• Implementing the Confusion Assessment Method to Improve the Care of Delirious Patients

      Akande, Irene (2016)
      Background: Delirium affects approximately fifty percent of adults aged 65 years or older. The prevalence of delirium can be as high as 74% in surgical patients and 11% to 42% in non-surgical patients. Delirium can go undetected in 72% of Intensive Care Unit (ICU) patients when routine neurological monitoring tool is not used but could be prevented in 30 to 40% of cases, if detected early. Using a valid and reliable delirium assessment tool in the ICU, is essential so early interventions can be initiated. Purpose: The purpose of this scholarly project was to implement use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for delirium assessment at a hospital in the Mid-Atlantic region of the United States. Methods: This quality improvement project was conducted with nurses that work in the intensive care unit. Informed consent was obtained by all nurse participants whose participation in the project was strictly voluntary. Pre and post-intervention questionnaires measured perceived self-confidence and comfort levels with providing ICU delirium care and delirium knowledge. The project involved three phases: pre-intervention questionnaire administration, in-service, case scenarios, brief videos and one-on-one training and implementation of the CAM-ICU tool in the ICU setting, and the administration of post-intervention questionnaire. Laminated CAM-ICU worksheet and flowsheet were placed at each bed space to provide cues to the nurses to complete their delirium assessment. Multiple modes of interventions were used for the implementation of the CAM-ICU. A total of 34 ICU nurses consented to the project. Results: Thirty-four participants completed the pretest; 22 participants completed the posttest. The age of the participants ranged between 36 - 66 years, the average age was 53 years (SD = 7.94); years of ICU experience ranged between 3 - 40 years, average ICU experience was 20 years (SD = 9.09); 77% of participants had a Bachelor of Science degree. Comfort assessing ICU patients for delirium increased, t(21) = -2.339, p =.029, confidence providing accurate definition of delirium increased, t(21) = -3.052, p = .006, and nurses improved ability to identify interventions to prevent or decrease delirium, t(21) = -2.731, p = .013. There were statistically significant differences between the mean scores on the knowledge test from pre- to post-intervention, t(21) = -10.784, p < .001. Nurses age (p = .620), years of ICU experience (p = .352) and level of education (p = .129) did not influence the knowledge scores. Compliance in using paper CAM-ICU worksheet for documentation was 21%. Nurses scored 28% of the ICU patients screened as delirious. Conclusion: This quality improvement project suggests that a formal training program for ICU nurses coupled with the use of in-service, one-on-one sessions, and videos for the implementation of the CAM-ICU tool, can result in increased awareness and knowledge of ICU delirium. The positive results have the potential to prompt treatment and improve outcomes for ICU patients who experience delirium. Adoption of the CAM-ICU into patient electronic health record is recommended for sustainability.