P.332 Implementation of a nurse led transplant specialty care team in a Pediatric Intensive Care Unit improves patient safety
Monday May 06, 2019 from 17:00 to 18:00
Exhibit-Poster Area
Presenter

Mihaela A Damian, United States

MD

Pediatric Critical Care MEdicine, Department of Pediatrics

Stanford University

Abstract

Implementation of a nurse led transplant specialty care team in a Pediatric Intensive Care Unit improves patient safety

Laura Blair1, Nicole Dykes1, Katherine Kent1, Aleyna Hamlin1, Tamara Kelley1, Denisia Chen2, Rajesh Shetty2, Mihaela Damian1.

1Pediatrics, Stanford Children’s Health/ Lucile Packard Children’s Hospital, Palo Alto, CA, United States; 2Center of Quality; Department of Solid Organ Transplantation, Stanford Children’s Health/ Lucile Packard Children’s Hospital, Palo Alto, CA, United States

Introduction: At Stanford Children’s Health/ Lucile Packard Children’s Hospital, a multidisciplinary transplant specialty care team led by pediatric intensive care unit (PICU) nurses was developed to increase nurse education, decrease patient safety events, and improve the outcomes of liver and kidney transplant patients in the critical care setting. 

Methods: All solid organ transplant related iCare incident reports for the PICU were analyzed pre (September 2016- August 2017) and post (September 2017- August 2018) development and  implementation of a specificnursing education program to target the main areas identified as gaps by the transplant specialty care team. iCare is the hospital's anonymous system of reporting patient safety related events. The education targeted appropriate lab draws, nutrition management and delivery, safety, immunosuppressive medication administration, discharge teaching, post-transplant blood pressure guidelines and specific medication pathways, implementation of bedside goals sheet, prevention of pressure ulcers and bloodstream catheter infections.

Results: A total of 276 transplant related iCare incident reports were analyzed: 175 pre-implementation (73 kidney transplant and 102 liver transplant) and 101 post-implementation (20 kidney transplant and 81 liver transplant) resulting in a 57.7% decrease in transplant related patient safety events. The majority of the reports were liver transplant related at 66% (80% pre and 58% post). All the identified areas for improving education had a decrease in iCare reports as recorded in table 1. In the liver transplant population, 25 patients had a PICU length of stay > 10 days. These patients had the majority of iCare reports, 110 out of 184 (60%), making this patient population at high risk for safety event occurrence (62/103 60 % pre vs 48/81 60% post) (table 2).

Conclusion: The existence of a transplant specialty care team in the pediatric intensive care setting resulted in a significant increase in liver and kidney transplant safety. This improvement was due to the increase in transplant specific education for critical care providers, as well as the implementation of evidence based changes that directly affected patient care. In addition, patients with longer ICU length of stay are prone to experience more safety events, thus efforts to decrease ICU stay should be made.


Lectures by Mihaela A Damian


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