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Improving the Performance of Anthropometry Measurements in the Pediatric Intensive Care Unit
Vijay Srinivasan1, Stephanie Seiple1, Monica Nagle1
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa.; Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.; Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pa.; Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, Pa.; Davidson College, Davidson, N.C.; Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa.; and Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pa.
Insights
A dedicated nutrition support team (NST) improved anthropometry measurements in the pediatric intensive care unit (PICU). Sustaining these gains proved challenging due to competing clinical priorities, highlighting the need for ongoing strategies.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Anthropometry
Background:
- Accurate anthropometry measurements in critically ill children are essential but challenging to obtain in the pediatric intensive care unit (PICU).
- A dedicated PICU nutrition support team (NST) was implemented to improve the process of obtaining anthropometric data.
Purpose of the Study:
- To enhance the process of obtaining anthropometry measurements in critically ill children within the PICU.
- To assess the impact of a dedicated NST on anthropometric data collection and its sustainability.
Main Methods:
- PICU staff received training including online education, skills sessions, and bedside teaching from the NST.
- Equipment standardization and electronic medical record order sets were implemented.
- Data on anthropometry measurements were collected pre-intervention, post-intervention, and monthly for up to 36 months to evaluate sustainability.
Main Results:
- The intervention significantly increased the number of patients with orders for weight, stature, and head circumference at PICU admission.
- Correspondingly, more patients had these measurements recorded at admission and for long-stay patients.
- While initial improvements were noted, sustainability beyond 12-36 months showed a trend, with competing clinical priorities identified as a key barrier.
Conclusions:
- A dedicated PICU NST can effectively improve anthropometry measurement performance.
- Sustaining these improvements long-term presents challenges due to competing clinical demands.
- Ongoing strategies are necessary to maintain consistent anthropometric data collection in the PICU.
Introduction:
Obtaining anthropometry measurements in critically ill children is challenging. Our objective was to improve the process of obtaining anthropometry measurements in the pediatric intensive care unit (PICU; even if previously obtained) using a dedicated PICU nutrition support team (NST).
Methods:
PICU staff were trained to perform anthropometry measurements through online education, skills training, and just-in-time bedside teaching by the PICU NST. Equipment was upgraded and standardized throughout the PICU along with implementation of preselected orders in the electronic medical record. Data were collected before and immediately after intervention and at monthly intervals from 12 to 36 months to test sustainability of practice change. PICU staff were surveyed on barriers to anthropometry measurements at 36 months after initial intervention.
Results:
Compared with baseline, the intervention resulted in more patients with orders for weight, stature, and head circumference (all P < 0.001) at PICU admission. Correspondingly, more patients had measurements of weight (P = 0.04), stature (P = 0.01), and head circumference (P = 0.009) at PICU admission. For long-stay patients (>7 days), compliance improved with measurements of serial weights (P = 0.002), stature (P < 0.001), and head circumference (P = 0.02). Between 12 and 36 months after the intervention, there was a noticeable trend to increases in weight measurements at PICU admission, and to a lesser extent, of stature and head circumference. Competing clinical priorities were a key barrier to anthropometry measurements.
Conclusions:
Performance of anthropometry measurements in the PICU can be improved by a dedicated PICU NST; however, sustaining these improvements is challenging due to competing clinical priorities.
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