Improving Delirium Assessments in Vanderbilt Pediatric and Pediatric Cardiovascular Intensive Care Units

Abstract

Introduction: Delirium is a disturbance of attention and awareness that represents a change from baseline mental status. Accurate diagnosis of delirium is of paramount importance to improving the management of pediatric delirium in the intensive care unit. Despite ongoing education, inconsistencies in delirium assessments occur. Here, we aimed to determine the extent of the problem and increase compliance with delirium assessments. Methods: We collected preintervention data to assess baseline compliance of delirium assessments in the Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU) at Monroe Carell Jr Children's Hospital at Vanderbilt in November 2020. We executed 2 Plan-Do-Study-Act cycles with different interventions and collected data after each and approximately 1 year after the interventions. The first intervention consisted of virtual lectures on delirium assessments for the nursing staff. The second intervention included an educational handout and a new electronic medical record documentation tool. Results: Five hundred five individual nurse-patient encounters were assessed and collected throughout the project. The mean compliance of delirium documentation before the interventions was 52.5%. Target compliance after interventions was 70%. Mean compliance was 70% after cycle 1, 78% after cycle 2, and 86% in March 2022. Conclusions: Using pre-and postintervention data from chart reviews and nurse interviews regarding delirium screenings, we found that interventions targeting nurse education and EMR flowsheet improved compliance with delirium assessment and documentation in the PICU and PCICU. Future work should focus on assessing the clinical implications of this project in diagnosing and treating delirium.

Recognition and Management of Delirium in the Neonatal Intensive Care Unit: Case Series From a Single-Center Level IV Intensive Care Unit

“…1,2,14,17,19,21,23,24,31,32 Given the increased morbidity, increased mortality, and variability in screening, the Society for Critical Care, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC), and others recommend using validated tools in intensive care units to screen for delirium and having processes in place to prevent, document, and treat delirium. 1,2,11,13,20,23,24,33,34 The Cornell Assessment for Pediatric Delirium is a validated screening tool for children of all ages including newborns. 24,32 If identified, appropriately treating the underlying cause, delirium hygiene, and environmental interventions such as cycled lighting, clustering of care, daily/routine schedules, and cognitive stimulation are often sufficient for treating delirium.…”

“…27,35 Successful implementation strategies for delirium management require protocols to minimize noise, cluster cares to optimize sleep cycles, and promote caregiver involvement. 9,20,[34][35][36] When these nonpharmacologic measures are not sufficient, pharmacologic therapy with atypical antipsychotics are often used. 4,5,7,28 Antipsychotics are classified as typical (first generation) or atypical (second generation) and differ based on receptor activity.…”