The Problem The Goal The Intervention Progress to Date Next Steps A hospital-wide, comprehensive approach to recognizing and responding to delirium is.

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Presentation transcript:

The Problem The Goal The Intervention Progress to Date Next Steps A hospital-wide, comprehensive approach to recognizing and responding to delirium is needed to minimize the consequences of hospital-acquired delirium, and contribute meaningfully to our goal of eliminating preventable harm. This project aimed to minimize adverse consequences of hospital-acquired delirium through a multi-pronged approach that a) identified patients at risk for delirium; b) prevented delirium in at-risk patients; c) monitored at-risk patients for development of delirium; and d) provided early and effective intervention for patients at-risk or who developed delirium. The GRACE Delirium Precautions pilot: Took an innovative approach to providing early and effective prevention and intervention for patients who developed delirium; Utilized the institution’s Precautions culture and associated care plans; Targeted a multi-disciplinary care bundle over an 8-week period (March – April 2014) on one medical floor in the hospital (CC7). Our Team Deb Adduci, PT: Manager Inpatient OT/PT May Adra, BS, Pharm D: Clinical Pharmacy Coordinator Andrea J. Branchaud, MPH: Healthcare Quality Suzanne Burger, MSN, RN: Unit-Based Educator Katelyn Campbell, OTR/L: Occupational Therapist Anthony Ishak, PharmD: Clinical Pharmacist Chris Kristeller, RN: Clinical Nurse Specialist Tracy Lee, MSN, RN: Nurse Manager Melissa Mattison, MD: Associate Chief, Hospital Medicine Robin McLaughlin, RN, RRT: Unit-Based Educator Jaclyn Miller, RN: Resource RN Crystal Sannella, OTR/L: Occupational Therapist Kim Sulmonte, RN, MHA, CSHA: Associate Chief Nurse, Quality & Safety Julius Yang, MD, PhD: Director, Inpatient Quality GRACE Delirium Precautions OTs and RNs using common language/tools for clinical discussion for patients (“How was pt’s test of attention?”) RNs reporting satisfaction with having Cognition/Toolkit resources (real-time availability of materials) MD satisfaction with consultant responses – pharmacy especially Culture built around delirium Team approach to patient care Non-pilot floor delirium precautions orders being entered: 47 other hospital-wide orders 27% had ICU stay 41% admitted from Home 76% discharged to Extended Care Facility 60% aged 81 and older Average rate for previous 5 years Average rate for previous 5 months Average rate during pilot Targeted Outcomes  Establish reliable prevalence of delirium  Decrease falls w/injury  Increase discharge to home  Decrease length of stay 59 patients over 8 weeks:Correlational effect on falls: General satisfaction with pilot:  CC7: RN & MD components re-launching February 2015  Hospital-wide: RN & MD components as part of “Roadshow”  Brainstorming around pharmacy components  Brainstorming about transfer of information to post- discharge facilities/home care: discharge summary, plan Click on an image below to explore the components of our intervention!

GRACE Delirium Precautions Sign (RN)

About Me poster (RN)

Patient/Family Education Fact Sheet (RN/OT/Social Work)

Bin for used items Clean bins to place new items & bring to pt rooms Suggested Items to use & Comments list Program Overview & Delirium 1-Point lessons Drawers sorted & Labeled by: Cognition Sensory Impairments Sleep/Wake, Other Labeled as: Reusable 1-TIME Use RN Packet: Drawer 3 DP Sign, Fall Sign, Education Fact Sheet, About Me poster, Markers Light for evening shift (requested) Cognition Toolcart/Closet