Table 1.

Delirium screening considerations for critically ill older adults during the COVID-19 pandemic

Challenges	Potential Solutions
HCWs limit contact with patients to conserve PPE and reduce risk of COVID-19 transmission	•Equip other HCWs beyond nurses to screen for delirium through traininga •Use brief delirium screening tools; eg, 2-min CAM-ICUa
Shortages of personnel caused by surge volumes	•Train other disciplines of HCWs in brief delirium screening as abovea
Assessing a change from baseline mental status (feature 1 of CAM-ICU) is challenging with family visitation restricted	•Involve family remotely through use of smartphones or tablets during or after rounds to facilitate communication with patient •Call nursing homes for patients admitted from a nursing home to understand baseline mental status
Surgical masks on HCWs impede older adults’ comprehension of delirium screening questions, especially in hearing impairment	•Reduce background noise •Speak slowly, clearly, in low pitch •Use sound amplifiers (pocket talkers) •Have hearing aid batteries available •Ask family to bring hearing aids •Use transparent surgical masks if available (https://www.theclearmask.com)
PPE may make certain patients with dementia more paranoid and not willing to participate in delirium screening	•Use large signs on gowns with pictures of providers and names/roles written in large font •Hand out baseball cards to patients for providers with picture, name, role •Allow family to visit patients with cognitive impairmentb •Be aware that refusal to participate in CAM-ICU may be a sign of delirium
Patients with dementia or history of stroke commonly have aphasia. Families are helpful in facilitating communication, but are not present at bedside	•Speak slowly •Ask yes/no questions •Involve family remotely through use of smartphones or tablets at the bedside to facilitate communication with patient •Allow family to visit patients with cognitive impairmentb
Delirium is unable to be assessed during deep sedation administered during neuromuscular blockade and proning to treat respiratory failure	•Assess sedation daily and limit as much as is feasible, adhering to A2F bundle

The A2F bundle stands for assess, prevent, and manage pain; both spontaneous awakening trial and spontaneous breathing trial; choice of sedation and analgesia; delirium assessment, prevention, and management; early mobility and exercise; and family engagement.

Abbreviations: CAM-ICU, Confusion Assessment Method for the ICU; HCW, health care worker; PPE, personal protective equipment.

^aThe CAM-ICU can be taught to ICU staff in less than 30 minutes and administered to patients in less than 2 minutes.

^bAllow family visitation provided that the family member passes a health screen and wears a mask.