David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
Both experts agree that nonpharmacologic prevention strategies (e.g., reorientation; early mobility; optimization of nutrition, oxygenation, and gastrointestinal and urinary function) form the backbone of delirium prevention.
One expert—a psychiatrist—recommends the use of prophylactic antipsychotic medications for some high-risk patients based on meta-analyses suggesting that they decrease the incidence of delirium and his experience that these medications can also help reduce the distress of perceptual disturbances, paranoia, and agitation.
Another expert—a geriatrician—recommends against the use of prophylactic antipsychotic medications to prevent delirium, noting that studies have used various of delirium assessment tools and may have underdiagnosed hypoactive delirium.
This systematic review concludes that the SEP-1 performance measure is not supported by strong evidence.
The authors submit that CMS performance measures should be based on strong evidence because the requirement for reporting these measures is resource-intensive and they often evolve into criteria for hospital accreditation or reimbursement.
An editorial suggests that this evidence review should prompt reconsideration of the components of this bundle.
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Wesorick DH, Chopra V. Annals for Hospitalists - 17 April 2018. Ann Intern Med. 2018;168:HO1. doi: https://doi.org/10.7326/AFHO201804170
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Published: Ann Intern Med. 2018;168(8):HO1.
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