University:
University of Edinburgh
Course:
NUST08022 | Mental Health: Life Sciences and Nursing Care 2
Academic year:

2023
Views:

380

Pages:

12
Author:

cancerosar5qt

Our Delirium Journey Our Delirium Journey so far  We reduced our delirium rates by 25% How? Through Quality Improvement Projects  We Improved our patients sleep  We Introduced early mobilisation  We listened to our patients Reduced noise  New unit with big windows  Bought equipment for our patients  ICU Delirium Delirium is a common clinical syndrome characterised by      Disturbed consciousness Cognitive impairment Altered Perception (hallucinations) Acute onset and fluctuating course It usually develops over hours to day It is a serious condition that is associated with poor outcomes & It’s reversible Why worry about delirium ? Incidence is between 45 % - 87% Prolongs ICU/HDU stay, ventilation time, reduces quality of life post ICU, increases mortality Multiple risk factors 3 types hypoactive, hyperactive and mixed delirium What can I do? Screen for it daily (CAM-ICU is recommended by NICE guidelines and SICS) Improve Sleep Early Mobilisation Glasses  Hearing aids  Lighting appropriate for time of day  Reduce Noise  Clocks/ Calendar  Orientation  Encourage visitors familiar faces / familiar objects/ photographs  Improving sleep     MDT  1st in ITU on non delirious patients  2nd delirious patients  3rd surgical HDU patients  Tested - Protocol for ear plugs and eye masks Informed all staff of QI project Funding from the endownment fund Tested in   Audit form Prompts were used as reminders at bed spaces Feedback Nearly all the patients found the ear plugs and eye masks comfortable ICU patients preferred to use the ear plugs and eye masks compared with SHDU patients – “dont like loss of control” “ like to know whats going on” 88% of patients found that they had a better sleep using the ear plugs and eye masks There was no adverse events in using the ear plugs and eye masks such as eating them! Introduced Early Mobilisation “The Daily Dangle”    MDT What will we test first?- “the daily dangle” Create a Protocol on the daily dangle – tested it  Weekly focus groups  Prompts  Collect weekly data  Run charts Daily dangle and Delirium run chart 100% 100% 80% 60% 40% 20% Proportion of Patients With Delirium Proportion Patients who Had a Dangle Jan-17 Oct-16 Jul-16 Apr-16 Jan-16 Oct-15 Jul-15 Apr-15 Jan-15 Oct-14 Jul-14 0% Apr-14 0% Feedback Nurses •Its now part of ICU daily routine •Still happens when the ICU is busy •Its my favourite part of the day •They will never do..... And they do! Physiotherapists •Reduced work load in ward patients •Patients are getting discharged quicker •Own goals setting •Improved communication Patients •Liked the freedom •Free from cables •Good to move about & get off my back Equipment Take home messages  It happens a lot in Critical Care  Can limit Quality of Life post ICU  Delirium is reversible  We can do something about it through simple measures

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