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.
AuthorsStewart, C and Bench, S
Abstract

Quality improvement (QI) is a way through which health care delivery can be made safer and more effective. Various models of quality improvement methods exist in health care today. These models can help guide and manage the process of introducing changes into clinical practice. The aim of this project was to implement the 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. Using the Model for Improvement framework, a multidisciplinary 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 multidisciplinary team were also produced. Audit data were collected at 6 weeks and 5 months post-implementation to evaluate compliance with the use of the tool across three critical care units within a single hospital in London. At 6 weeks, in 134 assessment points out of a possible 202, the tool was deemed to be used appropriately, meaning that 60% of patients received 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. This project emphasizes 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 that can address the challenging nature of modern health care. QI models guide changes in practice. Consideration should be given to the type of QI model used.

KeywordsClinical audit; Critical care nursing; Quality improvement; 1110 Nursing
Year2018
JournalNursing in Critical Care
PublisherWiley
ISSN1478-5153
Digital Object Identifier (DOI)doi:10.1111/nicc.12354
Publication dates
Print15 May 2018
Publication process dates
Deposited07 Jul 2018
Accepted21 Mar 2018
Accepted author manuscript
License
CC BY-NC 4.0
Permalink -

https://openresearch.lsbu.ac.uk/item/86qy5

  • 3
    total views
  • 6
    total downloads
  • 2
    views this month
  • 3
    downloads this month

Related outputs

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.
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.
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.
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.
Orthopaedic nurses’ engagement in clinical research; an exploration of ideas, facilitators and challenges
Bench, S (2019). Orthopaedic nurses’ engagement in clinical research; an exploration of ideas, facilitators and challenges. International Journal of Orthopaedic and Trauma Nursing.
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.
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.
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.
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.
Healthcare stakeholders' perceptions and experiences of factors affecting the implementation of critical care telemedicine (CCT): Qualitative evidence synthesis
Xyrichis, A, Mackintosh, NJ, Terblanche, M, Bench, S, Philippou, J and Sandall, J (2017). 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).
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).
Evaluating the Implementation of CAM-ICU using a Quality Improvement approach
Stewart, C and Bench, S (2018). Evaluating the Implementation of CAM-ICU using a Quality Improvement approach. Nursing in Critical Care.
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.
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.
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.
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.
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.
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.
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.
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.
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.