Prevention of ICU Delirium Through Implementation of a Sleep Promotion Bundle

Background: Intensive care unit (ICU) delirium is the prevalence of delirium in ICU patientswho do not have a history of drug/alcohol abuse, an admission for a mental status change, or anadmission to the ICU for less than 24 hours. Serious adverse outcomes have been linked to thepresence of ICU delirium resulting in overall longer hospital lengths of stay, longer duration ofmechanical ventilation, higher rates of mortality, and long-term neuropsychological deficits afterdischarge. At the site of this quality improvement project, the prevalence of ICU delirium was92.3% in a population determined to be high risk using the PRE-DELIRIC screening tool. Aim: The aim of this quality improvement project was to decrease the prevalence rate of ICUdelirium ICU through the implementation of a sleep-wake cycle bundle. Methods: The process began with screening new admissions within twenty-four hours ofadmission to determine whether intervention is needed. Intervention ended at their dischargefrom the unit, death, or the designation of “comfort measures only (CMO)” by the physician. The site of this quality improvement project was a surgical/trauma ICU in a large urban teachinghospital. ICU delirium prevalence rates were determined through a retrospective chart reviewover a period of thirty days. Using the PDSA framework, new admissions to the ICU werescreened using the PRE-DELIRIC model over a period of 30 days to determine their percent riskof developing delirium. Patients with a score of greater than 40% were enrolled in the projectand had a sleep promotion bundle initiated. These patients were followed throughout their ICUstay and presence of delirium was tracked. Compliance with the sleep promotion bundle wasalso tracked. Results: The 30 day rate of ICU delirium was reduced by 47.3% (p = 0.019).Conclusion: Limitations and implications of this quality improvement project will be discussed.Recommendations for practice will be made and the role of the Clinical Nurse Leader (CNL)will be addressed