In Nurses Hands: Delirium Screening in the Intensive Care Unit

Connolly, Gina M.

Saturday, 29 October 2011

Gina M. Connolly, RN, BSN, GNLA, Fellow
Intensive Care Unit, Wishard Memorial Hospital, Indianapolis, IN

Learning Objective 1: The learner will be able to identify implementation strategies to incorporate daily delirium screening in the ICU.

Learning Objective 2: The learner will be able to recognize gaps in the literature regarding best practices in the ICU in caring for the older adult.

Older adults and mechanically ventilated patients are at an increased risk for developing delirium in the ICU, which can lead to increased mortality, cognitive decline, and functional immobility. Bedside nursing staff is on the front-lines to prevent, monitor, and provide interventions for delirium. Despite recommendations from the Society of Critical Care Medicine that all patients should be screened once a shift, only a small percentage of ICUs across the nation routinely use a standardized screening tool. This issue was addressed in our ICU through an interprofessional team, to create the implementation process and ownership of bedside nursing. This quality improvement QI project used the Confusion Assessment-Method ICU (CAM-ICU) tool to screen for delirium.

This QI project will be conducted at Wishard Memorial hospital (WMH), a 450-bed, university-affiliated, urban public hospital staffed by Indiana University School of Medicine faculty and house staff. This initiative was the first of its kind in Indiana. WMH has an 8-bed surgical ICU, a 14-bed medical and coronary ICU, and a 29-bed PICU.

The QI project’s purposes are to: a) increase nursing staff’s knowledge of delirium, b) evaluate adherence, and c) determine reliability of the CAM-ICU. A retrospective chart review will be conducted on all patients admitted to the ICU during the 1 month post implementation for adherence in completing percent of Richmond Agitation Sedation Scale (RASS) every 4 hrs and percent of CAM-ICU every 12 hrs. Data will be collected from electronic records. An expert reviewer will audit staff reliability using both screening tools. The goal of 80 % adherence in completion of the delirium screening tools by bedside staff will be determined. Knowledge will be measured by comparing pre-post test results. Future research will be conducted regarding nursing interventions, interprofessional use of the CAM-ICU, and best practices for older adults in critical care.

See more of: Poster Session I - Geriatric Nursing Leadership Academy Invited Posters
See more of: Invited Posters