PM2026: Spiritual Screening of Patients Admitted to the Pediatric Intensive Care Unit (PICU)

Purpose/Objectives: Spirituality has been shown to affect healthcare decision-making and may aid in patient and family preparedness for urgent medical situations. A study auditing family meetings in multiple intensive care units (ICUs) found that physicians neglect topics of spirituality. While obtaining a spiritual screen is standard in the Pediatric ICU (PICU) at our institution, it is done infrequently. Potential reasons for infrequent spiritual screening include lack of a standardized screener and automatic prompt for performing a spiritual screen. Additionally, restrictions on chaplain documentation within our electronic medical record has limited the ability to effectively communicate across disciplines about patient’s and family’s spiritual needs. We therefore aimed to improve the frequency of spiritual screening and screening documentation in our PICU. Our goal was to perform and document a spiritual screen within 5 days of admission for ≥ 35% of patients hospitalized in the PICU for >72 hours.

Design/Methods: This quality improvement project utilized Plan-Do-Study-Act (PDSA) cycles to implement change ideas. Baseline data was obtained via a chart review. The PICU social worker and Palliative Care Team were identified to serve as spiritual screeners. A spiritual screening tool was adapted from the Rush Spiritual Screening Protocol. Patients had to be admitted to the PICU for >72 hours to be eligible and the spiritual screen had to be completed within 5 days of admission. Data was analyzed at two-week intervals over the course of two months.

Results: Baseline data obtained over a two-month period revealed documentation of a spiritual screen in 12.5% of patients who met eligibility criteria in the PICU. The percentage of spiritual screens for eligible patients at two-week intervals during the course of two PDSA cycles was as follows: 16.6%, 40%, 33%, 14%, 0%, 33%, 0%, and 60% (Figure 1). Additionally, we found that having a standard screener led to clearer documentation.

Conclusion/Discussion: Implementing a standard spiritual screening tool in the PICU led to an overall increase in screening and improved chart documentation. However, there were several missed opportunities for performing a spiritual screen despite frequent reminders to those providers who were identified as spiritual screeners. Therefore, a request was made to include a prompt for a spiritual screen in the nursing admission database so that nursing staff could perform and document the spiritual screen. Modifications to the palliative care inpatient consult template were also implemented to include a spiritual screening prompt. We continue to partner with the Pastoral Care department in order to further improve spiritual screening and documentation at our institution.