Nurse-Led Prevention and Early Identification of ICU Delirium: A Quality Improvement Project

Background Delirium prevention and early identification in the intensive care unit (ICU) are challenges for hospital systems focused on optimizing patient outcomes. The bedside nurse’s consistent presence at the bedside and influence of the patient environment places them in an ideal position to positively impact ICU delirium rates. This project aimed to implement nurse-led interventions to reduce the incidence of ICU delirium and improve early recognition of delirium in a subset of adult patients receiving ICU-level care in a 20-bed neuroscience ICU (NSICU) at a large academic medical center. Methods An Early Delirium Intervention (EDI) protocol was created by synthesizing existing delirium prevention literature. Nurses in the NSICU received education on the EDI protocol, including evidence-based measures to prevent delirium and guidelines on performing the Confusion Assessment Method for the ICU (CAM-ICU) and promptly reporting positive results. Dedicated nursing training included peer demonstration and CAM-ICU assessment practice in a simulated setting to improve nurse confidence. Nurse knowledge scores, CAM-ICU completion rates, and patient outcomes from the intervention period were compared to pre-intervention baseline data. Results Nursing competency with CAM-ICU completion increased from the pre-implementation phase (M = 74.4%) to the post-implementation (M = 89.1%) phase (t(47) = 4.02361 p = 0.000206). The nurses’ perceptions of comfort with utilizing the CAM-ICU and EDI protocol also increased following education (p = 0.0001). Consistent completion of delirium screening with the CAM-ICU increased among day-shift nurses (p = 0.004) while remaining stable among night-shift nurses (p = 0.224). The delirium prevention measures that were most feasible for the nursing staff, with improved utilization following education, included keeping the room lit during daytime hours (p = 0.012), television on during the day (p=0.02), and patient activity engagement during the day (p < 0.001). Conclusion An evidence-based, nurse-led protocol for preventing and detecting ICU delirium proved to be a feasible quality improvement project that increased nursing knowledge of delirium and comfort with the CAM-ICU assessment. Implementing nurse-driven delirium prevention and early identification strategies empowers nurses to play a crucial role in promoting positive outcomes for critically ill patients.