O3203: Family Engagement and Education on Delirium Prevention in the Pediatric Intensive Care Unit

Purpose/Objectives: Delirium is a prevalent cause of morbidity in critically ill children. Recent efforts in the pediatric ICU have focused on environmental prevention of delirium by nursing and physician staff. Family engagement in environmental prevention and treatment of delirium has the potential to reduce delirium in the pediatric ICU. However, parent’s baseline knowledge of delirium and empowerment to engage in delirium prevention is unknown. Therefore, the primary objective of this study is to determine baseline family knowledge of delirium and engagement in this ICU.

Design/Methods: We conducted an observational cohort study of family caregivers of children admitted to the pediatric ICU at a tertiary care hospital for more than 48 hours. Participants were excluded if their child was not expected to survive due to plans for withdrawal of care or pending brain death examination. Child demographic and illness characteristics were collected from the electronic health record. Family knowledge of delirium was assessed through an adapted caregiver ICU delirium knowledge questionnaire (CIDKQ) that has previously been validated in the adult population. Family engagement was measured using an adapted FAMily Engagement (FAME) tool with lower scores reflecting less engagement. Descriptive statistics were performed.

Results: Between November 2023 and March 2024, 81 (75.7% enrollment) family caregivers participated in this study. Most participants were parents (97.5%), while the remaining were individuals who were legally authorized to consent to the child’s general medical care (2.5%). The median age of their child was 3.5 years (IQR 0, 9 years) and the median length of stay was 11 days (IQR 4, 9). Approximately 61% (n=49) had a positive screen for delirium, 60% (n=47) required mechanical ventilation, 41% (n=32) received a benzodiazepine for sedation and 13% (n=10) received an atypical antipsychotic for treatment of delirium. The mean CIDKQ was 11/15 (SD ± 2, range 6 to 14). Knowledge gaps in risk factors and identification for delirium were present. The overall mean FAME score was 27/30 (SD ±4, range 10 to 30). In our cohort, the lowest FAME engagement scores reflected room for improvement in staff encouragement of family participation in their child’s care and involvement in decision making.

Conclusion/Discussion: An assessment of family caregiver knowledge of delirium and engagement in their child’s care at baseline demonstrated gaps in understanding risk factors and symptoms of delirium as well as the ability to engage in their child’s daily care in the ICU demonstrating the need for an intervention focused on family engagement in delirium prevention. In response to these findings, a family toolkit was developed to encourage family participation and engagement in environmental delirium prevention. Following an interventional period, we will evaluate the impact of this toolkit on family knowledge and engagement.