Increasing the visibility of delirium as a hospital acquired complication: A consumer co-designed, nurse-led quality improvement program in a quaternary intensive care unit.

Background

Delirium is common in critically ill patients but is frequently under-recognised, inconsistently documented, and poorly explained to families. In our 48-bed intensive care unit (ICU), baseline chart review identified probable delirium in 65% of sampled admissions, yet the term "delirium" was documented in only 23% of medical records.

Objectives

The objective of this study was to increase the visibility of delirium as a hospital-acquired complication through reliable screening, explicit interdisciplinary documentation, and consumer co-designed family engagement.

Methods

We conducted a nurse-led quality improvement program in a quaternary adult ICU. The program was co-designed with a consumer representative with lived experience of ICU delirium and delivered through two linked workstreams: Humanising Delirium, focused on Confusion Assessment Method for the ICU screening documentation reliability, family engagement, and nonpharmacological care; and Communicating Delirium, focused on standardised terminology, medical documentation, and handover. Interventions included multidisciplinary education, delirium champions, bedside prompts, a co-designed ICU Admission Pack and "This is Me" bedside tool, and iterative audit and feedback. Outcomes were evaluated using run charts, statistical process control p-charts, and before-and-after comparisons.

Results

Confusion Assessment Method for the ICU screening documentation reliability improved significantly: shifts meeting all documentation requirements increased from 26.5% to 65.9% (p < 0.001), with special-cause variation confirming sustained change. Completion of the "This is Me" bedside tool increased from 18.8% to 54.5%, and documented ICU Admission Pack distribution rose to 34%. Explicit use of "delirium" in medical documentation increased from 23% to a sustained performance of 44-60%: documentation of an underlying cause improved from 36% to 79-95%, and medical management plan documentation from 50% to 80-89%. Nursing documentation of nonpharmacological strategies increased from 29.7% to 74%, and the nursing-medical recognition gap narrowed from 26% to 2.4%.

Conclusions

A consumer co-designed, nurse-led quality improvement program improved process measures associated with delirium recognition and communication, including screening documentation reliability, delirium documentation, and caregiver engagement in a large adult ICU. Delirium improvement programs should treat recognition, explicit documentation, and caregiver communication as interdependent components of delirium care. Partnering with consumers helped shift project aims from clinician recognition to proactive family preparation and partnership.