Reducing Postintensive Care Syndrome: Pediatrics in the Child with Congenital Heart Disease by Addressing Delirium

Advances in healthcare are decreasing mortality but increasing morbidity. As a result of the advanced treatment, recognition of a cluster of long-term complications known as postintensive care syndrome – pediatrics, or PICS-p, has developed. PICS-p impacts four areas of health: psychological, cognitive, physical, and social. The literature revealed best practices for reducing PICS-p complications in patients with congenital heart disease (CHD). Based on the standard bundle for best practices to prevent PICS-p, the ABCDEF bundle, a quality improvement project was conducted with an emphasis on identifying and recognizing delirium in the child with CHD while admitted to an inpatient cardiology unit. Nurses caring for these patients were invited to attend an education session regarding PICS-p and delirium, including how to accurately score for delirium using the Cornell Assessment of Pediatric Delirium (CAPD) (Traube et al., 2014) tool. Pre and post tests were given prior to and after the educational session to assess baseline CAPD and PICS-p awareness. Scores were compared to assess knowledge acquisition. CAPD scores were tracked, and three separate points were chosen to be measured. Data analysis showed an increase in CAPD scoring and an overall reduction of CAPD scores by nearly 50%. Increased CAPD scoring and reduction in overall scores decrease a patient’s risk of developing PICS-p related to delirium once they are discharged. Additionally, an increase in nursing awareness of PICS-p and delirium can benefit patients with overall delirium reduction.