Barriers and facilitators to the delivery of delirium care in intensive care units: an analysis informed by the Theoretical Domains Framework

Introduction

Delirium is common in patients who are critically ill and associated with increased mortality and long-term cognitive impairment. The objective of this study was to explore the barriers and facilitators to the use of existing ICU delirium identification tools and implementation of care protocols.

Methods

Semi-structured interviews were conducted with healthcare professionals working in UK NHS ICUs. Purposive sampling was utilised to recruit a diverse range of participants to account for profession; user status of delirium identification tools or care packages; size of unit; and UK location. Thematic analysis was undertaken using the Theoretical Domains Framework.

Results

Twenty-one ICU healthcare professionals were interviewed from 20 hospitals. Participants included consultants (n = 9); nurses (n = 8); advanced critical care practitioners (n = 2); and allied health professionals (n = 2). Five major barriers to effective delirium care emerged: lack of prioritisation; lack of structured ICU delirium care protocols; inability to implement interventions due to physical space constraints and/or lack of resources; loss of experienced staff; and changes in ICU nursing culture. Facilitators included the presence of clear protocols; continued staff training; increased awareness; delirium champions; post-ICU follow-up clinics; family engagement; effective communication; and the use of digital prompts as a component of mandatory electronic documentation.

Discussion

Although ICU delirium is acknowledged as being important by clinical staff, management is often hindered by systemic and cultural barriers. Healthcare professionals highlighted the need for protocol-driven care, enhanced training and awareness, and the inclusion of families in care processes. These findings will inform the design of a multicomponent care package to improve delirium care in the ICU.