1. Bundle to Eliminate Delirium Improves Pediatric ICU Culture and Patient Outcome
Yu Kawai MD1; Gina Rohlik APRN2; Lori Neu DNP2; Debra Rowekamp MS RN2; Scott Feigal MSN2; Karen Fryer BSN3; Rahul Kashyap MBBS3; Michael Nemergut MD PhD4; Robert Kahoud MD1; Grace M Arteaga MD1
1Division of Pediatric Critical Care, 2Department of Nursing, 3Division of Anesthesia Clinical Research, 4Department of Anesthesia and Pediatrics
Mayo Clinic Children’s Center, Rochester MN
Pediatric delirium is a manifestation of brain dysfunction that is associated with:
↑ length of hospitalization
↑ mortality rate
↑ in direct medical cost
↑ psychiatric disorders after hospital discharge
1 in 4 children admitted to the PICU develop delirium
Background
Figure 1. BED Checklists
Frequency of Delirium Discussion
Frequency of Delirium Tasks Completed
To implement a bedside nursing checklist, the Bundle to Eliminate Delirium (BED) (Figure 1), focused on prevention/management of delirium
Evaluate nurse knowledge/confidence in delirium
Objectives
BED Compliance Rates
Methods
Pediatric Delirium Prevalence
10 point Likert Scale survey related to delirium distributed to 95 PICU nurses
1 month prior and 3 months after BED implementation
Assessed for frequency & confidence in performing delirium-related patient care
Survey data (pre-BED vs post-BED median) compared
Delirium prevalence calculated
Frequency of Pediatric Confusion Assessment Method (pCAM), a bedside tool to diagnose delirium, indicating positivity for delirium
Data from the first 12 weeks after BED deployment compared to data from the same 12 weeks in 2014, 2015, and 2016
Nurse Confidence
Conclusions
BED is easy to use and achieved high compliance
PICU nurses more confidently and more frequently performed delirium-related patient care
BED is associated with ↓ delirium prevalence