Transcript Medicine Hat Hospital - Canadian Patient Safety Institute

Medicine Hat Regional Hospital
ICU Delirium Collaborative
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
2
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.
Aim
Problem Statement
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
4
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)
5
Results
6
Results
ICDSC audit
ICU Delirium MHRH ICDSC Scoring Compliance Rate
100
100
40% staff attended inservice
57% staff attended inservice
90
85
81
80
78
76% staff received education
70
Percent of documented score on ICDSC
66% staff received education
60
57
Data 1
50
Median
40
30
25
20
10
0
4-Jun
11-Jun
18-Jun
25-Jun
27-Jul
27-Aug
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
9
Lessons Learned
Keys to success
• Interdisciplinary transformational team, including frontlinecare 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
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
11
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
12