Evaluating the implementation of confusion assessment method-intensive care unit using a quality improvement approach

Background: Quality improvement (QI) is a way in which health care delivery can be made safer and more effective. Various models of quality improvement methods exist in healthcare today. These models can help to guide and manage the process of introducing changes into clinical practice. Aims and Objectives: The aim of this project was to implement use of a delirium assessment tool into three adult critical care units within the same hospital, using a QI approach. The objective was to improve the identification and management of delirium. Method: Using the Model for Improvement framework, a multi-disciplinary working group was established. A delirium assessment tool was introduced via a series of educational initiatives. New local guidelines regarding the use of delirium assessment and management for the multi-disciplinary team were also produced. Audit data were collected at six weeks and five months post implementation to evaluate compliance with use of the tool across three critical care units within a single hospital in London. Results: At six weeks, in 134 assessment points out of a possible 202, the tool was deemed to be used appropriately, meaning that 60% of patients received a timely assessment. 18% of patients were identified as delirious in audit one. Five months later, only 95 assessment points out of a possible 199 were being appropriately assessed (47%), however, a greater number (32%) were identified as delirious. Conclusions: This project emphasises the complexity of changing practice in a large busy critical care centre. Despite an initial increase in delirium assessment, this was not sustained over time. The use of a QI model highlights the continuous process of embedding changes into clinical practice and the need to use a QI method which can address the challenging nature of modern healthcare. Relevance to practice: QI models help to guide changes in practice. Careful consideration should be given to the type of QI model used in any project

This is the peer reviewed version of the following article:Bench, S and Stewart, C (2018) Evaluating the Implementation of CAM-ICU using a Quality Improvement approach in Nursing in Critical Care which has been published in final form at 10.1111/nicc.12354. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.