[Implementation of a Checklist Improves Adherence to Evidence-based Practices in a Pediatric Intensive Therapy Unit]

Overview

Journal Rev Fac Cien Med Univ Nac Cordoba

Specialty General Medicine

Date 2022 Jun 14

PMID 35700461

Authors

Pedro Taffarel

Ana Paula Rodriguez

Claudia Meregalli

Facundo Jorro Baron Facundo

Affiliations

Soon will be listed here.

Abstract

Introduction: Adherence to evidence-based practices (EBP) allows better management of the health-disease process in critical ill patients, with a close relationship between compliance and the quality achieved. We set out to improve adherence to EBP in patients admitted to a Pediatric Intensive Care Unit (PICU) and to improve the quality-of-care indicators.

Methods: Controlled before-after study, developed at the PICU of the Pedro de Elizalde Children's General Hospital (PECGH), which involved all patients admitted in the period 12/01/2019 to 08/31/2020. The implementation consisted of a checklist (CL) that included 27 EBP, segmented into 10 improvement areas. Adherence to the CL was considered if it met 80% of EBP.

Results: During the study period, 153 patients were admitted to the PECGH PICU. The pre- and post-intervention groups were similar in mechanical ventilatory assistance (MVA) requirements and pre-established mortality. In the last stage, adherence to the CL increased 23% (p <0.001). The MVA usage rate experienced the greatest decrease (18%, p = 0.033). In relation to quality indicators, a decrease in episodes of MVA-associated pneumonia (p = 0.002) and bladder catheter-associated infection (p = 0.001) was evident. There were no differences in mortality or stay in the PICU.

Conclusion: The implementation of a CL allowed to increase compliance with the different EBP studied, a lower rate of MVA use, and a reduction in the rate of device-associated infections.

References

Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S . An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006; 355(26):2725-32. DOI: 10.1056/NEJMoa061115. View

Agarwal S, Frankel L, Tourner S, McMillan A, Sharek P . Improving communication in a pediatric intensive care unit using daily patient goal sheets. J Crit Care. 2008; 23(2):227-35. DOI: 10.1016/j.jcrc.2007.07.001. View

Eulmesekian P, Perez A, Diaz S, Ferrero M . Implementation of a checklist to increase adherence to evidence-based practices in a single pediatric intensive care unit. Arch Argent Pediatr. 2017; 115(5):446-452. DOI: 10.5546/aap.2017.eng.446. View

Pun B, Balas M, Barnes-Daly M, Thompson J, Aldrich J, Barr J . Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults. Crit Care Med. 2018; 47(1):3-14. PMC: 6298815. DOI: 10.1097/CCM.0000000000003482. View

Pageler N, Longhurst C, Wood M, Cornfield D, Suermondt J, Sharek P . Use of electronic medical record-enhanced checklist and electronic dashboard to decrease CLABSIs. Pediatrics. 2014; 133(3):e738-46. PMC: 3934335. DOI: 10.1542/peds.2013-2249. View

McKelvie B, McNally J, Menon K, Marchand M, Reddy D, Creery W . A PICU patient safety checklist: rate of utilization and impact on patient care. Int J Qual Health Care. 2016; 28(3):371-5. DOI: 10.1093/intqhc/mzw042. View

Phipps L, Thomas N . The use of a daily goals sheet to improve communication in the paediatric intensive care unit. Intensive Crit Care Nurs. 2007; 23(5):264-71. DOI: 10.1016/j.iccn.2007.02.001. View

Rehder K, Uhl T, Meliones J, Turner D, Smith P, Mistry K . Targeted interventions improve shared agreement of daily goals in the pediatric intensive care unit. Pediatr Crit Care Med. 2011; 13(1):6-10. PMC: 3163112. DOI: 10.1097/PCC.0b013e3182192a6c. View

De Bie A, Nan S, Vermeulen L, Van Gorp P, Bouwman R, Bindels A . Intelligent dynamic clinical checklists improved checklist compliance in the intensive care unit. Br J Anaesth. 2017; 119(2):231-238. DOI: 10.1093/bja/aex129. View

10.

Manning J, Pinto N, Rennick J, Colville G, Curley M . Conceptualizing Post Intensive Care Syndrome in Children-The PICS-p Framework. Pediatr Crit Care Med. 2018; 19(4):298-300. DOI: 10.1097/PCC.0000000000001476. View

11.

Siegel B, Figueroa J, Stockwell J . Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection. Pediatr Qual Saf. 2018; 3(3):e078. PMC: 6132817. DOI: 10.1097/pq9.0000000000000078. View

12.

Tarrago R, Nowak J, Leonard C, Payne N . Reductions in invasive device use and care costs after institution of a daily safety checklist in a pediatric critical care unit. Jt Comm J Qual Patient Saf. 2014; 40(6):270-8. DOI: 10.1016/s1553-7250(14)40036-9. View

13.

Cavalcanti A, Bozza F, Machado F, Salluh J, Campagnucci V, Vendramim P . Effect of a Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting on Mortality of Critically Ill Patients: A Randomized Clinical Trial. JAMA. 2016; 315(14):1480-90. DOI: 10.1001/jama.2016.3463. View

14.

Ullman A, Long D, Horn D, Woosley J, Coulthard M . The KIDS SAFE checklist for pediatric intensive care units. Am J Crit Care. 2013; 22(1):61-9. DOI: 10.4037/ajcc2013560. View

15.

Ganesan R, Rajakumar P, Fogg L, Silvestri J, Kane J . WE CARE 4 KIDS: Use of a Rounding Tool in the Pediatric Intensive Care Unit. Pediatr Qual Saf. 2018; 2(6):e044. PMC: 6132891. DOI: 10.1097/pq9.0000000000000044. View

16.

Lemkin D, Stryckman B, Klein J, Custer J, Bame W, Maranda L . Integrating a safety smart list into the electronic health record decreases intensive care unit length of stay and cost. J Crit Care. 2020; 57:246-252. DOI: 10.1016/j.jcrc.2019.09.016. View