Date of Graduation

Summer 8-9-2026

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Dr. Dave Ainsworth

Abstract

Abstract

Background: The following quality improvement project was performed in a 20-bed Neuro/Medical ICU in a large urban hospital in Northern California. Assessments with the IHI Clinical Microsystem Assessment Tool and the 5 P's framework indicated that the ICU had good practices in place to manage physiologic decompensation of ICU patients, but no practices to prevent delirium in those patients.

Problem: Delirium is associated with increased mortality rates for ICU patients, increased use of ICU ventilators, longer lengths of stay in the ICU, and long-term cognitive impairments (Devlin et al., 2018). The prevalence of delirium in patients who stayed in the ICU for longer than 24 hours was 48%, compared to the 25% prevalence rate of delirium in patients reported by the Society of Critical Care Medicine. Although CAM-ICU screenings were performed on all patients daily, there was no protocol to prevent delirium.

Interventions: An ABCDEF-based delirium prevention bundle was implemented over two PDSA cycles using Kotter's theory of change.

Outcome Measure: The aim was to reduce delirium prevalence from 48% to 36% by August 2026 among patients with an ICU stay longer than 24 hours. Compliance with the bundle and fall rates were used to measure the intervention’s success.

Results: The prevalence of delirium decreased from 47.9% at baseline to 36.5% after the intervention (32.7% after cycle two, when compliance was 88%). There was no increase in the number of patients who fell within the ICU. However, although the delirium reduction was notable, it did not reach statistical significance (χ²(1, N = 192) = 2.58, p = .108).

Conclusion: Not only was there a reduction in delirium, but the ICU also neared its goal of “High Reliability and Zero Preventable Harm.” Additionally, there was a reduction in the number of patients restrained and treated with antipsychotics without increasing the number of patients who fell within the ICU. These findings suggest that this low-cost intervention can be implemented within the ICU to improve patient care while maintaining current ICU protocols.

Keywords: delirium, ICU, ABCDEF bundle, CAM-ICU, prevention, quality improvement

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