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An Innovative Approach to Improving the Accuracy of Delirium Assessments Using the Confusion Assessment Method for
Justin DiLibero1, Sharon C O'Donoghue, Susan DeSanto-Madeya
1Justin DiLibero, MSN, RN, CNS, CCRN, ACCNS-AG, is a clinical nurse specialist at Beth Israel Deaconess Medical Center in Boston, Massachusetts. He was a graduate of the American Association of Critical Care Nurses Clinical Scene Investigator (CSI) Academy. Sharon C. O'Donoghue, MS, RN, CNS, was the internal coach to the Beth Israel Deaconess Medical Center Clinical Scene Investigator (CSI) team and is a clinical nurse specialists at Beth Israel Deaconess Medical Center in Boston, Massachusetts. Susan DeSanto-Madeya, PhD, RN, CNS, is an associate professor at Boston College and is the Beth Israel Hospital Nurses' Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center in Boston, Massachusetts. Janice Felix, BSN, RN, CCRN, is a staff nurse at Beth Israel Deaconess Medical Center. She was a graduate of the American Association of Critical Care Nurses Clinical Scene Investigator (CSI) Academy. Annalyn Ninobla, BSN, RN, is a staff nurse at Beth Israel Deaconess Medical Center. She was a graduate of the American Association of Critical Care Nurses Clinical Scene Investigator (CSI) Academy. Allison Woods, BSN, RN, CCRN, is a staff nurse at Beth Israel Deaconess Medical Center. She was a graduate of the American Association of Critical Care Nurses Clinical Scene Investigator (CSI) Academy.
Background:
Delirium occurs in up to 80% of intensive care unit (ICU) patients. Despite its prevalence in this population, there continues to be inaccuracies in delirium assessments. In the absence of accurate delirium assessments, delirium in critically ill ICU patients will remain unrecognized and will lead to negative clinical and organizational outcomes.
Objectives:
The goal of this quality improvement project was to facilitate sustained improvement in the accuracy of delirium assessments among all ICU patients including those who were sedate or agitated.
Methods:
A pretest-posttest design was used to evaluate the effectiveness of a program to improve the accuracy of delirium screenings among patients admitted to a medical ICU or coronary care unit.
Results:
Two hundred thirty-six delirium assessment audits were completed during the baseline period and 535 during the postintervention period. Compliance with performing at least 1 delirium assessment every shift was 85% at baseline and improved to 99% during the postintervention period. Baseline assessment accuracy was 70.31% among all patients and 53.49% among sedate and agitated patients. Postintervention assessment accuracy improved to 95.51% for all patients and 89.23% among sedate and agitated patients.
Conclusion:
The results from this project suggest the effectiveness of the program in improving assessment accuracy among difficult-to-assess patients. Further research is needed to demonstrate the effectiveness of this model across other critical care units, patient populations, and organizations.
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