1. Misericordia Hospital Edmonton, Alberta
Delirium Collaborative

2. Background
Currently, the ICU does not have baseline data, tools to assess the prevalence of delirium, nor is there a consistent approach followed when caring for patients with or at risk for delirium. This is evidenced by the lack of a common treatment plan shared and understood by all disciplines.

3. Aim Improve care of the critically ill patient at risk for delirium
Implementation of standardized screening tools and identification of prevention strategies to be used within the ICU
Goals/Objectives
Develop education and support for staff regarding delirium awareness, prevention,
and management within 12 months.
Determine baseline incidence/prevalence of delirium within 3-6 months.
Implement processes to screen 100% of all ICU patients for delirium within 6 months.
Implement standardized delirium prevention interventions in all ICU patients within 12 months.
Implement standardized interventions for the management of delirium within 12
months.
Implement strategies to support families of patients with delirium within 18 months
(i.e. information pamphlets)
Establish ongoing education parameters

4. Team Members Lead Coordination of Action- Kim Scherr, NP
Clinical Nurse Educator-Jennifer Barker
Nursing Representatives – all staff
Respiratory – all staff
Pharmacy – Gwen Bileski
PT - Stephanie Oviatt, Roselle De Castro
Medical Support- Dr. Heule
Unit Manager/Supervisor – Trish O’Toole, Geniene Stokowski

5. Results
ICDSC checklist developed for use and agreed upon by all disciplines
Over the month of February, 2012, education sessions were provided to 100% of nursing staff
and a large number of
multidisciplinary team members regarding: - “What is Delirium?”
“ How do we Screen for Delirium?”
“Why is Prevention of Delirium Important?”
“ How do we Manage Delirium in the ICU?”

6. Results
Learning posters were created to provide visual cueing for staff

7. Results Data collection tool was developed and implemented
Charge nurses were provided one on
one education on how to complete
the data collection tool accurately
Data is being collected daily on all ICU patients in respect to: delirium score, hours of sleep, presence of endotracheal tube, use of narcotics & sedation infusions, medication reconciliation completion, central line checklist completion (if applicable), self-extubation/line removal, and use of physical restraints

8. Results Random chart audits were completed on all ICU patients to
identify compliance with the ICDSC

9. Changes Tested
Utilization of data collection tools provide initial base line data

10. Lessons Learned
Change is a gradual process that is driven by champions, and requires continuous reaffirmation
Staff are willing participants in change strategies if they are given enough education and support, and can see that the change makes a positive difference in patient care
Incorporation of a data collection tool necessitates changes in other documentation in order to make the data collection process as seamless and time efficient as possible. Therefore, updates to our ICU admission orders, nursing documentation flow sheets, report sheets, etc. will be undertaken in the near future

11. Next Steps
Provide family focused care by using a tool that will allow us to “Know Our Patient”
Implement an Early Mobilization Tool
Review and change current Standing Admission Order sets to reflect change in practice
Review and change current nursing flow sheets and report sheets to reflect change in practice
Ongoing education for multidisciplinary team of work being done nationally, regionally and at the unit level
Continue data collection on incidence of delirium, restraint usage, sedation usage, and staff compliance for screening and documentation