Humber River Regional Hospital Delirium CAM-ICU

2 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

3 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

4 Team Members Yemi Adebayo- Manager Finch ICU Shirley Goguen- CPL 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

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

6 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

7 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

8 Next Steps Continue with Education Roll out of CAM-ICU Auditing compliance with using CAM-ICU Ongoing education on importance of Delirium Assessment Family education using a Delirium information package Reiterating the importance of communication with the patient/family and health care team