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J Crit Care. 2019 Aug;52:53-57. doi: 10.1016/j.jcrc.2019.04.004. Epub 2019 Apr 2.

Describing drug and fluid therapy in the paediatric intensive care unit: A pilot study.

Author information

1
Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada.
2
Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
3
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
4
Child Health Evaluative Sciences, The Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
5
Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Research Institute, Hospital for Sick Children, Toronto, ON, Canada. Electronic address: chris@sickkids.ca.

Abstract

PURPOSE:

Care in the paediatric intensive care unit (PICU) involves many clinical activities. The objectives of this study were to evaluate the feasibility of a novel observation method, the reliability of data abstraction, and to report the initial findings from application of this approach.

MATERIALS AND METHODS:

Bedside activities of patients and clinical staff were recorded by direct observational study using video recording and audio annotation. Data were abstracted into 9 broad clinical activities and 12 specific drug-fluid activities. Enrolment rates, agreement between abstractors, clinical activity durations and interruptions are reported.

RESULTS:

We enrolled 42 healthcare professionals, 12 family members of 13 patients, and recorded 12 patients (consent rates of 70%-92%). There were 884 clinical activity episodes. Each hour was comprised of a median (IQR) of 11.9 (4.8-16.5) minutes of drug and fluid related tasks. The 682 drug and fluid related activities were mainly preparation and administration. Interruptions occurred on average 7 times per hour. Data abstraction for 8 h had intra-class correlation co-efficient (95% CI) of 0.91 (079-0.96).

CONCLUSIONS:

Real-time recording of clinical tasks in the PICU using a direct observation model combined with video recording is feasible. Preliminary results suggest abundant and diverse activity is routine.

KEYWORDS:

Medication safety; Task analysis; Workload

PMID:
30974315
DOI:
10.1016/j.jcrc.2019.04.004

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