LAUSR

Introduction/Hypothesis: Research continues to demonstrate that benzodiazepines are associated with an increased risk of developing delirium in the pediatric population; despite this, a survey conducted in our own Pediatric Intensive Care Unit (PICU) revealed that 68% of bedside nurses believed that benzodiazepines are themselves an effective treatment for pediatric delirium. We set out to observe an overall reduction in the use of benzodiazepines by implementing a nursing education program targeted at increasing knowledge on pediatric ICU delirium. Methods: A standardized delirium education module was developed and provided to all bedside nurses and nurse practitioners by the author or an educated delirium champion in August of 2018. Using the validated Cornell Assessment of Pediatric Delirium (CAPD) tool, delirium screening was performed over a 6-month period. A retrospective chart review was performed to determine the overall use of benzodiazepines 6-months pre and post educational module. We excluded patients who received benzodiazepines for status epilepticus or procedural sedation. Chi-square testing was used to compare total number of intermittent doses of benzodiazepines administered per total number of PICU admissions, in addition the number of patients prescribed continuous infusions while intubated was also compared. Results: An overall decrease in the use of intermittent benzodiazepine was observed in the 6months following delirium education from 199 doses/700 admissions pre-education vs. 135 doses/729 admissions post-education (p-value < 0.0001). Similarly, the total number of patients prescribed continuous infusions decreased from 23/53 intubated patients compared to 14/54 prior; although not statistically significant (p= 0.0655). Conclusions: Implementing an educational program that highlights the contribution of benzodiazepine use to the incidence of delirium was shown to significantly reduce the overall use of benzodiazepines in our PICU. In addition, the overall use of benzodiazepine infusions used on our intubated patients also decreased. With continued education and awareness, we believe a significant reduction in benzodiazepine use should continue and could potentially result in an overall reduction in the incidence of pediatric delirium.