In the April 2021 issue of Critical Care Nurse, Parker and colleagues discuss the barriers to implementing cognitive stimulation in the intensive care unit (ICU). We read this article with great interest. As part of the bedside health care team, we applaud the attempt to decrease delirium days in the ICU and to identify barriers to delirium prevention and treatment. Although multiple barriers exist, we would like to emphasize 3 main points.

First, at our medical center, our positive delirium scores are not consistent with reports that delirium occurs in up to 80% of patients receiving mechanical ventilation and in up to 50% of patients not receiving mechanical ventilation during their stay in the ICU. Although nurses and physicians at our medical center are trained in delirium detection, we think the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)...

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