Effects of a Multidisciplinary Stewardship Program on the Prevention of Delirium in the Pediatric Intensive Care Unit

Abstract

OBJECTIVE To evaluate the effect of a multidisciplinary practice bundle on the incidence of delirium in the pediatric intensive care unit (PICU). METHODS This retrospective observational study evaluated patients admitted to the PICU with Cornell Assessment of Pediatric Delirium (CAPD) scoring. A multidisciplinary practice bundle was implemented involving pharmacists, nurses, and providers. Study endpoints included CAPD scores greater than or equal to 9, length of hospital stay, and days spent in the PICU. RESULTS The study included 192 patients. The pre-intervention mean CAPD score was 3.59, maximum of 24 (range, 0–24), and 4.5% of patients had a score ≥9. The post-intervention mean score was 4.04, maximum of 21 (range, 0–21), and 9.6% of patients had a score ≥9. The pre-intervention mean total length of hospital stay was 8.7 days, maximum of 149 days (range, 0–149); the mean number of days spent in PICU was 4.5 days, and maximum days in PICU was 89 days (range, 0–89). The post-intervention mean total length of hospital stay was 8.8 days, maximum of 57 days (range, 0–57); the mean number of days spent in PICU was 3.9 days, and maximum days in PICU was 31 days (range, 0–31). CONCLUSIONS Implementation of a multidisciplinary practice bundle, the use of CAPD scores, and the stewardship of high-risk patients increased overall awareness of the occurrence of pediatric delirium in the PICU and reduced length of stay in the intensive care unit and therefore reduced cost for families and the institute. ABBREVIATIONS CAPD, Cornell Assessment of Pediatric Delirium; DSM, Diagnostic and Statistical Manual of Mental Disorders; EHR, electronic health record; ICD, International Classification of Disease; ICU, intensive care unit; PICU, pediatric intensive care unit; RASS, Richmond Agitation and Sedation Scale.