Date of Award

8-13-2019

Document Type

Capstone

Degree Name

Doctor of Nursing Practice (DNP)

School Name

Donna and Allan Lansing School of Nursing and Health Sciences

Department

Nursing

Major Advisor

Heather Owens PhD, RN

Second Advisor

Kathy Hager DNP, APRN, FNP-BC, CDE

Third Advisor

Karen Rice, DNS, APRN, ACNS-BC

Fourth Advisor

Michael Northcraft BSN, MBA-HA

Abstract

Background: Delirium is a common complication in the ICU setting and has serious long-term consequences. Increased mortality and long-term cognitive issues are associated with under-recognition and lack of treatment for delirium. Nursing staff must identify delirium and manage the event, in addition to providing care to other assigned patients.

Purpose: The purpose of this evidence-based project was twofold. First, the project set out to determine if implementation of the delirium portion of the ABCDEF bundle promoted delirium recognition and decreased ICU length of stay and ventilator days. Second, the project examined if the use of a structured delirium education program improved nursing knowledge of delirium risk-factors and incidents in ICU patients.

Methods: Manual chart audits of 368 ICU patients was completed post-implementation of the delirium portion of the ABCDEF bundle. Screening variables included: (1) number of times delirium screening was completed, (2) number of opportunities for screening, (3) delirium incidence, and (4) screening compliance. Outcome variables were calculated by comparing 2018 and 2019 data (Jan.–April). Outcome variables included: (1) ICU length of stay, (2) mortality, (3) ventilator days, (4) number of patient days, and (5) illness severity. Descriptive statistics were calculated for items on a nursing delirium knowledge survey pre and post-implementation.

Results: Delirium screening compliance was 62.2% post-implementation, with 31.5% of patients screening positive. ICU length of stay decreased 11.41% and patient days decreased 5.34%. The average number of ventilator days decreased 13.86% while the severity of illness increased 2.83%, and ICU mortality increased 4.3%.

Conclusions: Use of the delirium portion of the ABCDEF bundle, along with staff education, improved ICU outcome measures as well as increased delirium recognition.

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