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[Implementation of a checklist improves adherence to evidence-based practices in a pediatric intensive therapy unit]
Pedro Taffarel1, Ana Paula Rodríguez2, Claudia Meregalli3
1Hospital General de Niños Pedro de Elizalde. pedrotaffarel@hotmail.com.
Insights
Implementing a checklist improved adherence to evidence-based practices (EBP) in a Pediatric Intensive Care Unit (PICU). This led to reduced mechanical ventilatory assistance (MVA) use and fewer device-associated infections, enhancing patient care quality.
Area of Science:
- Pediatric Intensive Care
- Healthcare Quality Improvement
- Evidence-Based Medicine
Background:
- Adherence to evidence-based practices (EBP) is crucial for managing critically ill patients.
- Improved compliance with EBP correlates directly with enhanced quality of care.
- Pediatric Intensive Care Units (PICUs) can benefit from targeted strategies to boost EBP adherence.
Purpose of the Study:
- To enhance adherence to EBP in a PICU setting.
- To improve key quality-of-care indicators for critically ill children.
- To evaluate the impact of a structured intervention on clinical practice.
Main Methods:
- A controlled before-after study was conducted at a children's hospital PICU.
- A checklist (CL) encompassing 27 EBP across 10 areas was implemented.
- Adherence was defined as meeting at least 80% of the EBP on the CL.
Main Results:
- Adherence to the CL increased by 23% (p <0.001) post-implementation.
- Mechanical ventilatory assistance (MVA) usage decreased by 18% (p = 0.033).
- Significant reductions were observed in MVA-associated pneumonia and bladder catheter-associated infections.
Conclusions:
- Checklist implementation effectively increased compliance with EBP in the PICU.
- The intervention led to reduced MVA utilization and device-associated infections.
- The study demonstrated a positive impact on quality indicators without affecting patient mortality or length of stay.
Introduction:
Adherence to evidence-based practices (EBP) allows better management of the health-disease process in critical ill patients, with a close relationship between compliance and the quality achieved. We set out to improve adherence to EBP in patients admitted to a Pediatric Intensive Care Unit (PICU) and to improve the quality-of-care indicators.
Methods:
Controlled before-after study, developed at the PICU of the Pedro de Elizalde Children's General Hospital (PECGH), which involved all patients admitted in the period 12/01/2019 to 08/31/2020. The implementation consisted of a checklist (CL) that included 27 EBP, segmented into 10 improvement areas. Adherence to the CL was considered if it met 80% of EBP.
Results:
During the study period, 153 patients were admitted to the PECGH PICU. The pre- and post-intervention groups were similar in mechanical ventilatory assistance (MVA) requirements and pre-established mortality. In the last stage, adherence to the CL increased 23% (p <0.001). The MVA usage rate experienced the greatest decrease (18%, p = 0.033). In relation to quality indicators, a decrease in episodes of MVA-associated pneumonia (p = 0.002) and bladder catheter-associated infection (p = 0.001) was evident. There were no differences in mortality or stay in the PICU.
Conclusion:
The implementation of a CL allowed to increase compliance with the different EBP studied, a lower rate of MVA use, and a reduction in the rate of device-associated infections.
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