Purpose: Pediatric patients with pulmonary hypertension (PHTN) are a high acuity, low frequency population. To mitigate the risk of precipitating a potentially life-threatening pulmonary hypertensive crisis, health care staff need to take specific precautions. This quality improvement (QI) project aims to increase the number of inpatient PHTN patients for whom PHTN precautions are applied to 100% by September 2021.
Methods: The QI project uses the Model for Improvement methodology. The primary outcome measure will be application of PHTN precautions for patients with PHTN, based on chart audit. A series of Plan-Do-Study-Act (PDSA) cycles were conducted to test ways to increase PICU staff knowledge and application of PHTN precautions.
Results: For the first PDSA cycle, a PHTN knowledge test was administered to 25 providers and staff. Most respondents got 13-15 out of 15 questions correct, with questions related to prevention and management of a PHTN crisis being the most frequently missed. Based on these results, the QI team decided to abandon further PDSAs related to didactic teaching, and focus on application of knowledge. Three PDSA cycles followed, testing a visual door prompt designed to remind all clinical team members to apply PHTN precautions. Verbal feedback was sequentially collected from residents, RNs, and a cardiology attending during these PDSAs, and directed changes to the door prompt to (1) include a more directive title (2) emphasize applied physiology and (3) state what to do as well as what not to do. A pathophysiology diagram was minimized and directive instructions were emphasized.
Conclusion: The QI team will continue to conduct PDSAs to test and refine the visual door prompt, targeting 100% use in all appropriate patients. Future PDSAs may address consistent identification of all patients who require PHTN precautions, with the goal of providing high reliability care.
Subbaswamy, Anjali; Nicholas Tan; Iric Guthrie; Cole Linzmeyer; Kelsey Fath; and Elizabeth Yakes Jimenez. "Providing High Reliability Care for PICU Patients with Pulmonary Hypertension: A Quality Improvement Project." (2021). https://digitalrepository.unm.edu/hsc_2021_pediatric_research/14