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Abstract

Background
Internationally, one in three children develop delirium during their intensive care stay. International guidelines strongly recommend twice‐daily screening for paediatric delirium using validated instruments. In the United Kingdom and Ireland, delirium was assessed only when suspected and few intensive care units (ICUs) used validated instruments.

Aim
This initiative aimed to implement a national screening strategy in 28 paediatric intensive care units (PICUs) across the United Kingdom and Ireland.

Study Design
The strategy involved: (a) rapidly reviewing, evaluating and ranking paediatric screening instruments for sensitivity, specificity, appropriateness and acceptability for national implementation; (b) achieving national agreement to implement a common tool; (c) creating and disseminating training materials while supporting training personnel in implementation; and (d) integrating delirium monitoring within the Paediatric Intensive Care Audit Network national database.

Results
Among seven validated instruments, the top ranked options (from 1, most applicable to 7, least applicable) were the Cornell Assessment of Pediatric Delirium (average rank 1.25) and the Sophia Observation withdrawal Symptoms‐Paediatric Delirium scale (1.5). Twenty‐three units voted for their preferred choice of instrument: fifteen preferred the Cornell instrument, eight favoured the Sophia instrument and five did not respond. Training and implementation began in November 2021 and by March 2023 18 of the 28 units (64%) had successfully implemented screening. The national database began actively collecting delirium data from units in January 2024.

Conclusions
This initiative outlined critical steps for implementing and maintaining practice of delirium screening in PICUs. We provided clinicians with validated screening tools for detecting paediatric delirium and the necessary support and infrastructure to maintain screening. Embedding and sustaining screening is an ongoing challenge.

Relevance to Clinical Practice
Undertaking routine screening for all intensive care patients from admission to discharge using validated instruments will provide earlier detection and treatment for critically ill children. This strategy offers a model for standardized and effective implementation in clinical practice in ICUs.

Publication Type:	Article
Additional Information:	© 2025 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords:	child, critical care, delirium, quality improvement
Subjects:	R Medicine > RJ Pediatrics R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Departments:	School of Health & Medical Sciences
SWORD Depositor:	Symplectic Administrator

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