1. Medicine Hat Regional Hospital
ICU Delirium Collaborative

2. Background 10 bed critical care unit in Medicine Hat Regional Hospital
Supports a catchment population of 110,000 people, SE AB & SW Saskatchewan
Team comprised of Registered Nurses (16.19fte’s), supported by Internal Medicine Specialists & an interdisciplinary team of HCP
AHS/MHRH has adopted the use of the intensive care delirium screening tool (ICDSC)
MHRH ICU introduced the ICDSC screening tool & trained staff July 2011 on the application of the ICDSC
The practice/process has not been consistently followed since being introduced

3. Background Rationale for non-adherence to delirium screening
Staff state if the patient is not presenting with S&S of delirium or changes to behaviour they simply forget to administer the delirium screening tool
lack of education,
timing bad for rollout (summer),
prompt/flag not on care plan or admission assessment,
screening tool instructions & scoring located on the back of the graphic record.

4. Aim Problem Statement Goal Statement AIM
Current screening practices/process for delirium detection, prevention &
management not consistently being adhered to in MHRH ICU
Goal Statement
AHS expectation is that within 6months 100% of patients admitted to ICU be screened,
using the ICDSC tool & standard care guidelines be implemented, to detect, prevent &
manage Delirium
AIM
To improve the care of critically ill patients at risk for delirium through the implementation of standards for screening and identification of preventative and management strategies.
Objectives
To determine the baseline incidence/prevalence of delirium within 3-6 months
Implement a process to screen 100% of ICU patients within 6 months
Develop education resources and support for staff to assist with screening, prevention and management of delirium in the ICU within next 6 months
Implement standardized prevention interventions within the next 12 months
Implement standardized management interventions within next 12 months
Implement strategies to support families within the next 18 months

5. Team Members
Team Lead/Sponsor, Brenda Ashman Director Critical Care and Medicine
ICU Manager, Rickie Pomreinke
Clinical Quality Improvement Consultant, Jill Forsyth
Transformational Team Leads
Environmental Lead, Melissa Hill RN
Mobility Lead, Stephen Yuen Team Lead Physical Therapy
Sedation/Vacation Lead, Catherine Johansen Manager Respiratory Therapy
Pharmacist Joyce Nishi
Occupational Therapy Shayne
Clinical Educator Jamie Fauth
Psychiatrist Dr. Patel
Social Worker Dan Stevens (to be invited to participate)

6. Results

7. Results

8. ICDSC audit

9. Changes Tested
Education of all ICU staff, excluding physicians, including allied health
“All about me” posters utilized & posted
Initiation of interdisciplinary daily Rapid Rounds
Establishment of day & night routines
Documentation of # of hours of sleep
Delirium awareness posters in each room
Patient brochure provided to patient/family
Vented patient PROM & mobilization plan documented

10. Lessons Learned Keys to success
Interdisciplinary transformational team, including frontline-care providers
Support/feedback from ICU Collaborative, networking, CoP
Lessons Learned
Small steps/tests, one at a time, prioritize areas to improve
Communication Key! Develop a formal plan, Make it visible
At onset establish responsibility, accountability for progression/completion of project

11. Lessons Learned Once again summer months created delay in roll-out
Changes to ICU Manger, Clinical Educator & Respiratory Therapist Manager hampered momentum, buy-in, sustainability
Education alone does not change practice
Front-line staff engagement in all stages of improvement initiative imperative for adoption of changes to practice. Change management plan required

12. Next Steps Continue chart audits for compliance with ICDSC
Perform root cause analysis for non-compliance to assessing & documenting ICDSC score per shift on every patient
Engage staff in brainstorming sol’ns for maintaining compliance with environmental, mobility, ICDSC assessment for Delirium. Develop PDSA’s to test sol’ns
Engage ICU physicians in supporting/developing plan for awake & breathing trials, (sedation vacations)
Monitor incidence/prevalence of delirium diagnosis in ICU
Assess effectiveness of Rapid Rounds
Establish accountability for monitoring & sustaining improvements