(1275) Shining a Light on Pediatric ICU Delirium

Introduction: Delirium is a non-specific syndrome characterized by acute impairment of cognition, awareness, and attention. Delirium is highly prevalent among critically ill patients with associated increases in morbidity and mortality. While the pathophysiology of delirium remains poorly understood, risk factors in the intensive care unit are numerous and require a multidisciplinary approach for early identification, minimization of risks, and early intervention to prevent detrimental short- and long-term consequences.

Methods: A quality improvement project with prospective observational analysis was implemented in a high-volume, 32-bed Pediatric Intensive Care Unit (PICU). A multidisciplinary team implemented an ICU delirium protocol using the Plan-Do-Study-Act cycles as part of a fellow-driven quality improvement project to better regulate patient circadian rhythm using light therapy during daytime. The primary outcome was increased compliance of drawing up shades and turning on lights in patient rooms by a specified time in the morning. Clinical protocols included nursing education and prompts to intervene, provider education and restructuring of presentations to enforce the intervention, and family education on ICU delirium prevention.

Results: Baseline rates of drawing up shades and turning on lights prior to intervention were 57% and 25%, respectively. Three months after the delirium protocol was implemented, the mean compliance rates of opening shades and turning on lights in patient rooms is 79% and 46%. Secondary analysis showed in increase in use of the Cornell Assessment of Pediatric Delirium (CAP-D) revised tool.

Conclusions: In this center’s PICU, opening of shades and turning on room lights during the daytime is a low cost and pragmatic way to enable light exposure therapy, but is variably and infrequently implemented. Implementation of a multidisciplinary delirium prevention bundle, along with staff education and regular bedside intervention screening is associated with an increase in delirium prevention compliance. Additionally, fellow-led quality improvement projects can be challenging given clinical workload but can be rewarding and effective.