(1248) Delirium Assessment in the ICU: CAM We Do It Right?

Introduction: Delirium in intensive care unit (ICU) patients can lead to increased length of stay, mortality, risk of complications, polypharmacy,and family distress. Research has shown that addressing modifiable risk factors can improve survival rate by up to 15%, and routine screening for delirium in ICU patients leads to decreased patient anxiety, reduced in-hospital mortality, early recognition, and treatment of delirium. This quality improvement project used evidence-based intervention to increase accurate documentation of the confusion assessment method in the ICU (CAM-ICU) to identify patients at risk for delirium.

Methods: A retrospective chart review and an observational descriptive design was used to evaluate comfort and knowledge of nursing staff in addressing delirium. 40 nurses participated in the presurvey, and 43 participated in the post survey. An educational intervention with a 1 page flyer focusing on the key features of delirium and CAM-ICU assessment was done in combination with in-person group training.

Results: Survey results indicated no significant improvement in comfort or knowledge in self-administered reflections of nurses, however documentation dramatically increased. Total number of encounters for April was 725 and for November was 322. A random sample of 159 from each month was used to review CAM-ICU documentation. Pre survey (November), 100 /159 (62.9%) were accurately documented. In the post survey period (April) the rate increased with 137/159 (86.2%). The rate in which the CAM-ICU was accurately documented in the electronic health record (EHR) was found to be statistically significant ( p < .001) indicating positive change in documentation.

Conclusions: RN self-evaluated knowledge did not change however, the documentation of appropriate CAM-ICU scores significantly improved. The opportunities for improvement include educating on the understanding on the use of RASS in non-sedated patients when assessing delirium with the CAM-ICU. Another gap in accurate documentation was the inappropriate scoring of CAM-ICU in patients that have a RASS of -4, -5. A potential modification to the EHR for a hard stop to prevent this issue has been escalated. We also plan to Incorporate discussions of delirium during daily rounds by modifying the patient presentation format.