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Quality Improvement Bedside Rounding Audits Enhance Protein Provision for Pediatric Patients Receiving Continuous
Molly Wong Vega1, Marisa Juarez1, Ji Yeon Lee1
1Section of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Insights
Quality improvement initiatives significantly enhanced protein delivery for pediatric patients undergoing continuous renal replacement therapy (CRRT). This study demonstrates improved protein goal achievement in critically ill children receiving CRRT.
Area of Science:
- Pediatric Critical Care Medicine
- Renal Replacement Therapy
- Quality Improvement Science
Background:
- Optimizing protein delivery is crucial for critically ill patients, especially those on continuous renal replacement therapy (CRRT).
- Suboptimal protein delivery can lead to adverse outcomes in pediatric intensive care unit (PICU) patients.
Purpose of the Study:
- To describe quality improvement process improvements in protein delivery during the initiation of CRRT.
- To evaluate the impact of structured interventions on meeting protein goals in pediatric CRRT patients.
Main Methods:
- A prospective study utilizing Plan-Do-Study-Act (PDSA) cycles in pediatric and cardiovascular intensive care units.
- Interventions included establishing an interdisciplinary quality improvement group, bedside safety rounds, dedicated nutrition monitoring, intensivist education, and regular quality improvement meetings.
- Outcomes measured were the percentage of time patients met protein goals within the first 5 days and throughout the duration of CRRT.
Main Results:
- The percentage of time meeting protein goals by day 5 increased from 22% to 71% across the PDSA cycles.
- Protein goal achievement throughout CRRT improved from 35% to 75%.
- Significant improvements in both primary and secondary outcomes were observed after the third PDSA cycle (p < 0.01).
Conclusions:
- Implementing an interprofessional quality improvement team effectively improved protein delivery in pediatric CRRT.
- These quality improvement efforts led to a significant decrease in CRRT days with unmet protein goals.
Objectives:
Describe quality improvement process improvements in protein delivery of continuous renal replacement therapy initiation.
Design:
Prospective study.
Setting:
PICU and cardiovascular ICU within a quaternary care children's hospital.
Patients:
PICU and cardiovascular ICU patients receiving continuous renal replacement therapy for greater than 48 hours. Inborn errors of metabolism were excluded.
Interventions:
Plan-Do-Study-Act cycles were initiated. Cycle 1 developed interdisciplinary quality improvement group continuously monitoring nutrition care with thrice weekly bedside safety rounds and protein prescriptions within nephrologist's notes. Cycle 2 included education to intensivists. Cycle 3 initiated monthly quality improvement meetings reviewing nutritional care goals.
Measurements And Main Results:
Primary outcome was percentage of time patients met protein goals in the first 5 days of continuous renal replacement therapy. Secondary outcome was percentage of time patients met protein goals for duration of continuous renal replacement therapy. Cohort (n = 55) mean age was 8.1 years (SD ± 6.8), 62% male, and 31% malnutrition at baseline. Percent of time meeting protein goals by day 5 was 22%, 33%, and 71% and percent of time meeting protein goals throughout was 35%, 39%, and 75% of groups 1, 2, and 3, respectively. Significant improvement occurred after Plan-Do-Study-Act 3 (group 2 vs group 3; p < 0.01) for primary and secondary outcomes.
Conclusions:
Implementation of an interprofessional quality improvement team significantly decreased number of continuous renal replacement therapy days with unmet protein goals and improved protein delivery.
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