Tracie Walker, MD
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Disclosure information not submitted.
LeeAnne Flygt
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Disclosure information not submitted.
Lavinia Kolarczyk, MD
Associate Professor of Anesthesiology Division Chief, Cardiothoracic Anesthesiology Executive Direct
University of North Carolina, United States
Disclosure information not submitted.
Darren Dewalt, MD, MPH
Epidemiology John R. and Helen B. Chambliss Distinguished Professor
University of North Carolina, United States
Disclosure information not submitted.
Matthew Jones, LSSGB, BA
Quality and Org Excellence Leader
University of North Carolina, United States
Disclosure information not submitted.
Lauren Walter, PharmD
Pediatric Clinical Pharmacist
University of North Carolina, United States
Disclosure information not submitted.
.jpg "Stephanie Schwartz, MD photo")
Stephanie Schwartz, MD
Assistant Professor, Pediatric Critical Care Medicine
University of North Carolina Childrens Hospital
Chapel Hill, North Carolina
Disclosure information not submitted.
Title: Stomp out Delirium: A descriptive account of PDSA cycles to implement delirium screening in the PICU
Introduction: Delirium is a significant morbidity in the pediatric intensive care unit (PICU) with reported prevalence rates of 22-44% in critically ill children. Pediatric delirium has been associated with increased mortality, hospital length of stay, and healthcare cost. Previous studies have shown that implementation of a delirium prevention and screening bundle can lead to decreased prevalence of delirium, however how to implement this bundle has not been previously published. We describe our experience using quality improvement to enact delirium screening in a quaternary PICU with no previous history of delirium screening.
Methods: A multidisciplinary team developed a plan to implement and monitor the use of a three-tier pediatric delirium bundle encompassing prevention, screening, and treatment. Iterative tests of change using frequent PDSA cycles were used to improve compliance and adjust processes to achieve our project aim. A focus on multi-disciplinary education led to a shared mental model for all members of the PICU team regarding sedation goals and delirium recognition. Process improvements included charge nurse driven check-ins, educational highlights at daily nursing huddles, inclusion of delirium screening to the safety sheet, delirium spirit weeks for continued education and addition of delirium screening into the electronic medical record as a nursing task.
Results: By using continuous quality improvement, we applied various process changes to increase the percentage of pediatric ICU patients appropriately screened for pediatric delirium from zero to >50% within six months after the introduction of a delirium bundle.
Conclusions: Implementation of a pediatric delirium screening bundle into an already busy nursing agenda can be challenging and should be customized to fit the needs of each PICU. By using PDSA cycles, we found multiple interventions that did not lead to sustained improvements. However, with iterative changes, we were able to successfully implement delirium screening into the daily nursing workflow, which has the potential to improve outcomes of our patients by early recognition of pediatric delirium.