrobik)

Delirium Clinical Practice Guidelines

Australian Commission on Safety and Quality in Health Care. Delirium Clinical Care Standard. Sydney: ACSQHC, 2016.

*Barr J, Fraser GL, Puntillo K et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41 (1): 263-306. doi: 10.1097/CCM.0b013e3182783b72.

Griffiths R, Beech F, Brown A, et al. Peri-operative care of the elderly 2014: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2014; 69 (Suppl 1): 81-98. doi: 10.1111/anae.12524.

O'Mahony R, Murthy L, Akunne A, Young J. Synopsis of the National Institute for Health and Clinical Excellence guideline for prevention of delirium. Ann Intern Med. 2011; 154 (11): 746-751. doi: 10.7326/0003-4819-154-11-201106070-00006.

Potter J, George J. The prevention, diagnosis and management of delirium in older people: concise guidelines. Clin Med. 2006; 6 (3): 303-308.

*Safer Healthcare Now! Prevention and managem​en​t of Delirium: Getting Started Kit. Canadian Patient Safety Institute, 2013. 

Additional Delirium Resources

Akunne A, Davis S, Westby M, Young J. The cost-effectiveness of multi-component interventions to prevent delirium in older people undergoing surgical repair of hip fracture. Eur J Orthop Surg Traumatol. 2014; 24 (2): 187-195. doi: 10.1007/s00590-013-1170-9.

Akunne A, Murthy L, Young J. Cost-effectiveness of multi-component interventions to prevent delirium in older people admitted to medical wards. Age Ageing. 2012; 41 (3): 285-291. doi: 10.1093/ageing/afr147.

Alagiakrishnan K, Marrie T, Rolfson D, et al. Gaps in p​atient care practices to prevent hospital-acquired delirium. Can Fam Physician. 2009; 55 (10): e41-e46.

Allen J, Alexander E. Prevention, recognition, and management of delirium in the intensive care unit. AACN Ad Crit Care. 2012; 23 (1): 5-11. doi: 10.1097/NCI.0b013e31822c3633.

Al-Qadheeb NS, Balk EM, Fraser GL, et al. Randomized ICU trials do not demonstrate an association between interventions that reduce delirium duration and short-term mortality: a systematic review and meta-analysis. Crit Care Med. 2014; 42 (6): 1442-1454. doi: 10.1097/CCM.0000000000000224.

Awissi DK, Begin C, Moisan J, Lachaine J, Skrobik Y. I-SAVE study: Impact of sedation, analgesia and delirium protocols evaluated in the intensive care unit: an economic evaluation. Ann Pharmacother. 2012; 46 (1) 21-28. doi: 10.1345/aph.1Q284.

Bail K, Berry H, Grealish L, et al. Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective cohort study. BMJ Open. 2013; 3 (6): pii: e002770. doi: 10.1136/bmjopen-2013-002770. 

Barr J, Pandharipande, P. P. The pain, agitation, and delirium care bundle: synergistic benefits of implementing the 2013 Pain, Agitation, and Delirium Guidelines in an integrated and interdisciplinary fashion. Crit Care Med. 2013; 41 (9 Suppl 1): S99-S115. doi: 10.1097/CCM.0b013e3182a16ff0.

Blackmore C, Ouellet JF, Niven D, Kirkpatrick AW, Ball CG. Prevention of delirium in trauma patients: are we giving thiamine prophylaxis a fair chance? Can J Surg. 2014; 57 (2): 78-81.

Brown CH. Delirium in the cardiac surgical ICU. Curr Opin Anaesthesiol. 2014; 27 (2): 117-122. doi: 10.1097/ACO.0000000000000061.

Bryczkowski SB, Lopreiato MC, Yonclas PP, Sacca JJ, Mosenthal AC. Delirium prevention program in the surgical intensive care unit improved the outcomes of older adults. J Surg Res. 2014; 190 (1): 280-288. doi: 10.1016/j.jss.2014.02.044.

Can delirium Assessments Be Accurately Labelled (CABAL) Investigators group, Devlin JW, Fraser GL, Joffe AM, Riker RR, Skrobik Y. The accurate recognition of delirium in the ICU: the emperor's new clothes?Intensive Care Med. 2013; 39 (12): 219602199. doi: 10.1007/s00134-013-3105-7.

Collinsworth AW, Priest EL, Campbell CR, Vasilevskis EE, Masica AL. A review of multifaceted care approaches for the prevention and mitigation of delirium in intensive care units. J Intensive Care Med. 2014; pii: 0885066614553925.

*Dammeyer JA, Baldwin N, Packard D, et al. Mobilizing outcomes: implementation of a nurse-led multidisciplinary mobility program. Crit Care Nurs Q. 2013; 36 (1): 109-119. doi: 10.1097/CNQ.0b013e31827535db.

Deschodt M, Braes T, Flamaing J, et al. Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc. 2012; 60 (4): 733-739. doi: 10.1111/j.1532-5415.2012.03899.x.

Devlin JW, Brummel NE, Al-Qadheeb NS. Optimising the recognition of delirium in the intensive care unit. Best Pract Res Clin Anaesthesiol. 2012; 26 (3): 385-393. doi: 10.1016/j.bpa.2012.08.002.

Devlin J, Skrobik Y. Antipsychotics for the prevention and treatment of delirium in the intensive care unit: What is their role? Harv Rev Psychiatry. 2011; 19 (2): 59-67. doi: 10.3109/10673229.2011.565247.

*Drolet A, DeJuilio P, Harkless S, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Phys Ther. 2013, 93 (2): 197-207. doi: 10.2522/ptj.20110400.

Flinn DR, Diehl KM, Seyfried LS, Malani PN. Prevention, diagnosis, and management of postoperative delirium in older adults. J Am Coll Surg. 2009; 209 (2): 261-268. doi: 10.1016/j.jamcollsurg.2009.03.008.

Fok MC, Sepehry AA, Frisch L, et al. Do antipsychotics prevent postoperative delirium? A systematic review and meta-analysis. Int J Geriatr Psychiatry. 2015; 30 (4): 333-344. doi: 10.1002/gps.4240.

Friedman JI, Soleimani L, McGonigle DP, Egol C, Silverstein JH. Pharmacological treatments of non-substance-withdrawal delirium: a systematic review of prospective trials. Am J Psychiatry. 2014; 171 (2): 151-159. doi: 10.1176/appi.ajp.2013.13040458.

Fukata S, Kawabata Y, Fujisiro K, et al. Haloperidol prophylaxis does not prevent postoperative delirium in elderly patients: a randomized, open-label prospective trial. Surg Today. 2014; 44 (12): 2305-13. doi: 10.1007/s00595-014-0859-7.

Furlow B. Might statins prevent delirium in intensive care units? Lancet Respir Med. 2014; 2 (3): 180.

Gosch M, Nicholas JA. Pharmacologic prevention of postoperative delirium. Z Gerontol Geriatr. 2014; 47 (2): 105-109. doi: 10.1007/s00391-013-0598-1.

Greer N, Rossom R, Anderson P, et al. Delirium: Screening, prevention, and diagnosis - a systematic review of the evidence. Washington, DC: Department of Veterans Affairs (US); 2011.

Hata RK, Han L, Slade J, et al. Promoting sleep in the adult surgical intensive care unit patients to prevent delirium. Nurs Clin North Am. 2014; 49 (3): 383-97. doi: 10.1016/j.cnur.2014.05.012.

Hempenius L, van Leeuwen BL, van Asselt DZ, et al. Structured analyses of interventions to prevent delirium. Int J Geriatr Psychiatry. 2011; 26 (5): 441-450. doi: 10.1002/gps.2560.

Holly C, Rittenmeyer L, Weeks SM. Evidence-based clinical audit criteria for the prevention and management of delirium in the postoperative patient with a hip fracture. Orthop Nurs. 2014; 33 (1): 27-34. doi: 10.1097/NOR.0000000000000020.

Holroyd-Leduc JM, Khandwala F, Sink KM. How can delirium best be prevented and managed in older patients in hospital?CMAJ. 2010; 182 (5): 465-470. doi: 10.1503/cmaj.080519.

Ijkema R, Langelaan M, van de Steeg L, Wagner C. Do patient characteristics influence nursing adherence to a guideline for preventing delirium? J Nurs Scholarsh. 2014; 46 (3): 147-156. doi: 10.1111/jnu.12067.

Inouye SK, Marcantonio ER, Metzger ED. Doing damage in delirium: The hazards of antipsychotic treatment in elderly persons. Lancet Psychiatry. 2014; 1 (4): 312-315. 

Institute for Healthcare Improvement (IHI). IHI Improvement Map: Acute delirium prevention and treatment. Cambridge, MA: IHI; 2012.

Javedan H, Tulebaev S. Management of common postoperative complications: delirium. Clin Geriatr Med. 2014; 30 (2): 271-8. doi: 10.1016/j.cger.2014.01.015.

*Koo KK. Survey of acute rehabilitation in Canadian intensive care units. Open Access Dissertations and theses: McMaster University; 2012.

Korc-Grodzicki B, Root JC, Alici Y. Prevention of post-operative delirium in older patients with cancer undergoing surgery. J Geriatr Oncol. 2015; 6 (1): 60-69. doi: 10.1016/j.jgo.2014.10.002.

Kostas TR, Zimmerman KM, Rudolph JL. Improving delirium care: prevention, monitoring, and assessment. Neurohospitalist. 2013; 3 (4): 194-202. doi: 10.1177/1941874413493185.

Kram BL, Kram SJ, Brooks KR. Implications of atypical antipsychotic prescribing in the intensive care unit. J Crit Care. 2015; 30 (4): 814-818. doi: 10.1016/j.jcrc.2015.03.030.

Li B, Wang H, Wu H, Gao C. Neurocognitive dysfunction risk alleviation with the use of dexmedetomidine in perioperative conditions or as ICU Sedation: A meta-analysis. Medicine. 2015; 94 (14): e597. doi: 10.1097/MD.0000000000000597.

Lee E, Kim J. Cost-benefit analysis of a delirium prevention strategy in the intensive care unit. Nurs Crit Care. 2014. doi: 10.1111/nicc.

MacLaren R, Preslaski CR, Mueller SW, et al. A randomized, double-blind pilot study of dexmedetomidine versus midazolam for intensive care unit sedation: patient recall of their experiences and short-term psychological outcomes. J Intensive Care Med. 2015; 30 (3): 167-175. doi: 10.1177/0885066613510874.

Martocchia A, Curto M, et al. The prevention and treatment of delirium in elderly patients following hip fracture surgery. Recent Pat CNS Drug Discov. 2015; 10 (1): 55-64.

Martinez FT, Tobar C, Beddings CI, Vallejo G, Fuentes P. Preventing delirium in an acute hospital using a non-pharmacological intervention. Ag Ageing. 2012; 41 (5): 629-634. doi: 10.1093/ageing/afs060.

McCormick WC. New guidance on the prevention and treatment of postoperative delirium in older adults. J Gerontol Nurs. 2015; 41 (1): 59-60. doi: 10.3928/00989134-20141211-01.

Mehta S, Cook D, Devlin JW, et al. Incidence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med. 2015; 43 (3) : 557-566. doi: 10.1097/CCM.0000000000000727.

Mirski MA, Lewin JJ 3rd, Ledroux S, et al. Cognitive improvement during continuous sedation in critically ill, awake and responsive patients: the Acute Neurological ICU Sedation Trial (ANIST). Intensive Care Med. 2010; 36 (9): 1505-1513. doi: 10.1007/s00134-010-1874-9.

Mistraletti G, Pelosi P, Mantovani ES, Berardino M, Gregoretti C. Delirium: clinical approach and prevention. Best Pract Res Clin Anaesthesiol. 2012; 26 (3): 311-326. doi: 10.1016/j.bpa.2012.07.001.

Moyce Z, Rodseth RN, Biccard BM. The efficacy of peri-operative interventions to decrease postoperative delirium in non-cardiac surgery: a systematic review and meta-analysis. Anaesthesia. 2014; 69 (3): 259-69. doi: 10.1111/anae.12539.

Mu JL, Lee A, Joynt GM. Pharmacologic agents for the prevention and treatment of delirium in patients undergoing cardiac surgery: systematic review and metaanalysis. Crit Care Med. 2015; 43 (1): 194-204. doi: 10.1097/CCM.0000000000000673.

*Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehab. 2010; 17 (4):271-281. doi: 10.1310/tsr1704-271.

*Needham DM, Korupolu R, Zanni JM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010; 91 (4): 536-542. doi: 10.1016/j.apmr.2010.01.002.

Neufeld KJ, Joseph Bienvenu O, et al. The Johns Hopkins Delirium Consortium: a model for collaborating across disciplines and departments for delirium prevention and treatment.  J Am GeriatrSoc. 2011; 59 (Suppl 2): S244-S248. doi: 10.1111/j.1532-5415.2011.03672.x.

O'Hanlon S, O'Regan N, Maclullich AM, et al. Improving delirium care through early intervention: from bench to bedside to boardroom. J Neurol Neurosurg Psychiatry. 2014; 85 (2): 207-213. doi: 10.1136/jnnp-2012-304334.

O'Regan NA, Fitzgerald J, Timmons S, O'Connell H, Meagher D. Delirium: a key challenge for perioperative care. Int J Surg. 2013; 11 (2): 136-144. doi: 10.1016/j.ijsu.2012.12.015. 

Olson T. Delirium in the intensive care unit: role of the critical care nurse in early detection and treatment. Dynamics. 2012; 23 (4): 32-36.

Pandharipande PP, Patel MB, Barr J. Management of pain, agitation, and delirium in critically ill patients. Pol Arch Med Wewn. 2014; 124 (3): 114-23.

Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007; 298 (22): 2644-2653.

Pasin L, Landoni G, Nardelli P, et al. Dexmedetomidine reduces the risk of delirium, agitation and confusion in critically ill patients: a meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth. 2014; 28 (6): 1459-1466. doi: 10.1053/j.jvca.2014.03.010.

Peitz GJ, Balas MC, Olsen KM, Pun BT, Ely EW. Top 10 myths regarding sedation and delirium in the ICU. Crit Care Med. 2013; 41 (9 Suppl 1): S46-S56. doi: 10.1097/CCM.0b013e3182a168f5.

Popp J, Arlt S. Prevention and treatment options for postoperative delirium in the elderly.  Curr Opin Psychiatry. 2012; 25 (6): 515-521. doi: 10.1097/YCO.0b013e328357f51c.

Rathier MO, Baker WL. A review of recent clinical trials and guidelines on the prevention and management of delirium in hospitalized older patients. Hosp Pract. 2011; 39 (4): 96-106. doi: 10.3810/hp.2011.10.928.

Reimers M, Miller C. Clinical nurse specialist as change agent: delirium prevention and assessment project. Clinical nurse specialist CNS. 2014; 28 (4): 224-30. doi: 10.1097/NUR.0000000000000063.

Reston JT, Schoelles KM. In-facility delirium prevention programs as a patient safety strategy: a systematic review. Ann Intern Med. 2013; 158 (5 Pt 2): 375-380. doi: 10.7326/0003-4819-158-5-201303051-00003. 

Rivosecchi RM, Smithburger PL, Svec S, Campbell S, Kane-Gill SL. Nonpharmacological interventions to prevent delirium: an evidence-based systematic review. Crit Care Nurse. 2015; 35 (1): 39-49. doi: 10.4037/ccn2015423. 

Rose L, Fitzgerald E, Cook D, et al. Clinician perspectives on protocols designed to minimize sedation. J Crit Care. 2015; 30 (2): 348-352. doi: 10.1016/j.jcrc.2014.10.021.

Rosenbloom-Brunton DA, Henneman EA, Inouye SK. Feasibility of family participation in a delirium prevention program for hospitalized older adults. J Gerontol Nurs. 2010; 36 (9): 22-33.

Russell-Babin KA, Miley H. Implementing the best available evidence in early delirium identification in elderly hip surgery patients. Int J Evid BasedbHealthc. 2013; 11 (1): 39-45. doi: 10.1111/1744-1609.12004.

*Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009; 373 (9678): 1874-1882. doi: 10.1016/S0140-6736(09)60658-9.

Shim JJ, Leung JM. An update on delirium in the postoperative setting: prevention, diagnosis and management. Best Pract Res Clin Anaesthesiol. 2012; 26 (3): 327-343. doi: 10.1016/j.bpa.2012.08.003.

Skrobik Y. Can critical-care delirium be treated pharmacologically? Lancet Respir Med. 2013; 1 (7): 498-499. doi: 10.1016/S2213-2600(13)70178-4.

Skrobik Y. Delirium prevention and treatment. Crit Care Clin. 2009; 25 (3): 585-91. doi: 10.1016/j.ccc.2009.05.003.

Skrobik Y, Ahern S, Leblanc M, Marquis F, Awissi DK, Kavanagh BP. Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates. Anesth Analg. 2010; 111 (2): 451-463. doi: 10.1213/ANE.0b013e3181d7e1b8. Erratum in: Anesth Analg. 2012 Jul;115(1):169.

Skrobik Y, Chanques G. The pain, agitation, and delirium practice guidelines for adult critically ill patients: a post-publication perspective. Ann Intensive Care. 2013; 3 (1): 9. doi: 10.1186/2110-5820-3-9.

Steiner LA. Postoperative delirium. part 2: detection, prevention and treatment. Eur J Anaesthesiol. 2011; 28 (10): 723-732. doi: 10.1097/EJA.0b013e328349b7db.

Strom C, Rasmussen LS, Sieber FE. Should general anaesthesia be avoided in the elderly? Anaesthesia. 2014; 69 (Suppl 1): 35-44. doi: 10.1111/anae.12493.

Stuck A, Clark MJ, Connelly CD. Preventing intensive care unit delirium: a patient-centered approach to reducing sleep disruption. Dimens Crit Care Nurs. 2011; 30 (6): 315-320. doi: 10.1097/DCC.0b013e31822fa97c.

Sykes PK. Prevention and management of postoperative delirium among older patients on an orthopedic surgical unit: a best practice implementation project. J Nurs Care Qual. 2012; 27 (2): 146-153. doi: 10.1097/NCQ.0b013e31823f8573.

Tabet N, Howard R. Non-pharmacological interventions in the prevention of delirium. Age Ageing. 2009; 38 (4): 374-379. doi: 10.1093/ageing/afp039.

Tomasi R, von Dossow-Hanfstingl V. Critical care strategies to improve neurocognitive outcome in thoracic surgery. Curr Opin Anaesthesiol. 2014; 27 (1): 44-48. doi: 10.1097/ACO.0000000000000026.

Trabold B, Metterlein T. Postoperative delirium: risk factors, prevention, and treatment. J Cardiothorac Vasc Anesth. 2014; 28 (5): 1352-1360. doi: 10.1053/j.jvca.2014.03.017.

van der Jagt M, Trogrlic Z, Ista E. Untangling ICU delirium: is establishing its prevention in high-risk patients the final frontier? Intensive Care Med. 2014; 40 (8): 1181-1182. doi: 10.1007/s00134-014-3383-8.

van Meenen LC, van Meenen DM, de Rooij SE, ter Riet G. Risk prediction models for postoperative delirium: a systematic review and meta-analysis. J Am Geriatr Soc. 2014; 62 (12): 2383-2390. doi: 10.1111/jgs.13138.

Vardi K, Harrington CJ. Delirium: treatment and prevention (part 2). R I Med J. 2014; 97 (6): 24-28.

Wand AP. Evaluating the effectiveness of educational interventions to prevent delirium. Australas J Ageing. 2011; 30 (4): 175-185. doi: 10.1111/j.1741-6612.2010.00502.x.

Wand AP, Thoo W, Sciuriaga H, Ting V, Baker J, Hunt GE. A multifaceted educational intervention to prevent delirium in older inpatients: a before and after study. Int J Nurs Stud. 2014; 51 (7): 974-982. doi: 10.1016/j.ijnurstu.2013.11.005.

Wassenaar A, van den Boogaard M, van Achterberg T, et al. Multinational development and validation of an early prediction model for delirium in ICU patients. Intensive Care Med. 2015; 41 (6): 1048-1056. doi: 10.1007/s00134-015-3777-2.

Wheeler M, Crenshaw C, Gunn S. Incidence and prevention of delirium in critical care patients. Crit Care Nurs Clin North Am. 2014; 26 (4): 461-468. doi: 10.1016/j.ccell.2014.08.003.

Yue J, Tabloski P, Dowal SL, Puelle MR, Nandan R, Inouye SK. NICE to HELP: Operationalizing National Institute for Health and Clinical Excellence guidelines to improve clinical practice. J Am Geriatr Soc. 2014; 62 (4): 754-761. doi: 10.1111/jgs.12768.

Zhang H, Lu Y, Liu M, et al. Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials. Crit Care. 2013; 17 (2): R47. doi: 10.1186/cc12566.