This timeframe was chosen to include periods of historically lower September—October and higher January—February patient volumes. The PICU is a mixed cardiac and medical-surgical unit with 12 beds. All patients admitted to the PICU were eligible for inclusion in the study, except for those being transferred or discharged that day or those admitted after 6 am on the day of rounds as the checklist is not typically done for these patients. A trained research assistant RA attended bedside rounds to assess compliance with the use of the checklist in eligible patients, and to determine whether discussion of an individual checklist element was associated with a change in the patient's care.
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If the decision had been made prior to the checklist being reviewed, the item would not be recorded as having altered care. The RA did not attend rounds if the primary investigator was on service that day. Morning rounds were usually attended by residents, fellows, the intensivist, the charge nurse, a PICU pharmacist, respiratory therapists and a PICU dietician; however, the exact composition of the team on any given day was not recorded. Compliance was defined as the initiation of the checklist by reading the elements aloud at the end of the patient's rounds.
If items on the checklist were missed, the RA still recorded that encounter as compliant. In order to ensure reliability and validity of data collection, the research assistant underwent a structured training process with the primary investigator. Data were also collected on patient census, severity of illness PELOD score and ventilation status , day of the week weekday vs. Sample size was determined as follows. Furthermore, we also sought to investigate the association between patient and unit factors and compliance.
Results were analyzed using SPSS v. Continuous variables were evaluated using means with standard deviation or medians with inter-quartile ranges. Associations were evaluated using logistic regression analysis. The Wilson score was used to correct for the potential clustering effect that could occur as multiple patient encounters were collected on a given day. Data were collected on a total of encounters.
Compliance with the use of the checklist was However, there was a trend toward better compliance in intubated patients, on weekends and when the unit census was lower. Use of the checklist resulted in a change in the patient management plan The items that most commonly resulted in a change in the patient's management plan included whether a chest radiograph was required in the morning There were some items that rarely resulted in a change in patient care, including whether the head-of-bed had been elevated, whether nutrition had been assessed or whether the patient was being prepared for extubation 0.
Discussion of two of the items never changed patient care: Daily rounds checklists have shown promise in promoting adherence to best practices [ 14 , 15 ]. The current study evaluated the compliance of the healthcare team with an established checklist and its impact on patient care.
Importantly, we found that the healthcare team was highly compliant with checklist use, completing it during These results are consistent with the results of other studies on PICU bedside rounds checklists, where compliance rates ranged from However, our study is the first to report on the compliance rates for an established PICU bedside rounds checklist, outside of the initiation phase. One study in adult ICU evaluated compliance with a bedside rounds checklist 2 years after initiation and found high rates of compliance to be sustainable [ 23 ].
This is in contrast to another study that found lower compliance rates and a rebound in VAP incidence during the checklist washout phase 4—14 months [ 24 ]. Our sustained high rates of checklist compliance may be due to several factors. Systematic reviews of quality improvement tools have found that certain factors are associated with their success including tailoring it to the local context, collaboration and teamwork and evaluation and monitoring of the tool [ 22 , 25 ]. The process of developing our checklist had all these factors; it was developed by a multidisciplinary team and is updated regularly based on user feedback.
Checklist Booklet
As time required for checklist completion has been negatively correlated with compliance, this may be a factor in the high compliance rates observed [ 22 ]. Given the low non-compliance rate However, we noted trends toward higher compliance in intubated patients and during times of lower unit census. With regard to the impact of the checklist, we found that in the majority of cases The checklist elements that most frequently altered patient care were those primarily associated with improved efficiency, such as reducing bloodwork frequency Our checklist's potential impact on patient care and efficiency is consistent with other studies on the use of checklists at PICU bedside rounds, which reported reductions in invasive device use, medication use and laboratory test frequency [ 16 , 17 ].
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The current study describes a novel process of checklist revision based on evaluating the impact of individual elements and is the first study to prospectively evaluate the frequency with which individual checklist items altered patient care. As iterative optimization of checklists has been associated with improved compliance [ 22 ], the results of this study will be used internally, with removal of items that do not have an impact on patient care. A limitation of our study is the fact we did not measure clinical outcomes, such as the frequency of VAP.
As well many of the items on the checklist have been incorporated based on evidence that they improve clinical outcomes for example, elements from the VAP prevention bundle have been incorporated into the checklist. Another limitation is that the presence of the RA during rounds may have improved checklist compliance. However, the team was not aware of the role of the RA, and we did not observe a trend towards lower compliance over time, as would have been expected if the team was becoming accustomed to the RA's presence. Another potential limitation is that we did not measure the extent to which checklist elements became integrated into routine patient care processes, resulting in an underestimation of checklist impact.
The study may also have underestimated checklist impact because we did not correct for the applicability of checklist elements to a given patient.
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For example, the removal of invasive devices applies only to patients with invasive devices but the element impact was calculated using all patients as the denominator. We demonstrated that long-term use of a bedside rounds checklist in a tertiary care PICU was associated with high compliance rates and still resulted in a change in patient management plan more than half the time Our study demonstrated that this low-risk and low-cost initiative has the potential to positively impact the care of critically ill children and thus believe that other PICUs could benefit from adopting a bedside rounds checklist and modifying it to their institution based on local factors.
The authors declare that they have no competing interests. The study funders were not involved in the study design, collection, or management. There are no contractual agreements that limit access for the investigators. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Close mobile search navigation Article navigation.
Conflict of interest statement. A PICU patient safety checklist: Address reprint requests to: Withdrawal assessment tool scores ordered? Deep venous thrombosis prophylaxis? Peptic ulcer disease prophylaxis ordered? HOB at 30—45 degrees? Sedation behavioral scale and modified comfort scale ordered? Patient at risk for withdrawal? Gastric ulcer prevention, bowel regimen ordered? Frequency of blood work evaluated? Is the patient's nameband on?
Patient Checklist for Safer Hospital Stay
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Get to know your nurses and aides. Nurses are the human face of technology-driven care. Your nurse is your day-to day point person and coordinates your daily care plan. She or he can be a powerful ally and helpful guide in navigating the foreign terrain of a hospital and its system and ways. Aides handle many of the daily personal-care issues that are crucial to your comfort but they generally do not dispense medications or perform other nursing duties. Understand that your nurse is caring for many sick patients but don't hesitate to ask for help when you need it.
Make sure you have the phone number for the nurses' station in case your call bell is not answered in a timely fashion and you really need assistance, especially at night, when there is less staff on hand. Make names a must in all hospital interactions. Names are the first thing to go in the hospital setting: Names are a reminder to everyone that you are a person first and a patient second. Using names encourages the essential human connection — the key to collaborating with your care team. Get to know your doctors' names — don't let them remain strangers to you at this most crucial time.
Consider your hospital room your temporary home. Find out how to work the TV, the phone, the bed and the call button. Make sure that everything actually functions properly. Climate control is essential to your comfort. Being cold slows healing and increases vulnerability to infections by suppressing the immune system. Make sure you have enough blankets to stay warm. Real estate is everything in a hospital.
PREP checklist saves time and improves patient safety
Just a modicum of sunlight, a quieter room or a sliver of privacy can make a world of difference to a patient. If you're going to be in the hospital for more than a day, and you're very uncomfortable with your room or bed assignment, ask for a change. You might want to bring a portable entertainment device such as an iPod containing music or audio books. However, keep in mind that hospitals are not responsible for personal effects so keep track of items like this. Place multiple sets of earplugs and a sleep mask on the bedside table within easy reach.
Put pens and a notebook in an easily accessible place so you can make notes and write down observations. Place a bottle of hand sanitizer on your bedside table within easy reach for your own use. You may be bedbound and not able to wash your hands very often. Facial wipes and mouthwash or mints are also good items to have on hand. Make cleanliness in your room a priority.
Hospital rooms are really dirty, period. Three-quarters of patients' rooms are contaminated with bacteria that can cause staph infections.
Advice on how to prepare and be a proactive patient
Use disinfectant wipes on "high-contact surfaces" that you might touch — the rolling table surface, chair armrests, bed railings, the phone, the call button and the TV remote. These are the things that are often overlooked by the janitorial staff. Disinfectant wipes are available on every hospital floor and your aide can probably help you with small tasks like this.
If your room is really dirty, ask for someone from the hospital's "environmental services" to come clean it. Create a master medication list — use the notebook you have brought. Keep a numbered list that includes drug name, prescribing physician, schedule with dosages, what day you started and stopped and why you are taking every drug, for example, "blood pressure. Your nurse can help "translate" instructions and abbreviations into plain language so that you understand exactly what is going into your body and why.
Nurses learn the "5 Rights" checklist for safe medication. You can use it, too, every single time you are given any medication by reviewing these "5 Rights": Speak up if something seems wrong to you.
Create a daily journal with the notebook you have brought. Record how you are actually feeling day to day. How you feel matters! You know yourself best, what feels normal to you. A daily journal is a good place to make notes of any questions for your doctors and nurses as a reminder to yourself since you may have only minutes with them at a time. Make a note to ask every day if catheters, IVs or other invasive devices are ready to be removed — that can help prevent infections.