No abstract

Background: Delirium is a common, devastating, and underrecognized syndrome in the intensive care unit (ICU). The study aimed to describe and evaluate a multicomponent education and training program utilizing a "Train-The-Trainer" (TTT) model, to improve delirium detection across a large health system. Methods: Fourteen ICUs across nine hospitals participated in a multicomponent delirium program consisting of a 1-day workshop that included: (1) patient testimonials, (2) small group discussions, (3) didactics, and (4) roleplaying. Additionally, four ICUs received direct observation/training via telehealth (tele-delirium training). The Kirkpatrick model was used for program evaluation in a pre/post-test design.Results: A 1-day delirium workshop was held at two time points and included 73 ICU nurses. Of the 65 nurses completing the post-workshop satisfaction survey, most (46.2) had >10 years of clinical experience, and no or minimal delirium training (69.2%). All nurses (100%) identified lack of knowledge as a barrier to delirium detection, while time constraints and lack of importance accounted for only 25%. Overall, nurses rated the workshop positively (excellent 66.7%, and very good 23.3%), and likely to change practice (definitely 73.3% and very likely 15.0%). All validated Confusion Assessment Method for the ICU (CAM-ICU) cases demonstrated improvement in number of correct responses. Delirium detection across the health system improved from 9.1% at baseline to 21.2% in ICUs that participated in the workshop and 30.1% in those ICUs that also participated in the tele-delirium training (p = 0.005). Conclusion:A multicomponent delirium education and training program using a TTT model was rated positively, improved CAM-ICU knowledge, and increased delirium detection.

Background. Central line–associated bloodstream infection (CLABSI) is the third most common nosocomial infection reported from the medical/surgical ICU setting. Rationale. The implementation of a central line protocol using a 3-part checklist would help ensure that all processes related to central line placement are executed for each line placement during the time it is used, thereby leading to improved outcomes. Physician assistants and nurses would be empowered to supervise the checklist and to stop or change the process if warranted. Methods. The intensivists performed a daily needs assessment of all central venous catheters (CVCs) in their respective ICUs. If the CVC was deemed unnecessary it was removed. The Surgical Continuum of Care comprised surgical physician assistants who made daily assessments of all CVCs among non-ICU inpatients. We hypothesized that these physician assistants would expedite the removal of CVCs among non-ICU inpatients. This would lead to a decreased number of central line days, and concomitant decrease in CLABSIs. Data collected were the standard data as used by the National Healthcare Safety Network. Results. From the year 2009 to 2012 the non-ICU lines decreased from 16 499 with a 3.3 CLABSI rate/1000 line days to 12 974 with a 0.85 CLABSI rate/1000 line days. The ICU line days decreased from 8190 with a 3.8 CLABSI rate/1000 line days to 5768 with 0.87 CLABSI rate/1000 line days. Conclusions. The number of CVCs used in the non-ICU patient areas has decreased with a concomitant decrease in CLABSI. The ICUs have seen a decrease in the number of CVC line/days and a concomitant decrease in CLABSI as well. Using a checklist and a clear standard policy in conjunction with a dedicated group of highly trained physician assistants and nurses has lead to a reduction in central line days and a reduction in CLABSI in the critical care areas as well as non-ICU areas.