(684) Multidisciplinary Survey of Early Mobility, Sedation, and Delirium Management in a Quaternary PICU

Introduction: Early and progressive mobility in the Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU) has been correlated with reduced mechanical ventilation and improved patient outcomes. Sedation and delirium are critical factors impeding early mobility but also strong contributors to pediatric post intensive care syndrome. Protocolized interventions, utilizing multidisciplinary perspectives, are emerging as promising avenues to address these issues and promote sustainable change in patient care. However, instituting change requires an understanding of the current culture of the unit and mindset of those being asked to participate. Guided by this understanding, a multidisciplinary needs assessment survey was developed to examine current practices in a quaternary PICU/PCICU.

Methods: The survey, investigating current practices related to sedation, delirium, and early mobility was disseminated to diverse professionals including nurses, physicians, therapists, pharmacists, and mental health specialists. The goal was to identify barriers to protocol implementation through questions concerning demographics and individual experiences.

Results: Out of 61 completed surveys (44% nursing), over 80% agreed on the necessity of a protocolized approach for sedation and weaning, recognizing its impact on preventing withdrawal and reducing ventilator days. Major barriers to implementation included caregiver bias (75%) and resistance to change (>50%). Pre- rollout education was requested by >85%. Understanding of delirium varied, with only 50% having clear comprehension. Over 70% of participants viewed delirium as important to address in the PICU. Early mobility was endorsed by 91% as enhancing care, but perceived barriers such as physician buy-in, safety concerns, knowledge, and service coordination were noted in >75% of respondents. Overarching themes to implementation encompassed the need for education, bedside tools, and collaboration.

Conclusions: A multidisciplinary survey elucidated essential factors for early mobility, sedation, and delirium management in a quaternary care PICU: education, staff support, resources, and institutional commitment. These findings form a foundation for shaping practice change and may guide subsequent protocol development.