Development and Validation of the Family ICU Delirium Detection Instrument.

OBJECTIVES BACKGROUND: Families play an important role in the care of ICU patients, yet their potential to contribute to the detection of delirium-a common and harmful complication-is often underutilized. This study aimed to adapt the Sour Seven to create the Family ICU Delirium Detection Instrument (FIDDI) and to assess its usability, reliability, and construct validity for delirium detection in ICU patients. DESIGN: Cross-sectional. SETTING: Canadian closed 34-bed general systems adult ICU providing tertiary level care. PARTICIPANTS: Patient-family pairs (dyads) were included. Eligible patients had no primary brain injury, a Richmond Agitation-Sedation Scale score of greater than or equal to -3 and were expected to remain in the ICU for at least 24 hours to complete all study assessments. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: The Sour Seven underwent adaptation using data from the Family ICU Delirium Detection Study and input from a multidisciplinary working group. The FIDDI was then tested for internal consistency using Cronbach's alpha and construct validity through confirmatory factor analysis. Family members provided feedback through surveys on the tool's usability and their experience with delirium detection. We enrolled 51 patient and family member pairs. Most family members were women (n = 38, 75%), including spouses (n = 17, 33%), adult children (n = 16, 31%), or siblings (n = 10, 20%). The FIDDI showed strong internal consistency (Cronbach's alpha = 0.858). The model fit indices indicated acceptable structure validity (Tucker-Lewis index [TLI] = 1.015, comparative fit index = 1.000, root mean square error of approximation = 0.000, and standardized root mean residual = 0.044). Family members reported that the tool was easy to use and helpful for understanding delirium, although some attributed behavioral changes to medical treatments or clinical conditions, highlighting the need for further education on delirium. CONCLUSIONS: The Sour Seven was successfully adapted for the ICU environment (FIDDI) and pre-tested, demonstrating reliability and construct validity for detecting delirium in the ICU. These findings support its potential as a family-engaged assessment tool. Further research is needed to test the value of the FIDDI relative to current delirium detection strategies.