(1262) Improving Delirium Screening in the Pediatric ICU

Introduction: Delirium can be a common occurrence in critically ill children admitted to a pediatric intensive care unit (PICU). It is associated with increased PICU length of stay, duration of mechanical ventilation, and morbidity and mortality. Delirium prevention and management is predicated on reliable detection and is a key component of ICU liberation strategies. The Cornell Assessment of Pediatric Delirium (CAPD) scoring system has been validated in the pediatric population and we sought to improve scoring compliance using the CAPD scoring system in our PICU to 50%.

Methods: This quality improvement project was conducted from December 2023 through July 2024 at a quaternary children’s hospital. Successful scoring compliance was defined as one CAPD score per 12 hours. Barriers to scoring were determined by soliciting input from PICU team members. This informed our interventions. Interventions included team education, manual electronic medical record (EMR) integration into task lists, reminders to PICU team members to include scoring in rounding discussions and compliance audits. All interventions were Level 1 or 2 as defined by the high reliability toolkit.

Results: During the study period, average weekly scoring compliance increased from 8% to 48%. Interventions with highest impact on compliance included those that made CAPD scoring part of the daily nursing task list within the EMR and compliance audits with staff reminders to complete CAPD scoring.

Conclusions: Ensuring delirium scoring occurred reliably in our PICU was dependent on automation of nursing task lists and multidisciplinary team awareness of – and attendance to – delirium scoring. Further improvement and sustainability will be dependent on implementation of Level 3 interventions, decreasing the reliance on human factors for sustained change.