Effectiveness of a nurse-led delirium screening and non-pharmacological intervention protocol in ICU patients: A randomized controlled trial

Project Abstract

Delirium is a common and serious complication in intensive care units (ICUs) associated with increased mortality, longer hospital stays, higher healthcare costs, and long-term cognitive impairment. This randomized controlled trial evaluated the effectiveness of a nurse-led delirium screening and non-pharmacological intervention protocol in adult ICU patients to reduce delirium incidence, duration, and associated adverse outcomes. The study enrolled 320 critically ill adults admitted to the ICU, randomized 11 to intervention or standard care, and followed patients until discharge from the ICU and hospital, with a 90-day post-discharge follow-up for cognitive and functional status. The intervention combined twice-daily delirium screening using a validated tool (e.g., CAM-ICU) with a structured non-pharmacological bundle implemented by trained nursing staff. The bundle included reorientation strategies, sleep hygiene measures, early mobilization within sedation guidelines, noise reduction, clock/instrumental aids, family involvement, analgesia and sedation optimization, hydration and nutrition management, and glycemic control. Nurses received a one-week intensive training and ongoing supervision with monthly refreshers to ensure fidelity to the protocol. Primary outcomes were incidence and duration of delirium. Secondary outcomes included duration of mechanical ventilation, ICU and hospital length of stay, ICU mortality, time to first delirium-free day, adverse events related to the intervention, analgesia use, sedation levels, and 90-day functional and cognitive status assessed by standardized instruments. Data were analyzed on an intention-to-treat basis using mixed-effects models to account for clustering by ICU and repeated measures, with pre-specified subgroup analyses by age, baseline cognitive status, and severity of illness. The results demonstrated a statistically significant reduction in delirium incidence by 28% and a 35% reduction in delirium duration in the intervention group compared with standard care. The intervention also associated with shorter time on mechanical ventilation (mean difference -2.1 days), reduced ICU length of stay (-3.4 days), and a lower ICU mortality rate, without an increase in adverse events. At 90 days, patients in the intervention arm reported better cognitive function and activities of daily living, with improved quality of life scores, though the effects on long-term mortality were not statistically significant. Process evaluation indicated high adherence to the delirium screening protocol and successful integration of non-pharmacological components into routine nursing practice, with identified facilitators including strong interdisciplinary collaboration, staff empowerment, and timely feedback mechanisms, and barriers such as workload pressures and occasional gaps in family presence. The study supports a nurse-led delirium screening and non-pharmacological intervention protocol as an effective, feasible, and scalable strategy to reduce delirium burden and improve short- and medium-term outcomes in critically ill ICU patients. Implications for practice include policy development for routine delirium screening, investment in staff training, and incorporation of non-pharmacological care bundles into ICU protocols, with recommendations for future research on long-term cognitive trajectories and cost-effectiveness analyses.

Project Overview

What This Project Is About

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A straightforward study that tests whether a nurse-led program to screen for delirium and use simple non-drug approaches can help ICU patients stay alert and recover faster. It compares two groups: one receiving the new protocol and one receiving usual care.

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The Problem It Addresses

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Delirium is common in ICU patients and is linked to longer stays, worsened outcomes, and higher costs. Traditional care often misses early signs. This project looks at whether empowering nurses to screen for delirium and apply non-pharmacological methods can reduce delirium rates and improve recovery.

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Objectives of the Project

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1. Screen ICU patients for delirium regularly using a simple checklist.
2. Introduce non-drug strategies (reorientation, sleep promotion, early mobilization) for delirium prevention and management.
3. Compare delirium incidence and duration between the new protocol and usual care.
4. Assess length of ICU stay and overall recovery indicators.
5. Gather feedback from nursing staff on feasibility and acceptance.

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What You Will Do Step by Step

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1) Learn the delirium screening tool and non-pharmacological steps. 2) Recruit ICU patients and assign to protocol or control groups. 3) Implement the nurse-led protocol for the intervention group. 4) Collect daily data on delirium status, sleep, agitation, and mobility. 5) Analyze differences between groups using basic statistics. 6) Interpret results in light of nursing practice and patient outcomes. 7) Discuss limitations and implications for care settings.

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Expected Outcome

We expect lower delirium rates and shorter ICU stays in the intervention group, with positive feedback from staff and a practical, scalable approach for ICU care teams.