Overcoming Barriers to Delirium Screening in the Pediatric Intensive Care Unit
| Autor: | Sandeep Tripathi, Julie Duncan, Robert J. Kahoud, Karen Fryer, Heather L. Coon, Gina Rohlik, Dipti R. Padhya |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Quality management Adolescent medicine.medical_treatment MEDLINE Critical Care Nursing Intensive Care Units Pediatric law.invention Midwestern United States 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Interquartile range law Surveys and Questionnaires medicine Humans Mass Screening 030212 general & internal medicine Child Mechanical ventilation Pediatric intensive care unit business.industry Case-control study Infant Newborn Delirium Infant 030208 emergency & critical care medicine General Medicine Case-Control Studies Child Preschool Emergency medicine Female medicine.symptom business |
| Zdroj: | Critical care nurse. 38(4) |
| ISSN: | 1940-8250 |
| Popis: | BACKGROUNDDelirium is associated with poor outcomes in adults but is less extensively studied in children.OBJECTIVESTo describe a quality improvement initiative to implement delirium assessment in a pediatric intensive care unit and to identify barriers to delirium screening completion.METHODSA survey identified perceived barriers to delirium assessment. Failure modes and effects analysis characterized factors likely to impede assessment. A randomized case-control study evaluated factors affecting assessment by comparing patients always assessed with patients never assessed.RESULTSDelirium assessment was completed in 57% of opportunities over 1 year, with 2% positive screen results. Education improved screening completion by 20%. Barriers to assessment identified by survey (n = 25) included remembering to complete assessments, documentation outside workflow, and “busy patient.” Factors with high risk prediction numbers were lack of time and paper charting. Patients always assessed had more severe illness (median Pediatric Index of Mortality 2 score, 0.90 vs 0.36; P < .001), more developmental disabilities (moderate to severe pediatric cerebral performance category score, 54% vs 32%; P = .007), and admission during lower pediatric intensive care unit census (median [interquartile range], 10 [9–12] vs 12 [10–13]; P < .001) than did those never assessed (each group, n = 80). Patients receiving mechanical ventilation were less likely to be assessed (41.0% vs 51.2%, P < .001).CONCLUSIONSSuccessful implementation of pediatric delirium screening may be associated with early use of quality improvement tools to identify assessment barriers, comprehensive education, monitoring system with feedback, multidisciplinary team involvement, and incorporation into nursing workflow models. |
| Databáze: | OpenAIRE |
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