Pediatric Delirium

Dear Colleagues,

The Pediatric Confusion Assessment Method for the Intensive Care Unit or the pCAM-ICU has been validated in ages 5–17 years for use by the bedside caregiver. The pCAM-ICU provides a simple, quick tool to assess for delirium in the pediatric intensive care patient. The assessment provides a means for early recognition of fluctuations or change in cognitive function. Early recognition of change in cognitive function can allow for more extensive follow-up and assessment that can subsequently confirm the presence of delirium and then evaluate the appropriate response or treatment.

It is important to decide how the assessment will be documented after it is completed. We have chosen to document "Delirium is Present" or "Delirium is Absent".

Providing a central location for easy access to the assessment tools is important. We provide each bedside clinician with a "Pocket Card" and a copy of the "Worksheet". The 2 sets of ASE Pediatric Pictures - Set A and Set B are filed in Resource Manuals located between each patient room. A copy of the Pocket Card is filed in the Resource Manual.

We appreciate your interest. We are passionate about the study of pediatric delirium. We hope you find the materials easy to use. We welcome questions, concerns or suggestions that will enhance our communication.

Sincerely,

Pam Berry, RN, CCRP
Heidi A. Beverley Smith, MD, MSCI

Education

Thank you for your interest in our Pediatric Delirium project and the pCAM-ICU Tool. You will find the following materials available for download on this website:

• Pediatric Pocket Card
• Pediatric Worksheet
• Daily Guide
• ASE Picture Packets

We can provide other educational materials by request.

The Pediatric CAM-ICU or pCAM-ICU is an assessment tool for use by the bedside clinician. It takes less than 2 minutes to complete. Training is easy and minimal.

We have adapted the adult model for use with children. It is important to meet the different cognitive and developmental stages in pediatrics. This assessment tool is validated for use in children 5 years and older.

pCAM-ICU Pocket Card
The Pediatric Pocket Card is a quick reference for the assessment tool. It is designed for easy access as a resource for the clinician trained in the use of the tool.

Pediatric Worksheet
The Worksheet is the instructional guide for the clinician to follow during the learning phase. It includes scripted language with recommended time intervals. Consistency and repetition improves the technique of the clinician and helps the clinician to become efficient with the tool.

Pediatric Daily Guide
The Daily Guide provides a map to follow each day to identify and assess your patients. The patient should be assessed once per shift or twice in a 24 hour period. But can be assessed more often if there is change in behavior. It takes less than 2 minutes to complete.

Read more about Delirium in Critically Ill Children here.

ASE Pictures

ASE Pictures is one of the tools that can be used to assess Attention for pCAM-ICU. With the pCAM-ICU, inattention is evaluated with either a letters (auditory) test or a pictures (visual) test. Either test can be used to test for attention. The letters test is the ABADBADAAY described in the flowsheet. The Pictures test uses pre-made picture packets. We have created a Power Point file to make it easier to reproduce the picture packet. Below is a link to the Power Point files. There are two sets of picture packets (Set A and Set B). However, only one packet is needed per assessment. You may choose to alternate daily between the two sets.

Pediatric ASE Pictures – Set A

Pediatric ASE Pictures – Set B

Directions for printing the Picture packets:
1. Print the pdf file one slide per page.
2. Size these to no smaller than 5X7.
3. Laminate with matte lamination (to avoid glare).
4. Punch a hole in the upper left hand corner of each card.
5. Place a ring in the holes to hold the packet together.