Improvement Charter

Project Name: /

ICU Delirium and Medication Reconcillation

Team Members: /

Rob Wiederick, Lisa Forster, Cory Komant, Mike Krause, Salima Ishmail, Todd Maclure, Rhonda Hardy-Joel

Team Sponsor: /

Jan Schmipf

WHAT ARE WE TRYING TO ACCOMPLISH? /

Purpose of Project

Recognize the mortality and long term neurological consequences of delirium among the critically ill. Our purpose in joining the delirium collaborative is to bring awareness, preventative measures and treatment strategies to the GNHICU in hopes that the prevalence of delirium is minimized. In addition, our team hopes to incorporate successful and useful strategies that have been developed and utilized by Canadian intensive care units involved in the collaborative.
Scope & Boundaries
Will involve multi-disciplinary ICU team members. Registered nurses, Nurse Educator, pharmacist, respiratory therapist, and nurse practitioners. Our team will be under the direction of Dr. Stollery (ICU director). Additional members not directly part of the team, but will be involved are physical therapists.
Improvement Objectives
Improvement in clinical assessment of delirium
Improvement in prevention, non-pharmacological and pharmacological treatment of delirium
Improvement strategies that are realistic, achievable, and sustainable
HOW WILL WE KNOW A CHANGE IS AN IMPROVEMENT? / Measures
  1. Delirium checklist compliance
  2. Sedation vacation
  3. Accurate hours of sleep recorded
  4. Appropriate antipsychotic medications
  5. Early mobilization
/ Current Performance
  1. Unknown (~ 60%)
  2. Unknown
  3. ~ 40%
  4. ~25%
  5. ~ 80%
/ Goals
  1. 100%
  2. 80% (on appropriate pts)
  3. 80-100%
  4. 80%
  5. 100% (on appropriate pts)

WHAT CHANGES CAN WE MAKE THAT WILL RESULT IN IMPROVEMENT? /

Change Concepts and Ideas to Test

Change the idea that benzodiazepines are inappropriate for the treatment of hyperactive delirium
Change the idea that sedation is not an adequate substitute for natural sleep
Change the concept that every icu patient may not require sleep interruptions for physical assessments
Multi-disciplinary team members require education to ensure adequate knowledge of what delirium is, how it is preventable and appropriate treatment measures.
HOW WILL WE MANAGE THE IMPROVEMENT PROJECT? /

Principles for Working Together

Monthly team meetings to describe areas of success and areas that need improvement. Open communication and encouragement from all collaborative members and multidisciplinary tema members. Open dialogue with attending ICU physicians to ensure buy in with prevention and treatment strategies

Roles & Responsibilities

Yet to be determined as each member is volunteering for the collaborative above their regular duties

Review Schedule

To be directed form the collaborative.

Key Dates

To be directed form the collaborative

Author: Todd Maclure NP ICU

Date: January 24, 2012

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