Question

5. What are the components of the Confusion Assessment Method (CAM)? What are the benefits of nursing staff using the CAM to screen patients for delirium?

Answer 1

The Confusion Assessment Method (CAM) includes an instrument and diagnostic algorithm for identification of the symptoms of confusion or delirium.

The CAM instrument assesses the presence, severity, and fluctuation of 9 delirium features: acute onset, inattention, disorganized thinking, altered level of consciousness, disorientation, memory impairment, perceptual disturbances, psychomotor agitation or retardation, and altered sleep-wake cycle.

The CAM diagnostic algorithm is based on four cardinal features of delirium:

1) acute onset and fluctuating course
2) inattention
3) disorganized thinking
4) altered level of consciousness.

The diagnosis of delirium by CAM requires the presence of BOTH features A and B and the presence of EITHER feature C or D

C A M Confusion Assessment Method

A. Acute onset and Fluctuating course	Is there evidence of an acute change in mental status from patient baseline? Does the abnormal behavior: - come and go? - fluctuate during the day? - increase/decrease in severity?
B. Inattention	Does the patient: - have difficulty focusing attention? - become easily distracted? - have difficulty keeping track of what is said?
C. Disorganized thinking	Is the patient’s thinking - disorganized - incoherent For example does the patient have - rambling speech/irrelevant conversation? -unpredictable switching of subjects? - unclear or illogical flow of ideas?
D. Altered level of consciousness	Overall, what is the patient’s level of consciousness: - alert (normal) - vigilant (hyper-alert) - lethargic (drowsy but easily roused) - stuporous (difficult to rouse) - comatose (unrousable)

The benefits of nursing staff using the CAM to screen patients for delirium are the following:

• This contributes to better quality care through early dysfunction identification that determines the causes, allows the identification of modifiable risk factors and allows the planning of therapeutic interventions and prevention together with the multidisciplinary team.
• Assessing delirium is essential in clinical practice because, It can reduce hospital stay, reduce incidence of infections and complications, allowing nurses to build another perspective on care and giving more autonomy in the implementation of non-pharmacological interventions to prevent and treat the dysfunction.
• This fact significantly promotes patient safety and the reduction of risks related to the event.