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Implementation of a checklist to increase adherence to evidence-based practices in a single pediatric intensive care
Pablo Eulmesekian1, Augusto Pérez2, Silvia Díaz2
1Servicio de Terapia Intensiva del Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires. pablo.eulmesekian@hospitalitaliano.org.ar.
Insights
A checklist improved adherence to evidence-based practices in a pediatric intensive care unit. This intervention successfully achieved over 90% compliance with key care protocols in mechanically ventilated children.
Area of Science:
- Pediatric Intensive Care
- Evidence-Based Medicine
- Quality Improvement
Background:
- Checklists are underutilized in pediatric intensive care units (PICUs) for evidence-based practices.
- Adherence to critical care protocols can be challenging in complex PICU environments.
Purpose of the Study:
- To implement an ad hoc checklist to improve adherence to specific evidence-based practices in a PICU.
- To achieve a compliance rate of at least 90% for the studied practices.
Main Methods:
- A time series quasiexperimental study was conducted in a PICU involving ventilated children.
- A checklist was used daily during ward rounds to track adherence to 10 key practices.
- Adherence was monitored via daily observations and summarized using control charts.
Main Results:
- The study included 1191 observations over 420 days in 218 mechanically ventilated patients.
- Adherence rates showed a positive trend, with a special cause variation pattern emerging.
- Compliance exceeded 90% in the final two months of the study period.
Conclusions:
- Implementing a checklist significantly enhanced adherence to evidence-based practices in the PICU.
- The checklist intervention successfully met the objective of achieving >90% compliance.
Introduction:
The use of checklists to increase adherence to evidence-based practices is not yet widespread in pediatric intensive care units. The objective of this study was to achieve 90% compliance with studied practices using an ad hoc checklist.
Population And Methdos:
Time series quasiexperimental study conducted in ventilated children hospitalized in the pediatric intensive care unit. Studied practices included sedation breaks, plateau pressure ≤ 30 cm H 2O, fraction of inspired oxygen ≤ 60%, maintenance of headboard at > 30°, chlorhexidine mouthwash, weekly ventilator circuit changes, preference for enteral feeding, reduction in the threshold for blood transfusions (hemoglobin: 7 g/dL), daily consideration of spontaneous breathing trials and central venous catheter removal. The checklist was used during ward rounds by the staff physicians in charge of the pediatric intensive care unit as part of an intervention to increase adherence and as a tracking tool. Each form completed on a daily basis was considered an observation. Observations were classified as defective in the case of non-compliance with one or more items. Adherence (the rate of nondefective units of observation) is summarized in the control chart.
Results:
The study period lasted 420 days. A total of 732 patients were hospitalized; 218 underwent mechanical ventilation; 1201 observations were made, and 1191 were included in the study. The control chart with a 14-month time horizon showed increased adherence, a special cause variation pattern in the last 3 months of the study period, and > 90% compliance over the last 2 months.
Conclusions:
The implementation of a checklist increased adherence to studied practices and achieved more than 90% compliance over the last 2 months of the study period.
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