At the American Delirium Society (ADS) 2nd annual conference in Indianapolis in early June 2012, I heard a presentation about a new delirium screening tool called the Recognizing Active Delirium As A Routine or RADAR. This was a presentation during the session entitled “Delirium in the 21st Century”, given by Ann Kolanowski, PhD, RN from Penn State University, and the title of her talk was “Innovative Nursing Approaches to Delirium Assessment, Intervention and Knowledge Dissemination.”
Dr. Kolanowski reported the RADAR was 82% sensitive and 65% specific, and perhaps equally important, that 95% of nurses liked it, which might mean nurses would be more likely to use it consistently. The Confusion Assessment Method (CAM, developed by Dr. Sharon Inouye and colleagues) was the reference standard tool. The reference is below:
Voyer, P., et al. (2016). “RADAR: A Measure of the Sixth Vital Sign?” Clinical Nursing Research 25(1): 9-29.
The objective of this study was to investigate the potential of RADAR (Recognizing Active Delirium As part of your Routine) as a measure of the sixth vital sign. This study was a secondary analysis of a study (N = 193) that took place in one acute care hospital and one long-term care facility. The primary outcome was a positive sixth vital sign, defined as the presence of both an altered level of consciousness and inattention. These indicators were assessed using the Confusion Assessment Method. RADAR identified 30 of the 43 participants as having a positive sixth vital sign and 58 of the 70 cases as not, yielding a sensitivity and specificity of 70% and 83%, respectively. Positive predictive value was 71%. RADAR’s characteristics, including its brevity and acceptability by nursing staff, make this tool a good candidate as a measure of the sixth vital sign. Future studies should address the generalizability of RADAR among various populations and clinical settings. (Open Access at BMC Nursing).
My notes about the presentation included her remarks of which one was that an important influence on the use of the tool was a “good working environment”, a part of which is a good working relationship between nurses and physicians.
Dr. Kolanowski also reminded the audience that nurses tend to focus on symptom management in delirium, which she highlighted as “the human response.” She contrasted that with the physician response, which generally is to focus on finding the etiologies of delirium and treatment.
I think the responses of nurses and doctors regarding delirium could be viewed as complementary. What’s vital is that nurses consistently feel comfortable enough in their working relationship with doctors to report the findings from delirium screening to physicians, so that they can work together to treat the patient.
In my opinion, I don’t think we need more delirium screening tools. We just need to pick one and use it effectively as a means to an end–providing high quality medical care to patients.