Eliminating Harm: Chronic Pediatric Ventilated Care

Sunday, 29 October 2017: 10:45 AM

Kimberly T. Hodges, DNP
Pediatric Intensive Care Unit, Riley Children's Health, GREENWOOD, IN, USA
Belinda Frazee, BSN
Pediatric Intensive Care Unit, Riley Children's Health, Indianapolis, IN, USA

Purpose and Significance:The Pediatric Intensive Care team developed an inclusive program for chronic pediatric ventilated patients to decrease length of stay, decrease catastrophic trach events post discharge, improve the educational process delivered to families and improve nursing engagement within the PICU nursing team. In August 2014 the chronic pediatric ventilated patient population was integrated into the PICU. The experienced nursing staff found delivering excellent patient care to this patient population challenging due to a lack of training for chronic care delivery. Medical teams reported dissatisfaction due to the variation of nursing expertise with chronic care and training abilities. Parents of ventilated patients received inconsistent discharge education and experienced delayed hospital discharges.

Literature Review:Care of the pediatric chronic ventilated patient requires complex considerations. Standardized hospital discharge criteria are suggested with at least two family caregivers trained specifically for the child’s care (Sterni et al., 2016). Inpatient teams identify the following four requirements of complex discharge planning; the child's medical stability for discharge, the family's preparedness for providing care in the home environment, acquiring necessary medical equipment and safety of the home environment (Moore et al., 2016). Integrating activities of daily living for complex pediatric patients is a significant means to support discharge planning. With chronic ventilated infants, activities of daily living in the hospital environment include play time and feeding during the traditional daytime hours (Dumas, 2012). Creating the home environment within the hospital setting is key in preparing chronic ventilated patient for potential discharge. Ongoing assessment and interventions from home health nurses or case managers post discharge promotes health of the chronic ventilated patient (Preutthipan, 2014).

Strategy and Implementation: A multidisciplinary team identified patient care gaps between the chronic care trained nurses and the critical care trained nurses in a program analysis. Several patient care gaps/nursing practice gaps were noted during the analysis; confidence in providing chronic care discharge education, adequate discharge education delivered to caregivers, location of designated beds for chronic patients and satisfaction in caring for chronic ventilated patients. The nursing team (n=102) was given a survey to analyze suspected gaps. A staffing plan of dedicated nurses for this program was implemented to improve confidence in delivering discharge education and increase engagement. A four-bed unit was designated for the program to support a consistent environment of care for this patient population. This home like environment was created in the 36 bed PICU to simulate the home setting and activities of daily care.

Evaluation/Outcome: Median length of stay decreased from 55.2 days in 2014, 38.2 days in 2015, to 37.8 days in 2016. Catastrophic trach events post discharge decreased from 3 events in 2015 to 0 events in 2016. This is a significant reduction in harm.

Implications for Practice: A program model exists for pediatric chronic ventilated patient population. Consistently utilizing a dedicated team of trained nurses has decreased length of stay and decreased harm. Chronic patients receive education that aligns with a coordinated plan for transition from hospital to home care.