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Improving Delirium Assessments in Vanderbilt Pediatric and Pediatric Cardiovascular Intensive Care Units
H Nur Eken1,2, Kristina A Betters3, D Catherine Fuchs2,4
1Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
Insights
Improving pediatric delirium assessment in intensive care units is crucial. Educational interventions and electronic health record tools significantly increased nurse compliance with delirium screenings and documentation.
Area of Science:
- Pediatric critical care medicine
- Nursing education
- Healthcare quality improvement
Background:
- Delirium, a disturbance in attention and awareness, requires accurate diagnosis for effective management in pediatric intensive care units (PICUs).
- Despite educational efforts, inconsistencies in delirium assessment compliance persist, impacting patient care.
- This study addresses the need to quantify and improve delirium assessment practices in pediatric critical care settings.
Purpose of the Study:
- To determine the extent of non-compliance with delirium assessments in pediatric intensive care units.
- To implement and evaluate interventions aimed at increasing compliance with delirium assessments.
- To improve the accuracy and consistency of pediatric delirium diagnosis and management.
Main Methods:
- A pre- and post-intervention study design was employed in the Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU).
- Two Plan-Do-Study-Act (PDSA) cycles were conducted, involving virtual lectures, educational handouts, and an electronic medical record (EMR) documentation tool.
- Data were collected through chart reviews and nurse interviews, assessing 505 individual nurse-patient encounters.
Main Results:
- Baseline compliance with delirium documentation was 52.5%.
- Following the first intervention (virtual lectures), compliance increased to 70%.
- After the second intervention (handout and EMR tool), compliance rose to 78%, reaching 86% approximately one year later.
Conclusions:
- Interventions focused on nurse education and EMR integration significantly improved delirium assessment and documentation compliance in PICUs.
- The study demonstrates the effectiveness of targeted strategies in enhancing adherence to critical care protocols.
- Further research is recommended to explore the clinical impact of improved delirium assessment on patient outcomes.
Introduction:
Delirium is a disturbance of attention and awareness that represents a change from baseline mental status. Accurate diagnosis of delirium is of paramount importance to improving the management of pediatric delirium in the intensive care unit. Despite ongoing education, inconsistencies in delirium assessments occur. Here, we aimed to determine the extent of the problem and increase compliance with delirium assessments.
Methods:
We collected preintervention data to assess baseline compliance of delirium assessments in the Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU) at Monroe Carell Jr Children's Hospital at Vanderbilt in November 2020. We executed 2 Plan-Do-Study-Act cycles with different interventions and collected data after each and approximately 1 year after the interventions. The first intervention consisted of virtual lectures on delirium assessments for the nursing staff. The second intervention included an educational handout and a new electronic medical record documentation tool.
Results:
Five hundred five individual nurse-patient encounters were assessed and collected throughout the project. The mean compliance of delirium documentation before the interventions was 52.5%. Target compliance after interventions was 70%. Mean compliance was 70% after cycle 1, 78% after cycle 2, and 86% in March 2022.
Conclusions:
Using pre- and postintervention data from chart reviews and nurse interviews regarding delirium screenings, we found that interventions targeting nurse education and EMR flowsheet improved compliance with delirium assessment and documentation in the PICU and PCICU. Future work should focus on assessing the clinical implications of this project in diagnosing and treating delirium.
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