Hamilton Health Sciences-General site (ICU West) sets the bar for the city’s ICUs
Seventeen multidisciplinary teams from intensive care units (ICUs) across Canada participated in the Safer Healthcare Now! Delirium and Medication Reconciliation Collaborative to improve the care and safety of critically ill patients. The 12-month collaborative used both virtual and face-to-face learning sessions and webinars to provide teams with high leverage changes and expert advice, provided by faculty from the Canadian ICU Collaborative.
Hamilton Health Sciences General Hospital-ICU West recognized that delirium was a common problem in patients who underwent cardiac surgery. The reasons were multi-factorial and delirium was costing the hospital money and contributing to patient safety issues. Many of the patients in ICU West post-cardiac surgery had complex medical issues. It was recognized that delirium needed to be treated as a medical emergency.
Joining the Safer Healthcare Now! Delirium and Medication Reconciliation Collaborative was a first for the Hamilton General. They had not done a lot of work with a collaborative previously, nor had they had physician engagement with a collaborative. The team set a goal to increase their knowledge and understanding of delirium and to reduce delirium in the ICU West by 50 per cent. The Hamilton General has since taken a leadership role for other ICUs in the city and set the bar for what others can achieve.
“We worked through Plan-Do-Study-Act (PDSA) cycles and when we reviewed and analyzed our data we found areas where we had room for improvement” says Courtney Mitchell, RN. “At first we were looking to audit the incidence of delirium in the ICU West as well as the compliance of frontline staff completing the CAM-ICU tool to screen for delirium. Those audits in turn gave us insight into the potential need to re-think how we care for patients in our ICU. And, we made all our audit data visible for families, patients and frontline staff to see.”
The Hamilton General team also used tips and tools from various teams within the Collaborative to help initiate delirium management. “If you want to implement best practice in your ICU and are struggling to get buy-in, this is one way to get a leap start,” says Sonya Lugowy, PharmD. “Rather than reinventing a tool or protocol, it is great to have work that is already done at your disposal. You can take it, tweak it and make it your own, rather than starting from scratch.”
The Hamilton General Hospital ICU West has begun to implement the 2013 Guidelines for the management of pain, agitation and delirium in adult patients in the intensive care (Barr et al). They have also made improvements to their ICU by using sound dampening tiles to reduce noise as well as making eye masks, ear plugs and radios available for patients to help improve sleep.
The Hamilton General ICU West team is now looking to sustain their efforts to prevent and manage delirium. They have applied for a knowledge translation grant to integrate their processes at all of the ICUs in the city. “We will continue to gather data for two more years,” says Dr. Alison Fox-Robichaud. “When you see your results, it is a wake-up call and provides an impetus to improve going forward.”
For more information on the Delirium and Medication Reconciliation Collaborative, click on the link, or visit www.saferhealthcarenow.ca