Transcript Misericordia Hospital Storyboard LS2

Misericordia Hospital
Edmonton, Alberta
Delirium Collaborative
Background
• Currently, the ICU does not have baseline
data, tools to assess the prevalence of
delirium, nor is there a consistent approach
followed when caring for patients with or at
risk for delirium. This is evidenced by the lack
of a common treatment plan shared and
understood by all disciplines.
2
Aim
•
•
Improve care of the critically ill patient at risk for delirium
Implementation of standardized screening tools and identification of prevention strategies to
be used within the ICU
Goals/Objectives
– Develop education and support for staff regarding delirium awareness, prevention,
and management within 12 months.
– Determine baseline incidence/prevalence of delirium within 3-6 months.
– Implement processes to screen 100% of all ICU patients for delirium within 6 months.
– Implement standardized delirium prevention interventions in all ICU patients within 12
months.
– Implement standardized interventions for the management of delirium within 12
– months.
– Implement strategies to support families of patients with delirium within 18 months
– (i.e. information pamphlets)
– Establish ongoing education parameters
3
Team Members
•
•
•
•
•
•
•
•
Lead Coordination of Action- Kim Scherr, NP
Clinical Nurse Educator-Jennifer Barker
Nursing Representatives – all staff
Respiratory – all staff
Pharmacy – Gwen Bileski
PT - Stephanie Oviatt, Roselle De Castro
Medical Support- Dr. Heule
Unit Manager/Supervisor – Trish O’Toole, Geniene
Stokowski
4
Results


ICDSC checklist developed
for use and agreed upon
by all disciplines
Over the month of
February, 2012, education
sessions were provided to
100% of nursing staff
and a large number of
multidisciplinary team
members regarding: “What is Delirium?”
“ How do we Screen for
Delirium?”
“Why is Prevention of
Delirium Important?”
“ How do we Manage
Delirium in the ICU?”
Results
•
Learning posters were
created to provide visual
cueing for staff
6
Results
•
•
•
Data collection tool was developed
and implemented
Charge nurses were provided one on
one education on how to complete
the data collection tool accurately
Data is being collected daily on all ICU
patients in respect to: delirium score,
hours of sleep, presence of
endotracheal tube, use of narcotics &
sedation infusions, medication
reconciliation completion, central line
checklist completion (if applicable),
self-extubation/line removal, and use
of physical restraints
Delirium
Delirium DATA
DATA Collection
Collection
•Initiate a form on EVERY patient
•Charge Nurses to collect data every
night when checking charts
•Active forms are kept in the CHARGE
BINDER with individual patient
information
•Once a sheet is full (q4days) grab a
new one and continue, all sheets stay
in CHARGE Binder until patient
discharged
•Once patient is discharged remove
all sheets and place them into the
DELIRIUM DATA BINDER at the unit
clerk desk
•Unit clerks can print new sheets if you
run out
•Kim will clean out Delirium DATA
binder and forward DATA to the analyst
7
Results
Random Chart Audit of Completed ICDSC
Random chart audits were
completed on all ICU patients to
identify compliance with the ICDSC
95
90
Percent
•
85
80
90
75
75
70
65
April 20 2012
May 3 2012
Changes Tested

Utilization of
data collection
tools provide
initial base line
data
9
Lessons Learned
• Change is a gradual process that is driven by champions, and
requires continuous reaffirmation
• Staff are willing participants in change strategies if they are
given enough education and support, and can see that the
change makes a positive difference in patient care
• Incorporation of a data collection tool necessitates changes in
other documentation in order to make the data collection
process as seamless and time efficient as possible. Therefore,
updates to our ICU admission orders, nursing documentation
flow sheets, report sheets, etc. will be undertaken in the near
future
10
Next Steps
• Provide family focused care by using a tool that will allow us
to “Know Our Patient”
• Implement an Early Mobilization Tool
• Review and change current Standing Admission Order sets to
reflect change in practice
• Review and change current nursing flow sheets and report
sheets to reflect change in practice
• Ongoing education for multidisciplinary team of work being
done nationally, regionally and at the unit level
• Continue data collection on incidence of delirium, restraint
usage, sedation usage, and staff compliance for screening and
documentation
11