Providing High Reliability Care for PICU Patients with Pulmonary Hypertension: A Quality Improvement Project
Anjali Subbaswamy, MD; Nicholas Tan, DO; Iric Guthrie, MD; Kelsey Fath, MD; Cole Linzmeyer, DO; Elizabeth Yakes Jimenez, PhD, RDN, LD
Purpose: Pediatric patients with pulmonary hypertension (PHTN) are a high acuity, low frequency population, and are often admitted to the pediatric intensive care unit (PICU). 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 48 providers and staff. Most respondents correctly answered five out seven questions, with questions related toprevention and management of a PHTN crisis being the most frequently missed. Based on these results, investigators abandoned further PDSAs related to didactic teaching, and focused on application of knowledge. Three PDSA cycles followed, which tested a visual door prompt designed to remind all clinical team members to apply PHTN precautions. Verbal feedback was sequentially collected from resident physicians, nursing staff, respiratory therapists, PICU attending physicians, and a pediatric cardiologist during these PDSAs. This feedback directed changes to the door prompt to (1) include a more directive title; (2) emphasize applied physiology; and (3) state specifically what to do as well as what not to do for individual providers. 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 and incorporating a stylized order set into the electronic medical record.
Subbaswamy, Anjali; Nicholas Tan; Iric Guthrie; Kelsey Fath; Cole Linzmeyer; and Elizabeth Yakes Jimenez. "Providing High Reliability Care for PICU Patients with Pulmonary Hypertension: A Quality Improvement Project." (2021). https://digitalrepository.unm.edu/hsc_qips/56