1. Delirium Collaborative
Bluewater Health ICU
Delirium Collaborative

2. 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

3. 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.

4. 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

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

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

7. 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

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

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

10. 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

11. 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 .

12. 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

13. 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