Use of computerized ICU documentation to capture ICU core measures

Area of Science:

• Healthcare Informatics
• Quality Improvement in Critical Care
• Patient Safety Initiatives

Background:

• Intensive care units (ICUs) implement core measures to prevent catheter-related bloodstream infections (CRBSIs) and ventilator-associated pneumonia (VAP).
• Data collection for these measures often necessitates additional personnel.
• This study explored using existing computerized ICU flowsheets for efficient data capture.

Purpose of the Study:

• To evaluate the feasibility of using a computerized ICU flowsheet for timely and accurate data collection on core measures.
• To assess the impact of this system on provider compliance with established protocols.
• To determine if the computerized system could achieve these goals without requiring additional staff.

Main Methods:

• A 10-bed surgical ICU implemented a reporting tool within its existing computerized flowsheet.
• The tool documented daily compliance with protocols for ventilator weaning, head of bed elevation, glucose control, deep vein thrombosis (DVT) prophylaxis, and stress ulcer bleeding prophylaxis (SUP).
• Compliance was assessed before and after staff education, with a glucose target of <150 mg/dL.

Main Results:

• Compliance with DVT prophylaxis, SUP, and head of bed elevation significantly improved, exceeding 95%.
• Mean glucose levels decreased from 144 to 122 mg/dL after intensive education.
• Despite improved compliance, rates of CRBSI, VAP, length of stay, and mortality remained unchanged compared to the previous year.

Conclusions:

• Computerized systems can accurately and promptly report ICU core measures to clinical staff.
• Staff education effectively improved compliance with targeted protocols.
• The computerized system facilitated data capture and compliance monitoring without additional personnel, but did not directly lead to improved clinical outcomes like reduced infections or mortality.