The Confusion Assessment Method (CAM) was developed by Dr. Sharon Inouye in 1988 to improve the identification and recognition of delirium. Its purpose is to enable non-psychiatrically trained clinicians to identify delirium quickly (under 5 minutes) and accurately (with a sensitivity of 91-97% and specificity of 85-94%). Because CAM can be administered and scored in a few minutes after a patient interview during clinical care, it represents a minimal burden on hospital staff.According to the CAM Training Manual and Coding Guide [Inouye SK. 2003; New Haven: Yale University School of Medicine], this method has become the most widely used instrument for detection of delirium. A note to our readers, the CAM was Dr. Inouye’s geriatric fellowship project!

In order to help learners to administer, score and interpret the CAM, the University of Miami Miller School of Medicine and its affiliated VA Medical Center, Mount Sinai School of Medicine and the Harvard School of Medicine, developed the Interactive Confusion Assessment Method (iCAM).It has been adapted with permission from: Inouye SK et. al, Clarifying Confusion: The Confusion Assessment Method: A New Method for Detecting Delirium. Ann Intern Med. 1990; 113:941-8.

The iCAM module begins with a brief introduction to delirium and its symptoms. It then outlines the 4 Steps of the CAM: 1. Acute Change and Fluctuating Course; 2. Inattention; 3. Disorganized Thinking; and 4. Altered Level of Consciousness. During the explanation of each Step the learner is presented with a brief video scenario of a patient’s progression through the 4 Steps. Before moving on, the learner is asked to answer a multiple-choice question, and is provided with an instant feedback regarding the accuracy of their answer.

Upon completion of the module, learners have a chance to apply the knowledge acquired to a practice case in which they are presented with a new patient. After looking though the patient’s virtual chart (where pages actually flip as if you were turning them), a video describing his symptoms, and written notes from a nurse, a doctor, and a duty aid, the learner is asked to score the CAM via an interactive form and to make a decision as to whether the patient is delirious.

This self-paced tutorial has a user-friendly interface which allows the learner to fast forward, skip, or rewind through the module. Furthermore, it includes a printable version of the CAM worksheet which can be brought to patient consultations.

There certainly should be no confusion on how to use the CAM to diagnose delirium after a learner has completed using the iCAM. Available now on POGOe!