Improvement Charter

Project Name: /

Delirium collaborative in the ICU West

Team Members: /

Alison Fox Robichaud, Dale Bialas, Trina Banko, Joanne Butler, Sonya Lugowy, Leslie St Jacques, Yuliya Tomilovska

Team Sponsor: /

Director of Cardiovascul;ar Program – Gail Johnson

WHAT ARE WE TRYING TO ACCOMPLISH? /

Purpose of Project

- to continue to strengthening prevention, early recognition and effective management of ICU delirium in cardiac post op patients
Scope & Boundaries
ICU West
possibly pre and post op as well
Improvement Objectives
- to reduce the incidence of delirium by 50% through early prevention and strategic management by February 1st, 2013
HOW WILL WE KNOW A CHANGE IS AN IMPROVEMENT? / Measures
  1. 100% CAM ICU compliance
  2. future ICDSC
  3. 100% use of clock's diagnostic results
  4. timely initiation of appropriate preventative/managing startegies fr delirium post screening
  5. addressing pre-op substance abuse (nicotine, ethanol, caffeine, etc.)
  6. limit use of restrains
  7. low/zero incidence of self harming events by delirious patients such as premature self extubation, removal of liens and tubes, falls, etc.
  8. Use of sedatives and antipsychotics (+ use of propofol versus lorazepam)
  9. total adherence to day and night cycle during recovery
/ Current Performance
  1. 70% CAMICU compliance
  2. partial use of clock's results (to be determined)
  3. previous delirium in-services for staff
  4. working group for delirium
  5. working group for transfers
and patient flow
  1. low incidence of elf harming events by delirious patients such as premature self extubation, removal of liens and tubes, falls, etc. (to be determined) due to effective use of restrains and continuous monitoring
  2. partial adherence to day and night cycle for patients' recovery (to be determined)
  3. delirium educational booklets in stock
/ Goals
  1. validating ICDSC vs CAMICU
  2. implement CIWA-Ar/ethanol screening
  3. improve discussion of delirium during rounds
  4. immediate initiation of appropriate preventative/managing startegies fr delirium post screening
  5. use of radios to stimulate and reorient patients
  6. reduce environmental noise
  7. retest patients for delirium prior to ward transfer
  8. Reassurance/validation of patients' experience with delirium
  9. increased accuracy of collecting and reviewing medical history (i.e. per-existing neurological deficits)
  10. increased participation of families in preventing and treating delirium

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

Change Concepts and Ideas to Test

determine true incidence of delirium post op
assessing and communicating pre-op risk for delirium (completing and reviewing the clocks' drawings, medication reconciliation, substance use, complete medical history, etc)
improving treatment of substance withdrawal; increased use of nicotine patches, CIWA-Ar screening for ethanol withdrawal and better management if present)
minimizing environmental stimuli at night (i.e. monitor alarms, lights, etc.)
early mobilization and increased activity during day times, improved rest during night times
involving families in screening for delirium and further treating it (i.e. providing them with booklets and coaching on reorienting patients)
improving communication during rounds about positive screening for delirium and initiating early management strategies (use of haloperidol and other antipsychotics)
decreased use of restrains when possible
HOW WILL WE MANAGE THE IMPROVEMENT PROJECT? /

Principles for Working Together

constant communication
appropriate role and task distribution
culture of constructive feedback vs criticism
effective planning
commitment to team progress

Roles & Responsibilities:

Alison: Team Lead
Yuliya: validating ICDSC vs CAMICU, bedside champion for implementation
Sonya: pharmacotherapy
Dale: education
Trena: Quality improvement methods and tools, as well as data collection and reporting
Joanne: education, meeting with working groups, bedside champion for implementation
Leslie: daily observation/facilitation/implementation during physician rounds in ICU W est

Review Schedule

January 24th – complete draft to be handed in
January 25th – discussion of key dates

Key Dates

- to be discussed

Author:Y.Tomilovska

Date:January 19, 2012

Improvement Charter draft.docPage 1