• Justin DiLibero, Susan DeSanto-Madeya, Rachael Dottery, Lauren Sullivan, and Sharon C O'Donoghue.
• Justin DiLibero, DNP, RN, CNS, CCRN, ACCNS-AG, is a clinical nurse specialist at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, and is a graduate of the Doctor of Nursing Practice Program at Northeastern University. Susan DeSanto-Madeya, PhD, RN, CNS, is an associate professor at Boston College and is the Beth Israel Hospital Nurses' Alumnae Association Endowed Nurse Scientist at BIDMC in Boston, Massachusetts, and served as the DNP scholarly project expert mentor for this project. Rachael Dottery, MSN, RN, is a staff nurse in the neuroscience and surgical ICU at BIDMC in Boston, Massachusetts. Lauren Sullivan, BSN, RN, CNRN, SCRN, is the unit-based educator in the neuroscience intermediate unit at BIDMC in Boston, Massachusetts. Sharon C. O'Donoghue, DNP, RN, is a clinical nurse specialist at BIDMC in Boston, Massachusetts.
• Dimens Crit Care Nurs. 2018 Jan 1; 37 (1): 26-34.

BackgroundDelirium affects up to 80% of critically ill patients; however, many cases of delirium go unrecognized because of inaccurate assessments. The effectiveness of interventions to improve assessment accuracy among the general population has been established, but assessments among neuroscience patients are uniquely complicated due to the presence of structural neurologic changes.ObjectivesThe purposes of this quality improvement project were to improve the accuracy of nurse's delirium assessments among neuroscience patients and to determine the comparative effectiveness of the intervention between medical and neuroscience patients.MethodsA multifaceted nurse-led intervention was implemented, and a retrospective analysis of preintervention and postintervention data on assessment accuracy was completed. Results were stratified by population, level of sedation, and level of care. Differences were analyzed using Fisher exact test.ResultsData from 1052 delirium assessments were analyzed and demonstrated improvement in assessment accuracy from 56.82% to 95.07% among all patients and from 29.79% to 92.98% among sedate or agitated patients. Although baseline accuracy was significantly lower among neuroscience patients versus medical intensive care unit patients, no significant differences in postintervention accuracy were noted between groups.ConclusionResults from this project demonstrate the effectiveness of the nurse-led intervention among neuroscience patients. Future research is needed to explore the effectiveness of this nurse-led intervention across other institutions and to describe the effectiveness of new interventions to improve outcomes at the patient and organizational levels.

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