Aims Paediatric delirium (PD) is a neuropsychiatric disorder with disrupted cerebral functioning due to underlying disease and/or as a result of critical care treatment.¹ PD presents as hypoactive, hyperactive, or mixed, with hypoactive PD more commonly reported in children.² PD is reported in 34% PICU admissions.³

The European Society of Paediatric and Neonatal Critical Care Medicine (ESPNIC) and Society of Critical Care Medicine recommends screening in 100% of PICU patients from all age groups.^{3 4} As part of a quality improvement initiative (QI) PD screening was introduced to our hospital, with training completed on 11th March 2020. Ad hoc spot checks revealed screening rates less than 50%. An ethics waver by CHI research committee and permission from the PICU research group was granted in March 2022, to start a point prevalence once a week and feedback results to the PICU multidisciplinary risk meeting.

Method The PICU is divided into two locations (floors). Patients on each floor were identified using the ward census book. Each electronic medical record (eHR) was accessed and screening compliance recorded using an MS Excel sheet.

Data was collected retrospectively by a student on placement from the months March-October.

Results Of the 565 patients records included, 146 (26%) had a morning PD score undertaken and 127 (22%) had an evening PD score undertaken on the day of audit. Compliance was higher in the morning for floor 1 (30%), with floor 2 having a higher compliance screening in the afternoon (27%). The highest compliance rates were recorded for both floors during May 2022. The highest compliance recorded was 46% for morning and 54% for afternoon screening.

Conclusions Despite formal education for all staff, and all new staff, PD screening rates remain low. Further work is required to identify strategies that could improve rates.

References

1. Schieveld JN, Leroy PL, van Os J, et al. Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit. Intensive Care Med 2007;33:1033–1040.

2. Semple D, Howlett MM, Strawbridge JD, et al. A systematic review and pooled prevalence of delirium in critically ill children. Crit Care Med 2022;50:317–328.

3. Harris J, Ramelet AS, van Dijk M, et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals. Intensive Care Med 2016;42:972–86.

4. Smith HAB, Besunder JB, Betters KA, et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med 2022;23:e74–e110.