Quality Improvement Programs
Pediatric Critical Care Medicine continues to emphasize safe and high-quality patient care as a primary focus in our clinical care mission.
Our Current Quality Improvement Projects
My Little Hearts
We are now trying to keep an updated diagram of each child in the PCICU’s heart with relevant procedures. These diagrams will be a reference for physicians, nurses, and families. Look for these diagrams to become laminated and passed on from PCICU to 5CH and eventually to home as our heart kids recover and get discharged. The diagrams will be created and maintained by Becky Smith, Kaitlin Campbell, and Jessica Floriano.
Stomp out Delirium
Prevention, recognition and treatment of Delirium in the PICU. Sleep promotion bundle, unit wide delirium screening using the CAPD screening tool, and treatment algorithm went live Feb 1st. All 3 arms of the project (prevention bundle, screening bundle, and treatment bundle are available on the PICU website. Couple key Points to remember: Nurses: Please notify providers for any new positive score (>/= 9) or a patient who was negative for a while and then re-screens positive. ALL admitted patients should have a CAPD score recorded at roughly 4a/4p unless their RASS is -4 or -5 for the majority of the shift. Providers: CAPD scores are now in the EPIC peds flowsheet. Please discuss on rounds AND help set developmental milestones for all developmentally delayed patients. This should be documented on the sticky note so that the patient is screened at the same point every time. Contact: Stephanie Schwartz, Tracie Walker, LeeAnne Flygt. Nurse champions: Danielle Stolfi, Kelly Cherry, Emily Bergonzi, Zach Wiercinski, Cari Miller, Allie Shumacher, Grace Neumann
VTE RISK Assessment
All patients 12 and up admitted to PICU/PCICU should have documentation of their VTE risk on admission. You can use the dot phrase .PEDVTEPPX. Contact: Katherine Clement
The RAP Sheet (Resuscitation Action Plan)
The RAP Sheet is an adjuvant to the bedside code sheet. It discusses preplanning for the unstable patient (pre‐oxygenation, pre‐sedation, declined baths or weights, etc.) as well as an ECMO plan (candidate vs no and where cannulation would happen). It also highlights the expected vitals for the patient and where alarm values should be for each patient. We are using this RAP sheet for all patients with code meds at the bedside and any patient at high risk of deterioration. We hope that the team can review the sheet once a shift (twice a day) with the bedside RN, RT, MD’s, and charge/resource RN. This “code prevention sheet” has been shown in a multicenter study to reduce cardiac arrests by 45% (https://www.ahajournals.org/doi/abs/10.1161/circ.140.suppl_1.11798) and is most effective in post‐op cardiac surgical patients. The sheets will be yellow in color and mounted on the wall next to the bedside code sheet. Contact: Rebecca Smith
Revision of our sedation protocol to promote optimization of sedation goals, standardization, and decreased benzodiazepines. Contact: Stephanie Schwartz, Tracie Walker, LeeAnne Flygt. Nurse champions: Danielle Stolfi, Kelly Cherry, and Lisa Tibbets.
Children’s QI initiative to decrease pressure injuries across all areas of patient care with focus on ICU prevention and medical device prevention techniques. Do not forget to pad your devices! Contact: Melissa Smith. Nurse champions: Joy Hazard, Danielle Stolfi, Claudette Gaballo, Cari Gunnells
Cardiac ICU Simulations
To enhance the cardiac education of pediatric residents. Targeted cardiac teaching followed by weekly simulations on cardiac situations. Contact: Jeremy Sites, Matthew Pizzuto
Aerodigestive Guide for Post Op Cardiac Patient
QI project to standardize PO feeding attempts following cardiac surgery.
Check out the guide www.med.unc.edu/ticker/theproject/implementation. Contact: Matthew Pizzuto