1. Humber River Regional Hospital
Delirium CAM-ICU

2. Background
Humber River Regional Hospital is one of Canada’s largest regional acute care hospitals
Serving a catchment area of more than 850,000 people in the Northwest GTA
The hospital currently operates on 3 sites with a total of 549 beds
Our Critical Care Units are located at 2 of our sites with a total of 28 beds
We look to our patients to share their hospital experiences with us in guiding us towards developing plans for success and improvement across the organization

3. Aim
Identify Critical Care patients at risk of delirium with the use of CAM-ICU at both of our sites
Goals/Objectives:
To implement delirium protocol in the ICU by December 2012
To assess the impact of the protocol on current self extubation rates
Early identification of patients with delirium

4. Team Members Yemi Adebayo- Manager Finch ICU
Sarah Morris- CPL Church ICU
Claudia Mitchell- Manager Church ICU
Dr Terry Cooligan- Intensivist
Mojgan Khoravis-Babadi- Pharmacist
Paula Abramczyk-Cazes- Social Worker
Jinhee Oh- Pharmacist
Cecile Marville- Williams- Sponsor

5. Results
Compliance with use of the Richmond Agitation Sedation Score in documentation
Identifying and reporting symptoms of delirium in daily rounds

6. Changes Tested
Started to look at incidence of delirium among patients during daily rounds
Compliance to Richmond Agitation Sedation Scale (RASS)
Roll out of our ICU daily rounds sheet which includes daily assessment of delirium
Staff’s understanding of the tool-pocket cards
Incorporated early mobilization in daily goal

7. Lessons Learned
Need for staff to understand the causes of delirium, including medications (eg Benzodiazepines) and other predisposing factors
Need for education for appropriate use of CAM-ICU
To develop delirium screen in meditech to improve documentation
Include delirium screening into our safety crosses

8. Next Steps Testing the tool
Audit incidence of delirium-numerator/denominator
Auditing CAM compliance
Ongoing huddle on the risk factors of delirium
Head of bed display