Enhancing Burn Nurses' Knowledge of Delirium Assessment Tools and Prevention Strategies

Abstract

Purpose: This quality improvement (QI) project aimed to create, implement, and evaluate an evidence-based educational presentation on delirium in a burn intensive care unit (ICU) in San Francisco, California. The goal was to enhance burn nurses’ knowledge of delirium identification and prevention to promote better health outcomes for critically ill burn patients. Background: Delirium is a common and severe complication in critically ill patients, characterized by sudden disturbances in cognition and brain function. Studies suggest it affects up to 70% of hospitalized patients, especially in intensive care units, and is linked to risk factors such as polypharmacy, advanced age, and infections. Delirium prolongs hospital stays and significantly increases mortality rates and post-discharge care requirements, contributing to a substantial financial burden on healthcare systems. Burn patients are particularly vulnerable, with delirium prevalence reaching as high as 80% in those on mechanical ventilation, leading to long-lasting impacts on quality of life and overall outcomes. Methods: This QI project utilized a retrospective pretest-posttest (RPP) design to assess the impact of the delirium education presentation on burn nurses' perceived knowledge, attitudes, intentions, and barriers to delirium management. Results: A total of thirteen (n=13) participants completed the survey. All participants showed improvement in their knowledge, attitudes, and intentions to change their practice after the education. Additionally, 100% of nurses strongly agreed on the need for more delirium education in the burn unit and expressed intent to incorporate prevention strategies into their daily practice. Identified barriers to delirium identification and prevention included lack of patient participation, high doses of sedatives and narcotics, unfamiliarity with the CAM-ICU tool, high patient acuity, resource limitations, conflicting prevention strategies, patient complexity, and gaps in nursing education Conclusions: Formal education for burn nurses enhances their knowledge, attitudes, and intentions regarding delirium. This QI project is a crucial first step in preventing delirium-related complications for burn patients at the Bothin Burn Center, underscoring the need for future practice, education, and policy changes to address barriers to delirium management. Further research is necessary to better understand the prevalence and impact of delirium in the burn population and to develop burn-specific prevention strategies.