Pediatric Health Assessment Tracker: A Quality Improvement Initiative to Obtain Weights Consistently and Appropriately in a Tertiary Pediatric Intensive Care Unit.

Abstract

Introduction: Weight is vital for tracking fluid status and nutrition and assuring patients have accurate dosing weights in the pediatric intensive care unit (PICU). Challenges in acquiring weights in critically ill patients include clinical instability, limited equipment, and lack of appropriate orders in the electronic medical record (EMR).

Methods: We implemented interventions that targeted EMR weight orders and actual collection of weights in the 42-bed PICU of a children's hospital. Preintervention data were collected from February to March 2023 for all patients admitted to the PICU with a length of stay (LOS) ≥3 days. We surveyed PICU nurses to identify barriers to collecting weights. Interventions included a multidisciplinary team approach, safety checklist, nursing education, and automatization of weight orders. The study team monitored the number of patients with weight orders and weights obtained as ordered twice weekly from March 2023 to April 2024 using statistical process control charts.

Results: There were 1728 patient instances of LOS ≥3 days. Preintervention data showed 70.4% of patients with appropriate weight orders and 35.5% with weights obtained. Implementing a safety checklist, nursing education, EMR changes, and automatizing weight orders, the centerline for weight orders shifted to 94.3% and for weights obtained to 69.5%. Reminder emails to all ICU providers and nursing check-ins maintained the centerline. No increase in unplanned extubations occurred.

Conclusions: Through interventions involving rounding providers, nurses, and the EMR, the frequency of weights ordered and obtained in a busy PICU sustainably increased.