Increasing Nurses’ Knowledge of Accurate CAM-ICU Completion through an Education Intervention

Abstract

Purpose: The purpose of this quality improvement project was to increase nurses’ perceived knowledge of accurate CAM-ICU completion and assess nurses’ changes in attitudes regarding the CAM-ICU assessment. Background: Delirium is an acute brain dysfunction that causes a fluctuating disturbance in attention, awareness, and cognition. Studies have reported delirium occurring in 20 to 40% of intensive care unit patients and up to 60 to 80% of mechanically ventilated medical or surgical intensive care unit patients. High prevalence rates of delirium are concerning because the condition is known to increase intensive care unit morbidity and mortality and increase healthcare spending. The Society of Critical Care Medicine recommends routine assessment of patients with a validated delirium screening tool, such as the CAM-ICU. Although delirium screening benefits are documented, the accuracy of delirium screening is questionable. More specifically, high rates of inappropriate “unable to assess” ratings on the CAM-ICU have been documented. Methods: The quality improvement study utilized a retrospective pretest-posttest design to evaluate the impact of an education intervention on nurses’ perceptions of knowledge and attitudes surrounding CAM-ICU completion. Participants received a recruitment email that included an education intervention in PowerPoint format and a post-pre survey through aQualtrics link. The education was adapted from Dr. Wesley Ely’s CAM-ICU training manual and included background information on delirium and the CAM-ICU, effects on patient outcomes, the steps in completing the CAM-ICU, and appropriate and inappropriate indications for an unable to assess rating. Results: The project’s key findings include an increase in the mean differences between pre-and post-survey scores for each survey question. Despite this growth for each question, the Wilcoxon Signed Rank Test revealed that only one survey question demonstrated a statistically significant change from pre- to post-survey scores. Conclusions: The results of this study indicate that an online education tool does not make an overall statistically significant change in nurses’ perceived knowledge of accurate CAM-ICU completion. Though the mean difference between pre-and post-survey scores showed a positive change for each question, this change did not demonstrate statistical significance for four out of the five survey questions.