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RES208
Psychometric Testing of the KU Delirium Assessment Tool (KU DAT) for Intubated Patients
By: M. Bolen, A. Kubo, A. O'Brien-Ladner, C. Goodyear-Bruch, & L. Connelly; University of Kansas; KS
For further information, please contact: mbolen@kumc.edu
Purpose: The purpose of this study was to test the psychometric properties of a clinician-developed screening tool for delirium in adult intensive care unit (ICU) patients who are ventilated..
Background/Significance: Delirium is a serious complication for ICU patients with reported three-fold increase in hospital death rates. Available instruments to screen for delirium were difficult to use on non-verbal patients and/or with poor visual/motor function. An easy to use screening tool based on current literature and a validated tool was developed. This new tool was clinically successful, but psychometric testing was needed.
Methods: The study was a psychometric evaluation of the Delirium Assessment Tool (DAT). The DAT consists of 4 assessment areas: Altered level of consciousness, inattention, psychomotor agitation, and psychosis. Each was rated as present or absent. If 2 or more areas were present, the screening tool was positive which prompted a physician referral for diagnosis. Psychometric evaluation included instrument reliability and concurrent validity. In addition, sensitivity and specificity based on whether delirium orders were written by the physician and inter-rater reliability were conducted.
Results: Out of 346 assessments, 202 assessments (58%) were done on 164 ventilated patients consisting of 104 males and 60 females with a mean age of 52 (range 19-83). Of the 202 ventilated patient assessments 38 (23%) were assessed as positive, indicating the need for physician referral. Sensitivity (true positives with delirium orders) was 95% with 95% CI =86-99% and specificity was 99% (162/164). Inter-rater reliability for the DAT was 100% between two nurse raters with only 6 disagreements on sub-items. The DAT captured one more patient with delirium than the original instrument (97% agreement). Incidence of delirium for ventilated patients in this sample was 19%.
Conclusions: Although further testing is needed, the DAT shows promise in being an effective, useable screening instrument for delirium. Staff learned the tool quickly with improved consistency in delirium assessment and documentation.
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