Improvement Charter

Project Name: /

Delirium

Team Members: /

Brenda Morgan (Chair), Jennifer Barr, Jonathan Chiu, Amber Davis, Alison Rowlands, Mithu Sen, Krista Shea, Jennifer Smith, Pat Vafiades, Dawna VanBoxmeer, Caroline Waring, Angela Walsh

Team Sponsor: /

Judy Kojlak (Director, Critical Care)

WHAT ARE WE TRYING TO ACCOMPLISH? /

Purpose of Project

To improve the care of critically ill patients at risk for delirium through implementation of standardized screening and management tools.
Scope & Boundaries
  • Patients in the Critical Care Trauma Centre at Victoria Hospital
  • Responsibility: All staff/disciplines
  • Boundaries: available mobilization equipment, on formulary medications

Improvement Objectives
  • Implementation of routine delirium screening for 100% of patients with LOS > 24 hours by November 1, 2012
  • Determine incidence of delirium by November 1, 2012
  • Implement delirium prevention strategies by November 1, 2012
  • Implement delirium management decision-tree by November 1, 2012
  • Examine sedation and sedation discontinuation practices November 1, 2012
  • Implement an alcohol withdrawal prophylaxis protocol by November 1, 2012

HOW WILL WE KNOW A CHANGE IS AN IMPROVEMENT? / Measures
  1. Screening compliance
  2. Incidence of delirium
  3. Sedation scoring
  4. Reduction/weaning of sedation
  5. Document risk factors
  6. Restraint use
  7. Self extubation
  8. AEMS
  9. Action on identified delirium
/ Current Performance
  1. Occasional screening
  2. Have research questionnaires developed
  3. Family brochure education
  4. Draft prevention and management tool developed
  5. New graphic has area for documentation of delirium
  6. Using a sedation scoring and pain scoring tool (may need compliance work)
  7. We prophylax for alcohol withdrawal but not through a developed protocol
  8. Minimal restraint policy
  9. Collect AEMS and self extubation data
/ Goals
  1. Selection of scoring tool
  2. 100% of patients with LOS > 24 hrs are screened at least daily
  3. Determine percentage of patients at target sedation score and increase by 25%.
  4. 100% of patients screened for sedation reduction readiness and 100% who pass have sedation reduced.
  5. 100% of positive screens reported during rounds
  6. 100% of patient’s screened for risk factors
  7. No increase in AEMS
  8. 100% of families receive a brochure.

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

Change Concepts and Ideas to Test

  • Definition of Delirium
  • Selection of diagnostic tool(s)
  • Inter-rater reliability with screening tool use
  • Development of assessment guidelines
  • Development of team education program
  • Evaluation of team perception and knowledge of delirium
  • Educational program regarding the collaborative process; all staff have a responsibility to ensure compliance
  • Development of prevention strategies
  • Personalize the reason for implementation of protocol i.e., look at how Delirium impacted Mary’s critical care experience; look at the post ICU experience
  • Team to play a role in best practice implementation
  • Development of delirium prevention guidelines
  • Development of standardized management decision-tree
  • Development of alcohol withdrawal prophylaxis PPO
  • History taking

HOW WILL WE MANAGE THE IMPROVEMENT PROJECT? /

Principles for Working Together

  • All members of team have important contributions
  • Each member brings unique perspective
  • Mutual respect
  • All staff in CCTC are accountable for supporting practice guidelines and standards
  • Education plan is needed to address all team member needs
  • All staff members have the right to contribute/address compliance observations
  • Everyone in CCTC owns delirium
  • Groups make better decisions than individuals
  • Everyone shares work

Roles & Responsibilities

  • TBA as project evolves

Review Schedule

First Tuesday 0930-1130 and third Thursday 1300-1500
  • February 21, 2012 1300-1500 CCTC Large Conference Room
  • March 6, 2012, 0930-1130 hrs CNF - B2-116
  • March 20, 2012 1400-1600 hrs Cerner BoardRoom (3rd Floor beside C bank elevators) ***Note time change due to room availability
  • April 3, 2012 0930-1130 hrs CNF - B2-116
  • April 17, 2012 1300-1500 hrs E1-409 (Westminister Tower Building)
  • May 1, 2012 0930-1130 hrs CNF - B2-116
  • May 15, 2012 1300-1500 hrs CCTC Large Conference Room
  • June 5, 2012 0930-1130 hrs CNF - B2-116
  • June 19, 2012 1300-1500 hrs CCTC Large Conference Room

Key Dates

  • May 28, 29 2012, Team meeting in Toronto
  • November 14 and 21: 1200-1500 final two webinars

Author:London Health Sciences Centre, CCTC, Delirium QI Team

Date:February 7, 2012

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