Gupta Neha, Sones Amber, Powell Maegan, Robbins Johanna, Wilson Stephanie, Hill Amy, Thomas Christy, Ledbetter Sara, Schmidtke Anne Grace, Rutledge Chrystal, Hayes Leslie
Division of Pediatric Critical Care, University of Alabama at Birmingham, Birmingham, Ala.
Department of Physical Therapy, Children's of Alabama, Birmingham, Ala.
Pediatr Qual Saf. 2020 Dec 28;6(1):e369. doi: 10.1097/pq9.0000000000000369. eCollection 2021 Jan-Feb.
Utilization of robust quality improvement methodology in conjunction with traditional interventions to enhance an Early Mobility program (EMP) in a tertiary pediatric intensive care unit (PICU).
EMP was implemented in our PICU in May 2017. The percentage of appropriate physical and occupational therapist consults were determined. We also evaluated the activity levels received by the patient and the levels for which they qualified based on their medical condition. Failure Modes and Effects Analysis (FMEA) was performed to identify potential complications related to the mobilization of critically ill children. We created 4 simulation scenarios based on FMEA prioritized results.
After the implementation of EMP, appropriate physical and occupational therapist consults significantly increased ( < 0.0001). However, most patients still failed to receive the optimal level of activity recommended by protocol. This failure was partly due to concern for safety events during mobilization. FMEA identified vital sign changes [Risk Priority Number (RPN) 97.8], staff injury (RPN 64), and pain/anxiety (RPN 60.5) as potential safety events. We performed various in-situ simulation sessions based on these potential events. In post-simulation evaluations, 100% of participants agreed that the simulation experience would improve their performance in the actual clinical setting. Feedback from simulations led to the development of an EM patient safety checklist and clinical pathway.
We describe a novel technique of using FMEA to develop scenarios that simulate potential adverse events to optimize safe EM in PICU. An EM checklist and pathway can guide in the implementation of safe EMP.
结合传统干预措施，运用稳健的质量改进方法，以加强三级儿科重症监护病房（PICU）的早期活动计划（EMP）。
2017年5月在我们的PICU实施了EMP。确定了物理治疗师和职业治疗师进行适当会诊的百分比。我们还评估了患者接受的活动水平以及根据其病情应达到的活动水平。进行了失效模式与效应分析（FMEA），以识别与危重症儿童活动相关的潜在并发症。我们根据FMEA的优先排序结果创建了4个模拟场景。
实施EMP后，物理治疗师和职业治疗师的适当会诊显著增加（<0.0001）。然而，大多数患者仍未达到方案推荐的最佳活动水平。这种失败部分归因于对活动期间安全事件的担忧。FMEA将生命体征变化[风险优先数（RPN）97.8]、工作人员受伤（RPN 64）和疼痛/焦虑（RPN 60.5）识别为潜在安全事件。我们基于这些潜在事件进行了各种现场模拟演练。在模拟后的评估中，100%的参与者一致认为模拟体验将提高他们在实际临床环境中的表现。模拟反馈促成了一份早期活动患者安全检查表和临床路径的制定。
我们描述了一种利用FMEA开发模拟潜在不良事件场景的新技术，以优化PICU中的安全早期活动。一份早期活动检查表和路径可指导安全EMP的实施。
