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.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Wesorick DH, Chopra V. Annals for Hospitalists - 17 April 2018. Ann Intern Med. ;168:HO1. doi: 10.7326/AFHO201804170
Download citation file:
Published: Ann Intern Med. 2018;168(8):HO1.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use