Humber River Regional Hospital Delirium CAM-ICU

Background Humber River Regional Hospital is one of Canada’s largest regional acute care hospitals Serving a catchment area of more than 850,000 people in the Northwest GTA The hospital currently operates on 3 sites with a total of 549 beds Our Critical Care Units are located at 2 of our sites with a total of 28 beds We look to our patients to share their hospital experiences with us in guiding us towards developing plans for success and improvement across the organization

Aim Identify Critical Care patients at risk of delirium with the use of CAM-ICU at both of our sites Goals/Objectives: To implement delirium protocol in the ICU by December 2012 To assess the impact of the protocol on current self extubation rates Early identification of patients with delirium

Team Members Yemi Adebayo- Manager Finch ICU Sarah Morris- CPL Church ICU Claudia Mitchell- Manager Church ICU Dr Terry Cooligan- Intensivist Mojgan Khoravis-Babadi- Pharmacist Paula Abramczyk-Cazes- Social Worker Jinhee Oh- Pharmacist Cecile Marville- Williams- Sponsor

Results Compliance with use of the Richmond Agitation Sedation Score in documentation Identifying and reporting symptoms of delirium in daily rounds

Changes Tested Started to look at incidence of delirium among patients during daily rounds Compliance to Richmond Agitation Sedation Scale (RASS) Roll out of our ICU daily rounds sheet which includes daily assessment of delirium Staff’s understanding of the tool-pocket cards Incorporated early mobilization in daily goal

Lessons Learned Need for staff to understand the causes of delirium, including medications (eg Benzodiazepines) and other predisposing factors Need for education for appropriate use of CAM-ICU To develop delirium screen in meditech to improve documentation Include delirium screening into our safety crosses

Next Steps Testing the tool Audit incidence of delirium-numerator/denominator Auditing CAM compliance Ongoing huddle on the risk factors of delirium Head of bed display