Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Ng KF(1), Ip KM(1), Yuen WS(1), Lo SY(1), Tang PY(1), Cham YK(1), Lam KN(1)
Affiliation :
(1) Intensive Care Unit, North District Hospital
Introduction :
Delirium accounts for 20-30% of inpatients while the incidence rate of delirium in intensive care units (ICU) is as high as 25-87% with a mean of 29%. Patients experienced delirium during ICU admission may be associated with unfavourable outcomes. Review from literatures showed that multi-component bundle focusing on ICU delirium monitoring and prevention in bundle would have improved clinical outcomes.
A delirium assessment tool, CAM-ICU (Confusion Assessment Method – Intensive Care Unit) was introduced to nurses in North District Hospital (NDH) in June 2021. All patients except those undergoing EOL care, admitted with delirium, communication problem and neurological disease are included. A delirium care bundle including five interventions was introduced: (1) Early mobilization, (2) Pain control, (3) Reorientation, (4) Sleep promotion and (5) Family involvement.
Objectives :
(1) To evaluate the clinical outcomes of delirium care bundle on delirium occurrence, delirium free days and restraint free days (2) To examine staff compliance on delirium care bundle and individual interventions within the bundle
Methodology :
Delirium occurrence, delirium free days, restraint free days in terms of percentage and length of stay (LOS) were calculated pre and post intervention. Staff compliance on bundle and individual interventions were examined.
Result & Outcome :
ICU LOS was decreased from 8.2 to 6 days. Delirium occurrence was reduced from 25.6% to 24.2%. Delirium free days increased from 38.72% to 58.1% while restraint free days enhanced from 21.5% to 23%. Application of delirium bundle for >66% LOS means good compliance whereas 33-65% LOS was defined as fair compliance. The rest means poor compliance. Good compliance rate was 18%, fair compliance rate was 61% while poor compliance rate was 21%. For individual intervention of mobilization, pain control, reorientation, sleep promotion and family involvement, their compliance rate was 73%, 32%, 42%, 46% and 23% respectively. It was found that this program improved clinical outcomes by facilitating other well-proven effective clinical interventions in ICU and staff was capable to achieve the bundle.
