Delirium Collaborative Bluewater Health ICU Delirium Collaborative

Background Community hospital 16 bed medical surgical ICU Closed Intensivist led unit Sedation and Analgesia treatment protocol with RASS scoring in place Acute Alcohol Withdrawal Delirium protocol in place Accreditation Canada Critical Care Standard to screen and assess patients for delirium BWH ICU did not screen for delirium

Aim Improve care of the ICU patient and family through implementation of a delirium assessment and treatment protocol in our ICU by Dec 31, 2012. Implement an assessment tool to screen by June 30, 2012. Develop and implement prevention strategies by November 30, 2012. Develop and implement a management protocol for delirium in our ICU by November 30, 2012.

Team Members Dr Michel Haddad, ICU Medical Director Debbie Matchett, Manager, ICU, CCU, MEDT George Rudanycz, Charge Nurse Kim Kraeft, Educator Lynne Schmidt, Staff Nurse Jackie Lacey, Staff Nurse Susan Aquilina, Staff Nurse Mihala Balan, Pharmacist Carol Columbus, Manager, Respiratory Therapy Krista Steeves, Physiotherapist

Delirium and Med Rec Collaborative Results 24-Dec-18 Delirium and Med Rec Collaborative

Modified CAM ICU Worksheet 24-Dec-18 Delirium and Med Rec Collaborative Collaboration sur le delirium et le BCM

Results – Assessment Tools Goal set to screen all ICU patients for delirium once a shift and as needed using CAM- ICU tool CAM-ICU tool is a paper tool (until it can be built in electronic documentation) CAM- ICU tool adjusted to show assessments over time Results of screening added to SBAR shift to shift handoff tool Audits of compliance and incidence posted monthly in team room Delirium screening added to Daily ICU Goal Checklist Paper Tool not always present on the chart, trigger to screen not present A P S D

Delirium and Med Rec Collaborative Results 24-Dec-18 Delirium and Med Rec Collaborative

Delirium and Med Rec Collaborative Goal Sheet and SBAR 24-Dec-18 Delirium and Med Rec Collaborative

Delirium and Med Rec Collaborative Results – Reporting Results of screening added to SBAR shift to shift handoff tool Delirium screening added to Daily ICU Goal Checklist Updates on Delirium are standing agenda items at ICU program council, ICU Department, and Unit Base Council monthly meetings Intensivists to lead discussion on patients screening results at individual patient daily rounds Audits of compliance and incidence posted monthly in team room A P S D 24-Dec-18 Delirium and Med Rec Collaborative

Lessons Learned Compliance will increase when the screening tool is a mandatory screen within the our ICU assessment that exists in the electronic documentation Increased compliance will provide actual numbers of delirium incidence Staff knowledge of actual numbers will support need for prevention and management strategies Staff are very interested in this work, they have independently signed up for the 5 session webinar “IHI Expedition Mobility in the ICU “ , and one staff attended Toronto General for a course on Physio therapy in Acute Care with focus on early mobility in the ICU .

Next Steps Audit accuracy and compliance of how staff perform the delirium screening and provide further education if required Adjust our aims, implementation of prevention and management strategies extended to November 30 Implement an electronic documentation screen for CAM-ICU Instruct Unit Clerks to stock patient chart daily with the CAM-ICU screening tool Trial Charge nurse leading discussion on patients screening results at individual patient daily rounds

Next Steps (cont’d) Implement the Non pharmacological protocol for prevention of and management of delirium Improve audit tools for restraint use and compliance with prevention and management strategies Include reporting of delirium history in our SBAR transfer documentation as patient transitions out of ICU and through continuum of care. 24-Dec-18 Delirium and Med Rec Collaborative Collaboration sur le delirium et le BCM