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Implementing Screening for Neonatal Delirium in the Neonatal Intensive Care Unit: A Quality Improvement Initiative
Meghana Karmarkar1, Mark Speziale2,3, Willough Jenkins4
1From the Neonatal ICU, Department of Pediatrics, Kaiser Santa Clara, Santa Clara, Calif.
Insights
Neonatal delirium screening in the NICU increased significantly through a quality improvement initiative. This enhanced recognition of delirium in critically ill infants, improving patient care.
Area of Science:
- Neonatal intensive care unit (NICU) care
- Quality improvement initiatives
- Pediatric critical care
Background:
- Delirium is underdiagnosed in NICUs, potentially impacting infant outcomes.
- Early recognition of neonatal delirium is crucial for intervention.
Purpose of the Study:
- To implement and assess a quality improvement initiative to increase neonatal delirium screening in the NICU.
- To achieve an 85% screening compliance rate by March 2022.
Main Methods:
- Utilized a quality improvement framework with interdisciplinary stakeholder input.
- Developed and implemented a clinical algorithm for delirium screening using standardized tools.
- Optimized the screening process within the electronic medical record (EMR) through iterative Plan-Do-Study-Act cycles.
Main Results:
- Initial screening compliance reached 76%, with a subsequent dip to 59% after criteria expansion.
- Implementation of an EMR checklist sustained average weekly screening compliance at 77%.
- An average of 82% of eligible NICU patients were screened for delirium before discharge.
Conclusions:
- Quality improvement methods successfully increased the screening and recognition of neonatal delirium in the NICU.
- Further research should explore preventive strategies and the long-term impact of neonatal delirium on patient outcomes.
Introduction:
Delirium is not commonly diagnosed in neonatal intensive care units and can adversely impact patient outcomes in the ICU setting. Recognition of delirium in the NICU is a necessary first step to address the potential impact on neonatal outcomes.
Methods:
We conducted a quality improvement initiative implementing screening for neonatal delirium. We aimed to increase screening in NICU patients from 0% to 85% by March 2022. Interdisciplinary meetings were held with key stakeholders to develop a clinical algorithm. We used standardized tools for delirium screening. Our process measures included weekly nursing compliance with Richmond Agitation Sedation Scale/Cornell Assessment of Pediatric Delirium/ scoring documentation (Fig. 1) and patients referred to psychiatry. Outcome measures included the percentage of patients screened for delirium before discharge. We conducted Plan-Do-Study Act cycles to optimize the screening process in the electronic medical record (EMR). This included creating an order set, documentation flowsheets, and prompts in the EMR for patients.
Results:
After initial implementation, we achieved an average weekly screening compliance of 76% (Fig. 1). Inclusion criteria expansion resulted in a downward compliance shift to 59%. Subsequently, the addition of the EMR checklist resulted in a center-line shift to a sustained average weekly screening compliance of 77%. An average of 82% of all eligible NICU patients received delirium screening before discharge (Fig. 2).
Conclusions:
Using quality improvement methodology, there was increased screening and recognition of delirium in our NICU. Future research efforts could focus on assessing preventive measures and the impact of neonatal delirium on patient outcomes.
