Interdisciplinary Collaborative Strategies to Improve Delirium Screening Documentation in the Pediatric CICU.

Abstract

Background and objectives: A lack of consistent delirium screening and documentation has been a recurring problem across intensive care units. We aim to improve the rate of delirium screening and documentation among patients admitted to cardiac intensive care units (CICU) in a 34-bed tertiary pediatric cardiac intensive care unit from 10% to 85% over 12 months.

Methods: We first reviewed our existing practice of delirium screening and documentation in the electronic Epic patient database system. Once key barriers in our unit practice were identified, the intervention included Epic admission order-sets and Flowsheet updates for standardized delirium screening ordering and documentation. We also provided unit-wide nursing education on delirium screening and documentation using the Cornell Assessment of Pediatric Delirium tool. Delirium documentation compliance was assessed before and after the implementation of the new strategy for those with age <18 years and CICU admission > 48 hours.

Results: Our initial review showed inconsistent and sporadic screening and documentation of delirium where only 10% of eligible admitted patients had documented delirium scores in the chart. After implementing Epic changes and education, 97% of admitted patients had screening and documentation of delirium over a 1-year period following the change.

Conclusions: Newly implemented multi-disciplinary strategy targeting a standardized delirium screening order and efficient Flowsheet organization along with nurse-focused education on delirium led to significant improvement in delirium screening and documentation in our pediatric cardiac intensive care unit.