Date Available

4-23-2024

Year of Publication

2024

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Misty Ellis

Clinical Mentor

Dr. Laura Sobylya

Committee Member

Dr. Candice Falls

Abstract

Background. Delirium is an acute clinical syndrome that is characterized by features of disrupted arousal, attention, cognition, sleep, and perception. Delirium is a well-documented phenomenon in critical care settings in both adult and pediatric populations, particularly among patients with length of stay greater than or equal to 48 hours. Delirium has multiple adverse effects, including increased mortality rate, prolonged duration of mechanical ventilation, higher reintubation rates, prolonged intensive care unit (ICU) admission, prolonged hospital admission, short- and long-term cognitive impairment, and posttraumatic stress disorder. There are currently no accepted guidelines or FDA approved medications to treat ICU delirium in the pediatric population, but there is promising research that indicates nonpharmacologic interventions may decrease the incidence and severity.

Purpose. The purpose of this project was to increase the utilization of nonpharmacologic interventions by providing education and creating new documentation requirements for bedside nurses with a goal of decreasing Cornell Assessment of Pediatric Delirium (CAPD) scores in patients intubated and sedated in a Pediatric ICU (PICU).

Methods. This project utilized a quasi-experimental design with a retrospective chart review to evaluate the impact of nurse-driven nonpharmacologic interventions on CAPD scores in patients intubated and sedated in a PICU.

Results. After bedside nurses received education on delirium, a new documentation requirement for nonpharmacologic interventions to prevent and/or decrease the incidence of delirium was implemented for intubated and sedated patients in the PICU. In the pre-intervention chart review, one third of patients (33%) scored positive for delirium (CAPD > 8), compared to 13% in the post-intervention chart review (p=.008).

Conclusions. This DNP project reinforces The American College of Critical Care Medicine’s recommendation that nonpharmacologic prevention strategies are the strongest recommendation for the prevention and treatment of delirium. These results suggest that nurse-driven nonpharmacologic interventions could significantly decrease the incidence and severity of delirium in intubated and sedated patients who are receiving care in a PICU. This DNP project showed favorable changes in delirium scores, which would hopefully lead to shortened ICU stays and improved morbidity and mortality in this patient population.

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