Scope of Problem q Delirium is a common brain disorder with an acute onset and fluctuating course occurring within Intensive Care Units 1 q It is a serious medical condition associated with negative outcomes for patient safety and quality of care 1 q > 7 million Americans develop delirium in hospitals each year 2 q > 60% of patients with delirium are not properly diagnosed by healthcare providers 2 Purpose and Objectives q This quality improvement project emphasizes the importance of nursing contributions to delirium assessment and management in preventing complications that impact patient safety and quality of care q This project improves current nursing practice by improving nurses’ knowledge of delirium and implementing an effective delirium protocol Evidence-Based Initiative q Several evidence-based studies demonstrated significant nurse enhancement of delirium knowledge, assessment, intervention, and prevention strategies through nursing education q Several evidence-based studies regarding delirium assessment, management, and care protocols that have yielded positive changes in patients’ outcomes q Structured educational nursing interventions and patient care protocols must be developed to improve delirium nursing practice q Conceptual Framework The Knowledge to Action Framework 3 Using the Evidence: Developing an ICU Delirium Protocol Whayoun Lee, MA, MSN, APRN, RN, Kimberly J. Oosterhouse, PhD, RN Loyola University of Chicago Marcella Niehoff School of Nursing Project Plan q Ethics: Quality Improvement approval was received from University of Chicago Medicine. Institutional Review Board approval was received from Loyola University Health System; verbal consent obtained q Feasibility of the site: Site does not implement specific delirium protocols or guidelines that nurses can follow, or provide nursing education to improve knowledge on delirium q Stakeholder’s support: Intensive Care Unit Medical Director, Nurse Manager, Unit Educator, staff nurses, and hospital administration q Budget: No specific funds allocated to this project; printing costs for presentation & pocket card for CAM-ICU tools and ABCDEF patient care bundle q Design: A quality improvement project with a pre- and post-test design performed at a single center q Setting: 16-bed surgical/trauma ICU of 811-bed single center tertiary teaching hospital in Midwest America q Participants: Registered nurses (RN) working in the surgical/trauma ICU q Implementation: December 2020- March, 2021 Results and Evaluation q Demographics and Experience q Nurse’s Delirium Confidence Level q Delirium Knowledge Scores (N=38) q Nurse’s Perception Level • Self-administered questionnaire regarding nurse’s demographic data • Assessment of Nursing Knowledge Regarding ICU Delirium • Assessment of Nursing Perception Levels on Usefulness of CAM-ICU and ABCDEF Care Bundle • Nursing Staff Compliance with Delirium Assessment Screening Instruments and Care Bundle Items Pre-Test (2 weeks) • Formal Didactic Educational Intervention for ICU Delirium • Formal Education for CAM-ICU Screening Tool and ABCDEF Delirium Care Protocol Bundle Intervention (5 weeks) • Paired t-test to evaluate pre-and post-intervention delirium knowledge and the nurse’s perception on use of delirium assessment tools and patient care bundles • Evaluated the frequency of the proper usage of CAM-ICU assessment and ABCDEF patient care bundles Post-Test (2 weeks) <25 years (5) 13% 26-34 years (15) 40% 35-44 years (11) 29% 45-54 years (2)) 5% > 55 years (5) 13% Age Group (N=38) <25 years (5) 26-34 years (15) 35-44 years (11) 45-54 years (2)) > 55 years (5) 0-5 years (11) 29% 6-10 years (10) 26% 11-15 years (8) 21% 16-20 years (2) 5% >20 years (7) 19% Years of experiences (N=38) 0-5 years (11) 6-10 years (10) 11-15 years (8) 16-20 years (2) >20 years (7) Bachelors (33) 87% Masters (5) 13% Level of nursing education (N=38) Bachelors (33) Masters (5) 2.42 2.42 2.71 3.02 2.92 2.95 3.24 3.02 4.68 4.66 4.67 4.97 4.9 4.9 4.81 4.09 0 1 2 3 4 5 6 Knowledge… I received… My delirium… The CAM-ICU is… Patient care is… Monitoring for… Frequent… Routine… Nurse's Perception Level of CAM - ICU & ABCDEF Bundle (N=38) Pre-Test Post-Test 3.61 2.47 2.76 2.18 4.71 4.79 4.71 4.34 0 1 2 3 4 5 6 I feel confident defining delirium I feel confident differentiating the different types of delirium I feel confident completing the CAM-ICU I feel confident completing the ABCDEF care bundle Nurse's Confidence Level on CAM - ICU and ABCDEF Bundle (N=38) Pre-Test Post-Test Pre-test Correct M(SD) Post -test Correct M(SD) t(df) P Overall Knowledge 72.37 (12.83) 95 (6.47) -9.29 (37) p<0.0001 71.32 95 0 10 20 30 40 50 60 70 80 90 100 Pre-Test Post-Test Nurse's Knowledge Level of Delirium Results and Evaluation Cont. qCompliance Rates of CAM-ICU qCompliance Rates of ABCDEF Bundle Practice Implications q Appropriate educational interventions significantly improve nursing knowledge and perception levels on ICU delirium assessment and management q Delirium assessments and management protocols at an institutional level must be developed for for improvement of patient safety and practice change Conclusion q This quality improvement project demonstrates that an educational intervention for nurses can result in improved knowledge of ICU delirium and nurse’s confidence and perception levels on usefulness of delirium assessment tools and intervention bundles. q An adequate formal education involvement is essential to promote ICU delirium management practice and to develop delirium protocol Acknowledgements The author would like to thank Dr. Kimberly Oosterhouse, Dr. Audrey Klopp, the nursing staff at University of Chicago Medicine, “Delirium Champions” Griselda Hempstead, Nicole Holcomb, and Kimberley Reed. References 1. Arumugam, S., El-Menyar, A., Al-Hassani, A., Strandvik, G., Asim, M., Mekkodithal, A., Mudali, I., & Al-Thani, H. (2017). Delirium in the intensive care unit. Journal of Emergencies, Trauma and Shock, 10(1), 37–46. https://doi.org/10.4103/0974-2700.199520 2. American Delirium Society. (n.d.). Retrieved from https://americandeliriumsociety.org/ 3. Field, B., Booth, A., Liotta, I., & Gerrish, K. (2014). Using the Knowledge to Action Framework in practice: a citation analysis and systematic review. Implementation Science : IS, 9, 172. https://doi.org/10.1186/s1301-014-0172-2 Pre-test Frequency Rates (N=80) Post-test Frequency Rates (N=76) Overall Rates of CAM-ICU 6.25% (5 times/80 patients over 6 days) 48.68% (37 times/76 patients over 6 days) Pre-test Frequency Rates(N=80) Post-test Frequency Rates (N=76) Overall Rates of ABCDEF intervention Bundle 3.75% (3 times/80 patients over 6 days) 46.05% (35 times/76 patients over 6 days) 6.25% 48.68% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% Pre-Test Post-Test Compliance Rates of CAM - ICU 3.75% 46.05% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% Pre-Test Post-Test Compliance Rates of ABCDEF Bundle Paired t-test(p<0.05): Significant changes in confidence and perception level scores from pre- to post-test (P<0.0001) Paired t-test(p<0.05): Significant changes in nurse’s knowledge of delirium scores from pre- to post-test (P<0.0001)