From Paper to Proactive Safety: Digitalising Shift Checklists in a Paediatric Cardiac ICU

In paediatric cardiac intensive care units (PCICUs), shift-based safety checks are critical to ensuring equipment readiness during time-sensitive emergencies. Reliance on paper-based checklists resulted in variable compliance and limited accountability. A critical incident involving a non-functional defibrillator during a paediatric cardiac arrest was identified as a system-level failure rather than individual staff error, exposing the risk of unpreparedness.

To improve and sustain compliance with shift safety checks through a QR code-based digital checklist system with automated reminders and escalation, enhancing patient safety and staff readiness.

Following root cause analysis and guided by a Just Culture approach, this quality improvement project, conducted in a tertiary PCICU in the United Arab Emirates, used Kotter's eight-step change model and Plan-Do-Check-Act (PDCA) cycles. A multidisciplinary team developed a mobile-accessible digital checklist. QR codes were placed on critical equipment and clinical areas. Staff scanned the QR code at the item location and completed checks in real time. Microsoft Power Automate sent reminders to the team leader after 2 h, with escalation to the unit manager after 3 h if checks remained incomplete. The intervention was piloted over 1 month and expanded unit wide.

Compliance with shift safety checks improved from a baseline of 82% to 90% at 3 months. After resolution of technical issues and reinforcement of staff education, compliance reached and was sustained at 100% by 6 months. Staff satisfaction increased from 68% at baseline to 91% at 3 months and 96.3% at 6 months. Documentation became fully auditable, equipment readiness at the start of each shift markedly improved, and no further critical equipment failures were reported during emergency events.

Sustained improvement was achieved by combining accessible digital technology with structured change management, iterative PDCA cycles and a Just Culture approach, supporting durable transformation of shift safety checks in a high-acuity PCICU.

QR code-based digital checklists with automated reminders and escalation offer a low-cost, scalable approach for critical care units to strengthen equipment readiness, enable real-time documentation at the point of checking, improve auditability and reduce reliance on paper and time away from patients.