Utilization of Kotter’s Stages and Statistical Process Control to Implement and Sustain Delirium Screening in PICU

Kupferschmid, Megan; Tripathi, Sandeep

doi:10.1097/pq9.0000000000000536

Cited by 2 publications

(2 citation statements)

References 25 publications

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“…In one study [4], a delirium rate of 69% was found in patients with a length of stay > 48 hrs (37% of the total sample). Delirium in children leads to adverse outcomes, such as complications, falls, prolonged hospital stay, and prolonged mechanical ventilation and even death [5,6]. Delirium also makes it more likely that the child's cognitive, emotional, and social abilities were impaired after discharge, which makes the caregivers suffering [2,4,7].…”

Section: Overview and Research Significancementioning

confidence: 99%

Risk factors of delirium in paediatric intensive care units: A meta-analysis

et al. 2022

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Background Delirium is a brain dysfunction syndrome, which children have a higher incidence. At present, there have been more and more studies and reports on delirium in paediatric intensive care unit, but there are some differences in the risk factor results among different studies. To better manage delirium, this study was performed. Objective To integrate and clarify the risk factors for delirium in paediatric intensive care unit. Methods CNKI, CBMdisc, Wanfang Data Knowledge Service Platform, VIP, PubMed, Embase, Cochrane Library, JBI and PsycInfo were searched for relevant literature. The study subjects were patients in PICU and literature was included according to the PICOS principle. Literature screening and risk of bias assessment were mainly completed by two researchers, and RevMan 5.3 software and Stata software were used for data analysis. The GRADE systerm was used to assess the quality of evidence. Results A total of 10 studies were included, all in English, involving 4343 children. Within the GRADE system, 4 indicators were scored A, 1 indicators were scored B, and 3 indicators were scored C regarding evidence levels. Three studies analysed the influence of developmental delay on the occurrence of delirium in PICU, total sample size of which was 1823, and the results showed that the combined effect was statistically significant [OR = 3.34, 95%CI(2.46–4.53), Z = 7.75, P<0.001]; Five studies analysed the effects of mechanical ventilation on the occurrence of delirium in PICU, sample size of which was 1562, and the results showed that the combined effect was statistically significant [OR = 4.11, 95%CI(3.13–5.40), Z = 10.16, P<0.001]; Two studies analysed the effects of benzodiazepines on children developing delirium, sample size of which was 1635, and the results showed that the combined effect was statistically significant [OR = 5.05, 95%CI(3.65–6.97), Z = 9.83, P<0.001]; Two studies analysed the effects of anticholinergic drug use on children developing delirium in PICU, sample size of which was 1703, and the results suggested the combined effect was statistically significant [OR = 5.04, 95%CI (3.62–7.00), Z = 9.63, P<0.001]; Two studies compared the same age period, sample size of which was 1724 and the results showed that children 2–5 years old has a 48% incidence rate of delirium relative to children younger than 2 years old, and the combined effect was statistically significant [OR = 0.48, 95%CI(0.25–0.92), Z = 2.22, P = 0.030], children 5–13 years old has a 39% incidence rate of delirium relative to children younger than 2 years old, and the combined effect was statistically significant [OR = 0.39, 95%CI(0.26–0.59), Z = 4.43, P<0.001]. Two studies analysed the effects of PICU LOS on children developing delirium and the combined effect of PICU LOS on the occurrence of delirium in children in PICU was statistically significant [OR = 1.10, 95%CI(1.05–1.15), Z = 4.07, P<0.001]. Conclusion Developmental delay, mechanical ventilation, benzodiazepine use, anticholinergic use, age and PICU length of stay are independent risk factors for delirium in children in PICU. However, only a few articles were included in this study, which may lead to a certain bias and affect the analysing results. More large-sample, multicentre studies should be conducted to further explore and clarify the independent influencing factors of delirium in children in PICU and to provide guidance for clinical practice.

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Section: Overview and Research Significancementioning

confidence: 99%

Risk factors of delirium in paediatric intensive care units: A meta-analysis

et al. 2022

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“…Delirium in both adults and children is associated with a prolonged hospital stay, increased morbidity and mortality, increased workloads, and consequent increased social and health care costs [ 13 ], and decreased quality of life for the patient and/or family [ 14 , 15 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Challenges of the Implementation of a Delirium Rate Scale in a Pediatric Intensive Care Unit: A Qualitative Approach

Balsalobre-Martínez,

Montosa-García,

Marín-Yago

et al. 2023

Healthcare

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Introduction: Delirium in the pediatric population admitted to intensive care is a worrying reality due to its potential complications and the increase in associated costs. This study aims to explore the experiences of nursing staff of a Pediatric Intensive Care Unit after 15 months of starting a program to fight against childhood delirium in their unit. Methodology: A qualitative study was conducted through semi-structured interviews with Pediatric Intensive Care Unit (PICU) Key Informants. The Standards for Reporting Qualitative Research (SRQR) and the consolidated criteria for Reporting Qualitative Research (COREQ) were followed as quality measures for the study. Seven nurses (33% of the eligible population) from the PICU of a referral hospital were interviewed. Text transcripts were analyzed using the Interpretative Description and Qualitative Content Analysis method. Results: The interviewees indicated not identifying delirium as an important reality; with great deficiencies observed in what is related to the identification of delirium; identifying CAPD as an unreliable tool in their unit; and not sharing therapeutic objectives in this respect with the medical staff. Conclusions: The nursing staff presented a series of negative attitudes towards the phenomena of delirium in their unit, with gaps in training and in clinical management, and the diagnostic tool used, and did not see it as a priority objective of the unit, partly due to a resistance to change and a latent interprofessional communication conflict. A change at the formative, attitudinal, and relational levels is urgently needed for the success of the program and the well-being of the children in the unit.

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Utilization of Kotter’s Stages and Statistical Process Control to Implement and Sustain Delirium Screening in PICU

Cited by 2 publications

References 25 publications

Risk factors of delirium in paediatric intensive care units: A meta-analysis

Risk factors of delirium in paediatric intensive care units: A meta-analysis

Challenges of the Implementation of a Delirium Rate Scale in a Pediatric Intensive Care Unit: A Qualitative Approach

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