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Improving Pediatric Delirium Assessment Documentation and Implementation of a Nonpharmacologic Delirium Management
Gina Rohlik1, A Jeanne Pfeiffer2, Christine E Collins1
1Mayo Clinic Department of Nursing, Mayo Clinic Children's Center, MN, USA.
Insights
Pediatric delirium assessment documentation increased with nursing education, boosting nurse confidence. However, the Bundle to Eliminate Delirium (BED) had inconsistent implementation and unclear impact on outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Nursing Quality Improvement
- Delirium Management
Background:
- Pediatric delirium is prevalent in ICUs, linked to adverse outcomes, and often underassessed.
- Cardiac PICU delirium assessments were infrequently documented, prompting an initiative to improve documentation and management.
- A nurse-driven protocol, the Bundle to Eliminate Delirium (BED), was implemented to address these issues.
Purpose of the Study:
- To evaluate the impact of a nurse-driven quality improvement project on pediatric delirium assessment documentation and management.
- To assess nurses' perceptions, knowledge, and barriers related to delirium management before and after the initiative.
- To determine the effectiveness of the Bundle to Eliminate Delirium (BED) protocol.
Main Methods:
- A pre- and postimplementation survey was administered to 113 nurses in a cardiac PICU.
- Nurses received education on delirium principles and assessment, followed by regular feedback on documentation rates.
- The Bundle to Eliminate Delirium (BED) was introduced, with ongoing monitoring and observational audits.
Main Results:
- Delirium assessment documentation rates increased by 33% following the intervention.
- Nurses reported significantly greater confidence in managing pediatric delirium.
- The implementation of the BED protocol was inconsistent, and its specific impact on outcomes remains unclear.
Conclusions:
- Nursing education and feedback effectively improved pediatric delirium assessment rates and nurse confidence.
- A nurse-driven quality improvement project can enhance pediatric delirium care.
- An interprofessional approach and further research are needed to optimize delirium management strategies, including the BED.
Background:
Pediatric delirium is common, associated with negative patient outcomes, and infrequently assessed in the ICU. Locally, pediatric delirium assessments in the cardiac PICU were infrequently documented resulting in an initiative to increase assessment documentation and implement a nurse-driven management protocol, the Bundle to Eliminate Delirium (BED).
Methods:
This was a nurse-driven, quality improvement project in an eleven-bed cardiac PICU at a large academic health care facility. A pre- and postimplementation survey evaluating delirium management perceptions, knowledge, and assessment barriers was emailed to 113 nurses. Nurses received education about general delirium principles and assessment followed by weekly emails that included delirium assessment documentation rates and targeted education. Subsequently, BED education was provided via email followed by BED implementation, inclusion of BED completion rates in weekly emails, and observational audits of BED implementation.
Findings:
1522 delirium assessment opportunities were evaluated. Assessment documentation increased by 33%. Nurses reported greater confidence in their ability to manage delirium (P < .05 for numerous aspects of delirium care) and were less likely to report 'positive delirium assessments not acted upon' as a barrier to delirium assessment. BED implementation was inconsistent.
Discussion:
Nursing education and feedback can increase delirium assessment rates and confidence in management but the impact of BED on these outcomes is not clear.
Application To Practice:
Improvement in pediatric delirium care may be obtained through a nurse-driven quality improvement project but an interprofessional approach is needed for optimal management. More studies are needed to identify effective pediatric delirium management strategies such as the BED.
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