Saskatoon Health RegionDepartment of Critical Care

Prevention of Delirium

2

Background

• The Department of Critical Care in the Saskatoon Health Region is made up of 3 units on 2 sites.– Royal University Hospital Intensive Care Unit – 15 beds and

2 satellite beds.– St. Paul’s Hospital Intensive Care Unit – 15 beds.– St. Paul’s Hospital Progressive Care Unit – 8 beds.

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Aim

• To reduce the incidence of delirium in critically ill patients and to standardize and improve management of patients with delirium. We aim for this project to be part of an “ABCDE bundle” approach to the care of our critically ill patients.

• Goals/Objectives– To assess for and report delirium q shift and when changes

in patient condition.– To implement a mobility protocol to guide mobilization of

all patients to their maximum capacity each shift

Aim

• Goals / Objectives Continued– To measure the duration of delerium– To implement the use of Yacker Trackers in all 3 units to

increase awareness of noise levels in the units and help to decrease noise level.

– To implement a daily checklist to be used on rounds which includes looking at delirium assessment and what changes can be made t reduce the duration of delirium

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Team Members

• There are multidisciplinary team members representing each unit, some team members work across all 3 units.

• There are physicians, RN’s, Physiotherapists, Pharmacists and Dieticians.

• The team is sponsored by the Director and Physician Leader of the Department of Critical Care – Patti Simonar and Dr. Mark James

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Results

Incidence of DeliriumIncidence of Delerium

0%

10%

20%

30%

40%

50%

14-Feb-12 28-Feb-12 13-Mar-12

Pts. Unable toAssess

Cam Positive

Results

Active in Mobility protocolSPH-ICU 2011

0%10%20%30%40%50%60%70%80%90%

100%

Fe

b

Ma

rch

Ap

ril

Ma

y

Jun

e

July

Au

gu

st

Se

pt

Oct

No

v

De

c

date

pe

rce

nta

ge

Results

SHR Cr i ti cal Care: Mobi l i ty protocol char ted 2012

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Feb. 14 Mar . 1 Mar . 14 Apr . 30 May. 31 J une. 30 J uly 31.

D ate

Implemented

1 unit

Implemented

al l uni ts

Decr eased

audi ting and

qual i ty suppor t

pr esence on unit

Goal : 100%

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Results

SHR Cr i ti cal Care: Average Days of Duration of Deler ium per Patient

2012

0

1

2

3

4

5

6

7

Apr . 30 May. 15 May. 31 J une. 15 J une. 30 J uly. 15 J uly. 31 Aug. 15 Aug. 31 Sept. 15 Sept. 30

Date

SP H ICU SP H P CU RUH ICU

NOT E : SP H P CU has ver y f ew

patients with deler ium

Changes Tested – Utilization of CAM-ICU Assessment Tool

Changes Tested – Implementation of a Mobility Protocol

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Lessons Learned

• Difficult to do the CAM-ICU if patient a RASS of -3; using the criteria of a RASS of -2 or greater to do the assessment

• Importance of education of staff that CAM-ICU can be assessed if patient is a RASS of -2 or greater as they often feel that they cannot assess patient if they do not squeeze hands and fail the test for inattention.

• Challenges with ensuring that patients are being mobilized to their maximum capacity.

• Patients are often confused but CAM-ICU negative• Duration of delirium appears to be longer at SPH ICU – may be

due to patient population. There is a need to continue to study further

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Next Steps

• Implementation of a checklist that includes delirium and mobilization goals

• Intermittent measurement of incidence of delirium to observe trends.

• Continued measurement of duration of delirium to observe trends and determine reasons for variation in duration.

• Explore more accurate ways of measuring mobilization – charting mobilization step is not always an accurate measurement of mobilization.