Elvia Rivera-Figueroa, MD, MPH,
Pediatric Critical Care Fellow
UMMC
Jackson, MS
Disclosure information not submitted.
Cynthia Karlson, Ph.D.
Psychology
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Whitney Mays, PharmD
Clinical Pharmacist
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Sara Jones, PharmD
Clinical Pharmacist
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Jennifer Hong, MD
Associate Professor, School of Medicine, Department of Pediatrics, University of Mississippi Medical
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Title: Optimizing Delirium Assessment Within the Children's of Mississippi Pediatric Critical Care Unit
Introduction: Delirium in the pediatric intensive care unit (PICU) is unrecognized and undertreated. It is defined as a disturbance in attention, awareness, and cognition from baseline. Its negative impact on hospital course is becoming more recognized, encouraging the need to prevent, identify, and manage delirium early. Prior to 2020, our PICU did not screen for delirium and recognition was based on clinical suspicion. We present the baseline data of a quality improvement project that aims to improve the assessment, identification, and management of pediatric delirium in the Children’s of Mississippi PICU.
Design: Prospective observational analysis of pediatric delirium at a thirty-bed mixed PICU in a tertiary academic medical center. Inclusion Criteria: Ages 6 months-old to 18 years-old admitted to the medical and surgical ICU from March 2021-July 2021. Exclusion criteria: younger than 6 months or 18y/o, State Behavioral Scale scores of -2 or -3, patients on paralytic infusion, and cardiac surgery.
Methods: Our multidisciplinary team implemented a daily delirium screen using the validated the Preschool and Pediatric Confusion Assessment Method for the ICU (psCAMICU)/(pCAM-ICU). Bedside nurse’s awareness of delirium, the pCAM/psCAM-ICU assessment tools, and nurse opinion regarding ease of daily screening were assessed.
Results: Delirium screening was conducted for 87 consecutive patients. 24/87 (28%) screened positive for delirium. 67% of patients who screened positive for delirium were 5 years or older. 7/24(29%) of patients with delirium did not have a family member present at the time of screening. 77% of bedside nurses were not familiar with the pCAM/psCAM-ICU assessment for delirium. 100% of the bedside nurses had a positive response towards performing the delirium screen.
Conclusion: Consistent with previous published prevalence rates, results of this baseline QI project data reveal that delirium is prevalent (28%) in the Children's of Mississippi PICU. Nurse knowledge regarding formal psCAM/pCAM-ICU screening for delirium is low; however, enthusiasm for daily screening was high. Future QI intervention cycles will educate staff and families about delirium prevention, establish a delirium-prevention order set, implement nurse screening for delirium.