Date of Graduation

Winter 12-16-2022

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


Kaiser cohort MSN capstone

First Advisor

Liesel Buchner



Problem: From April 2021 to January 2022 there were 17 cases of reported patient aggression and staff injury due to patients in the hyperactive state of delirium. In a stroke/tele unit, diagnosis of delirium was delayed due to subjective assessment from the confusion assessment method (CAM) tool. This delay allowed patients to reach the hyperactive state of delirium which poses a threat to patient and staff safety. An objective form of assessment for delirium was needed on this stroke/tele unit.

Context: Through a microsystem assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis, stakeholders in this performance improvement plan began to develop a successful and sustainable change that would benefit the patients and staff. Members of the interdisciplinary team partnered with the geriatric clinical nurse specialist (CNS)/unit educator and psychiatry, to create a unit-based, as well as facility-wide delirium committee that met daily to discuss any difficult patients and met monthly to discuss the ongoing care of delirious patients.

Intervention: The unit-based delirium committee implemented the inattention and disorganized thinking assessments of the CAM-ICU tool to replace the inattention and disorganized thinking portions of the CAM tool. This change of practice was shared by the committee during staff meetings and daily huddles.

Measures: The outcome measure was the reduction of staff injuries. Process measures included introducing the CAM-ICU tool to staff and rationale of why features the inattention and disorganized assessment portions were to be used. Data was collected on the percentage of patients assessed for delirium, the number of violent incidents reported to security, the number of code greys called for security assistance, and finally, the number of staff injuries due to violent patients. This project was successful due to the reduction of staff injury.

Results: There was a reduction in staff injury from assault by hyperactive delirious patients. Other findings from the project included reports of violent incidents increased which resulted in security being more involved in rounding on the unit and psychiatry involvement with daily check-ins proved to be invaluable as communication with the interdisciplinary team was enhanced.

Conclusions: Utilization of inattention and disorganized thinking assessments from the CAM-ICU tool proved to be useful in objectively assessing patients for delirium on a poststroke floor. To ensure staff safety, a cohesive, collaborative, and communicative multidisciplinary team was necessary.