Gardner Mary Katherine, Amado Patricia J, Baig Muhummad Usman, Mohiuddin Sana, Harden Avis, Ewing Linette J, Razvi Shehla, Cortes Jose A, Mejia Rodrigo, Petropoulos Demetrios, Tewari Priti, Ahmad Ali H
Pediatric Critical Care, Division of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Pediatric Oncology Fellowship Program, Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Children (Basel). 2022 Apr 18;9(4):580. doi: 10.3390/children9040580.
Standardized rounding checklists during multidisciplinary rounds (MDR) can reduce medical errors and decrease length of pediatric intensive care unit (PICU) and hospital stay. We added a standardized process for MDR in our oncologic PICU. Our study was a quality improvement initiative, utilizing a four-stage Plan-Do-Study-Act (PDSA) model to standardize MDR in our PICU over 3 months, from January 2020 to March 2020. We distributed surveys to PICU RNs to assess their understanding regarding communication during MDR. We created a standardized rounding checklist that addressed key elements during MDR. Safety event reports before and after implementation of our initiative were retrospectively reviewed to assess our initiative's impact on safety events. Our intervention increased standardization of PICU MDR from 0% to 70% over three months, from January 2020 to March 2020. We sustained a rate of zero for CLABSI, CAUTI, and VAP during the 12-month period prior to, during, and post-intervention. Implementation of a standardized rounding checklist may improve closed-loop communication amongst the healthcare team, facilitate dialogue between patients' families and the healthcare team, and reduce safety events. Additional staffing for resource RNs, who assist with high acuity patients, has also facilitated bedside RN participation in MDR, without interruptions in clinical care.
多学科会诊（MDR）期间的标准化查房清单可减少医疗差错，并缩短儿科重症监护病房（PICU）住院时间和医院住院时长。我们在肿瘤PICU中增加了MDR的标准化流程。我们的研究是一项质量改进举措，采用四阶段计划-实施-研究-改进（PDSA）模型，在2020年1月至2020年3月的3个月内对我们PICU的MDR进行标准化。我们向PICU护士发放调查问卷，以评估她们对MDR期间沟通的理解。我们创建了一份标准化查房清单，涵盖MDR期间的关键要素。对我们举措实施前后的安全事件报告进行回顾性审查，以评估我们的举措对安全事件的影响。从2020年1月到2020年3月的三个月里，我们的干预措施使PICU MDR的标准化率从0%提高到了70%。在干预前、干预期间和干预后的12个月期间，我们的中心静脉导管相关血流感染（CLABSI）、导尿管相关尿路感染（CAUTI）和呼吸机相关性肺炎（VAP）发生率均维持为零。实施标准化查房清单可能会改善医疗团队之间的闭环沟通，促进患者家属与医疗团队之间的对话，并减少安全事件。为协助处理重症患者的资源护士增加人员配置，也促进了床边护士参与MDR，且不影响临床护理工作。
