Covenant Health has implemented a data collection tool and processes to ensure 100 per cent of intensive care unit (ICU) patients are screened for Delirium. Delirium is very difficult to recognize in a critical care setting and very often goes undiagnosed. The most important step in Delirium management is early recognition. When Alberta Health Services asked its Edmonton zone to standardize and implement Delirium screening, the team at Covenant Health's Misericordia Hospital site, along with other teams in Edmonton, looked for help from the
Safer Healthcare Now! Delirium and Medication Reconciliation Collaborative to improve care for critically ill patients.
To increase Delirium awareness for staff on the unit, Covenant Health created and put into practice a comprehensive education program. From this program came strategies to arm families of Delirium patients with support and information. The team has also developed noise reduction strategies to minimize sleep disturbance for patients in the ICU and a mobilization protocol to ensure that patients are out of bed when appropriate. A new pain assessment tool is under development for intubated patients who cannot express their pain level.
The Covenant Health team included the nurse practitioner, educator, supervisor, manager, pharmacist, respiratory therapist and two physiotherapists – all instrumental in the development of Delirium reduction strategies and making the mobilization protocol a reality. A physician group provided support in the ongoing management of appropriate medications.
"The Covenant Health team has made huge strides in implementing a significant change in practice and improved care," says Kim Scherr, Nurse Practitioner. "Our efforts to manage and prevent delirium have had a positive impact on the health and quality of life for countless ICU patients." (Safer Healthcare Now! One pager, 2013)
Of the patients admitted to Halton Healthcare's Oakville Hospital, 65 per cent are aged 65 and over; among this group, those 85 and over represent the fastest growing age group in the Halton Region. Clinical staff at Halton Healthcare Services (HHS) recognized the unique needs of this population, and initiated an interdisciplinary Delirium prevention project in 2007 which would evolve into the Safer Elder Care program in 2009. The Safer Elder Care program encompasses three other related projects at the HHS hospital in Oakville – falls prevention, restraint prevention, and skin and wound care (Accreditation Canada, Leading Practices).