Nu-DESC

Overview

The Nu-DESC was developed to enable nursing staff to screen for delirium once per shift based on direct observations during routine care. Unlike the CAM-ICU, it does not require formal cognitive testing; instead it captures observable behavioural signs. It detects both hyperactive and hypoactive delirium subtypes. Original validation (n = 74 medical oncology patients) reported sensitivity 85.7 % and specificity 86.7 % against DSM-IV criteria.

Scale Items

Item	Description
1. Disorientation	Verbal or behavioural manifestation of not being oriented to time, place, or person
2. Inappropriate behaviour	Behaviour inappropriate to place and/or person (e.g. pulling lines, attempting to get out of bed when unsafe, aggressive)
3. Inappropriate communication	Communication inappropriate to place and/or person (e.g. incoherence, non-communicativeness, nonsensical speech)
4. Illusions / Hallucinations	Seeing or hearing things that are not there; distortion of visual objects
5. Psychomotor retardation	Delayed responsiveness, few or no spontaneous actions/words; e.g. when patient is prodded, reaction is slow and/or patient is unresponsive

Rating

Score	Meaning
0	Absent — not present during shift
1	Mild — present but not prominent; no specific intervention required
2	Present — prominently evident during shift

Score Interpretation

Total Score	Interpretation
0	No delirium
1	Borderline — increased vigilance warranted
≥ 2	Delirium present — notify physician; initiate delirium management protocol
≥ 5	Severe delirium — high risk of harm; escalate care

Assessment Procedure

1. Assess the patient at the beginning and/or end of each nursing shift (at least once per 8–12 hours).
2. Rate each of the five items based on observations made throughout the entire shift — not just at the moment of assessment.
3. Sum the five item scores (maximum 10).
4. A total score ≥ 2 constitutes a positive delirium screen; document and notify the medical team to confirm diagnosis and initiate management.

Literature

Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage. 2005;29(4):368–375.