Saskatoon Health Region
Department of Critical Care
Prevention of Delirium
Background
• The Department of Critical Care in the Saskatoon
Health Region is made up of 3 units on 2 sites.
– Royal University Hospital Intensive Care Unit – 15 beds and
2 satellite beds.
– St. Paul’s Hospital Intensive Care Unit – 15 beds.
– St. Paul’s Hospital Progressive Care Unit – 8 beds.
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Aim
• To reduce the incidence of delirium in critically ill
patients and to standardize and improve
management of patients with delirium. We aim for
this project to be part of an “ABCDE bundle”
approach to the care of our critically ill patients.
• Goals/Objectives
– To assess for and report delirium q shift and when changes
in patient condition.
– To implement a mobility protocol to guide mobilization of
all patients to their maximum capacity each shift
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Team Members
• There are multidisciplinary team members
representing each unit, some team members work
across all 3 units.
• There are physicians, RN’s, Physiotherapists,
Pharmacists and Dieticians.
• The team is sponsored by the Director and Physician
Leader of the Department of Critical Care – Patti
Simonar and Dr. Mark James
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Results
Incidence
ofDelerium
Delirium
Incidence of
50%
40%
30%
Pts. Unable to
Assess
Cam Positive
20%
10%
0%
14-Feb-12
28-Feb-12
13-Mar-12
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Results
date
Dec
Nov
Oct
Sept
August
July
June
May
April
March
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Feb
percentage
Active in Mobility protocol
SPH-ICU 2011
Results
Mobility Protocol Charted
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
14/02/2012
Mobility protocol
charted
28/02/2012
13/03/2012
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Results
Average Days of Duration of Delirium
SPH PCU
SPH ICU
0
2.5
May-15
2.3
0
2
2.2
2.3
3.6
Apr. 30
RUH ICU
4
6
8
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Changes Tested – Utilization of CAM-ICU
Assessment Tool
Changes Tested – Implementation of a Mobility
Protocol
Lessons Learned
• Difficult to do the CAM-ICU if patient a RASS of -3; using the
criteria of a RASS of -2 or greater to do the assessment
• Importance of education of staff that CAM-ICU can be
assessed if patient is a RASS of -2 or greater as they often feel
that they cannot assess patient if they do not squeeze hands
and fail the test for inattention.
• Challenges with ensuring that patients are being mobilized to
their maximum capacity.
• Patients are often confused but CAM-ICU negative
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Next Steps
• Identify other contributing factors and interventions
to reduce incidence and duration of delirium – such
as day / night protocols.
• Implementation of a checklist that includes delirium
and mobilization goals
• Intermittent measurement of incidence and duration
of delirium to observe trends.
• Explore ways of measuring mobilization.
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