P0470 - Initial Findings of Delirium Screening Using the Cornell Assessment of Pediatric Delirium at a Large, Tertiary Pediatric Intensive Care Unit

Title:
Initial Findings of Delirium Screening Using the Cornell Assessment of Pediatric Delirium (CAPD) at a Large, Tertiary Pediatric Intensive Care Unit

Background:
Delirium, which is associated with significant potential morbidity and mortality, has been under-recognized in critically ill children. The Cornell Assessment of Pediatric Delirium (CAPD) is a validated screening tool. Application of this tool as a manual paper screening tool in our pediatric ICU began in Spring 2018.

Objectives:
Describe initial findings of delirium screening and assess effects of training/educational interventions on screening.

Methods:
Screening with the CAPD tool was conducted on all qualifying pediatric patients admitted to our general medical/surgical ICU. Paper CAPD surveys were distributed daily to bedside nurses to be completed once per 12-hour shift from April 30, 2018 to May 20, 2018. Exclusion criterion included a State Behavioral Scale (SBS) of -2 or lower. Nurses received training prior to screening initiation as well as throughout the screening period. Data collected included age, gender, date and shift of CAPD screen, SBS at time of screen, CAPD scores (range 0-32) with overall assessment (positive screen, negative screen, positive screen but at neurologic baseline, unable to determine), and comments. A CAPD score of 9 or greater along with the assessment that the patient was not at neurologic baseline was used as the threshold for a positive screen. Data were entered into REDCap and analyzed. This work was approved by the Baylor College of Medicine IRB (#H38700).

Results:
Between April 30-May 20, 2018, a total of 177 assessments were completed in 51 unique patients. True positive screens (score 9 or greater) were 24% [n=42] of responses. 68% [n=121] of assessments were deemed negative. 8% [n=7] of assessments were deemed “unable to determine,” with the most common reason being nurses’ uncertainty of the patients’ neurologic baseline.

Conclusion:
Initiation of CAPD screening with a paper tool revealed a rate of approximately 24% positive screens of surveys returned, potentially similar to other published data. One major limitation of this study was our low capture rate with paper CAPD surveys. Assuming full capacity every day for our unit (32 beds), we should have had ~1350 screens for time period in question, whereas we actually obtained 177 screens (~13%). Important next steps include standardizing across the institution a systematic approach to address patients who screen positive. To ensure consistent and accurate screening, nurses and healthcare providers need continued education on risk factors for and techniques to prevent ICU delirium.