{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T12:30:30Z","timestamp":1789129830869,"version":"build-2803163510"},"reference-count":49,"publisher":"AACN Publishing","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Delirium is common among the critically ill. Nonpharmacologic interventions are reportedly effective in reducing incident delirium, but limited data specific to this population exist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>To assess the efficacy and describe the implementation strategy of a multicomponent intervention to prevent delirium in an intensive care unit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A before-and-after study was conducted in an intensive care unit between May 2014 through August 2015. Adult participants were enrolled consecutively, excluding only those who refused to participate. Tailored interventions took available evidence into consideration. Components included early mobilization, physical therapy, reorientation, cognitive stimulation, drug reviews, environmental stimulation, avoidance of sensory deprivation, pain control, restraint use avoidance, and family participation. Incident delirium was assessed twice daily using the Confusion Assessment Method for the Intensive Care Unit. Multivariate logistic regression was used to control for confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The study included 227 patients (54.7% male; mean [SD] age, 63.3 [18.3] years). Our strategy significantly reduced delirium (from 38% to 24%; relative risk, 0.62; 95% CI, 0.40\u20130.94; P = .02), an association that remained significant after adjusting for confounders. Adherence rates were more than 85% in all intervention domains (except daily reorientation) that were overseen by health care providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONs<\/jats:title>\n                    <jats:p>The strategy was successful in reducing delirium. Self-removals of invasive implements decreased, an observation that has not been previously described. No difference in mortality rate was seen, as has been reported in other studies. Early participation of the whole team, shared leadership, and the provision of concrete tasks were key to the success of this multicomponent intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4037\/ccn2017531","type":"journal-article","created":{"date-parts":[[2017,12,1]],"date-time":"2017-12-01T04:15:11Z","timestamp":1512101711000},"page":"36-46","source":"Crossref","is-referenced-by-count":40,"title":["Implementing a Multicomponent Intervention to Prevent Delirium Among Critically Ill Patients"],"prefix":"10.4037","volume":"37","author":[{"given":"Felipe","family":"Mart\u00ednez","sequence":"first","affiliation":[{"name":"Felipe Mart\u00ednez is an intensive care physician at Unidad de Cuidados Intensivos Generales, Hospital Naval Almirante Nef, Vi\u00f1a del Mar, Chile, and a research coordinator at Area de Investigaci\u00f3n y Estudios Cl\u00ednicos, Cl\u00ednica Ciudad del Mar, Vi\u00f1a del Mar, and a clinical researcher at Centro de Investigaciones Biom\u00e9dicas, Escuela de Medicina, Universidad de Valpara\u00edso, Centro de Investigaciones Biom\u00e9dicas, Escuela de Medicina, Universidad de Valpara\u00edso, Chile."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Mar\u00eda","family":"Donoso","sequence":"additional","affiliation":[{"name":"Ana Mar\u00eda Donoso is an anesthesiologist at Unidad de Cuidados Intensivos Generales, Hospital Naval Almirante Nef."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Marquez","sequence":"additional","affiliation":[{"name":"Carla Marquez is a clinical nurse at Unidad de Cuidados Intensivos Generales, Hospital Naval Almirante Nef."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Labarca","sequence":"additional","affiliation":[{"name":"Eduardo Labarca is a senior intensivist at Unidad de Cuidados Intensivos Generales, Hospital Naval Almirante Nef."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2471","reference":[{"issue":"1","key":"2019112519032677100_b1-0370036","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.ccc.2012.10.007","article-title":"Preventing delirium in the intensive care unit","volume":"29","author":"Brummel","year":"2013","journal-title":"Crit Care Clin"},{"issue":"5","key":"2019112519032677100_b2-0370036","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1034\/j.1600-0579.2003.00201.x","article-title":"Delirium in the intensive care unit: occurrence and clinical course in older patients","volume":"51","author":"McNicoll","year":"2003","journal-title":"J Am Geriatr Soc"},{"issue":"5","key":"2019112519032677100_b3-0370036","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1056\/NEJMra1208705","article-title":"Sedation and delirium in the intensive care unit","volume":"370","author":"Reade","year":"2014","journal-title":"N Engl J Med"},{"issue":"2","key":"2019112519032677100_b4-0370036","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.genhosppsych.2012.11.003","article-title":"Impact of delirium on clinical outcome in critically ill patients: a meta-analysis","volume":"35","author":"Zhang","year":"2013","journal-title":"Gen Hosp Psychiatry"},{"issue":"4","key":"2019112519032677100_b5-0370036","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.ccc.2008.05.008","article-title":"Delirium in the acute care setting: characteristics, diagnosis and treatment","volume":"24","author":"Maldonado","year":"2008","journal-title":"Crit Care Clin"},{"issue":"11","key":"2019112519032677100_b6-0370036","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1056\/NEJMra052321","article-title":"Delirium in older persons","volume":"354","author":"Inouye","year":"2006","journal-title":"N Engl J Med"},{"issue":"14","key":"2019112519032677100_b7-0370036","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1001\/jama.291.14.1753","article-title":"Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit","volume":"291","author":"Ely","year":"2004","journal-title":"JAMA"},{"issue":"4","key":"2019112519032677100_b8-0370036","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1001\/archinte.162.4.457","article-title":"Delirium predicts 12-month mortality","volume":"162","author":"McCusker","year":"2002","journal-title":"Arch Intern Med"},{"issue":"12","key":"2019112519032677100_b9-0370036","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1097\/CCM.0b013e3181f85759","article-title":"Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients","volume":"38","author":"Shehabi","year":"2010","journal-title":"Crit Care Med"},{"issue":"3","key":"2019112519032677100_b10-0370036","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1176\/appi.psy.50.3.218","article-title":"Falls in the general hospital: association with delirium, advanced age, and specific surgical procedures","volume":"50","author":"Lakatos","year":"2009","journal-title":"Psychosomatics"},{"issue":"1","key":"2019112519032677100_b11-0370036","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.archger.2008.06.004","article-title":"Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit","volume":"49","author":"Corsinovi","year":"2009","journal-title":"Arch Gerontol Geriatr"},{"issue":"4","key":"2019112519032677100_b12-0370036","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.ccc.2006.11.006","article-title":"Coma, delirium, and cognitive dysfunction in critical illness","volume":"22","author":"Stevens","year":"2006","journal-title":"Crit Care Clin"},{"issue":"3","key":"2019112519032677100_b13-0370036","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.emc.2010.03.005","article-title":"Delirium in the older emergency department patient: a quiet epidemic","volume":"28","author":"Han","year":"2010","journal-title":"Emerg Med Clin North Am"},{"issue":"1","key":"2019112519032677100_b14-0370036","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1093\/ageing\/afn253","article-title":"Persistent delirium in older hospital patients: a systematic review of frequency and prognosis","volume":"38","author":"Cole","year":"2009","journal-title":"Age Ageing"},{"issue":"11","key":"2019112519032677100_b15-0370036","doi-asserted-by":"crossref","first-page":"746","DOI":"10.7326\/0003-4819-154-11-201106070-00006","article-title":"Synopsis of the National Institute for Health and Clinical Excellence guideline for prevention of delirium","volume":"154","author":"O\u2019Mahony","year":"2011","journal-title":"Ann Intern Med"},{"issue":"7598","key":"2019112519032677100_b16-0370036","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1136\/bmj.39169.706574.AD","article-title":"Delirium in older people","volume":"334","author":"Young","year":"2007","journal-title":"BMJ"},{"issue":"9","key":"2019112519032677100_b17-0370036","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1111\/j.1532-5415.2005.53466.x","article-title":"Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial","volume":"53","author":"Vid\u00e1n","year":"2005","journal-title":"J Am Geriatr Soc"},{"issue":"3","key":"2019112519032677100_b18-0370036","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1007\/BF03324687","article-title":"Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study","volume":"19","author":"Lundstr\u00f6m","year":"2007","journal-title":"Aging Clin Exp Res"},{"issue":"6","key":"2019112519032677100_b19-0370036","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1111\/j.1532-5415.2010.02871.x","article-title":"Randomized trial of a delirium abatement program for postacute skilled nursing facilities","volume":"58","author":"Marcantonio","year":"2010","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"2019112519032677100_b20-0370036","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1093\/ageing\/afu173","article-title":"Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature","volume":"44","author":"Martinez","year":"2015","journal-title":"Age Ageing"},{"issue":"6","key":"2019112519032677100_b21-0370036","doi-asserted-by":"crossref","first-page":"e0123090","DOI":"10.1371\/journal.pone.0123090","article-title":"Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: a systematic overview. The SENATOR project ONTOP series","volume":"10","author":"Abraha","year":"2015","journal-title":"PLoS ONE"},{"issue":"4","key":"2019112519032677100_b22-0370036","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1001\/jamainternmed.2014.7779","article-title":"Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis","volume":"175","author":"Hshieh","year":"2015","journal-title":"JAMA Intern Med"},{"issue":"2","key":"2019112519032677100_b23-0370036","first-page":"CD005563","article-title":"Interventions for preventing delirium in hospitalised patients","author":"Siddiqi","year":"2007","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"2019112519032677100_b24-0370036","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/CCM.0b013e3182783b72","article-title":"Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit","volume":"41","author":"Barr","year":"2013","journal-title":"Crit Care Med"},{"issue":"3","key":"2019112519032677100_b25-0370036","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/j.1741-6612.2008.00301.x","article-title":"Clinical practice guidelines for the management of delirium in older people in Australia","volume":"27","author":"Tropea","year":"2008","journal-title":"Australas J Ageing"},{"issue":"suppl 2","key":"2019112519032677100_b26-0370036","first-page":"S42","article-title":"National guidelines for seniors\u2019 mental health: the assessment and treatment of delirium","volume":"9","author":"Hogan","year":"2006","journal-title":"Can J Geriatr"},{"key":"2019112519032677100_b27-0370036","unstructured":"Greer\n              N\n            , RossomR, AndersonP, . Delirium: Screening, Prevention, and Diagnosis \u2013 A Systematic Review of the Evidence. Washington, DC: US Department of Veterans Affairs; September2011. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK82554\/. Accessed September 8, 2017."},{"issue":"9","key":"2019112519032677100_b28-0370036","first-page":"1051","article-title":"Delirium: the clinical confusion [in Spanish]","volume":"131","author":"Gonz\u00e1lez","year":"2003","journal-title":"Rev Med Chil"},{"issue":"2","key":"2019112519032677100_b29-0370036","first-page":"82","article-title":"Prevalencia de delirium y diagn\u00f3stico por los m\u00e9dicos tratantes [Delirium prevalence and diagnosis by the physician]","volume":"4","author":"Tobar","year":"2010","journal-title":"Rev ANACEM"},{"issue":"5","key":"2019112519032677100_b30-0370036","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1093\/ageing\/afs060","article-title":"Preventing delirium in an acute hospital using a non-pharmacological intervention","volume":"41","author":"Martinez","year":"2012","journal-title":"Age Ageing"},{"issue":"7","key":"2019112519032677100_b31-0370036","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1001\/jama.2010.1182","article-title":"Does this patient have delirium?: value of bedside instruments","volume":"304","author":"Wong","year":"2010","journal-title":"JAMA"},{"issue":"21","key":"2019112519032677100_b32-0370036","doi-asserted-by":"crossref","first-page":"2703","DOI":"10.1001\/jama.286.21.2703","article-title":"Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU)","volume":"286","author":"Ely","year":"2001","journal-title":"JAMA"},{"issue":"4","key":"2019112519032677100_b33-0370036","doi-asserted-by":"crossref","first-page":"R115","DOI":"10.1186\/cc11407","article-title":"The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies","volume":"16","author":"Gusmao-Flores","year":"2012","journal-title":"Crit Care"},{"issue":"3","key":"2019112519032677100_b34-0370036","doi-asserted-by":"crossref","first-page":"R125","DOI":"10.1186\/cc13929","article-title":"Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study","volume":"18","author":"Wolters","year":"2014","journal-title":"Crit Care"},{"key":"2019112519032677100_b35-0370036","doi-asserted-by":"crossref","first-page":"h2538","DOI":"10.1136\/bmj.h2538","article-title":"Outcome of delirium in critically ill patients: systematic review and meta-analysis","volume":"350","author":"Salluh","year":"2015","journal-title":"BMJ"},{"issue":"5","key":"2019112519032677100_b36-0370036","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1097\/CCM.0000000000000129","article-title":"Effectiveness and safety of the awakening and breathing coordination, delirium monitoring\/management, and early exercise\/mobility bundle","volume":"42","author":"Balas","year":"2014","journal-title":"Crit Care Med"},{"issue":"9 suppl 1","key":"2019112519032677100_b37-0370036","doi-asserted-by":"crossref","first-page":"S116","DOI":"10.1097\/CCM.0b013e3182a17064","article-title":"Implementing the awakening and breathing coordination, delirium monitoring\/management, and early exercise\/mobility bundle into everyday care: opportunities, challenges, and lessons learned for implementing the ICU Pain, Agitation, and Delirium Guidelines","volume":"41","author":"Balas","year":"2013","journal-title":"Crit Care Med"},{"issue":"12","key":"2019112519032677100_b38-0370036","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1111\/j.1532-5415.2000.tb03885.x","article-title":"The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program","volume":"48","author":"Inouye","year":"2000","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"2019112519032677100_b39-0370036","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/j.1532-5415.2010.03243.x","article-title":"Sustainability and scalability of the Hospital Elder Life Program at a community hospital","volume":"59","author":"Rubin","year":"2011","journal-title":"J Am Geriatr Soc"},{"issue":"9607","key":"2019112519032677100_b40-0370036","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/S0140-6736(08)60105-1","article-title":"Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial","volume":"371","author":"Girard","year":"2008","journal-title":"Lancet"},{"issue":"10","key":"2019112519032677100_b41-0370036","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1111\/j.1532-5415.2006.00869.x","article-title":"Dissemination of the hospital elder life program: implementation, adaptation, and successes","volume":"54","author":"Inouye","year":"2006","journal-title":"J Am Geriatr Soc"},{"issue":"3","key":"2019112519032677100_b42-0370036","first-page":"369","article-title":"Sedation in the intensive care unit","volume":"78","author":"McGrane","year":"2012","journal-title":"Minerva Anestesiol"},{"issue":"9 suppl 1","key":"2019112519032677100_b43-0370036","doi-asserted-by":"crossref","first-page":"S46","DOI":"10.1097\/CCM.0b013e3182a168f5","article-title":"Top 10 myths regarding sedation and delirium in the ICU","volume":"41","author":"Peitz","year":"2013","journal-title":"Crit Care Med"},{"issue":"2","key":"2019112519032677100_b44-0370036","first-page":"CD005594","article-title":"Antipsychotics for delirium","author":"Lonergan","year":"2007","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"2019112519032677100_b45-0370036","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.ccc.2009.04.003","article-title":"Sedation and sleep disturbances in the ICU","volume":"25","author":"Weinhouse","year":"2009","journal-title":"Crit Care Clin"},{"issue":"8","key":"2019112519032677100_b46-0370036","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.medin.2010.04.003","article-title":"Latin American survey on delirium in critical patients [in Spanish]","volume":"34","author":"Ceraso","year":"2010","journal-title":"Med Intensiva"},{"issue":"3","key":"2019112519032677100_b47-0370036","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/nicc.12239","article-title":"Attitudes, knowledge and practices concerning delirium: a survey among intensive care unit professionals","volume":"22","author":"Trogrlic","year":"2017","journal-title":"Nurs Crit Care"},{"issue":"4","key":"2019112519032677100_b48-0370036","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.mehy.2013.06.032","article-title":"Delirium: a disturbance of circadian integrity?","volume":"81","author":"Fitzgerald","year":"2013","journal-title":"Med Hypotheses"},{"issue":"4","key":"2019112519032677100_b49-0370036","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1089\/rej.2012.1405","article-title":"Melatonin deficiency hypothesis in delirium: a synthesis of curreTablent evidence","volume":"16","author":"de Rooij","year":"2013","journal-title":"Rejuvenation Res"}],"container-title":["Critical Care Nurse"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/aacnjournals.org\/ccnonline\/article-pdf\/37\/6\/36\/115530\/36.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/aacnjournals.org\/ccnonline\/article-pdf\/37\/6\/36\/115530\/36.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,11,25]],"date-time":"2019-11-25T19:03:49Z","timestamp":1574708629000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacnjournals.org\/ccnonline\/article\/37\/6\/36\/3563\/Implementing-a-Multicomponent-Intervention-to"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,1]]},"references-count":49,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2017,12,1]]}},"URL":"https:\/\/doi.org\/10.4037\/ccn2017531","relation":{},"ISSN":["0279-5442","1940-8250"],"issn-type":[{"value":"0279-5442","type":"print"},{"value":"1940-8250","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,1]]}}}