Evidence Based Practice Implementation of the Delirium Portion of the ABCDEF Bundle

Background: Delirium is a common complication in the ICU setting and has serious long-term consequences. Increased mortality and long-term cognitive issues are associated with under-recognition and lack of treatment for delirium. Nursing staff must identify delirium and manage the event, in addition to providing care to other assigned patients. Purpose: The purpose of this evidence-based project was twofold. First, the project set out to determine if implementation of the delirium portion of the ABCDEF bundle promoted delirium recognition and decreased ICU length of stay and ventilator days. Second, the project examined if the use of a structured delirium education program improved nursing knowledge of delirium risk-factors and incidents in ICU patients. Methods: Manual chart audits of 368 ICU patients was completed post-implementation of the delirium portion of the ABCDEF bundle. Screening variables included: (1) number of times delirium screening was completed, (2) number of opportunities for screening, (3) delirium incidence, and (4) screening compliance. Outcome variables were calculated by comparing 2018 and 2019 data (Jan.–April). Outcome variables included: (1) ICU length of stay, (2) mortality, (3) ventilator days, (4) number of patient days, and (5) illness severity. Descriptive statistics were calculated for items on a nursing delirium knowledge survey pre and post-implementation. Results: Delirium screening compliance was 62.2% post-implementation, with 31.5% of patients screening positive. ICU length of stay decreased 11.41% and patient days decreased 5.34%. The average number of ventilator days decreased 13.86% while the severity of illness increased 2.83%, and ICU mortality increased 4.3%. Conclusions: Use of the delirium portion of the ABCDEF bundle, along with staff education, improved ICU outcome measures as well as increased delirium recognition

An Educational Intervention on Daily Chlorhexidine Gluconate Bathing and Central Venous Catheter Infection Rates in the Pediatric Population: A Quality Improvement Initiative

The use of Central Venous Catheters (CVCs) in the healthcare setting is essential to patient survivability. While convenient, the utilization of such devices places patients at risk for Central Line- Associated Bloodstream Infections (CLABSI). The US spends nearly $2 billion dollars annually treating CLABSIs. The utilization of CLABSI bundles has shown to be effective in infection prevention. Daily bathing with Chlorhexidine Gluconate (CHG) is recommended by the Centers for Disease Control and Prevention (CDC) and is often included in CLABSI bundles. In an attempt to reduce the incidence of CLABSIs at a metropolitan pediatric hospital in the Southern US, a nurse driven quality improvement (QI) initiative is being proposed. The proposed QI initiative will target pediatric hematology/oncology nurses and will consist of a 15-minute educational session regarding CHG bathing. A pretest/posttest design combined with retrospective chart reviews will be utilized. A hopeful increase in daily bathing compliance rates with a subsequent reduction in the occurrence of CLABSIs will be a direct result of the QI initiative