Effectiveness of Consolidated National Institute for Health and Care Excellence Delirium Prediction Rule for Predicting the Risk of Delirium in Intensive Care Unit Patients with Stroke Managed by Pharmacist-led Interventions
Aisha Vaiyani1, Catherine Paiste2, Melanie Cornelius2, Alexander Crossley3, Sunita Dergalust4
1VA Greater Los Angeles Healthcare System, 2Pharmacy, 3Research, VA Greater Los Angeles Healthcare System, 4Pharmacy, West LA VA Healthcare Center
Objective:
Evaluate the effectiveness of the Consolidated National Institute for Health and Care Excellence Delirium Prediction Rule (NICE) in identifying the risk of delirium in stroke patients admitted to the ICU. Secondary outcomes include evaluating efficacy of interventions implemented to prevent delirium and identifying risk factors for the development of delirium in stroke patients.
Background:
The pooled prevalence of delirium in patients admitted to neurocritical care units ranges from 12 to 43%. Patients with an acute stroke or a chronic history of stroke are at a higher risk of developing delirium. A VA study (2018) found that NICE had a high discriminatory function in identifying patients in the ICU with intermediate-high risk of delirium.
Design/Methods:
This is a prospective project led by pharmacists to screen ICU patients for delirium utilizing the NICE rule from 12/1/2020 to 12/30/2022. Pharmacist-led interventions to prevent delirium were implemented in veterans who have an intermediate-high risk NICE score. Data were collected on patients’ baseline characteristics, delirium development, medications, hospital course, and adverse events.
Results:
To date, 175 patients admitted to the ICU have been screened. Preliminary results show that NICE was effective in predicting delirium (p=0.0002, <0.05). Twenty-six patients were identified with an intermediate-high risk of developing delirium and interventions were implemented for prevention. Thirteen of the 26 patients had a diagnosis of stroke and 3/13 (23%) developed delirium. The control arm had 26 patients; all were at intermediate-high risk of developing delirium. Of these 26 patients in the control arm, 9 had a diagnosis of stroke and 3/9 (33%) developed delirium.
Conclusions:
Preliminary results suggest screening with NICE is effective in capturing the risk of delirium in ICU patients with or without stroke. Though current data is limited, there is a trend towards reduction in the incidence of delirium when pharmacist-led interventions in stroke patients are implemented.