PC1215: Improving Delirium Recognition in the Pediatric Critical Care Units

Purpose/Objectives: Delirium is a problem that has significant impacts on morbidity, mortality, and financial costs. It has been shown to lead to increased length of stays, increased ventilator days, and mortality. Delirium has been shown to increase hospital costs. Our objective was to increase compliance with the delirium screen; Cornell Assessment of Pediatric Delirium (CAPD) from < 10% to 80% by Dec 2022 for eligible patients in the Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU).

Design/Methods: We tracked daily compliance with CAPD scoring of every eligible patient admitted to the PICU/PCICU; eligible patients include those not receiving neuromuscular blockade or comatose. We created a key driver diagram to identify targets for intervention. Several PDSA cycles were conducted. Interventions have included: improved nursing education on the purpose of a CAPD score and how to correctly perform CAPD scoring, incorporation of reminders from charge nurses to bedside nurses to perform CAPD scores into the daily workflow, optimized and streamlined nursing workflow by integrating the CAPD score into the main nursing flowsheet so they do not have to open an additional tab, and created a dashboard to monitor compliance easily and in real time.

Results: Since October 2021, we have increased compliance with CAPD scoring to approximately 51% (figure 1). There have been 2 shifts, starting in October 2021 following education endeavors and January 2022 after changes were made to flowsheets and workflow. We have also identified that approximately 34% of patients who are screened are positive for delirium (figure 2).

Conclusion/Discussion: With increased nursing education and improvement in ease of workflow, we have been able to consistently increase compliance with CAPD scoring, a tool used to identify delirium. Nursing education efforts began in October 2021 which is evidenced by an increase in CAPD screening. In January 2022, the CAPD score was integrated into the nursing vitals flowsheet and there has been a consistent improvement in CAPD scoring. This has led to improvement in the ability to identify patients who meet criteria for delirium in the PICU and PCICU. Next steps include further optimizing workflow, increase provider awareness, and standardize treatment of delirium in pediatrics with the implementation of a clinical pathway. With improvement in delirium recognition, we hope to improve treatment of delirium, and ultimately prevent delirium with a goal to improve patient outcomes and reduce hospital costs.