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.