Reducing delirium days in Critical Care by 20%

Quality Improvement Poster Download

Background & Problems

Research shows that 80% of patients in Critical Care suffer with delirium and that 40% are preventable. Mortality increases by 11% for every additional 48hrs of active delirium. Studies have suggested delirium results in 9 extra hospital days. Patients are going home suffering with Post Traumatic Stress Disorder and a recent large study in 2017 say people are 3 times more likely to develop dementia if they have suffered delirium.

In Critical Care we are fairly poor at assessing for delirium and acting upon it when recognised until the patient is unmanageable.

Aim

Reduce delirium days by 20% by firstly introducing a sleep bundle for all patients on the Critical Care cross site.

Method

A poster showing the importance of sleep, including data on how sleep impacts recovery and increases the risk of delirium was produced. Highlighting the sleep cycles. This was displayed in the coffee room and office on both sites. A further poster was produced with the project change ideas: a sleep bundle clipped to all of the ITU charts, all sedated patients to have a wash before 22.00hr, lavender cream applied to hands and feet, monitor alarms to vol 5, lights off and bedside lights only by 23.00hr, ear plugs, and eye masks applied, consideration of melatonin prescription and planned care timed according to skin etc, and then hands off. In addition, to this a night shift coordinator check list, laminated including aspects such as telephone volumes. A roller banner to be displayed at the entrance of Critical Care asking visitors to talk quietly and turn down their radios and a listening ear has been mounted on the wall which flashes red when noise escalates to remind staff to be quite.

All patients to receive a sleep package for their hospital stay to remain with them on discharge to ward, with a written explanation in the package for the patient explaining what delirium is and the importance of sleep and when to seek advice if experiencing certain symptoms.

Results

Difficult to compare data as patients arriving on the units with very different illnesses which would put them at higher risk of delirium. Unpredictable dependency levels. Verbal feedback from patients, relatives, and staff are all positive,

Baseline audit gathered across site 173 patients with 93 days of delirium post audit 163 patients with 122 delirium days over 33 days data collection. This could be also as greeter awareness and testing for delirium.

Implications

We have learnt that night time on the unit can be very noisy, staff felt patients were asleep if sedated when in fact it is not the same. More delirium teaching needs to be undertaken, and I have updated the delirium teaching packs.

The sleep packages to stay with the patients should empower them if they start to develop symptoms.

Plan to seek out delirium link nurses on the wards, and develop a delirium study day for the trust inviting patients to come and talk about their experiences.

This is only a small part of the project, a whole delirium bundle is being developed to share with the south west critical care network, and paperwork to be developed for the wards for handover purposes. GP involvement for future dementia testing is a possibility.