25 - PICU Rounding Checklist: Improving the Quality of Interdisciplinary Patient and Family-Centered Rounds

Poster Number: 25
Publication Number: 25.201

Adam Lee, Miller Children's & Women's Hospital Long Beach, LONG BEACH, CA, United States; Christopher Babbitt, Miller Children's & Women's Hospital Long Beach, Long Beach, CA, United States; Alireza Fathi, Miller Children's & Women's Hospital Long Beach, Palos Verdes Estates, CA, United States; Paulina Zale, Miller Children's & Women's Hospital Long Beach, Ladera Ranch, CA, United States; Quynh-Uyen P. Nguyen, Miller Children's & Women's Hospital Long Beach, Fountain Valley, CA, United States

Background: Currently there is no data on the use of a rounding checklist to help in ABCDEF bundle maintenance. We hypothesized that implementing a standardized checklist would allow the PICU team to better address two of the bundle’s critical components, delirium and early mobility.

Objective: This study was undertaken to evaluate whether improved recognition and documentation of delirium and immobility led to better preventative strategies and outcomes.

Design/Methods: This is a pre and post implementation study evaluating the use of a rounding checklist in a 30-bed PICU. The inclusion criteria were pediatric patients admitted to PICU for ≥ 3 days during the first 9 months of 2021. There were no exclusion criteria. The primary outcome measures were Cornell Assessment of Pediatric Delirium (CAPD) score on PICU days 1 and 3 and number of days to OT/PT order placement pre and post implementation. The secondary outcome measures were percentage of CAPD scores documented and results of the resident and nursing rounds satisfaction survey. Patients were identified from the PICU database and Likert scoring was used for the surveys. Continuous variables were compared by student t-test and categorical variables by Chi square and Fisher exact test, with p values < 0.05 considered significant.

Results: Compliance with checklist completion was 94% among attendings. 67 patients were identified pre and 56 patients post implementation, all similar in baseline age, PRISM III and functional severity score (Table 1). There was no change in number of days to OT/PT order placement, nor a difference in delirium scores from days 1 to 3 pre and post implementation. The percentage of missing CAPD scores decreased from 13% to 7% (p=0.05). Patients who were correctly not given CAPD scores due to sedated status (Richmond Assessment Sedation Scale ≤-4) increased from 14% to 50% (p=0.02). The proportion of residents endorsing great understanding of delirium management increased from 5% to 52% (p=0.001, Figure 1). The proportion of nurses who believed that OT/PT needs were adequately addressed during rounds increased from 63% to 87% (p=0.06, Figure 2).Conclusion(s): Although a standardized rounding checklist was not associated with any reduction in delirium nor change in timing of mobility orders, it improved overall documentation of delirium scoring and increased staff satisfaction with delirium management.
Table 1.Comparing outcomes pre and post rounding checklist implementation
Figure 1.Results of Resident Rounding Satisfaction Survey