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Medicine Hat Regional Hospital

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

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Medicine Hat Regional Hospital

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  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 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

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