Date of Graduation

Winter 12-18-2015

Document Type

Project

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Dr. Elena Capella

Abstract

Abstract

The goal to consistently mobilize the mechanically ventilated patient to decrease the risk or progression of delirium is the primary focus of my project. This project took place in two, 12-bed critical care units. One is a cardiovascular, medical, surgical intensive care unit and the other is a neurotrauma critical care unit. The methods for implementation included writing the management of pain, agitation, and delirium policy based upon the recommended bundle from the Society of Critical Care Medicine referred to as the ABCDE bundle. As part of this bundle, the progressive mobility policy was revised so that a physician order is not required to mobilize a patient and the confusion assessment method for ICU to assess for delirium was implemented. There have been multiple PDSA cycles performed to evaluate the process, address barriers, educate, and make needed changes.

Retrospective data has shown an improvement that when a patient meets criteria to mobilize, mobility is occurring more consistently. There are minimal changes in our delirium rate. Fifty per cent of our mechanically ventilated patients have one or more episodes of delirium while in our unit.

Adding support to the team, consistent multidisciplinary rounds with improved intensivist participation, has helped to reduce some of the barriers identified of time and fear, which will help us reach our goal to mobilize our patients 95 percent of the time when criteria is met. We will continue to work to reach this goal by the end of the first quarter of 2016.

The role function of the CNL is clinician and outcomes manager. The CNL clinician role will coordinate and evaluate care based upon best practice for a specific patient population. The outcomes manager will use collected data to address barriers, achieve sustainability, and revise patient care as needed.

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