PURPOSE

A diagnosis of delirium places a critically ill child at risk of increased morbidity/mortality. Although delirium is common in critically ill children, only 2% of pediatric intensive care units (PICU) screen for delirium. The impediments to screening include knowledge deficits regarding delirium and delirium screening tools. The purpose of this improvement science project was two-fold. The first was to implement delirium screening in a PICU. The second was to evaluate the impact of multifaceted education on PICU nurses' delirium knowledge, self-confidence and attitude towards delirium.

DESIGN & METHOD: A series of three plan-do-study-act cycles (PDSA) were used to implement this practice change. Multifaceted education was provided during the PDSA cycles. Two questionnaires were used to assess for changes in delirium knowledge, self-confidence and attitude towards delirium among PICU nurses. Analysis of variance (ANOVA) was used for data analysis.

RESULTS

Forty-two PICU nurses completed a questionnaire measuring delirium knowledge, self-confidence, and attitude during each PDSA cycle. A significant increase in delirium knowledge, self-confidence, and attitude towards delirium was found after education (p = .003; p < .001; p = .036) and 3 months post implementation of delirium screening (p = .023; p < .001; p = .027) as compared to pre-education.

CONCLUSION & PRACTICE IMPLICATIONS: Multifaceted education is a successful tool in improving nurses' knowledge, self-confidence and attitude regarding delirium. The use of PDSA cycles is a practical systematic method to improve quality of care. Improving knowledge, self-confidence and attitude have the potential to mitigate adverse effects of delirium in the critically ill child.