Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Up to 87% of individuals in intensive care units (ICUs) are at risk of developing delirium (American Psychiatric Association, 2013). OT is a skilled service that has been shown to help prevent and decrease the severity of delirium (lvarez et al., 2017). However, OT practitioners are not always welcome within ICUs to treat this population. OTs were surveyed to identify the factors influencing the OT presence in the management of ICU delirium.
Primary Author and Speaker: Jenna S. Leveille
Additional Authors and Speakers: Julie L. Watson, Rae Ann Smith, and Jennifer O'Connor Duffy
PURPOSE: 70-87% of individuals in intensive care units (ICUs) across the country are at risk for developing delirium (American Psychiatric Association [APA], 2013). Delirium can significantly impact the hospitalization of the severely ill population, prolonging ICU stays, debilitating overall conditions, and decreasing independence at the time of discharge (APA, 2013; Cavallazzi, et al., 2013). Occupational therapy (OT) is a service that has been cited as a beneficial means to positively impact the incidence and severity of ICU delirium (Álvarez et al., 2017). Despite this, there is little evidence to suggest that OT is a welcomed service within the ICU to provide treatment specifically for the prevention and treatment of delirium. This study aimed to identify the facilitators and barriers OT practitioners face when attempting to manage ICU delirium.
DESIGN: A survey was developed to determine perceived facilitators and barriers impacting OT practitioners' involvement in the management of delirium within ICUs. Using an online survey, participants were invited to take the survey through multiple social media platforms.
METHOD: A survey was developed by the researcher using current literature to reflect facilitators and barriers impacting OT presence within an ICU. The online survey was posted through Google Forms, which allowed OT practitioners from across the country to participate in the study. Data was collected and analyzed to identify the frequency of responses, and a chi-square analysis was used to determine if the type of ICU in which the therapist worked indicated a higher prevalence of OT management of ICU delirium.
RESULTS: The results of this study indicate that current OT practitioners feel as though they are a supported profession within the ICU; however, there are many factors preventing them from providing delirium management services. These factors include a general lack of understanding that OT is a valuable service in delirium management; OT practitioners lack knowledge of how to assess and treat delirium; ICU protocols for delirium do not include OT. Only 51% of participants within this study identified that they provide delirium-specific interventions within the ICU, detailing a gap in practice within the profession.
CONCLUSION: Understanding these trends related to the management of ICU delirium can help promote OT in acute care. As delirium is a prevalent issue across the country (American Psychiatric Association, 2013), it is imperative to find effective solutions to prevent and manage this condition. As recent studies have bolstered the use of occupational therapy within the ICU (Álvarez et al., 2017; Brummel et al., 2017), this research identifies the lack of occupational therapy services for this population. The results from this study further indicate the failure to utilize occupational therapy as a viable treatment method due to the lack of understanding of its use within the delirium management context. Understanding this gap of practice highlights the need for additional research as well as advocacy within the hospital setting for the occupational therapy profession.
References
Álvarez, E., Garrido, M., Tobar, E., Prieto, S., Vergara, S., Briceño, C., & González, F. (2017). Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial. Journal of Critical Care, 40, 265-265. https://doi.org/10.1016/j.jcrc.2017.03.016
American Psychiatric Association. (2013). Neurocognitive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm17
Brummel, N. E., Girard, T. D., Ely, E. W., Pandharipande, P. P., Morandi, A., Hughes, C. G., -¦ Jackson, J. C. (2014). Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: The activity and cognitive therapy in ICU (ACT-ICU) trial. Intensive Care Medicine, 40(3), 370–379. https://doi-org.baypath.idm.oclc.org/10.1007/s00134-013-3136-0
Cavallazzi, R., Saad, M., & Marik, P. E. (2012). Delirium in the ICU: An overview. Annals of Intensive Care, 2(1), 1-11. https://doi.org/http://dx.doi.org.baypath.idm.oclc.org/10.1186/2110-5820-2-49
