Timmins and District Hospital Critical Care Unit Delirium Collaborative November 2012

2 Background 6 bed Critical Care Unit with one over-flow bed Mix of medical and surgical patients with Sudbury as our main referral hospital One part-time educator and rotating charge between the 2-3 staff RN’s on each shift Locum internists on one week of call and only a few return regularly 3 general surgeons with frequent locum coverage

3 Aim Implement a screening process within 6 months Implement standardized interventions to manage delirium within 12 months Staff educated on delirium awareness and prevention and poorer patient outcomes Staff actively participate in screening for delirium and participate in managing symptoms of delirium within 6 months

4 Team Members Jennifer Plant, Quality and Performance Improvement Manager Trevor Morden, CCU Manager Clarice Watt, Educator for CCU Dr. Voogjarv, Medical Director Ad hoc: CCU RN, Pharmacist, RRT, Physician Assist, Physiotherapist and Social Worker

5 Results ICDSC picked as the tool we will use at TDH All CCU nursing staff educated on delirium and screening process Draft #8 of screening tool added to admission packages and available for staff On-going audits of compliance being done and October result 78% (only our second month) Self-directed learning package in draft form

6 Changes Tested Decision between use of ICDSC and CAM-ICU tool Drafts of format of tool –now on draft 8

7 Lessons Learned Need in-put from staff Continuous reinforcement required Staff champions help to reinforce process Conflicting priorities make moving forward slow at times Staying positive so can complete the process over the next 6 months

8 Next Steps Solidify delirium screening as part each patient’s assessment each shift and continue to audit to achieve a 90% completion each shift Complete a Mobility component Complete ABCDE self-directed learning package Revise protocol to include ABCDE Pre-printed orders for Delirium positive patients