Defeat Delirium: Yes We CAM!

Lehigh Valley Hospital (Allentown, Pennsylvania)

CSI Summary

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CSI Presentation

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CSI Toolkit

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Project Topic:

Delirium prevention

Hospital Unit:

Trauma-Neuro Intensive Care Unit

CSI Participants:

  • Angela Strausser BSN, RN, CCRN, TCRN
  • Eileen Wasson MSN, RN, CCRN, TCRN

Video Presentation:

View this CSI team's project presentation video to earn CERPs.

Project Goals/Objectives:

  1. To increase staff compliance with and accuracy of the Confusion Assessment Method for the ICU (CAM-ICU) tool 60%
  2. To increase early identification of delirium to decrease length of stay
  3. To provide delirium education and readily available resources for staff use

Project Outcomes:

  1. Increased RN comfort levels with using CAM-ICU tool completion 51%
  2. Increased staff compliance with and accuracy of the CAM-ICU tool 89%
  3. Decreased length of stay for geriatric patients with a delirium diagnosis 28% (4.1 days)
  4. Initiated monthly geriatric pearl (tips) email to staff to support best practices
  5. Secured approval at InterProfessional Informatics Council for defaulting the open RASS group to improve efficiency
  6. Fully educated staff on delirium prevention and CAM-ICU tool use
  7. Increased staff awareness of strategies to prevent, identify, and treat delirium
  8. These outcomes resulted in an estimated annual fiscal impact of $10.3 million.

Project Overview:

The diagnosis of delirium in the Trauma-Neuro ICU (TNICU) for 2021 was 3% higher than the Pennsylvania state average for all trauma patients and 4.5% higher than the state average for geriatric patients. In an effort to decrease the incidence of delirium and, ultimately, decrease length of stay, our CSI team implemented a project designed to help staff proficiently use evidence-based strategies in identifying, preventing and treating delirium.

We conducted a survey of the TNICU nursing staff and learned that they lacked comfort with CAM-ICU scoring. As a result, we focused our project on educating unit nurses about use of the CAM-ICU tool. Our team hosted a project kickoff party, followed by mandatory educational sessions, and introduction of new tools, as well as a post-education survey and continued data collection to evaluate the success of our efforts.

Staff feedback was positive despite the COVID-19 challenges we all faced during this project, and comfort levels in the use of the CAM-ICU tool increased 51%. Also, implementation of our “getting to know you” poster enabled TNICU nursing staff to further individualize care of geriatric patients as we work toward our overall goal of decreasing delirium incidence.

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The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.