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Create an interdisciplinary team.
These “delirium champions” (e.g., physicians, nurses, pharmacists, respiratory therapists, physical and occupational therapists) will become local delirium experts champion the cause of delirium screening and serve as resources throughout the implementation process. Involve ICU leadership, get their buy-in and to help in “selling” change on rounds and in all forms of interdisciplinary interactions
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Choose a validated delirium screening tool
The CAM-ICU and ICDSC are recommended by expert guidelines and are the most well-validated and widely used delirium screening tools worldwide.
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Identify and address barriers to delirium screening in your ICU
The most commonly cited barriers include perceived difficulty using a delirium screening tool, concern about assessing delirium in sedated and intubated patients, and time constraints. These barriers are overcome with ongoing education and training of delirium screening tools.
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Use a multi-faceted approach to train clinicians to screen for delirium
Effective strategies include:
Didactic instruction, training videos or online resources about delirium, its symptoms adverse outcomes associated with the syndrome, and how to use the screening tool. Case-based scenarios to reinforce concepts learned during didactic sessions. Utilize additional educational materials including pocket cards, posters and flyers. One-on-one teaching by the delirium champions Unit-wide metrics regarding compliance and accuracy
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Provide follow-up training
Involvement and engagement with front-line personnel with continual feedback (and reinforcement) will help maintain a high degree of motivation Utilize monthly staff meetings to reinforce delirium screening concepts, address concerns and provide additional education Train new staff members at orientation and provide refresher training to current staff
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Incorporate the delirium screen into daily interdisciplinary bedside rounds
Communication amongst interdisciplinary staff is key Have “the talk”: Utilize bedside nursing presentation of the Brain Roadmap or other communication frameworks to rapidly report the patient’s level of consciousness and delirium status. Discuss the patient’s brain status and strategy to manage sedatives and/or delirium.
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Incorporate results of the delirium screen into documentation systems
Incorporation of these results reminds clinicians to complete the screen, facilitates communication across shifts, and makes the delirium status part of the medical record.
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Utilize “Small Tests of Change” and Plan-Do-Study-Act (PDSA) Cycles
Remember that small changes can make a big difference.
Ask:
”What are we trying to accomplish?” ”How will we know that a change is an improvement?” ”What changes can we make that will result in improvement?”
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