EHR Software Helps Prevent Patient ICU Delirium

A new electronic health record (EHR) add-on helps implement The ICU Liberation Bundle (A-F), which both individually and collectively can help reduce delirium, improve pain management, and decrease long-term consequences for adult intensive care unit (ICU) patients.

The Epic (Verona, WI, USA) ICU Liberation Bundle will help health systems coordinate patient care, with a specific focus on ICU delirium, using a protocol that includes well calibrated pain assessment, prevention, and management (A),daily spontaneous awakening and spontaneous breathing trials (B), Choosing sedation and analgesic depth and timing, including prompt discontinuation when necessary (C), delirium assessment and treatment throughout the day (D), early mobility and exercise in the ICU (E), and family engagement (F).

The ICU Liberation Bundle was developed in cooperation with Vanderbilt University Medical Center (VUMC, Nashville, TN, USA). The Epic system update and associated ICU workflows, which involve nurses, pharmacists, physicians, physical therapists, occupational therapists, respiratory therapists, and family members is already in use at VUMC and other medical centers that assisted Epic with the update.

“What this bundle does is stop people from just looking at one organ at a time. It takes the overall person and says, 'This is a whole human being and we're going to pay attention to how their brain is working, and their liver and lung and kidney, all at once,” said Professor E. Wesley Ely, MD, co-director of the Critical Illness, Brain Dysfunction, and Survivorship Center at VUMC. “We're going to wake them up, we're going to get them out of the bed, we're going to walk them. It makes us take a step back and help people avoid injury that might otherwise occur in intensive care.”

“The implications for patient outcomes are stark and so is the improvement opportunity. There's a vital role here for clinical information technology,” said Professor Kevin Johnson, PhD, of the department of biomedical informatics and informatician-in-chief at VUMC. “We're very pleased that our colleagues at Epic have fully embraced this opportunity and are working closely with VUMC and others to promote and support new workflows in the ICU.”

Post-operative delirium usually strikes within the first two days of waking from general anesthesia, and the risk increases with age and time under anesthesia. Symptoms range from relatively mild, such as a person not knowing their name or where they are, to more severe ones, such as aggressive behavior, paranoia, or even hallucinations. The causes are unknown, but one theory is that major surgery can trigger inflammation throughout the body, which in some cases can spread to the brain.

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Vanderbilt University Medical Center