Implementation of Delirium Screening in Thoracic and Surgical Intermediate Care Units
AuthorFaherty, Karen M.
MetadataShow full item record
Other TitlesDelirium Screening in TIMC and SIMC Units
AbstractProblem: Delirium is a disorder experienced by 13-50% of patients over the age of 50 during their hospital stay. The thoracic and surgical intermediate care units (TIMC and SIMC) at a large, teaching hospital care for many elderly patients at high-risk of delirium, but unit-level chart audits revealed a 0-5% incidence of detected delirium. Current practice did not include delirium screening, which placed patients at higher risk for undetected delirium. Unrecognized and untreated delirium may lead to longer hospital stays, higher risks of falls, and longer duration of delirium episodes. Purpose: The purpose of this quality improvement project was to implement delirium screening using a validated screening instrument to improve delirium detection on the thoracic and surgical intermediate care units. Methods: The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), a validated screening instrument (sensitivity 81%, specificity 95.8%; inter-rater reliability kappa=0.79-0.96), was implemented on two high-acuity intermediate care units over a fifteen-week period (September to December 2021). The CAM-ICU was located in the electronic health record (EHR), and all registered nurses (RN, n=47) and advanced practice registered nurses (APRN, n=16) on the two units were educated on how to complete the screen and manage screening results. Chart audits of the EHR were completed weekly for every patient admitted to the two units to assess adherence to the screening procedures. Results: Staff on both units achieved and sustained a high (>90%) rate of adherence to delirium screening among SIMC patients (n=110) and TIMC patients (n=101). Of the patients screened, 10% were identified as positive for delirium on the SIMC and 12.8% were identified as positive for delirium on the TIMC. Nurses notified the APRN or covering medical provider about patients with first-time positive screens 100% of the time. No special-cause variation was noted in the number of transfers to a higher level of care, falls, or restraint use. Conclusions: Implementing the CAM-ICU can increase delirium detection and interdisciplinary team communication on thoracic and surgical intermediate care units. Having the instrument in the EHR was a major factor in assuring adherence to and sustainability of the delirium screening procedures.
Rights/TermsAttribution-NonCommercial-NoDerivatives 4.0 International
KeywordConfusion Assessment Method for the Intensive Care Unit (CAM-ICU)
Intermediate Care Facilities
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/18911
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- Creative Commons
Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivatives 4.0 International