The Improving Pediatric Critical Care (IPCC) program was formed in 2009 through a partnership between N.C. Children's Center for Clinical Excellence and UNC Dance Marathon. Over the past two years, the program aimed to create a coordinated approach to improving quality and safety of care for critically ill pediatric patients at N.C. Children’s Hospital. Through efforts of PICU leaders, frontline staff and the program management team, several accomplishments were made in the areas of eliminating hospital-acquired infections, partnering with families, and improving communication systems.
Goals were set to enhance the improvements led by Six Sigma project teams to improve rates of central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonias (VAPs), and Foley catheter-associated urinary tract infections (UTIs). Staff were engaged in hand hygiene observations and immediate feedback and the compliance data included on the quality dashboard. Strategies were developed to better communicate about line maintenance and to address daily whether lines can be removed. Over the past two years, the VAP rate decreased by 65%, the CLABSI rate by 28%, and the UTI rate has decreased by 7%.
Family members of recent PICU patients were recruited to serve as family advisors. They participated as members of the IPCC advisory committee, attended focus groups, or served on teams to develop policies and materials. Results of partnering with families projects include a statistically significant increase of daily documented communication between the PICU team and families and an increase from baseline of staff perception of patient- and family-centered care. A parking and meals assistance fund was also established with funds from UNC Dance Marathon and will continue to serve families in need in the current fiscal year.
To improve communication systems, two evidence-based strategies were implemented: 1) the Daily Goals Communication Sheet to ensure that the entire team understands the documented plan for the patient each day, and 2) a standardized approach to daily multidisciplinary rounds to make them more effective and efficient. 87% of individuals completing staff feedback surveys felt that the Daily Goals Communication Sheet improved communication and patient care in the PICU. The majority of staff also reported that the standardized structure made rounds “better” or “much better.” Both of these strategies have been used as examples in other clinical areas at UNC Health Care.
As the second year drew to a close, the program team developed a sustainability plan and identified an owner for each implementation area. The PICU Clinical Operations team, a multidisciplinary group of individuals providing care in the PICU, has taken responsibility of the program team to raise and address issues and concerns, to discuss potential changes and implementation, and to coordinate the larger multidisciplinary advisory group, which meets quarterly.