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      Promoting vision and hearing aids use in an intensive care unit

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      BMJ Quality Improvement Reports
      British Publishing Group

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          Abstract

          Vision and hearing impairments have long been recognised as modifiable risk factors for delirium.[1,2,3] Delirium in critically ill patients is a frequent complication (reported as high as 60% to 80% of intensive care patients), and is associated with a three-fold increase in mortality and prolonged hospital stay.[1] Guidelines by the UK Clinical Pharmacy Association recommend minimising risk factors to prevent delirium, rather than to treat it with pharmacological agents which may themselves cause delirium.[4] To address risk factors is a measure of multi-system management, such as sleep-wake cycle correction, orientation and use of vision and hearing aids, etc.[5]

          We designed an audit to survey the prevalence and availability of vision and hearing aids use in the intensive care unit (ICU) of one university hospital. The baseline data demonstrated a high level of prevalence and low level of availability of vision /hearing aid use.

          We implemented changes to the ICU Innovian assessment system, which serves to remind nursing staff performing daily checks on delirium reduction measures. This has improved practice in promoting vision and hearing aids use in ICU as shown by re-audit at six month. Further amendments to the Innovian risk assessments have increased the rate of assessment to 100% and vision aid use to near 100%.

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          Most cited references3

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          Evaluation and management of delirium in hospitalized older patients.

          Delirium is common in hospitalized older patients and may be a symptom of a medical emergency, such as hypoxia or hypoglycemia. It is characterized by an acute change in cognition and attention, although the symptoms may be subtle and usually fluctuate throughout the day. This heterogeneous syndrome requires prompt recognition and evaluation, because the underlying medical condition may be life threatening. Risk factors for delirium include visual impairment, previous cognitive impairment, severe illness, and an elevated blood urea nitrogen/serum creatinine ratio. Interventions that have been shown to reduce the incidence of delirium in at-risk hospitalized patients include repeated reorientation of the patient to person and place, promotion of good sleep hygiene, early mobilization, correction of dehydration, and the minimization of unnecessary noise and stimuli. The treatment of delirium centers on the identification and management of the medical condition that triggered the delirious state. Nonpharmacologic interventions may be beneficial, but antipsychotic agents may be needed when the cause is nonspecific and other interventions do not sufficiently control symptoms such as severe agitation or psychosis. Although delirium is a temporary condition, it may persist for several months in the most vulnerable patients. Patient outcomes at one year include a higher mortality rate and a lower level of functioning compared with age-matched control patients.
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            Contact lens care in the unconscious.

            We present a case of gradual visual loss in a patient after a severe road traffic accident. The cause of visual loss was prolonged contact lens wear. We stress the importance of excluding contact lens wear and suggest a method for bedside examination of an unconscious patient to detect the presence of contact lenses.
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              Delirium in intensive care. Continuing Educaion in Anaesthesia

              J King (2009)
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                Author and article information

                Journal
                BMJ Qual Improv Rep
                BMJ Qual Improv Rep
                bmjqir
                bmjqir
                BMJ Quality Improvement Reports
                British Publishing Group
                2050-1315
                2015
                9 February 2015
                : 4
                : 1
                : u206276.w2702
                Affiliations
                University Hospital Bristol NHS Foundation Trust, UK
                Author notes
                [Correspondence to ] Qiaoling Zhou qz8028@ 123456my.bristol.ac.uk
                Article
                bmjquality_uu206276.w2702
                10.1136/bmjquality.u206276.w2702
                4645874
                9dd15f9b-2125-4b3d-aa48-7b9b7eb69473
                © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ http://creativecommons.org/licenses/by-nc/2.0/legalcode

                History
                : 3 October 2014
                : 24 October 2014
                : 9 November 2014
                Categories
                BMJ Quality Improvement Programme

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