Scope of Problemq Delirium is a common brain disorder with an acute

onset and fluctuating course occurring within Intensive Care Units1

q It is a serious medical condition associated with negative outcomes for patient safety and quality of care1

q > 7 million Americans develop delirium in hospitals each year2

q > 60% of patients with delirium are not properly diagnosed by healthcare providers2

Purpose and Objectivesq This quality improvement project emphasizes the

importance of nursing contributions to delirium assessment and management in preventing complications that impact patient safety and quality of care

q This project improves current nursing practice by improving nurses’ knowledge of delirium and implementing an effective delirium protocol

Evidence-Based Initiativeq Several evidence-based studies demonstrated

significant nurse enhancement of delirium knowledge, assessment, intervention, and prevention strategies through nursing education

q Several evidence-based studies regarding delirium assessment, management, and care protocols that have yielded positive changes in patients’ outcomes

q Structured educational nursing interventions and patient care protocols must be developed to improve delirium nursing practice

q Conceptual Framework

The Knowledge to Action Framework 3

Using the Evidence: Developing an ICU Delirium ProtocolWhayoun Lee, MA, MSN, APRN, RN, Kimberly J. Oosterhouse, PhD, RN

Loyola University of Chicago Marcella Niehoff School of Nursing

Project PlanqEthics: Quality Improvement approval

was received from University of Chicago Medicine. Institutional Review Board approval was received from Loyola University Health System; verbal consent obtained

qFeasibility of the site: Site does not implement specific delirium protocols or guidelines that nurses can follow, or provide nursing education to improve knowledge on delirium

qStakeholder’s support: Intensive Care Unit Medical Director, Nurse Manager, Unit Educator, staff nurses, and hospital administration

qBudget: No specific funds allocated to this project; printing costs for presentation & pocket card for CAM-ICU tools and ABCDEF patient care bundle

qDesign: A quality improvement project with a pre- and post-test design performed at a single center

qSetting: 16-bed surgical/trauma ICU of 811-bed single center tertiary teaching hospital in Midwest America

q Participants: Registered nurses (RN) working in the surgical/trauma ICU

q Implementation: December 2020-March, 2021

Results and Evaluation qDemographics and Experience

q Nurse’s Delirium Confidence Level

qDelirium Knowledge Scores (N=38)

qNurse’s Perception Level

• Self-administered questionnaire regarding nurse’s demographic data • Assessment of Nursing Knowledge Regarding ICU Delirium• Assessment of Nursing Perception Levels on Usefulness of CAM-ICU and ABCDEF Care Bundle• Nursing Staff Compliance with Delirium Assessment Screening Instruments and Care Bundle

Items

Pre-Test (2 weeks)

• Formal Didactic Educational Intervention for ICU Delirium• Formal Education for CAM-ICU Screening Tool and ABCDEF Delirium Care Protocol BundleIntervention (5 weeks)

• Paired t-test to evaluate pre-and post-intervention delirium knowledge and the nurse’s perception on use of delirium assessment tools and patient care bundles

• Evaluated the frequency of the proper usage of CAM-ICU assessment and ABCDEF patient care bundles

Post-Test (2 weeks)

<25 years (5)13%

26-34 years (15)40%

35-44 years (11)29%

45-54 years (2))5%

> 55 years (5)13%

Age Group (N=38)

<25 years (5) 26-34 years (15) 35-44 years (11)45-54 years (2)) > 55 years (5)

0-5 years (11)29%

6-10 years (10)26%

11-15 years (8)

21%

16-20 years (2)5%

>20 years (7)19%

Years of experiences (N=38)

0-5 years (11) 6-10 years (10) 11-15 years (8)

16-20 years (2) >20 years (7)

Bachelors (33)87%

Masters (5)13%

Level of nursing education (N=38)

Bachelors (33) Masters (5)

2.42 2.42 2.71 3.02 2.92 2.95 3.24 3.02

4.68 4.66 4.67 4.97 4.9 4.9 4.814.09

0123456

Knowled

ge…

I rece

ived…

My deli

rium…

The CAM-IC

U is…

Patient c

are is…

Monitorin

g for…

Frequen

t…

Routine…

Nurse's Perception Level of CAM-ICU & ABCDEF Bundle (N=38)

Pre-Test Post-Test

3.612.47 2.76 2.18

4.71 4.79 4.71 4.34

0123456

I feel confidentdefining delirium

I feel confidentdifferentiating thedifferent types of

delirium

I feel confidentcompleting the

CAM-ICU

I feel confidentcompleting the

ABCDEF carebundle

Nurse's Confidence Level on CAM-ICU and ABCDEF Bundle (N=38)

Pre-Test Post-Test

Pre-test Correct M(SD)

Post-test Correct M(SD)

t(df) P

Overall Knowledge

72.37 (12.83)

95 (6.47)

-9.29(37) p<0.0001

71.32

95

0102030405060708090

100

Pre-Test Post-Test

Nurse's Knowledge Level of Delirium

Results and Evaluation Cont.qCompliance Rates of CAM-ICU

qCompliance Rates of ABCDEF Bundle

Practice ImplicationsqAppropriate educational interventions significantly

improve nursing knowledge and perception levels on ICU delirium assessment and management

qDelirium assessments and management protocols at an institutional level must be developed for for improvement of patient safety and practice change

ConclusionqThis quality improvement project demonstrates that

an educational intervention for nurses can result in improved knowledge of ICU delirium and nurse’s confidence and perception levels on usefulness of delirium assessment tools and intervention bundles.

qAn adequate formal education involvement is essential to promote ICU delirium management practice and to develop delirium protocol

AcknowledgementsThe author would like to thank Dr. Kimberly

Oosterhouse, Dr. Audrey Klopp, the nursing staff at University of Chicago Medicine, “Delirium Champions” Griselda Hempstead, Nicole Holcomb, and Kimberley

Reed.References

1. Arumugam, S., El-Menyar, A., Al-Hassani, A., Strandvik, G., Asim, M., Mekkodithal, A., Mudali, I., & Al-Thani, H. (2017). Delirium in the intensive care unit. Journal of Emergencies, Trauma and Shock, 10(1), 37–46. https://doi.org/10.4103/0974-2700.199520

2. American Delirium Society. (n.d.). Retrieved from https://americandeliriumsociety.org/

3. Field, B., Booth, A., Liotta, I., & Gerrish, K. (2014). Using the Knowledge to Action Framework in practice: a citation analysis and systematic review. Implementation Science : IS, 9, 172. https://doi.org/10.1186/s1301-014-0172-2

Pre-test Frequency

Rates (N=80)

Post-test Frequency

Rates (N=76)

Overall Rates of CAM-ICU

6.25% (5 times/80 patients over

6 days)

48.68% (37 times/76

patients over 6 days)

Pre-test Frequency

Rates(N=80)

Post-test Frequency

Rates (N=76)Overall Rates

of ABCDEF intervention

Bundle

3.75% (3 times/80

patients over 6 days)

46.05% (35 times/76

patients over 6 days)

6.25%

48.68%

0.00%10.00%20.00%30.00%40.00%50.00%60.00%

Pre-Test Post-Test

Compliance Rates of CAM-ICU

3.75%

46.05%

0.00%10.00%20.00%30.00%40.00%50.00%

Pre-Test Post-Test

Compliance Rates of ABCDEF Bundle

Paired t-test(p<0.05): Significant changes in confidence and perception level scores from pre- to post-test (P<0.0001)

Paired t-test(p<0.05): Significant changes in nurse’s knowledge of delirium scores from pre- to post-test (P<0.0001)