Making Time to Make It Clear

PICU checklist preps bedside nurses to keep families in the loop

Interdisciplinary teamwork, advanced technical skills, and a mastery of a range of life-support technologies are essential to patient care on the pediatric intensive care unit, or PICU.

But nurses in All Children’s 28-bed PICU must be as ready to help families understand a young patient’s potentially complex course of treatment as to quickly respond to a medical emergency. So when a number of families reported that they were often unsure of their child’s plan of care, the unit’s clinical leaders launched a multidisciplinary quality improvement project designed to enhance bedside nurses’ ability to articulate it.

“Our project illustrates that ACH nurses have a direct influence on patient outcomes by contributing to interprofessional decision-making through structural empowerment.”
– PICU Director Melissa Macogay, RN

A key factor is the nature of an ICU. Baseline data showed that the assigned RN, a critical member of the interdisciplinary team, was present at the bedside at the start of multidisciplinary rounds only 36 percent of the time due to competing needs on the unit. Consequently, the bedside nurse was able to articulate a patient’s plan of care to a family just 43 percent of the time.

So a standardized approach was added to daily rounding in the PICU that uses a “Time Out” in order for nurses to give full focus to a 19-point safety checklist. The plan is verbalized aloud, with a charge nurse prompting a bedside nurse through each item on the list.

Improvement has been dramatic. Three months after introduction of the checklist, the bedside nurse was present at the beginning of rounds 85 percent of the time, and the percentage of nurses able to successfully articulate a patient’s plan of care increased to 96 percent. The satisfaction score also improved as families felt more confident in their understanding of a loved one’s plan of care.

“We continued to refine the process for several months, creating a drop-down menu to ensure the use of standard language for questions and answers and to capture data on changes made as a result of the safety checklist,” explains PICU Director Melissa Macogay, RN. “Our project illustrates that ACH nurses have a direct influence on patient outcomes by contributing to interprofessional decision-making through structural empowerment.”

– All Children’s Staff