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Keywords

Critical care, Delirium, Nurses, Quality improvement

 

Authors

  1. O'Donoghue, Sharon C. DNP, RN
  2. Meyers, Karen MSN, RN, CCRN
  3. Manning, Cathie R. BS, RN, CCRN
  4. Pellegrino, Linda S. BSN, RN, CCRN
  5. Ryan, Colleen P. MSN, RN, CCRN
  6. Crowell, Amanda M. MSN, RN, CCRN
  7. Nolan, Lisa M. AD, RN, CCRN
  8. Gallagher, Gail E. RN, CCRN

Abstract

Background and Relevance: Early recognition of delirium mobilizes nurses to intervene in a timely manner to minimize cognitive, physical, and mental health burdens. The life-altering challenges of unrecognized delirium in intensive care unit (ICU) patients motivated a group of Massachusetts ICU nurse leaders to form a collaborative and improve delirium screening accuracy in 4 area hospitals.

 

Local Problem: Baseline audits confirmed a lack of delirium screening accuracy across multiple institutions. The purpose of this article is to describe how our collaborative was developed and to outline our delirium accuracy assessment program.

 

Methods: In March of 2015, 2 graduates from the Clinical Scene Investigator Academy contacted members within the Boston cohort to form a regional collaborative to improve patient outcomes. The purpose of our project was to improve our delirium assessment accuracy to greater than 80% in patients across our ICUs. Using a successful project, we scaled this work based on the needs of each institution. A preaudit-postaudit design was used to evaluate the effectiveness of our programs.

 

Results: Data showed an improved overall accuracy assessment of 88.3% (P < .01), whereas the patients with an altered Richmond Agitation Sedation Scale markedly improved to 87.7% (P < .01).

 

Conclusions: Every ICU in the United States is working on improving reportable quality metrics, but all too often, this work is being done in silos. When critical care nurses have the knowledge, skills, and time to work together, they can begin to transform health care.