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A Family-Centred Paediatric Delirium Bundle: A Feasibility Study
Rikke Louise Stenkjaer1, Ingrid Egerod2,3, Mala Moszkowicz4
1Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Insights
A new family-centered, non-pharmacological bundle for paediatric delirium (PD) shows promise. While acceptable to clinicians and parents, further revisions are needed before a randomized controlled trial.
Area of Science:
- Pediatric Critical Care Medicine
- Delirium Management
- Family-Centered Care
Background:
- Paediatric delirium (PD) is prevalent in critically ill children, necessitating improved management strategies.
- A family-centered, non-pharmacological delirium management bundle was developed using expert and parent consensus.
- The bundle includes interventions like establishing daily routines and promoting parental presence.
Purpose of the Study:
- To evaluate the feasibility of the PD bundle by assessing its acceptability, implementation, and practicality.
- To gather feedback from parents, nurses, and physicians on the bundle's usability in clinical settings.
Main Methods:
- A mixed-methods process evaluation was conducted, incorporating quantitative surveys and qualitative focus group interviews.
- The study took place in two pediatric cardiac units between March and May 2024.
- Feasibility was assessed against pre-defined goals for acceptability, implementation, and practicality.
Main Results:
- The PD bundle was found acceptable by parents, nurses, and physicians, with all interventions deemed relevant and familiar.
- Six out of eleven interventions were implemented in over 80% of cases, as reported by parents; five interventions fell short of targets.
- Training for delivering the bundle reached 90% of invited nurses and physicians, exceeding the 80% goal. Practical application was challenged by organizational factors and differing hygiene policy interpretations.
Conclusions:
- The developed PD bundle demonstrates potential for acceptance, implementation, and practical use in clinical settings.
- Despite promising initial results, the bundle's delivery fell short of target goals, indicating a need for revision.
- A revised non-pharmacological paediatric delirium bundle should be tested prior to initiating a randomized controlled trial.
Background:
Paediatric delirium (PD) is a common disorder in critically ill children. PD management, however, needs improvement. To this end, we developed a family-centred non-pharmacological delirium management bundle based on consensus from paediatric intensive care unit experts and parents. The bundle included interventions such as developing a day structure and encouraging parent presence.
Aim:
We aimed to test the feasibility of our PD bundle by investigating acceptability, implementation and practicality for parents, nurses and physicians.
Study Design:
A multiple-method process evaluation study with quantitative and qualitative data, using questionnaires and focus group interviews. To determine the feasibility of the PD bundle, we set provisional goals for the acceptability, implementation and practicality prior to conducting our study. The study took place in two paediatric cardiac units from March to May 2024.
Results:
Two focus group interviews were held with 15 nurses and four physicians. Parents, nurses and physicians found the PD bundle acceptable because all the interventions were intuitively relevant and familiar, meeting our target goals to proceed with an RCT study. We surveyed 31 parents to estimate the degree of implementation of the 11 interventions in the PD bundle. Six of the interventions in the bundle were delivered in more than 80% reported by the parents, while five fell short of our target goals. Nurses and physicians suggested that the PD bundle could be implemented if the interventions were consolidated into fewer elements. We trained 90% of the invited nurses and physicians to deliver the PD bundle, which met our target goal of 80%. Hospital organisation, environment and differences in hygienic policy interpretations challenged the practical application of the PD bundle according to the nurses and physicians.
Conclusions:
The PD bundle appears promising for acceptance, implementation and practical application in clinical practice. However, as the delivery of the PD bundle fell short of our target goals, a revised PD bundle should be tested before performing an RCT.
Relevance To Clinical Practice:
A non-pharmacological paediatric delirium bundle is now available to critical care nurses to prevent and manage delirium in critically ill children.
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