P2.O287: Increasing Delirium Screening in the Pediatric Intensive Care Unit: A Quality Improvement Project.

Purpose/Objectives: In November 2022, an ABCDEF liberation bundle was introduced in the pediatric intensive care unit (PICU) at Carilion Children’s Hospital. Six months after the introduction, we noticed a very low utilization rate of the Cornell Assessment of Pediatric Delirium (CAP-D) screening tool that had been implemented. We identified this as an opportunity for a quality improvement project to increase rates of delirium screening. Our SMART goal was to increase screening for delirium using the CAP-D tool in the PICU to 30% by February 2024.

Design/Methods: Three interval Plan-Do-Study-Act (PDSA) cycles were performed. First, we provided didactic nursing education on delirium and the CAP-D tool. Second, we held a liberation bundle workshop which included interactive learning and simulation. The final intervention involved the addition of CAP-D screening to a pre-existing PICU rounding checklist. We speculated that increased awareness of CAP-D scores would lead to decreased sedation levels and improved sleep hygiene, and that this could impact rates of unplanned extubations and pressure injuries, so these were also monitored.

Results: We successfully increased the rate of CAP-D usage by >50% between July 2023 and February 2024 (figure 1). Although the initial didactic education had no impact on CAP-D usage, we saw a significant increase following the interactive workshop. The third intervention did not impact rates of screening. Fortunately, we did not see an increase in unplanned extubations or pressure injuries.

Conclusion/Discussion: A PDSA cycle approach can be used to increase CAP-D screening rate. Research supports the increased impact of experiential learning over didactic learning and the results of this project are consistent with that. Checklists are known to decrease errors of omission; our lack of findings with adding it to our checklist may be due to the timing as it was implemented just before the end of the study. Further interventions are planned to continue to improve our delirium screening rates.