Delirium Management Quality Improvement Project to Improve Awareness and Screening in a Medical ICU
<b>Background/Objectives:</b> Although delirium is common during critical illness, standard-of-care detection and prevention practices in real-world intensive care unit (ICU) settings remain inconsistent, often due to a lack of provider education. Despite availability for over 20 years o...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-12-01
|
| Series: | Nursing Reports |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2039-4403/15/1/6 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832587813984403456 |
|---|---|
| author | Hirsh Makhija Kyle Digrande Omar Awan Russell G. Buhr Rajan Saggar Victoria Ramirez Rainbow Tarumoto Janelle M. Fine Atul Malhotra Dale M. Needham Jennifer L. Martin Biren B. Kamdar |
| author_facet | Hirsh Makhija Kyle Digrande Omar Awan Russell G. Buhr Rajan Saggar Victoria Ramirez Rainbow Tarumoto Janelle M. Fine Atul Malhotra Dale M. Needham Jennifer L. Martin Biren B. Kamdar |
| author_sort | Hirsh Makhija |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> Although delirium is common during critical illness, standard-of-care detection and prevention practices in real-world intensive care unit (ICU) settings remain inconsistent, often due to a lack of provider education. Despite availability for over 20 years of validated delirium screening tools such as the Confusion Assessment Method in the ICU (CAM-ICU), feasible and rigorous educational efforts continue to be needed to address persistent delirium standard-of-care practice gaps. <b>Methods:</b> Spanning an 8-month quality improvement project period, our single-ICU interdisciplinary effort involved delivery of CAM-ICU pocket cards to bedside nurses, and lectures by experienced champions that included a live delirium detection demonstration using the CAM-ICU, and a comprehensive discussion of evidence-based delirium prevention strategies (e.g., benzodiazepine avoidance). Subsequent engagement by health system leadership motivated the development of an electronic health record dataset to evaluate unit-level outcomes, including CAM-ICU documentation and benzodiazepine administration. <b>Results:</b> Using a dataset that spanned 9 pre- and 37 post-project months and included 3612 patients, 4470 admissions, and 33,913 patient days, we observed that delirium education was followed by a dramatic rise in CAM-ICU documentation, from <1% for daytime and nighttime shifts to peaks of 73% and 71%, respectively (<i>p</i> < 0.0001 for trend), and a fall in the proportion of mechanically ventilated patients ever receiving benzodiazepine infusions (69% to 41%; <i>p</i> < 0.0001). <b>Conclusions:</b> An interdisciplinary delirium project comprising rigorous lectures on standard-of-care practices can yield significant improvements in documentation and sedative administration. This approach can help ICUs jumpstart efforts to build awareness and address longstanding gaps in standard-of-care delirium practices. |
| format | Article |
| id | doaj-art-bfdc377933c94fdeb83f387ae290e0d7 |
| institution | Kabale University |
| issn | 2039-439X 2039-4403 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nursing Reports |
| spelling | doaj-art-bfdc377933c94fdeb83f387ae290e0d72025-01-24T13:44:26ZengMDPI AGNursing Reports2039-439X2039-44032024-12-01151610.3390/nursrep15010006Delirium Management Quality Improvement Project to Improve Awareness and Screening in a Medical ICUHirsh Makhija0Kyle Digrande1Omar Awan2Russell G. Buhr3Rajan Saggar4Victoria Ramirez5Rainbow Tarumoto6Janelle M. Fine7Atul Malhotra8Dale M. Needham9Jennifer L. Martin10Biren B. Kamdar11Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego Health, La Jolla, CA 92093, USADepartment of Medicine, University of California, Irvine, CA 92697, USAPulmonary Section, Medicine Service, VA Medical Center, Washington, DC 20422, USADivision of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USADivision of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USAMedical Intensive Care Unit, Ronald Reagan UCLA Hospital, Los Angeles, CA 90095, USADivision of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USADivision of Pulmonary, Critical Care and Sleep Medicine, UC San Diego Health, La Jolla, CA 92093, USADivision of Pulmonary, Critical Care and Sleep Medicine, UC San Diego Health, La Jolla, CA 92093, USADivision of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USAVA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, CA 90073, USADivision of Pulmonary, Critical Care and Sleep Medicine, UC San Diego Health, La Jolla, CA 92093, USA<b>Background/Objectives:</b> Although delirium is common during critical illness, standard-of-care detection and prevention practices in real-world intensive care unit (ICU) settings remain inconsistent, often due to a lack of provider education. Despite availability for over 20 years of validated delirium screening tools such as the Confusion Assessment Method in the ICU (CAM-ICU), feasible and rigorous educational efforts continue to be needed to address persistent delirium standard-of-care practice gaps. <b>Methods:</b> Spanning an 8-month quality improvement project period, our single-ICU interdisciplinary effort involved delivery of CAM-ICU pocket cards to bedside nurses, and lectures by experienced champions that included a live delirium detection demonstration using the CAM-ICU, and a comprehensive discussion of evidence-based delirium prevention strategies (e.g., benzodiazepine avoidance). Subsequent engagement by health system leadership motivated the development of an electronic health record dataset to evaluate unit-level outcomes, including CAM-ICU documentation and benzodiazepine administration. <b>Results:</b> Using a dataset that spanned 9 pre- and 37 post-project months and included 3612 patients, 4470 admissions, and 33,913 patient days, we observed that delirium education was followed by a dramatic rise in CAM-ICU documentation, from <1% for daytime and nighttime shifts to peaks of 73% and 71%, respectively (<i>p</i> < 0.0001 for trend), and a fall in the proportion of mechanically ventilated patients ever receiving benzodiazepine infusions (69% to 41%; <i>p</i> < 0.0001). <b>Conclusions:</b> An interdisciplinary delirium project comprising rigorous lectures on standard-of-care practices can yield significant improvements in documentation and sedative administration. This approach can help ICUs jumpstart efforts to build awareness and address longstanding gaps in standard-of-care delirium practices.https://www.mdpi.com/2039-4403/15/1/6benzodiazepinesdeliriumintensive care unitoutcome assessmentquality improvementnursing |
| spellingShingle | Hirsh Makhija Kyle Digrande Omar Awan Russell G. Buhr Rajan Saggar Victoria Ramirez Rainbow Tarumoto Janelle M. Fine Atul Malhotra Dale M. Needham Jennifer L. Martin Biren B. Kamdar Delirium Management Quality Improvement Project to Improve Awareness and Screening in a Medical ICU Nursing Reports benzodiazepines delirium intensive care unit outcome assessment quality improvement nursing |
| title | Delirium Management Quality Improvement Project to Improve Awareness and Screening in a Medical ICU |
| title_full | Delirium Management Quality Improvement Project to Improve Awareness and Screening in a Medical ICU |
| title_fullStr | Delirium Management Quality Improvement Project to Improve Awareness and Screening in a Medical ICU |
| title_full_unstemmed | Delirium Management Quality Improvement Project to Improve Awareness and Screening in a Medical ICU |
| title_short | Delirium Management Quality Improvement Project to Improve Awareness and Screening in a Medical ICU |
| title_sort | delirium management quality improvement project to improve awareness and screening in a medical icu |
| topic | benzodiazepines delirium intensive care unit outcome assessment quality improvement nursing |
| url | https://www.mdpi.com/2039-4403/15/1/6 |
| work_keys_str_mv | AT hirshmakhija deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu AT kyledigrande deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu AT omarawan deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu AT russellgbuhr deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu AT rajansaggar deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu AT victoriaramirez deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu AT rainbowtarumoto deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu AT janellemfine deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu AT atulmalhotra deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu AT dalemneedham deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu AT jenniferlmartin deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu AT birenbkamdar deliriummanagementqualityimprovementprojecttoimproveawarenessandscreeninginamedicalicu |