Implementation of a checklist improves adherence to evidence-based practices in a pediatric intensive therapy unit
DOI:
https://doi.org/10.31053/1853.0605.v79.n2.34210Keywords:
checklist, critical care, evidence-based practicesAbstract
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.
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References
Institute of Medicine (US) Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000.
Institute of Medicine. America’s health in transition: protecting and improving quality. Washington DC: National Academy Press; 1994. doi: 10.17226/9147.
Writing Group for the CHECKLIST-ICU Investigators and the Brazilian Research in Intensive Care Network (BRICNet), Cavalcanti AB, Bozza FA, Machado FR, Salluh JI, Campagnucci VP, Vendramim P, Guimaraes HP, Normilio-Silva K, Damiani LP, Romano E, Carrara F, Lubarino Diniz de Souza J, Silva AR, Ramos GV, Teixeira C, Brandão da Silva N, Chang CC, Angus DC, Berwanger O. 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 Apr 12;315(14):1480-90. doi: 10.1001/jama.2016.3463.
Lemkin DL, Stryckman B, Klein JE, Custer JW, Bame W, Maranda L, Wood KE, Paulson C, Dezman ZDW. Integrating a safety smart list into the electronic health record decreases intensive care unit length of stay and cost. J Crit Care. 2020 Jun;57:246-252. doi: 10.1016/j.jcrc.2019.09.016.
Tarrago R, Nowak JE, Leonard CS, Payne NR. 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 Jun;40(6):270-8. doi: 10.1016/s1553-7250(14)40036-9.
Agarwal S, Frankel L, Tourner S, McMillan A, Sharek PJ. Improving communication in a pediatric intensive care unit using daily patient goal sheets. J Crit Care. 2008 Jun; 23(2):227-35. doi: 10.1016/j.jcrc.2007.07.001.
Pageler NM, Longhurst CA, Wood M, Cornfield DN, Suermondt J, Sharek PJ, et al. Use of electronic medical record-enhanced checklist and electronic dashboard to decrease CLABSIs. Pediatrics. 2014 Mar; 133(3):e738-46. doi: 10.1542/peds.2013-2249.
Eulmesekian P, Pérez A, Díaz 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 Oct 1; 115(5):446-452. English, Spanish. doi: 10.5546/aap.2017.eng.446.
Mckelvie BL, Mcnally JD, Menon K, Marchand MG, Reddy DN, Creery WD. A PICU patient safety checklist: rate of utilization and impact on patient care. Int J Qual Health Care. 2016 Jun; 28(3):371-5. doi: 10.1093/intqhc/mzw042.
Reese C. Implementation of a Daily Checklist to Improve Patient Safety and Quality of Care in a Pediatric Intensive Care Unit. [Disertación]; 2017. Disponible en: https://irl.umsl.edu/dissertation/655/
Ullman A, Long D, Horn D, Woosley J, Coulthard MG. The KIDS SAFE checklist for pediatric intensive care units. Am J Crit Care. 2013 Jan; 22(1):61-9. doi: 10.4037/ajcc2013560.
Phipps LM, Thomas NJ. The use of a daily goals sheet to improve communication in the paediatric intensive care unit. Intensive Crit Care Nurs. 2007 Oct; 23(5):264-71. doi: 10.1016/j.iccn.2007.02.001.
Rehder KJ, Uhl TL, Meliones JN, Turner DA, Smith PB, Mistry KP. Targeted interventions improve shared agreement of daily goals in the pediatric intensive care unit. Pediatr Crit Care Med. 2012 Jan; 13(1):6-10. doi: 10.1097/PCC.0b013e3182192a6c.
Siegel BI, Figueroa J, Stockwell JA. Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection. Pediatr Qual Saf. 2018 May 18;3(3):e078. doi: 10.1097/pq9.0000000000000078.
De Bie AJR, Nan S, Vermeulen LRE, Van Gorp PME, Bouwman RA, Bindels AJGH, et al. Intelligent dynamic clinical checklists improved checklist compliance in the intensive care unit. Br J Anaesth. 2017 Aug 1; 119(2):231-238. doi: 10.1093/bja/aex129.
Manning JC, Pinto NP, Rennick JE, Colville G, Curley MAQ. Conceptualizing Post Intensive Care Syndrome in Children-The PICS-p Framework. Pediatr Crit Care Med. 2018 Apr; 19(4):298-300. doi: 10.1097/PCC.0000000000001476
Pun BT, Balas MC, Barnes-Daly MA, Thompson JL, Aldrich JM, Barr J, et al. Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults. Crit Care Med. 2019 Jan; 47(1):3-14. doi: 10.1097/CCM.0000000000003482.
Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006 Dec 28; 355(26):2725-32. doi: 10.1056/NEJMoa061115. Erratum in: N Engl J Med. 2007 Jun 21; 356(25):2660.
Ganesan R, Rajakumar P, Fogg L, Silvestri J, Kane JM. WE CARE 4 KIDS: Use of a Rounding Tool in the Pediatric Intensive Care Unit. Pediatr Qual Saf. 2017 Nov 17;2(6):e044. doi: 10.1097/pq9.0000000000000044.
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