Arizona Nurse - January 2022

January, February, March 2022 Arizona Nurse • Page 5
Preventing Delirium in Pediatric Intensive Care Unit Patients
Kelsey Randall
Delirium is a concern in many intensive care
unit settings and has been recognized as having
potential implications in the pediatric population.
This problem was identified by a pediatric intensive
care unit (PICU) nurse who floated to an adult
intensive care unit and noticed that they screened
their patients for delirium. After searching the
literature, she found that this topic was emerging
as an area of concern in the pediatric realm as well.
Sadly, pediatric delirium is an under-recognized,
untreated problem, but can be avoided (Holly, et
al., 2018).
Evidence is strong that delirium can be quite
costly for PICU patients. Systematic reviews suggest
that pediatric delirium increased patient duration
of stay, cost, and even resulted in mortality (Holly,
et al., 2018). However, prevention is possible with
early detection, staff education, implementation of
screening tools, and preventative interventions.
Nurses are heavily involved in pediatric patient
care and as such they are in an optimal position
to recognize delirium characteristics and reduce
risk (Holly, et al., 2018). Recognition of delirium
and education on this topic are key in preventing
detrimental outcomes for high acuity pediatric
patients.
Nurse-driven evidence-based projects can lead
to a technology improvement where a delirium
screening tool can be incorporated into a nurse
charting system. This process was implemented in
one Scottsdale pediatric intensive care unit with
success. The first objective of this project was to
provide extensive education on delirium to the staff
(assessment of knowledge occurred with a pre- and
post-test). Then the Cornell Assessment of Pediatric
Delirium (CAPD), a valid, rapid, observational
nurse screening tool was implemented into nurse
charting to help with the detection of delirium
in the PICU setting (Traube, et al., 2017). This
technology improvement project also focused on
directing nurses to apply preventative interventions
and to follow up on action items such as provider
notification if a screening was positive.
Implementation allows for the CAPD screening
tool to be completed and documented on all PICU
patients in this hospital each shift. Furthermore,
preventative interventions for delirium are
applied and score trends are monitored in
documentation. Following project completion,
doctors and nurses now round together and
collaborate to decrease the rates of pediatric
delirium. Since January 2021, over 270 PICU
patients have been screened for delirium on this
unit. Twenty-six patients were identified as having
positive screenings. Physician collaboration with
nursing to reduce risk in these patients has been
initiated to improve outcomes.
References
Holly, C., Porter, S., Echevarria, M., Dreker, M.,
& Ruzehaji, S. (2018). CE: Original research:
Recognizing delirium in hospitalized children:
A systematic review of the evidence on risk
factors and characteristics. The American
Journal of Nursing, 118(4), 24-36. doi:10.1097/01.
NAJ.0000532069.55339.f9.
Traube, C., Silver, G., Kearney, J., Patel, A., Atkinson,
T. M., Yoon, M. J., Greenwald, B. (2014). Cornell
assessment of pediatric delirium. Critical
Care Medicine, 42(3), 656-663. doi:10.1097/
ccm.0b013e3182a66b76
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