Iatrogenic Delirium Driver Diagram AIMPrimary Drivers Secondary Drivers Change Ideas Reduction incidence of Iatrogenic Delirium Early Identification &

Slides:

Advertisements

Similar presentations

Patient Centered Care Model The model which was drawn from NMH’s Henderson Framework for Nursing Practice proposes to provide a healing environment centered.

Advertisements

Introduction to Patient Education Purpose: Promote patient’s ability to a.Understand the hospital environment b.Independently meet their own health needs.

Humber River Regional Hospital Delirium CAM-ICU. 2 Background Humber River Regional Hospital is one of Canada’s largest regional acute care hospitals.

Delirium Assessment and Management Presented by: Jonna Bobeck BSN, RN, CEN.

Introduction to ‘Immediate management of delirium care bundle’ and change package Karen Goudie, Clinical Advisor a Michelle Miller, Improvement Advisor.

Baseline Assessments Hospital: Pressure ulcer Incidence 8-13% Pilot Ward (Anglesey): Baseline incidence rate - 4.5% Nutritional assessment - 50% Pressure.

Jeff Reece, RN, MSN, MBA Chief Executive Office Chesterfield General Hospital.

Patient safety bundles for critical care

Improving Patient Safety in Long- Term Care Facilities: Falls Prevention and Management Student Version.

Misericordia Hospital Edmonton, Alberta Delirium Collaborative.

The Hospital Elder Life Program © 2000, Sharon K. Inouye, MD, MPH.

Palliative Care in the Nursing Home. Objectives Develop an awareness of how a palliative care environment can be created. Recognize the need for changes.

RENI PRIMA GUSTY, SK.p,M.Kes

Pain Agitation & Delirium SCCM Pain assessment i. We recommend that pain be routinely monitored in all adult ICU patients (+1B). ii. The Behavioral.

Improving Care for Older People in Acute Care Penny Bond Implementation and Improvement Team Leader Healthcare Improvement Scotland.

Pain, Agitation, and Delirium: Bringing it All Together Peter Dodek.

Building Your CUSP Team Part I Michael Rosen, PhD August 28, 2012 Armstrong Institute for Patient Safety and Quality Conference Number(s):

Saskatoon Health Region Department of Critical Care Prevention of Delirium.

LEARN FROM A DEFECT Emily Pasola RN, MSN, CNL Clinical Nurse Leader Surgical Intensive Care Unit Saint Joseph Mercy Hospital Ann Arbor, Michigan.

Improving Harm Across the Board Dalton, Georgia Breakthrough in Identification of HARM: 2.

CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Strategies for Collecting and Entering Early Mobility ARMSTRONG INSTITUTE FOR PATIENT.

CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Data Webinar 5 Defining the Early Mobility Measures ARMSTRONG INSTITUTE FOR PATIENT.

Joseph Brant Memorial Hospital (JBMH) Delirium in Critical Care.

1 National Patient Safety Goals (NPSG). 2 National Patient Safety Goals – set forth by The Joint Commission Identity patients correctly: – Use at least.

Scottish Patient Safety Programme – Pharmacist Engagement Gordon Thomson Arlene Coulson Shadi Botros.

Catholic Medical Center Rapid Response Teams

Medicine Hat Regional Hospital

A partnership of the Healthcare Association of New York State and the Greater New York Hospital Association NYSPFP Preventable Readmissions Pilot Project.

Towards Fall Prevention

Results: The Staff Safety Assessment Survey Lisa Lubomski, PhD April 11, 2013.

Pre-Operative and Post-Operative Care

Sustaining Respiratory Therapist Engagement in ICU Liberation Tamra Kelly BS, RRT, Meg Blankinship MBA, BSRC, RRT, Alan Cubre MD, Kelly Switzler RRT, Latecia.

HQSC Quality & Safety Challenge 2012 Real Time Data Gathering of Factors Associated with Falls in a Hospital Setting Ken Stewart Jan Nicholson.

1 Search and Rescue: The keys to Surviving Sepsis July 22, 2008 Emmel B. Golden, Jr., MD, ICU Medical Director Melanie Polzin, RN, CCRN, ICU Head Nurse.

RML Specialty Hospital FALL PREVENTION PROGRAM NATIONAL NALTH WINNER 2006 for BEST PRACTICE.

Safety Sitter Education Task Force September 30, 2012 ALL ABOUT SAFETY SITTERS.

CARE OF THE GERONOLOGIC PATIENT IN VARIOUS SETTINGS Home Assisted Living Hospital Long Term Care.

NPASS and the journey to improved documentation Team Members: Elaine Trulis, RN, BSN – NICU Manager NICU Nursing Staff Patricia Hummel, RNC, MS, APN-NNP/PNP.

Falls Driver Diagram OHA HEN 2.0. Fall Prevention AIMPrimary Drivers Secondary DriversChange Ideas Reduce Patient Falls Fall and Injury Risk Assessment.

Readmissions Driver Diagram OHA HEN 2.0. Readmissions AIMPrimary Drivers Secondary DriversChange Ideas Reduce Readmissions Identify patients at high-risk.

E A B C D Reducing Delirium in the ICU Patient: The ABCDE Bundle

.  Purpose: To decrease the occurrence of patient related falls and related injuries through accurate assessment, identification of patients at risk,

Driver Diagrams Reduction of Early Elective Deliveries OHA HEN 2.0.

ADVERSE DRUG EVENT (ADE) Driver Diagram OHA HEN 2.0.

Hospital Acquired Pressure Ulcers Driver Diagram

Misericordia Hospital Edmonton, Alberta

Patient Safety Overview 2014

MULTI DISPLINARY CARE.. . PATIENT PHYSICIANNURSESOTHERSDIETITIANPHYSIOTHERAPIST.

Scottish Improvement Skills

Improving Care For Older People in Acute Care

Fall Reduction Program

1st International Online BioMedical Conference (IOBMC 2015)

Nancy Correa, RN Clinical Manager, Critical Care Challenge:

BREAK THE CIRCLE OF HARM and eliminate avoidable pressure ulcers

Falls Prevention Accreditation ROP Compliance

Implement Sleep Hygiene Measures

Scottish Improvement Skills

Fall Reduction Program

Information Transfer – ROP Compliance

General Systems ICU & Burns

DELIRIUM A significant ICU problem!

All About Safety Sitters

Hotel-Dieu Grace Hospital

ABCDEF Checklist Instructions:

Humber River Regional Hospital

ABCDEF Checklist Instructions:

ABCDEF Checklist Instructions:

Mayo Clinic Children’s Center, Rochester MN

ABCDEF Checklist Instructions:

Presentation transcript:

Iatrogenic Delirium Driver Diagram AIMPrimary Drivers Secondary Drivers Change Ideas Reduction incidence of Iatrogenic Delirium Early Identification & Monitoring of Delirium Identify pts. at risk Implement delirium assessment tool Think Delirium – Screen on admission and on transfer within hospital to identify delirium Adapt/adopt a risk-assessment tool assess pt. at least daily & prn for changes in pt. behavior Assess ALL patients in ICU at least twice daily and Pre/post Spontaneous Awakening Trail & prn for changes in pt. behavior Use experts to spot check delirium screening to assess performance reliability & identify learning opportunities Use nurse champion to communicate reasons for & importance of this initiative Include RASS/delirium screening in multi-disciplinary rounds & hand-off communication Document assessment in a highly visible location Optimize Medications Use a goal-oriented sedation protocol designed to reduce sedation Assess agents that may be causing or exacerbating delirium Use valid & reliable pain-monitoring tools then treat pain first prior to sedation Administer sedation as ordered using a target according to a scale i.e. RASS or SAS Reduce or remove sedation when possible Use physician champion to communicate reasons for & importance of reducing sedation/other meds contributing to delirium Implement pharmacist review of medication list to help identify meds which might be removed/decreased Avoid using benzodiazepines especially for high risk pts. Implement an alert for when benzodiazepine order is entered

Iatrogenic Delirium Driver Diagram AIMPrimary Drivers Secondary Drivers Change Ideas Reduction incidence of Iatrogenic Delirium Delirium Management & Prevention Reorientation Cognitive stimulation Early ambulation Limit devices Nutrition & hydration Sleep promotion Immediate management of delirium (2 hours of diagnosis) Implement delirium care bundle Familiarize pt. with surroundings & date/time Encourage use of pt.’s eye glasses/hearing aids Incorporate reorientation into pt. care activities Use care boards, large clock, & calendar to aid reorientation Develop progressive early ambulation programs Involve respiratory therapists, physical therapists, nursing assistants, etc. to mobilize pts. as appropriate Assess need for urinary and central line catheters daily Reassess need for restraints Correct dehydration & electrolyte imbalance quickly Provide feeding assistance if necessary Adopt a “sleep protocol” to cluster pt. care activities, minimize unnecessary noise/light/stimulation reducing sleep disruption Enhance skin and fall prevention measures Patient & Family Engagement Family involvement Create a culture that supports family/caregiver involvement in care and reorientation Encourage Family/friends to furnish some familiar objects to help reorient pt. & more secure Promote family/caregiver feedback to improve care Ensure patient requirements are accurately reflected in care plan Family/caregiver education includes delirium risk factors, how to recognize delirium & their role in prevention of delirium