• Carmen L Adams, Elizabeth Ann Scruth, Christina Andrade, Susan Maynard, Kathryn Snow, Terry L Olson, Stephen D Ingerson, Barbara A Duffy, and Eugene Cheng.
• Author Affiliations: Clinical Practice Consultant (Dr Adams) and Quality Strategy Leader, Quality Division Northern California Kaiser Permanente, Oakland (Dr Scruth); Intensive Care Unit (ICU) Clinical Nurse Specialist (CNS), Santa Rosa Kaiser Medical Center (Mss Andrade and Maynard); Neuro ICU CNS, Redwood City Kaiser Permanente Medical Center (Ms Snow); ICU CNS, Modesto Kaiser Medical Center (Ms Olson); ICU CNS, Vacaville Kaiser Medical Center (Mr Ingerson); Trauma ICU CNS, South Sacramento Kaiser Medical Center (Ms Duffy); and Medical Director Intensive Care Unit, San Jose Kaiser Medical Center-the Permanente Medical Group (Ms Cheng), California.
• Clin Nurse Spec. 2015 Jan 1; 29 (1): 29-37.

PurposeThe purpose of this article was to describe a quality improvement process on a diverse adult intensive care unit (ICU) population for a large healthcare organization for early detection of delirium.BackgroundDelirium is often considered a common unpreventable problem in the ICU. A process for early detection of delirium allows the critical care team to evaluate the patient and intervene to improve or reverse the delirium.DescriptionA business case was first developed, and then using performance improvement methodology combined with quality improvement methods and oversight from a Delirium/Sedation Workgroup, an implementation plan was developed. Intensive care clinical nurse specialists were educated; patients in the ICU were screened for delirium twice daily by bedside nurses using the Confusion Assessment Method. The clinical nurse specialist in each ICU was instrumental for driving the process of change and supporting the bedside nurse and physicians to discuss preventing, screening, and treating delirium.OutcomeSystem-wide process implementation was completed in 1 year, 2011. In 2012, all medical centers had a program in place to decrease the use of benzodiazepines and improve communication in the multidisciplinary teams during daily rounds about the treatment and prevention of delirium. The process of performance improvement is ongoing with continual reassessment and feedback required to ensure sustainability.Conclusions/Implications For PracticePerformance improvement involving 21 medical centers is a large-scale undertaking by an organization. It requires a systematic approach with key stakeholders and advanced practice nurses as subject matter experts involved throughout all phases of the implementation. Bedside clinicians assessing the patient must feel supported and valued members of the process. Challenges of all care providers need to be acknowledged and addressed.

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