Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-12-2023

Graduate Advisor

Susan Dean-Baar, PhD, RN, CENP, FAAN

Committee

Jennifer Vines, DNP, RN

Carrie Sona, RN, MSN, CCRN, CCNS, ACNS-BC, FCCM

Abstract

Delirium in intensive care unit (ICU) patients can lead to increased length of stay in the hospital, increased risk of complications, increased polypharmacy, family distress and increased rate of mortality (Vasilevskis et al., 2018). 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 (Krewulak et al., 2021 ; Vasilevskis et al., 2018). 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. In addition to retrospective chart review, 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. Results indicated no significant improvement in comfort or knowledge in self-administered reflections of nurses, however behaviors of documentation dramatically increased. Total number of encounters for April was 725 and total for November was 322. A random sample of 159 from each month was used to determine rate of appropriate CAM-ICU documentation. Pre survey (November), 100 of the 159 were accurately documented resulting in 62.9% whereas in the post survey period (April) the rate increased with 137 of 159 appropriate documentation with a rate of 86.2%. The rate in which the CAM-ICU was accurately and appropriately documented in the electronic health record (EHR) was found to be statistically significant ( p < .001) indicating positive change in documentation.

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