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

Journal article


Stewart, C. and Bench, S. (2018). Evaluating the implementation of confusion assessment method-intensive care unit using a quality improvement approach. Nursing in Critical Care. 23 (4), pp. 172-178. https://doi.org/10.1111/nicc.12354
AuthorsStewart, C. and Bench, S.
Abstract

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

KeywordsCritical Care
Year2018
JournalNursing in Critical Care
Journal citation23 (4), pp. 172-178
PublisherWiley
ISSN1362-1017
Digital Object Identifier (DOI)https://doi.org/10.1111/nicc.12354
Publication dates
Print15 May 2018
Online15 May 2018
Publication process dates
Deposited23 Mar 2018
Accepted21 Mar 2018
Accepted author manuscript
File Access Level
Open
Additional information

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.

Licensehttp://onlinelibrary.wiley.com/termsAndConditions#vor
Permalink -

https://openresearch.lsbu.ac.uk/item/86qy4

Download files


Accepted author manuscript
  • 176
    total views
  • 46
    total downloads
  • 4
    views this month
  • 1
    downloads this month

Export as

Related outputs

Experiences of siblings of children with congenital heart disease during Coronavirus disease 2019; A qualitative interview study.
Bichard, E., McKeever, S., Bench, S. and Wray, J. (2022). Experiences of siblings of children with congenital heart disease during Coronavirus disease 2019; A qualitative interview study. Journal of Pediatric Nursing. https://doi.org/10.1016/j.pedn.2021.12.019
How COVID-19 has affected staffing models in intensive care: A qualitative study examining alternative staffing models (SEISMIC).
Endacott, R., Pearce, S., Rae, P., Richardson, A., Bench, S., Pattison, N. and SEISMIC Study Team (2021). How COVID-19 has affected staffing models in intensive care: A qualitative study examining alternative staffing models (SEISMIC). Journal of Advanced Nursing. https://doi.org/10.1111/jan.15081
Prevalence and experience of fatigue in survivors of critical illness: a mixed‐methods systematic review
Bench, S., Stayt, L., Shah, A., Dhiman, P. and Czuber‐Dochan, W. (2021). Prevalence and experience of fatigue in survivors of critical illness: a mixed‐methods systematic review. Anaesthesia. 76 (9), pp. 1233-1244. https://doi.org/10.1111/anae.15441
Clinical Academic Research Internships: what works for nurses and the wider nursing, midwifery and allied health professional workforce
Olive, P., Maxton, Fiona, Bell, Cate Ann, Bench, Suzanne, Tinkler, Linda, Jones, Steph and Kenkre, Joyce (2020). Clinical Academic Research Internships: what works for nurses and the wider nursing, midwifery and allied health professional workforce. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.15611
Exploring adult critical illness survivors’ experiences of fatigue; a qualitative study
Bench, S., Czuber-Dochan, W., Shah, A. and Stayt, L. (2021). Exploring adult critical illness survivors’ experiences of fatigue; a qualitative study. Journal of Advanced Nursing. https://doi.org/10.1111/jan.14995
Healthcare stakeholders’ perceptions and experiences of factors affecting the implementation of critical care telemedicine (CCT): qualitative evidence synthesis
Xyrichis, A., Iliopoulou, K., Mackintosh, N.J., Bench, S., Terblanche, M., Philippou, J. and Sandall, J. (2021). Healthcare stakeholders’ perceptions and experiences of factors affecting the implementation of critical care telemedicine (CCT): qualitative evidence synthesis. Cochrane Database of Systematic Reviews. 2017 (11). https://doi.org/10.1002/14651858.cd012876.pub2
Critical Care Nurses' Views and Experiences of Preanalytical Factors Influencing Point-of-Care Testing A Qualitative Study
Bench, S. (2020). Critical Care Nurses' Views and Experiences of Preanalytical Factors Influencing Point-of-Care Testing A Qualitative Study. Point of Care: The Journal of Near-Patient Testing and Technology. 19 (4), pp. 97-100. https://doi.org/10.1097/POC.0000000000000212
Empathy in Action in Healthcare (EACH): A mixed methods study of nurses' and therapists’ empathy
Catlow, R, Aikins-Snyper, F, Carson, M, Jaggi, A and Bench, S (2020). Empathy in Action in Healthcare (EACH): A mixed methods study of nurses' and therapists’ empathy. International Journal of Orthopaedic and Trauma Nursing. https://doi.org/10.1016/j.ijotn.2020.100777
Patient and Family Member Experiences in Critical Care Research and Quality Improvement Projects
Bench, S, O'Shea, A and Boaz, Z (2020). Patient and Family Member Experiences in Critical Care Research and Quality Improvement Projects. Nursing Research. https://doi.org/10.1097/nnr.0000000000000443
Neurological Alterations and Management
Bench, S. (2019). Neurological Alterations and Management. in: Aitken, L., Marshall, A. and Chaboyer, W. (ed.) Critical Care Nursing Elsevier.
Involving patients and families in critical care research and quality improvement
Bench, S (2019). Involving patients and families in critical care research and quality improvement. Nursing in Critical Care. 24 (2), pp. 67-69. https://doi.org/10.1111/nicc.12418
Education provision for patients following a spinal cord injury
Rodger, S and Bench, S (2019). Education provision for patients following a spinal cord injury. British Journal of Nursing. 28 (6), pp. 377-381. https://doi.org/10.12968/bjon.2019.28.6.377
A Rapid Review of Educational Preparedness of Advanced Clinical Practitioners
Bench, S (2019). A Rapid Review of Educational Preparedness of Advanced Clinical Practitioners. Journal of Advanced Nursing. https://doi.org/10.1111/jan.14105
Orthopaedic nurses’ engagement in clinical research; an exploration of ideas, facilitators and challenges
Bench, S, Dowie-Baker, J-A. and Fish, P. (2019). Orthopaedic nurses’ engagement in clinical research; an exploration of ideas, facilitators and challenges. International Journal of Orthopaedic and Trauma Nursing. 35, p. 100699. https://doi.org/10.1016/j.ijotn.2019.04.002
Use of a Virtual Reality device for basic life support training; prototype testing and an exploration of users' views and experience
Bench, S and Francis, G (2019). Use of a Virtual Reality device for basic life support training; prototype testing and an exploration of users' views and experience. Simulation in Healthcare. 14 (5), pp. 287-292. https://doi.org/10.1097/SIH.0000000000000387
Randomised Controlled Trials: an introduction for nurse researchers
Bench, S, Day, T and Metcalfe, A (2013). Randomised Controlled Trials: an introduction for nurse researchers. Nurse Researcher. 20 (5), pp. 38-44. https://doi.org/10.7748/nr2013.05.20.5.38.e312
Ventilator-associated pneumonia and suction: a review of the literature
Letchford, E and Bench, S (2018). Ventilator-associated pneumonia and suction: a review of the literature. British Journal of Nursing. 27 (1), pp. 13-18. https://doi.org/10.12968/bjon.2018.27.1.13
The education and training needs of advanced clinical practitioners: an exploratory, qualitative study
Bench, S, Lee, G, Baker, E, Trenchard-Turner, N, Whaley, S, Peacock, S, Garry, B, Dover, N, Nwosu, W and Worth, T (2018). The education and training needs of advanced clinical practitioners: an exploratory, qualitative study. Journal of Nursing Education and Practice. 8 (8). https://doi.org/10.5430/jnep.v8n8p66
Reviewing interventions supporting parents' well-being after a child’s intensive care unit discharge
Bench, S and Bedford, Z (2018). Reviewing interventions supporting parents' well-being after a child’s intensive care unit discharge. Nursing in Critical Care. https://doi.org/10.1111/nicc.12405
The nature and extent of service user involvement in critical care research and quality improvement; a scoping review of the literature.
Bench, S, Eassom, E and Poursanidou, K (2017). The nature and extent of service user involvement in critical care research and quality improvement; a scoping review of the literature. International Journal of Consumer Studies. 42 (2), pp. 217-231. https://doi.org/10.1111/ijcs.12406
Intensive care discharge summaries for general practice staff: a focus group study
Bench, S, Cornish, J and Xyrichis, A (2016). Intensive care discharge summaries for general practice staff: a focus group study. British Journal of General Practice. 66 (653), pp. e904-e912. https://doi.org/10.3399/bjgp16X688045
Evaluating the feasibility and effectiveness of a critical care discharge information pack for patients and their families: a pilot cluster randomised controlled trial
Bench, S, Day, T, Heelas, K, Hopkins, P, White, C and Griffiths, P (2015). Evaluating the feasibility and effectiveness of a critical care discharge information pack for patients and their families: a pilot cluster randomised controlled trial. BMJ Open. 5 (11), pp. e006852-e006852. https://doi.org/10.1136/bmjopen-2014-006852
Providing critical care patients with a personalised discharge summary: A questionnaire survey and retrospective analysis exploring feasibility and effectiveness
Bench, S, Heelas, K, White, C and Griffiths, P (2014). Providing critical care patients with a personalised discharge summary: A questionnaire survey and retrospective analysis exploring feasibility and effectiveness. Intensive and Critical Care Nursing. 30 (2), pp. 69-76. https://doi.org/10.1016/j.iccn.2013.08.007
Effectiveness of Critical Care Discharge Information in Supporting Early Recovery From Critical Illness
Bench, S, Day, T and Griffiths, P (2013). Effectiveness of Critical Care Discharge Information in Supporting Early Recovery From Critical Illness. Critical Care Nurse. 33 (3), pp. 41-52. https://doi.org/10.4037/ccn2013134
Developing user centred critical care discharge information to support early critical illness rehabilitation using the Medical Research Council's complex interventions framework
Bench, S, Day, TL and Griffiths, P (2012). Developing user centred critical care discharge information to support early critical illness rehabilitation using the Medical Research Council's complex interventions framework. Intensive and Critical Care Nursing. 28 (2), pp. 123-131. https://doi.org/10.1016/j.iccn.2012.02.002
Involving Users in the Development of Effective Critical Care Discharge Information: A Focus Group Study
Bench, S, Day, T and Griffiths, P (2011). Involving Users in the Development of Effective Critical Care Discharge Information: A Focus Group Study. American Journal of Critical Care. 20 (6), pp. 443-452. https://doi.org/10.4037/ajcc2011829
The user experience of critical care discharge: A meta-synthesis of qualitative research
Bench, S and Day, T (2010). The user experience of critical care discharge: A meta-synthesis of qualitative research. International Journal of Nursing Studies. 47 (4), pp. 487-499. https://doi.org/10.1016/j.ijnurstu.2009.11.013
Recognition and management of critical illness by midwives: implications for service provision
Bench, S (2007). Recognition and management of critical illness by midwives: implications for service provision. Journal of Nursing Management. 15 (3), pp. 348-356. https://doi.org/10.1111/j.1365-2834.2007.00759.x
Clinical skills: assessing and treating shock: a nursing perspective
Bench, S (2004). Clinical skills: assessing and treating shock: a nursing perspective. British Journal of Nursing. 13 (12), pp. 715-721. https://doi.org/10.12968/bjon.2004.13.12.13260