Pediatric Nurse Practitioner - Acute Care Children's Hospital New Orleans Louisiana Slidell, Louisiana, United States
Abstract:
Background: Delirium in the adult ICU patients is well-documented. In pediatrics one study found 25% of critically ill pediatric patients experience pediatric delirium (PD) during their ICU stay. PD is associated with increased length of stay, more days on mechanical ventilation and can also be a predictor of mortality. The majority of Pediatric ICUs and Cardiac ICUs do not screen nor monitor for PD. ICU nurses are thus not trained nor educated on assessing children for delirium.
Goal: This was a QI project to asses our nursing staff ability to recognize delirium and then administer an educational program to improve their skills to identify, and enact nursing interventions for delirium.
Methods: Using the Model for Improvement and Plan (Do, Study, Act), screening of patients for delirium using the psCAM-ICU and pCAM-ICU was implemented. Education regarding the identification and treatment of PD was administered to staff along with pre and post-tests to assess nursing understanding. Bedside reporting sheets were used for screening and documenting interventions made by nursing staff.
Results: Completion rate was almost 100% (28 of 29 staff nurses completed the pre and post tests). Pre-test scores averaged 76%, while post-test scores averaged 85%. During the 12-weeks of implementation, 44 bedside PD screening forms where completed (15 were excluded as incomplete). Of the remaining 29 forms, 4 indicated a positive finding of PD giving a positivity rate of 14%.
Conclusion: Pediatric delirium education program was successful in educating the nursing staff of this 28-bed pediatric cardiac ICU. Education and screening protocols can be successfully implemented in similar units. Implementation of PD screening protocols is an important component of delivering high quality evidenced based care. Future research is needed to assess:1. The benefit of monitoring for pediatric delirium in the CVICU and 2. The tools to prevent it.
