Efune Proshad N, Morse Rustin B, Sheehan Maeve, Malone Loren M, Robertson Tammy S, Darnell Cindy
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Tex., Department of Emergency Medicine, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX.
Department of Pediatric Critical Care Medicine, University of Oklahoma, Oklahoma City, Okla.
Pediatr Qual Saf. 2018 Nov 8;3(6):e117. doi: 10.1097/pq9.0000000000000117. eCollection 2018 Nov-Dec.
Effective pediatric intensive care requires addressing many important aspects of care delivery during morning rounds, often achieved using a rounding checklist. Our objective was to develop a care goal rounding template and then double the reliability of discussion of rounding topics during morning rounds without the use of a checklist.
The Institute for Healthcare Improvement Model for Improvement was used for this initiative. A care goal rounding template was established through discussions and consensus with pediatric intensive care unit (PICU) faculty. Rounds were audited in a blinded fashion over a 3-month period to obtain baseline data on rounding topic discussion. Three interventions were then trialed (plan, do, study, act cycles) over a 12-month period. Weekly reliability in rounding topic discussion was tracked.
Baseline reliability with discussion of rounding topics was 36%. The first intervention included the use of a standardized progress note in the electronic health record, which contained topics and served to prompt the discussion on rounds. The second intervention was implementation of laminated cards provided to PICU fellows highlighting the elements of the care goal rounding template. The third intervention addressed a standardized handoff sheet often used during rounds. Mean reliability for discussion of rounding topics improved to 52% shortly following the second intervention. Reliability was sustained more than 1 year later.
Following the establishment of a PICU care goal rounding template and various interventions, the reliability in discussing important care goal elements on patient rounds improved.
有效的儿科重症监护需要在晨间查房时关注护理工作的许多重要方面，通常通过查房清单来实现。我们的目标是开发一个护理目标查房模板，然后在不使用清单的情况下将晨间查房时查房主题讨论的可靠性提高一倍。
本项目采用了医疗改进研究所的改进模式。通过与儿科重症监护病房（PICU）教员的讨论和共识，建立了一个护理目标查房模板。在3个月的时间内以盲法对查房进行审核，以获取关于查房主题讨论的基线数据。然后在12个月的时间内进行了三项干预措施（计划、执行、研究、行动循环）。跟踪查房主题讨论的每周可靠性。
查房主题讨论的基线可靠性为36%。第一项干预措施包括在电子健康记录中使用标准化的病程记录，其中包含主题并用于在查房时引发讨论。第二项干预措施是向PICU住院医师提供覆膜卡片，突出护理目标查房模板的要素。第三项干预措施涉及查房时常用的标准化交班表。在第二项干预措施实施后不久，查房主题讨论的平均可靠性提高到了52%。一年多后可靠性得以维持。
在建立PICU护理目标查房模板并采取各种干预措施后，在患者查房时讨论重要护理目标要素的可靠性得到了提高。
