In an urban community hospital pediatric intensive care unit (PICU) in the Pacific Northwest a multidisciplinary team developed an evidence-based delirium guideline. This project is a step forward in taking a more proactive approach to pediatric delirium prevention and management. A PICU delirium guideline can aid in the prevention of delirium as shown in the decreased use of known risk factors (i.e. restraints and benzodiazepines) and subsequent decrease in overall delirium rates.