Enhancing Delirium Awareness and Recognition in the MSICU: An Evidence-based Patient Safety and Quality Improvement Initiative

C. Santiago, RN, MN, CNCC(C)1,2, K. Wannamaker, RN, BSc, CNCC(C)1, M. T. Diston, RN, BScN, CNCC(C)1, Jasmine Soliven, RN, BScN1, M. Guiyab2, J. Filice, O. M. Smith, RN, MN, PhD (Cand)1, 2

1Medical Surgical Intensive Care Unit, Critical Care Department, St. Michael’s Hospital, Toronto, Ontario, Canada; 2Lawence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario,

NAME OF PRESENTATION (Change this in slide master)BackgroundContext• Delirium is common among critically ill patients with prevalence

estimates ranging up to 80% (Ely et al., 2004)• Modifying delirium risk is contingent upon prompt recognition by

ICU clinicians• Bedside ICU nurses are ideally positioned to screen; however, data

on nurses’ awareness and uptake of delirium and delirium assessment practices is limited

Objective• To describe a Research Ethics Board-approved quality

improvement program designed for the Medical Surgical Intensive Care Unit at St. Michael’s Hospital to:– Increase nurses’ awareness of delirium– Select and implement a delirium screening tool in daily practice– Assess trends in rates of delirium

NAME OF PRESENTATION (Change this in slide master)Project DescriptionStep 1: Tool Selection• 16 nurses in 4 ICUs completed a clinical utility assessment of the

Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC)

• 81% of respondents preferred the ICDSC

Step 2: Pre-Education Nurse Attitudes Survey• Distributed to 115 full and part-time MSICU nurses• Response rate was 69% (n=79)

Step 3: Multi-modal Education Program• Education focused on training nurses on the use of the ICDSC• Education highlighted existing delirium prevention and management• The ICDSC was incorporated into the ICU nursing flowsheet• One-on-one real-time tool scoring assistance at the bedside was provided

Step 4: ICDSC Completion and Delirium Prevalence Studies• Audit and feedback of results

NAME OF PRESENTATION (Change this in slide master)Results and ConclusionResultsTable 1: Delirium Education EvaluationDelirium Education Evaluation Questions

Strongly Agree

Somewhat Agree

The delirium education session was presented in a clear and concise format

83% 13%

The case study was helpful in my understanding of the concepts presented

78% 18%

The delirium education session encouraged my participation during the discussion

80% 20%

The use of the video clips helped to inform me about the implications of delirium in ICU patients

72% 16%

The content of this session is relevant to my practice 85% 15%

I have a better understanding of the importance of early recognition of ICU delirium

75% 23%

I feel confident that I have the knowledge to complete the Intensive Care Delirium Screening Checklist (ICDSC)

74% 21%

I have a better appreciation of the important role of nurses in recognizing delirium

79% 20%

I recognize the existing interventions in place at MSICU that help prevent and manage delirium

79% 19%

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ICDSC Completion Rate Delirium Prevalence Rate

Table 2: ICDSC Completion and Delirium Rate

Conclusion1. The first step in addressing

delirium is creating clinician awareness about the use of a reliable screening tool

2. Our multi-faceted program has achieved its initial outcomes of increased awareness and uptake of the ICDSC

3. Next steps include the implementation of a standardized prevention and management algorithm

4. Existing program components are readily adaptable to other organizations