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Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection

INTRODUCTION: In critically ill children, inappropriate urinary catheter (UC) utilization is associated with increased morbidity, including catheter-associated urinary tract infections (CAUTIs). Checklists are effective for reducing medical errors, but there is little data on their impact on device...

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Autores principales: Siegel, Benjamin I., Figueroa, Janet, Stockwell, Jana A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132817/
https://www.ncbi.nlm.nih.gov/pubmed/30229190
http://dx.doi.org/10.1097/pq9.0000000000000078
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author Siegel, Benjamin I.
Figueroa, Janet
Stockwell, Jana A.
author_facet Siegel, Benjamin I.
Figueroa, Janet
Stockwell, Jana A.
author_sort Siegel, Benjamin I.
collection PubMed
description INTRODUCTION: In critically ill children, inappropriate urinary catheter (UC) utilization is associated with increased morbidity, including catheter-associated urinary tract infections (CAUTIs). Checklists are effective for reducing medical errors, but there is little data on their impact on device utilization in pediatric critical care. In this study, we evaluated UC utilization trends and CAUTI rate after implementing a daily rounding checklist. METHODS: A retrospective review of our checklist database from 2006 through 2016 was performed. The study setting was a 36-bed pediatric intensive care unit in a quaternary-care pediatric hospital. Interventions included the “Daily QI Checklist” in 2006, ongoing education regarding device necessity, and a CAUTI prevention bundle in 2013. UC utilization and duration were assessed via auto-correlated time series models and Cochran-Armitage tests for trend. Changes in CAUTI rate were assessed via Poisson regression. RESULTS: UC utilization decreased from 30% of patient-days in 2006 to 18% in 2016 (P < 0.0001, Cochran-Armitage trend test), while duration of UC use (median, 2.0 days; interquartile range, 1–4) did not change over time (P = 0.18). CAUTI rate declined from 9.49/1,000 UC-days in 2009 to 1.04 in 2016 (P = 0.0047). CONCLUSIONS: Implementation of the checklist coincided with a sustained 40% reduction in UC utilization. The trend may be explained by a combination of more appropriate selection of patients for catheterization and improved timeliness of UC discontinuation. We also observed an 89% decline in CAUTI rate that occurred after stabilization of UC utilization. These findings underscore the potential impact of a checklist on incorporating best practices into daily care of critically ill children.
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spelling pubmed-61328172018-09-18 Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection Siegel, Benjamin I. Figueroa, Janet Stockwell, Jana A. Pediatr Qual Saf Individual QI Projects from Single Institutions INTRODUCTION: In critically ill children, inappropriate urinary catheter (UC) utilization is associated with increased morbidity, including catheter-associated urinary tract infections (CAUTIs). Checklists are effective for reducing medical errors, but there is little data on their impact on device utilization in pediatric critical care. In this study, we evaluated UC utilization trends and CAUTI rate after implementing a daily rounding checklist. METHODS: A retrospective review of our checklist database from 2006 through 2016 was performed. The study setting was a 36-bed pediatric intensive care unit in a quaternary-care pediatric hospital. Interventions included the “Daily QI Checklist” in 2006, ongoing education regarding device necessity, and a CAUTI prevention bundle in 2013. UC utilization and duration were assessed via auto-correlated time series models and Cochran-Armitage tests for trend. Changes in CAUTI rate were assessed via Poisson regression. RESULTS: UC utilization decreased from 30% of patient-days in 2006 to 18% in 2016 (P < 0.0001, Cochran-Armitage trend test), while duration of UC use (median, 2.0 days; interquartile range, 1–4) did not change over time (P = 0.18). CAUTI rate declined from 9.49/1,000 UC-days in 2009 to 1.04 in 2016 (P = 0.0047). CONCLUSIONS: Implementation of the checklist coincided with a sustained 40% reduction in UC utilization. The trend may be explained by a combination of more appropriate selection of patients for catheterization and improved timeliness of UC discontinuation. We also observed an 89% decline in CAUTI rate that occurred after stabilization of UC utilization. These findings underscore the potential impact of a checklist on incorporating best practices into daily care of critically ill children. Wolters Kluwer Health 2018-05-18 /pmc/articles/PMC6132817/ /pubmed/30229190 http://dx.doi.org/10.1097/pq9.0000000000000078 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Individual QI Projects from Single Institutions
Siegel, Benjamin I.
Figueroa, Janet
Stockwell, Jana A.
Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection
title Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection
title_full Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection
title_fullStr Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection
title_full_unstemmed Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection
title_short Impact of a Daily PICU Rounding Checklist on Urinary Catheter Utilization and Infection
title_sort impact of a daily picu rounding checklist on urinary catheter utilization and infection
topic Individual QI Projects from Single Institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132817/
https://www.ncbi.nlm.nih.gov/pubmed/30229190
http://dx.doi.org/10.1097/pq9.0000000000000078
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