title: Identifying Barriers to Delirium Screening and Prevention in the Pediatric ICU: Evaluation of PICU Staff Knowledge.
abstract: Delirium in the pediatric intensive care unit (PICU) setting is often unrecognized and undertreated. The importance of screening and identification of ICU delirium has been identified in both adult and pediatric literature. Delirium increases ICU morbidity, length of mechanical ventilation and length of stay. The objective of this study was to determine the current knowledge level about delirium and its risk factors among pediatric critical care nurses through a short questionnaire. We hypothesized that before a targeted educational intervention, PICU care providers do not have an adequate knowledge base for accurate screening and diagnosis of delirium in critically ill children. A 17 question online survey was given to all nurses in a tertiary 36-bed PICU to assess current knowledge about delirium in children. The response rate was 73% (105/143). When asked to identify the correct way to diagnose pediatric delirium, 11.4% of nurses surveyed (12/105) incorrectly believed that Glasgow Coma Score is the appropriate screening tool. A large proportion of respondents (40/105) believed that benzodiazepines are helpful in treatment of delirium. The results of the survey identified specific knowledge gaps about risk factors and treatment of pediatric delirium in the critically ill child. There is a critical need for education about pediatric delirium and its risk factors among PICU staff prior to unit-wide implementation of a delirium screening and prevention program, specifically with regards to screening methods and pharmacologic risk factors. These results are likely generalizable to all physicians, nurses and staff who care for critically ill children.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine & Pediatrics, Johns Hopkins University, Maryland.
authors.forename: Melanie Cooper
authors.initials: MC
authors.lastname: Flaigle
authors.affiliation: Johns Hopkins Hospital, Maryland.
authors.forename: Judy
authors.initials: J
authors.lastname: Ascenzi
authors.affiliation: Department of Anesthesiology and Critical Care Medicine & Pediatrics, Johns Hopkins University, Maryland. Electronic address: skudcha1@jhmi.edu.
authors.forename: Sapna R
authors.initials: SR
authors.lastname: Kudchadkar
mesh_terms: D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003422:Critical Care / Q000592:standards / Q000639:trends; D016638:Critical Illness / Q000451:nursing; D003693:Delirium / Q000175:diagnosis* / Q000451:nursing* / Q000517:prevention & control; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D019359:Knowledge; D008297:Male; D008403:Mass Screening / Q000379:methods; D008991:Monitoring, Physiologic / Q000451:nursing; D024802:Nurse's Role; D009746:Nursing, Team; D010371:Pediatric Nursing / Q000193:education*; D010865:Pilot Projects; D011795:Surveys and Questionnaires
keywords: Critical care; Delirium; Nursing education; Pediatric delirium; Pediatrics; Sleep