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Published on: January 16, 2019
Implementation of a Pediatric Delirium Screening Program in a Pediatric Intensive Care Unit
Nada Mallick1, Marisa Mize2, Anita K Patel3
1Nada Mallick is an attending physician, Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC.
Background:
Knowledge of and screening for delirium are important to patient care. As bedside caregivers, nurses are in a strategic position to observe changes that may indicate delirium.
Objective:
To institute a delirium screening protocol in a pediatric intensive care unit using the Cornell Assessment of Pediatric Delirium.
Methods:
Implementation strategies included cycles of education and repeated, timed compliance and accuracy assessments. Surveys administered before and 6 months after implementation were used to identify nurses' perceptions of screening. Compliance with and accuracy of screening were measured over 3 years. During the second and third years, text messages to bedside nurses' telephones served as screening reminders.
Results:
Responses on the nursing surveys before (n = 89) and after (n = 74) implementation were compared. After implementation, time to complete the assessment, medical providers, and procedures were less likely to be perceived as obstacles to screening. Nurses' confidence in delirium screening improved over time. Accuracy increased from 60% during the first year to 100% during the second and third years (P < .05). Unit-wide compliance with delirium screening was 68% in the first year, 51% in the second year, and 72% in the third year, a trend toward improvement that was statistically significant (P < .05).
Conclusions:
Although unit-wide compliance with the screening protocol decreased without regular monitoring, it subsequently improved after the institution of reminders and reeducation of nursing staff. Nursing perceptions evolved to view screening as an important component of patient care that did not disrupt daily workflow.
