Implementation of the CAM-ICU
The CAM-ICU was designed to be used as a bedside delirium assessment tool for any healthcare professionals. On average, the entire test takes less than 1 minute to complete. Since implementation of any new tool in healthcare can be a challenge, we have created this page to include some helpful hints for the implementation of the CAM-ICU, and we consider it a work in progress. While we plan on providing more information in the future, this a brief set of comments to get you started. More than anything, we want you to feel free to contact us with any questions.
We have found that a system of spot-checking is incredibly helpful in identifying misunderstandings about the CAM-ICU and areas that need further clarification and teaching. What is spot-checking? This can be done in a variety of ways, but typically a couple nurses (charge nurses, nurse educators, staff nurses who are looking for a clinical ladder project, etc) become very familiar with the CAM-ICU (local experts). Periodically (once a week, once a month, etc) they do delirium rounds on the unit going from bed to bed spot-checking the staff nurses. The spot-checker and the bedside nurse assess a patient together using the CAM-ICU. They walk outside the room and compare assessments. The bedside nurse explains how the patient did on each feature. Then the spot-checker shares his/her findings and takes the opportunity to educate the nurse regarding any mistakes or misconceptions.
Case scenarios have been used to improve recognition of delirium and accuracy of delirium assessment at the bedside. This is a simple educational intervention using before-and-after case studies. These case scenarios can be found here.
Case-Based Scenario Study Read more here.
The first step is to decide where the CAM-ICU assessment results will be documented. We recommend documenting the CAM-ICU in the hourly portion of the nursing flowsheet. Most institutions document the overall CAM-ICU score and not the individual features. However, if you have room, the individual feature documentation can help with compliance and accuracy of the overall assessment and provide excellent data for chart review when trying to identifying weaknesses in the assessment.
Once you have decided where to document the CAM-ICU findings, the next step is to identify how CAM-ICU findings will be documented. We have found that different institutions choose to record the overall CAM-ICU as either "positive" or "negative" OR "Yes", "No" and "UTA." The table below shows the various terminologies that have been used. We recommend picking language that your staff best understands.
|Overall CAM-ICU score
We recommend adding the CAM-ICU and RASS documentation to the check-list that you use in the regularly scheduled documentation compliance reviews (e.g. chart review).
The following studies documented the implementation of the RASS and CAM-ICU into the bedside nursing assessments of critically ill patients in Medical and Trauma Intensive Care Units.
Implementation Study – Medical ICU
Read more here.
Implementation Study – Trauma ICU
Read more here.