Date of Award

Summer 2025

Project Type

Thesis

College or School

CHHS

Department

Nursing

Program or Major

Direct Entry Master of Nursing

Degree Name

Master of Science

First Advisor

Deborah Simonton

Second Advisor

Jessica Dane

Third Advisor

Pamela Kallmerten

Abstract

Background: Delirium is an acute state of confusion that can lead to increased morbidity and longer hospital stays. Patients in the ICU are at high risk for developing delirium due to additional risk factors such as mechanical ventilation and sedation. The Confused Assessment Method for the Intensive Care Unit (CAM-ICU) is a tool used by nursing staff to document and assess for delirium.

Local Problem: The microsystem in this project is a 16-bed medical ICU in central New Hampshire. In the microsystem, CAM-ICU documentation compliance is tracked monthly, but the accuracy of the documentation is not routinely assessed. Stakeholders have expressed concern regarding the high number of positive CAM-ICU assessments documented, suggesting that some patients said to be delirious might be sedated rather than delirious. To address this knowledge gap, this quality improvement (QI) project was conducted, focusing on nursing knowledge of the CAM-ICU on the sedated patient.

Methods: A pre-intervention survey was provided to nursing staff, assessing their knowledge, attitudes, and practice of the CAM-ICU. An educational PowerPoint™ presentation was provided, including a Zoom option. The presentation outlined key points and current best practice for the CAM-ICU. Participants then completed a post-intervention survey. A chart review of positive CAM-ICU assessments two weeks prior and two weeks post-intervention was also completed.

Results: There was a +16.5% change in nursing knowledge regarding accurate CAM-ICU assessment and documentation after the educational intervention. The chart review showed a 15% decrease in inappropriate documentation and a 30% decrease in positive CAM-ICU assessments after the educational intervention, suggesting improved accuracy of documentation.

Conclusion: This QI Project increased nursing knowledge of the CAM-ICU for the sedated patient. Continued education and reinforcement of the tool should be provided in order for the increase in knowledge to be sustained.

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