Recognizing Delirium in the PICU: An Evidence-based Practice Improvement Project

Introduction: Pediatric delirium is underrecognized in the pediatric population and can lead to increased length of stay, hospital costs, and post-traumatic stress disorder (PTSD). Using a standardized screening tool to assess for delirium is an easy way for bedside nurses to evaluate patients and intervene as necessary. This quality improvement project aimed to implement the Cornell Assessment of Pediatric Delirium (CAPD) and complete a delirium screening on applicable patients once a shift > 85% over four months.

Methods: Between January 2020 to May 2020, bedside nurses completed a delirium screening assessment on applicable patients, first on paper and then through the electronic medical record (EMR). A retrospective chart review was conducted every two weeks to assess compliance and demographic data such as hospital length of stay, length of mechanical ventilation, Midazolam usage, and CAPD scores.

Results: By the fourth week of implementation, 85% of nurses were compliant with screening. The aim was met and continued above 85% throughout the project. A positive delirium screen of more than 48 hours statistically increased length of stay (P < .001). The average CAPD score pre-intervention to post-intervention and during and after intubation was significantly lower (P = .016 and P = .001, respectively).

Conclusions: Providing the delirium screening tool in the Electronic Medical Record (EMR) increases compliance and ensures that the providers acknowledge the positive delirium screens. While the screen’s implementation was successful, additional measures are needed to manage and prevent delirium and improve patient care.