Saskatoon Health RegionDepartment of Critical Care

Prevention of Delirium

2

Background

• The Department of Critical Care in the Saskatoon Health Region is made up of 3 units on 2 sites.– Royal University Hospital Intensive Care Unit – 15 beds and

2 satellite beds.– St. Paul’s Hospital Intensive Care Unit – 15 beds.– St. Paul’s Hospital Progressive Care Unit – 8 beds.

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Aim

• To reduce the incidence of delirium in critically ill patients and to standardize and improve management of patients with delirium. We aim for this project to be part of an “ABCDE bundle” approach to the care of our critically ill patients.

• Goals/Objectives– To assess for and report delirium q shift and when changes

in patient condition.– To implement a mobility protocol to guide mobilization of

all patients to their maximum capacity each shift

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Team Members

• There are multidisciplinary team members representing each unit, some team members work across all 3 units.

• There are physicians, RN’s, Physiotherapists, Pharmacists and Dieticians.

• The team is sponsored by the Director and Physician Leader of the Department of Critical Care – Patti Simonar and Dr. Mark James

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Results

Incidence of DeliriumIncidence of Delerium

0%

10%

20%

30%

40%

50%

14-Feb-12 28-Feb-12 13-Mar-12

Pts. Unable toAssessCam Positive

Results

Active in Mobility protocolSPH-ICU 2011

0%10%20%30%40%50%60%70%80%90%

100%Fe

b

Mar

ch

Apr

il

May

June July

Aug

ust

Sep

t

Oct

Nov

Dec

date

perc

enta

ge

7

Results

Mobility Protocol Charted

0%10%20%30%40%50%60%70%80%90%

100%

14/02/2012 28/02/2012 13/03/2012

Mobility protocolcharted

Results

Average Days of Duration of Delirium

3.6

2.5

2.3

0

2.2

2.3

0 2 4 6 8 10

Apr. 30

May-15

SPH ICU SPH PCU RUH ICU

Changes Tested – Utilization of CAM-ICU Assessment Tool

Changes Tested – Implementation of a Mobility Protocol

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Lessons Learned

• Difficult to do the CAM-ICU if patient a RASS of -3; using the criteria of a RASS of -2 or greater to do the assessment

• Importance of education of staff that CAM-ICU can be assessed if patient is a RASS of -2 or greater as they often feel that they cannot assess patient if they do not squeeze hands and fail the test for inattention.

• Challenges with ensuring that patients are being mobilized to their maximum capacity.

• Patients are often confused but CAM-ICU negative

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Next Steps

• Identify other contributing factors and interventions to reduce incidence and duration of delirium – such as day / night protocols.

• Implementation of a checklist that includes delirium and mobilization goals

• Intermittent measurement of incidence and duration of delirium to observe trends.

• Explore ways of measuring mobilization.