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. 2023 Jul 13;5(7):e0939.
doi: 10.1097/CCE.0000000000000939. eCollection 2023 Jul.

Development and Validation of an ICU Delirium Playbook for Provider Education

Hirsh Makhija  1 , Janelle M Fine  1 , Daniel Pollack  2   3 , Francesca Novelli  2   3   4 , Judy E Davidson  2   5 , Shannon A Cotton  2   3 , Bianca Diaz De Leon  1 , Paola Alicea Reyes  6 , Jessica L Montoya  5 , Carmen Mabel Arroyo-Novoa  7 , Milagros I Figueroa-Ramos  7 , Yeonsu Song  8   9   10 , Ana Lucia Fuentes  1 , Jamie Nicole LaBuzetta  11 , Alison A Moore  12 , E Wesley Ely  13   14   15 , Atul Malhotra  1 , Dale M Needham  16   17 , Jennifer L Martin  9   10 , Biren B Kamdar  1
Affiliations

Development and Validation of an ICU Delirium Playbook for Provider Education

Hirsh Makhija et al. Crit Care Explor. .

Abstract

Although delirium detection and prevention practices are recommended in critical care guidelines, there remains a persistent lack of effective delirium education for ICU providers. To address this knowledge-practice gap, we developed an "ICU Delirium Playbook" to educate providers on delirium detection (using the Confusion Assessment Method for the ICU) and prevention.

Design: Building on our previous ICU Delirium Video Series, our interdisciplinary team developed a corresponding quiz to form a digital "ICU Delirium Playbook." Playbook content validity was evaluated by delirium experts, and face validity by an ICU nurse focus group. Additionally, focus group participants completed the quiz before and after video viewing. Remaining focus group concerns were evaluated in semi-structured follow-up interviews.

Setting: Online validation survey, virtual focus group, and virtual interviews.

Subjects: The validation group included six delirium experts in the fields of critical care, geriatrics, nursing, and ICU education. The face validation group included nine ICU nurses, three of whom participated in the semi-structured feedback interviews.

Interventions: None.

Measurements and main results: The 44-question quiz had excellent content validity (average scale-level content validity index [S-CVI] of individual items = 0.99, universal agreement S-CVI = 0.93, agreement κ ≥ 0.75, and clarity p ≥ 0.8). The focus group participants completed the Playbook in an average (sd) time of 53 (14) minutes, demonstrating significant improvements in pre-post quiz scores (74% vs 86%; p = 0.0009). Verbal feedback highlighted the conciseness, utility, and relevance of the Playbook, with all participants agreeing to deploy the digital education module in their ICUs.

Conclusions: The ICU Delirium Playbook is a novel, first-of-its-kind asynchronous digital education tool aimed to standardize delirium detection and prevention practices. After a rigorous content and face validation process, the Playbook is now available for widespread use.

Keywords: critical care; delirium; early diagnosis; nursing education; validation study.

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Figures

Figure 1.
Figure 1.
Flowchart of ICU Delirium Playbook development. aRefers to the original ICU Delirium Video Series (31). bOne item removed based on expert comments. cAll items removed based on expert comments. CAM-ICU = Confusion Assessment Method for the ICU, v = version.
See this image and copyright information in PMC

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