National screening for delirium in paediatric intensive care units: A quality improvement initiative

Internationally, one in three children develop delirium during their intensive care stay. International guidelines strongly recommend twice-daily screening for paediatric delirium using validated instruments. In the United Kingdom and Ireland, delirium was assessed only when suspected and few intensive care units (ICUs) used validated instruments.

This initiative aimed to implement a national screening strategy in 28 paediatric intensive care units (PICUs) across the United Kingdom and Ireland.

The strategy involved: (a) rapidly reviewing, evaluating and ranking paediatric screening instruments for sensitivity, specificity, appropriateness and acceptability for national implementation; (b) achieving national agreement to implement a common tool; (c) creating and disseminating training materials while supporting training personnel in implementation; and (d) integrating delirium monitoring within the Paediatric Intensive Care Audit Network national database.

Among seven validated instruments, the top ranked options (from 1, most applicable to 7, least applicable) were the Cornell Assessment of Pediatric Delirium (average rank 1.25) and the Sophia Observation withdrawal Symptoms-Paediatric Delirium scale (1.5). Twenty-three units voted for their preferred choice of instrument: fifteen preferred the Cornell instrument, eight favoured the Sophia instrument and five did not respond. Training and implementation began in November 2021 and by March 2023 18 of the 28 units (64%) had successfully implemented screening. The national database began actively collecting delirium data from units in January 2024.

This initiative outlined critical steps for implementing and maintaining practice of delirium screening in PICUs. We provided clinicians with validated screening tools for detecting paediatric delirium and the necessary support and infrastructure to maintain screening. Embedding and sustaining screening is an ongoing challenge.

Undertaking routine screening for all intensive care patients from admission to discharge using validated instruments will provide earlier detection and treatment for critically ill children. This strategy offers a model for standardized and effective implementation in clinical practice in ICUs.