Early Recognition and Management Of Delirium To Decrease Length Of Stay

Project Topic:

Delirium

Hospital, City and State:

Ochsner Medical Center Westbank Campus, Gretna, Louisiana

Unit:

• Medical Surgical Intensive Care Unit

CSI Participants:

• Hannah Plaisance, BSN, RN
• Sara Toups, BSN, RN
• Cayleigh Weiymann, BSN, RN

Project Goals/Objectives:

1. Increase charting compliance on the ICU liberation flowsheet (specifically Delirium and Family Engagement/ Empowerment) 15%
2. Increase Healthy Work Environment Assessment Tool (HWEAT) score for Skilled Communication from 3.66 to 4.0
3. Decrease the average ICU LOS by 0.5 day

Project Outcomes:

1. Charting compliance on the ICU liberation flowsheet increased:
   • 12.7% for Delirium
   • 44.3% for Family Engagement
2. HWEAT results for Skilled Communication decreased from 3.66 to 3.13
3. Average ICU LOS was unchanged; average 2.6 LOS pre and post implementation.

Project Overview:

We recognized that delirium is a significant issue within our ICU, and many nurses were not consistently utilizing the ICU Liberation flowsheet or the CAM-ICU assessment tool. The purpose of this project was to educate staff on the proper use of the CAM-ICU tool to improve early recognition and management of delirium, while also increasing engagement with patients’ family members.

The first goal of the project was to increase charting compliance on the ICU Liberation flowsheet—specifically for the delirium and family engagement components—by 15% by the end of the project. The second goal was to improve the HWEAT communication score from 3.66 to 4.0. The third goal was to decrease the average length of stay (LOS) by 0.5 days to achieve a measurable fiscal impact.

To support these goals, several interventions were implemented. These included engaging providers to order delirium precautions, introducing “quiet packs” to promote rest, and providing ongoing staff education on the ICU Liberation Bundle and CAM-ICU tool. Additionally, virtual nursing was utilized to send informational videos to family members, helping them better understand what to expect during an ICU stay and encouraging their involvement in care.

The project encountered several challenges. After the midpoint presentation, the team experienced the loss of a team member. Shortly thereafter, the unit also lost its manager. Morale was further impacted by increased patient ratios and staffing shortages. Despite these obstacles, the team remained committed and continued working toward the project goals.

By the end of the project, charting compliance on the ICU Liberation flowsheet improved by 12.7% for delirium and 44.3% for family engagement. Although the first goal was not fully met, meaningful progress was achieved. The second goal was not met, as the HWEAT communication score decreased from 3.66 to 3.13 instead of improving to 4.0. The third goal of reducing LOS by 0.5 days was also not fully achieved.

Overall, the results suggest improvements in patient throughput and care efficiency, despite the challenges faced during implementation.