669: IMPACT OF A DELIRIUM PREVENTION STANDING ORDER SET IN A SINGLE-CENTER PICU

Abstract

Introduction: Delirium is a syndrome of acute and fluctuating mental disturbance characterized by inattention, unawareness and confusion. Delirium is highly prevalent in the pediatric intensive care unit (PICU) and could potentially develop in all critically ill patients. The 2022 SCCM pediatric PANDEM guidelines recommends nonpharmacologic measures to prevent delirium prior to initiating pharmacologic therapy such as antipsychotics. The purpose of this study is to evaluate the need for pharmacologic therapy to treat delirium after implementation of a delirium prevention standing order-set at a freestanding children’s hospital. Methods: A retrospective chart review was conducted for patients admitted to the PICU at a free standing children’s hospital between September 2020 and September 2021. Patients were included in the study if they were less than 18 years of age and required the sedation protocol for mechanical ventilation. Orders for non-pharmacologic delirium prevention strategies and the use of the order-set were recorded in addition to the description of the pharmacological regimens prescribed, side effects, and clinical outcomes such as days of mechanical ventilation, ICU length of stay and mortality. Descriptive statistics were utilized to assess results. Results: There were a total of 193 patients assessed with 158 included for analysis, 60 (38%) prior to the standing order-set and 98 (62%) after. The average age was 5.8 years old, with the majority of patients being male (57%) and admitted with respiratory failure (41.1%). Prior to the standing order-set, 10% of patients needed pharmacologic therapy to prevent delirium with 30% of patients having orders for non-pharmacologic delirium prevention strategies. After the standing order-set was implemented, only 9.2% of patients needed pharmacologic therapy and 52% had the non-pharmacologic strategies ordered. Days of mechanical ventilation (6.6 days vs 6.4 days), ICU length of stay (13.9 days vs 13.8 days) and mortality (5% vs 7.1%) were similar between the pre order-set and post order-set groups, respectively. Conclusions: Since creating the delirium prevention standing order-set, non-pharmacologic strategies were ordered more often and there were less patients requiring the use of pharmacologic therapy to treat delirium.