A Clinical Pathway to Standardize Care of Children With Delirium in Pediatric Inpatient Settings
Hospital Pediatrics
Silver, G. H., Kearney, J. A., et al. (2019).
Hospital Pediatrics, 9(11), 909-916.
<div>This guideline provides clinical pathway recommendations for improving outcomes in children with delirium in pediatric inpatient settings. This summary highlights recommendations within the scope of speech-language pathology.</div>
Pathways for Clinical Care Workgroup
<div>Multidisciplinary teams can implement the best physiologic, pharmacologic, and environmental practices to prevent and reduce the incidence of delirium in children in inpatient settings. Recommendations include:</div>
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<ul>
<li>supporting nutritional intake;</li>
<li>promoting day and night routines and establishing regular daily schedules; </li>
<li>clustering care to minimize interruptions; </li>
<li>optimizing patient orientation using the patient's name and regular reassurance and reorientation as needed;</li>
<li>introducing care members by identifying their roles and explaining activities;</li>
<li>communicating with calm, clear, and concrete sentences;</li>
<li>managing the physical environment (e.g., noise, clutter, temperature, familiar items from home, music);</li>
<li>ensuring optimal sensory function (e.g., glasses, hearing aids, communication boards); and </li>
<li>engaging in patient and care provider education.</li>
</ul>
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<div>Screening for delirium is recommended for patients in the pediatric intensive care unit setting and pediatric populations at risk for delirium (e.g., traumatic brain injury, epilepsy, sickle cell, and postoperative patients). Screening tools to consider include the Cornell Assessment of Pediatric Delirium (CAPD), the Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU), the Preschool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU), and the Delirium Rating Scale-Revised.</div>
