O3012: Using a Situation Awareness Bundle to Reduce Cardiac Arrests in the Pediatric ICU

Purpose/Objectives: Failure to recognize and treat clinical deterioration remains a source of serious preventable harm for hospitalized pediatric patients. Patients who experience cardiac arrest are at increased risk for mortality. Prior research has demonstrated that improved situation awareness in the pediatric ICU may reduce CPR events.

Objectives: To increase days between CPR events in the PICU from one event every 36 days to one event every 50 days by October 2023. The primary process metric was to increase compliance with the situation awareness bundle to identify high-risk patients and create an actionable mitigation plan by 25% from 54% to 70% by June 2022.

Design/Methods: Adapting prior research, a situation awareness bundle was designed to guide the recognition of patients meeting high-risk criteria for decompensation. All patients admitted to the pediatric ICU were included. The pediatric ICU is a 16-bed tertiary-care closed combined cardiac, medical/surgical ICU with over 1,000 annual admissions. Before initiating cycles of change, a baseline survey was conducted to evaluate the current perceived level of situation awareness, identification of high-risk patients, and the sharing of desired mitigation plans. Key drivers included identification of high-risk patients, actionable mitigation plans, accurate tracking of cardiac arrests and timely review of CPR events. Following an in-depth literature review and consulting expert opinion, criteria were developed for identifying high-risk patients. A checklist was then created to share the at-risk criteria and worksheets were created to share etiologies of decompensation and descriptive mitigation plans. The unit implemented twice a day huddles to review these identified patients and mitigation plans. Code events were defined as occurring in the PICU and the patient receiving at lest 2 minutes of chest compressions and a dose of epinephrine. Compliance with the situation awareness bundle was tracked weekly on a statistical process control chart.

Results: After the implementation of the situation awareness bundle and huddles, days between code events increased from one CPR event every 36 days to one event every 104 days in the pediatric ICU (Fig.1). The percentage of watcher bundle compliance improved from 54% to 71% (Fig.2)

Conclusion/Discussion: Implementation of a previously described situation awareness bundle including a standardized risk assessment tool, huddles and mitigation plans may lead to decreased cardiac arrest events in the PICU.