Transcript Bluewater Health Storyboard LS3

Bluewater Health ICU
Delirium Collaborative
Background
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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
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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.
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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
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Results
Screening Compliance
80
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68
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Admissions
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July
August
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Screened
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0
16-Jul-15
Sept
Delirium and Med Rec Collaborative
Oct
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Modified CAM ICU Worksheet
16-Jul-15
Delirium and Med Rec Collaborative
Collaboration sur le delirium et le BCM
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Results – Assessment Tools
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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
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Results
16-Jul-15
Delirium and Med Rec Collaborative
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Goal Sheet and SBAR
16-Jul-15
Delirium and Med Rec Collaborative
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Results – Reporting
16-Jul-15
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• 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
Delirium and Med Rec Collaborative
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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
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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 CAMICU screening tool
• Trial Charge nurse leading discussion on patients screening
results at individual patient daily rounds
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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.
16-Jul-15
Delirium and Med Rec Collaborative
Collaboration sur le delirium et le BCM
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