Department of Critical Care Medicine Calgary Delirium Assessment and Treatment

2 Background Calgary DCCM comprised of 4 adult critical care sites Mix of medical, surgical, neurological, and cardiovascular surgery patients Disciplines involved: Intensivists, Nurse Practitioners, Registered Nurses, Respiratory Therapists, Occupational Therapists, Pharmacists, Nurse Educators, Physiotherapists The literature has demonstrated that delirium is a strong predictor for patient morbidity and mortality We currently do not have a standardized assessment tool or treatment algorithm in place for recognition and management of delirium

Aim Complete roll-out of Delirium Screening using ICDSC across all Adult ICU’s in Calgary Zone by April Complete implementation of the ABCDE Bundle across all Adult ICU’s in Calgary Zone by September Reduce the incidence of Delirium in adult ICU’s in Calgary Zone by 50% by April 2014.

Team Members Intensivists/Nurse Practitioner – Dr. Terry Hulme, Dr. Sid Viner, Nicki Johal Nursing Management – Melissa Redlich, Rebecca Eldridge RNs/Educators – Joan Harris, Joanne Xu, Deborah Banack, Heather Sartison, Laura Sullivan RTs – Suzanne Boyd Pharmacists – Barry Kushner, Diana Callfas PT/OT – Megan Hudson / Alanna Cunningham 27-May-164 Delirium and Med Rec Collaborative Collaboration sur le delirium et le BCM

Results Results pending for feasibility study looking at RN workload for implementation of Best Practice Guidelines: Non-Pharmacological Prevention and Management of Delirium in the ICU” Results pending for survey of core nursing group on pre-implementation knowledge regarding the recognition and treatment of delirium 27-May-165 Delirium and Med Rec Collaborative Collaboration sur le delirium et le BCM

6 Changes to be Tested Baseline measurement of “perceived” delirium prior to introduction of the ICDSC Delirium prevalence following introduction of ICDSC Comparison of pre- and post-intervention knowledge of delirium recognition and screening Calgary zone specific ICDSC worksheet for workload and ease of use Audit of ICDSC tool for inter-rater reliability once implemented

Lessons Learned Competing interests/projects create a significant barrier towards implementation Strong educational component will be required to address diverse learning needs associated with utilization of the ICDSC. We need to mobilize quickly to start collecting baseline data prior to ICDSC implementation We need to continue to identify change champions from all disciplines prior to implementation 27-May-167 Delirium and Med Rec Collaborative Collaboration sur le delirium et le BCM

8 Next Steps We intend to start using the ICDSC at one site by Jan or Feb Engagement of our Respiratory Therapy group to assist in the development of protocols for spontaneous awakening and breathing trials To continue to update our sedation and pain management guidelines in preparation for rollout Comparison of delirium incidence before and after the implementation of standardized assessment and treatment tools

9 EXAMPLE – DELETE BEFORE SAVING Title Background Aim Team Members ResultsChanges Tested Lessons Learned Next Steps