Misericordia HospitalEdmonton, Alberta

Delirium Collaborative

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Background

• Currently, the ICU does not have baseline data, tools to assess the prevalence of delirium, nor is there a consistent approach followed when caring for patients with or at risk for delirium. This is evidenced by the lack of a common treatment plan shared and understood by all disciplines.

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Aim• Improve care of the critically ill patient at risk for delirium • Implementation of standardized screening tools and identification of prevention strategies to

be used within the ICU

Goals/Objectives– Develop education and support for staff regarding delirium awareness, prevention,

and management within 12 months.– Determine baseline incidence/prevalence of delirium within 3-6 months.– Implement processes to screen 100% of all ICU patients for delirium within 6 months.– Implement standardized delirium prevention interventions in all ICU patients within 12

months.– Implement standardized interventions for the management of delirium within 12– months.– Implement strategies to support families of patients with delirium within 18 months– (i.e. information pamphlets)– Establish ongoing education parameters

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Team Members

• Lead Coordination of Action- Kim Scherr, NP• Clinical Nurse Educator-Jennifer Barker• Nursing Representatives – all staff• Respiratory – all staff• Pharmacy – Gwen Bileski• PT - Stephanie Oviatt, Roselle De Castro• Medical Support- Dr. Heule• Unit Manager/Supervisor – Trish O’Toole, Geniene

Stokowski

Results ICDSC checklist developed

for use and agreed upon by all disciplines

Over the month of February, 2012, education sessions were provided to 100% of nursing staff and a large number ofmultidisciplinary team members regarding: - “What is Delirium?”

“ How do we Screen for Delirium?”

“Why is Prevention of Delirium Important?”

“ How do we Manage Delirium in the ICU?”

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Results

• Learning posters were created to provide visual cueing for staff

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Results

• Data collection tool was developed and implemented

• Charge nurses were provided one on one education on how to completethe data collection tool accurately

• Data is being collected daily on all ICU patients in respect to: delirium score, hours of sleep, presence of endotracheal tube, use of narcotics & sedation infusions, medication reconciliation completion, central line checklist completion (if applicable), self-extubation/line removal, and use of physical restraints

Delirium DATA CollectionDelirium DATA Collection

•Initiate a form on EVERY patient

•Charge Nurses to collect data every night when checking charts

•Active forms are kept in the CHARGE BINDER with individual patient information

•Once a sheet is full (q4days) grab a new one and continue, all sheets stay in CHARGE Binder until patient discharged

•Once patient is discharged remove all sheets and place them into the DELIRIUM DATA BINDER at the unit clerk desk

•Unit clerks can print new sheets if you run out

•Kim will clean out Delirium DATA binder and forward DATA to the analyst

Results

• Random chart audits were completed on all ICU patients to identify compliance with the ICDSC

Random Chart Audit of Completed ICDSC

90

75

65

70

75

80

85

90

95

April 20 2012 May 3 2012

Perc

ent

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Changes Tested Utilization of

data collection tools provide initial base line data

Preliminary Delirium Data for ICU Misericordia Hospital

0

4

8

12

16

20

24

Nu

mb

er o

f in

cid

ents

Delirium Score 4or greater

Continuoussedation/drip

Restraints

Ventilated

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Lessons Learned

• Change is a gradual process that is driven by champions, and requires continuous reaffirmation

• Staff are willing participants in change strategies if they are given enough education and support, and can see that the change makes a positive difference in patient care

• Incorporation of a data collection tool necessitates changes in other documentation in order to make the data collection process as seamless and time efficient as possible. Therefore, updates to our ICU admission orders, nursing documentation flow sheets, report sheets, etc. will be undertaken in the near future

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Next Steps

• Provide family focused care by using a tool that will allow us to “Know Our Patient”

• Implement an Early Mobilization Tool• Review and change current Standing Admission Order sets to

reflect change in practice• Review and change current nursing flow sheets and report

sheets to reflect change in practice• Ongoing education for multidisciplinary team of work being

done nationally, regionally and at the unit level• Continue data collection on incidence of delirium, restraint

usage, sedation usage, and staff compliance for screening and documentation