1. Saskatoon Health Region Department of Critical Care Prevention of Delirium

2. 2 Background The Department of Critical Care in the Saskatoon Health Region is made up of 3 units on 2 sites. – Royal University Hospital Intensive Care Unit – 15 beds and 2 satellite beds. – St. Paul’s Hospital Intensive Care Unit – 15 beds. – St. Paul’s Hospital Progressive Care Unit – 8 beds.

3. 3 Aim To reduce the incidence of delirium in critically ill patients and to standardize and improve management of patients with delirium. We aim for this project to be part of an “ABCDE bundle” approach to the care of our critically ill patients. Goals/Objectives – To assess for and report delirium q shift and when changes in patient condition. – To implement a mobility protocol to guide mobilization of all patients to their maximum capacity each shift

4. Aim Goals / Objectives Continued – To measure the duration of delerium – To implement the use of Yacker Trackers in all 3 units to increase awareness of noise levels in the units and help to decrease noise level. – To implement a daily checklist to be used on rounds which includes looking at delirium assessment and what changes can be made t reduce the duration of delirium

5. 5 Team Members There are multidisciplinary team members representing each unit, some team members work across all 3 units. There are physicians, RN’s, Physiotherapists, Pharmacists and Dieticians. The team is sponsored by the Director and Physician Leader of the Department of Critical Care – Patti Simonar and Dr. Mark James

6. 6 Results Incidence of Delirium

7. Results

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10. Changes Tested – Utilization of CAM-ICU Assessment Tool

11. Changes Tested – Implementation of a Mobility Protocol

12. 12 Lessons Learned Difficult to do the CAM-ICU if patient a RASS of -3; using the criteria of a RASS of -2 or greater to do the assessment Importance of education of staff that CAM-ICU can be assessed if patient is a RASS of -2 or greater as they often feel that they cannot assess patient if they do not squeeze hands and fail the test for inattention. Challenges with ensuring that patients are being mobilized to their maximum capacity. Patients are often confused but CAM-ICU negative Duration of delirium appears to be longer at SPH ICU – may be due to patient population. There is a need to continue to study further

13. 13 Next Steps Implementation of a checklist that includes delirium and mobilization goals Intermittent measurement of incidence of delirium to observe trends. Continued measurement of duration of delirium to observe trends and determine reasons for variation in duration. Explore more accurate ways of measuring mobilization – charting mobilization step is not always an accurate measurement of mobilization.