A quality improvement project to improve the identification and management of delirium

Sutton-Smith, Lynsey

doi:10.1111/nicc.12549

Cited by 7 publications

(4 citation statements)

References 39 publications

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“…Impact of the CAM-ICU tool on delirium detection : The compliance rate for performing CAM-ICU during the intervention period was 98.9%. The nurses received proper training to complete the CAM-ICU tool every 12 hr; this task contributed to a compliance rate of more than 98%, consistent with published studies (Blevins & DeGennaro, 2018; Sutton-Smith, 2021). A total of 28.6% ( n = 108) of CCU patients screened positive for delirium at least once during CCU admission.…”

Section: Discussionsupporting

confidence: 70%

Bringing Delirium to Light

Savino,

Vergara,

Ramos

et al. 2024

Professional Case Management

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Background: Delirium is a serious complication in patients in the critical care unit (CCU) that may lead to prolonged hospitalization if left undetected. The CCU at our hospital does not have a framework for determining delirium that could affect patient outcomes and discharge planning. Primary Practice Setting: CCU in a community hospital. Method: A posttest-only design was used for this study. We established a framework for the early assessment of delirium, educated and trained nurses to detect delirium, collaborated with the informatics department, intensivist, nursing, respiratory therapy and worked with case management to deploy the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We used a one-tailed independent t test to determine the impact of CAM-ICU on length of stay (LOS). Cross-tabulation and chi-square tests were used to examine the impact of CAM-ICU tool on home care utilization between the intervention and comparison groups. Results: There was a 3.12% reduction in LOS after implementing the CAM-ICU tool. Also, a reduction in home care service utilization demonstrated statistical significance (p= .001) between the intervention group (62.5%; n= 177) and the comparison group (37.5%; n= 106). Implications for Case Management Practice: Case managers are essential in improving care transitions. Case managers need to become competent in understanding the implications of the CAM-ICU tool because of their relevant role in the multidisciplinary rounds as advocates to improve care transitions across the continuum of care. Case managers need to have an understanding on how to escalate when changes in the Richmond Agitation-Sedation Scale scores occur during the multidisciplinary rounds because it can affect care coordination throughout the hospital. Conclusions: Implementing the CAM-ICU decreased LOS, and reduced health care utilization. The early identification of patients with delirium can affect the outcomes of critically ill patients and entails multidisciplinary collaboration.

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Section: Discussionsupporting

confidence: 70%

Bringing Delirium to Light

Savino,

Vergara,

Ramos

et al. 2024

Professional Case Management

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“…It has undergone extensive development, validation and is routinely utilised with a once-daily assessment 5 18. However, in a previous study, the nurse-to-intubated-and-ventilated-patient ratio was high (1:1), and the adherence to the CAM ICU assessment was found to be low at 45% 19. Consequently, to ensure better compliance with the PODIUM protocol, it is advisable to initiate the CAM ICU assessment at a low frequency.…”

Section: Methods and Analysismentioning

confidence: 99%

“…5 18 However, in a previous study, the nurse-to-intubated-and-ventilatedpatient ratio was high (1:1), and the adherence to the CAM ICU assessment was found to be low at 45%. 19 Consequently, to ensure better compliance with the PODIUM protocol, it is advisable to initiate the CAM ICU assessment at a low frequency. Implementing an hourly assessment could potentially result in a decreased rate of compliance.…”

Section: Study Endpointsmentioning

confidence: 99%

PupillOmetry for preDIction of DeliriUM in ICU (PODIUM): protocol for a prospective multicentre cohort study

Jaquet

Couffignal²,

Tardivon³

et al. 2023

BMJ Open

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IntroductionDelirium is a severe complication that is associated with short-term adverse events, prolonged hospital stay and neurological sequelae in survivors. Automated pupillometry is an easy-to-use device that allows for accurate objective assessment of the pupillary light responses in comatose patients in the intensive care unit (ICU). Whether automated pupillometry might predict delirium in critically ill patients is not known. We hypothesise that automated pupillometry could predict the occurrence of delirium in critically ill patients without primary brain injury, requiring more than 48 hours of invasive mechanical ventilation in the ICU.Methods and analysisThe PupillOmetry for preDIction of DeliriUM in ICU (PODIUM) study is a prospective cohort study, which will be conducted in eight French ICUs in the Paris area. We aim to recruit 213 adult patients requiring invasive mechanical ventilation for more than 48 hours. Automated pupillometry (Neurological Pupil Index; NPi-200, Neuroptics) will be assessed two times per day for 7 days. Delirium will be assessed using the Confusion Assessment Method in ICU two times per day over 14 days in non-comatose patients (Richmond Agitation and Sedation Scale ≥−3).The predictive performances of the seven automated pupillometry parameters (ie, pupillary diameter, variation of the pupillary diameter, pupillary constriction speed, pupillary dilatation speed, photomotor reflex latency, NPi and symmetry of pupillary responses) measured to detect the delirium occurrence within 14 days will be the main outcomes. Secondary outcomes will be the predictive performances of the seven automated pupillometry parameters to detect complications related to delirium, ICU length of stay, mortality, functional and cognitive outcomes at 90 days.Ethics and disseminationThe PODIUM study has been approved by an independent ethics committee, the Comité de Protection des Personnes (CPP) OUEST IV—NANTES (CPP21.02.15.45239 32/21_3) on 06 April 2021). Participant recruitment started on 15 April 2022. Results will be published in international peer-reviewed medical journals and presented at conferences.Trial registration numberNCT05248035; clinicaltrials.gov.

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“…Sutton‐Smith 18 takes us to a 24‐bed general ICU in New Zealand and reports about the planning, implementation and outcome evaluation of a quality improvement initiative related to delirium and sedation assessment and management. The project was based on the Plan‐Do‐Study‐Act (PDSA) framework 19 and involved the development of a delirium clinical pathway and sedation algorithm, a delirium resource book, a family information pamphlet and an online education module, supplemented by extensive teaching, newsletter reminders and posters in key areas.…”

mentioning

confidence: 99%