Edmonton, Alberta

• 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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• 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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• 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
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 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 of multidisciplinary 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?”

• Learning posters were created to provide visual cueing for staff
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• Data collection tool was developed and implemented
• Charge nurses were provided one on one education on how to complete the 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
•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
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• Random chart audits were completed on all ICU patients to identify compliance with the ICDSC
85
80
75
70
65
95
90
Random Chart Audit of Completed ICDSC
90
April 20 2012
75
May 3 2012

 Utilization of data collection tools provide initial base line data
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• 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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• 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
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