Yesterday our Delirium Early Detection and Prevention Project was supposed to meet but we got 12-17 inches of snow over eastern Iowa and we got snowed in. I couldn’t get in to work. I sent the members and others a message instead and passing it on to you:
So we couldn’t meet today because of inclement weather. We shoveled our driveways but our streets didn’t get plowed.
I’ve noticed that even though our Sharepoint intranet site is up and running and I’ve started a couple of Discussion Boards and posted several documents, only one person besides me seems to have participated. Our facilitator has posted the minutes from the first meeting and the charter, to which I’ve made some edits, the Discussion Board for which is on Sharepoint. The delirium guidelines are posted as are some remarks by one member and me. For those who haven’t found it, you can reach it from The Point under Initiatives, look all the way to the bottom of the page for the Delirium project title and click that for entry if you have permissions.
I’ve been working on educational materials for nurses and doctors along with one of our soon-to-be graduated med-psych residents who I’m very pleased to announce will be joining our department of psychiatry in July as an Assistant Professor. Anyone else who would like to volunteer making some slide sets for instruction of nurses and physicians and pre-tests and post-tests about delirium is welcome to submit their work to me. I can upload them to the Sharepoint site.
I’ve therefore widened the pool of potential participants to onlookers who might want to help. I’m also copying some key people who might also be interested in what we’re doing and soliciting their involvement.
For those who might be interested in being champions in medicine and surgery, please have a look at the instructional video below on delirium and the use of the short Confusion Assessment Method (CAM). It’s a little long but was made in 2007 and it’s current. As you view it, count how many times psychiatry is mentioned. I’ll give you a hint—zero.
There are other educational materials at the links and URLs below you could look at. I’d like to know what you think.
There’s room for more people to participate in making the UIHC a safer place for the elderly and whoever else is at risk for delirium. I also think inertia is always a difficult hurdle to overcome. Our neuropsychologist who is a real innovator regarding the way we plan to screen for delirium asked me how soon I think the project is to action in response to my question about whether or not we should consider adding another cognitive screening test, the Trails A and B to the Coding Task as the cognitive test to be administered as a screen for the risk factor of premorbid cognitive impairment and as the cognitive companion test to be administered with the CAM. The question is how much time we need to train nurses to give the tests efficiently and effectively.
I don’t want to see our rules for how the project is structured getting in the way of making it happen. We need structure and adherence to protocol, both to ensure that what we’re doing on behalf of patients as quality improvement is just that, and to satisfy funding sources who are currently deciding on whether or not to support the project.
We can’t do anything about the weather. We can choose to move forward on the charter, which delirium guideline to use (my opinion is on the Discussion Board on the Sharepoint site) and stepping up production and presentation of the delirium educational program.
So what do you think about the following points?
- What needs to be added or subtracted from the charter? I’ve made some edits you can view, add to or subtract from, etc on the Sharepoint Discussion Board.
- Which set of delirium management guidelines do we want to adopt? So far I like CoN acute confusion AHRQ summary, see Sharepoint Discussion Board with link.
- Would we like to use the teaching video as is? I for one like the video and think the physicians as well as nurses could learn a great deal from it.
- Are we going to use the CAM or the CAM-ICU? I’m not sure it matters since we’re substituting the Coding Task and possibly the Trails Test for their respective brief cognitive exams. The stem CAM is essentially the same.
- Are we going to use Haldol if certain parameters are met, e.g., evidence for early delirium on testing? I vote yes, see Sharepoint on safety measures and adverse effects rating scales proposed for monitoring.
I think there might be room for two pharmacists and I invite them to discuss how they might function as a team within the team.
The next meeting is February 16, 2011 and my secretary will be sending out reminders and Outlook Meeting Planner messages to the small group members. Sorry everybody, there’s not enough space in the conference room for all of the people who might be interested. I’ll try to keep everyone posted. One way I might do that is by my blog, The Practical Psychosomaticist: James Amos, M.D. | A psychiatrist’s perspective about the importance of thinking both/and rather than either/or about medical and psychiatric issues., so check it regularly. Those who want read or read/write access to the Sharepoint site (based on need), let me know. I think I’ve finally figured out how to do that.
Education about CAM Video: Geriatric Nursing Resources for Care of Older Adults :: need help stat or URL http://consultgerirn.org/topics/delirium/need_help_stat
PDF about Delirium: Delirium Management and Recognition or URL http://www.hopkinsmedicine.org/gec/nursing_education/Module_1_Delirium
TRYTHIS Educational Tools: Hartford Institute for Geriatric Nursing :: Try This/ How to Try This Assessment Series or URL http://hartfordign.org/Resources/Try_This_Series