(1342) PICking up Infants in the PICU: A Quality Improvement Project

Introduction: Recent pediatric studies have demonstrated that implementation of early mobility practices is safe, and when adjusted for patient acuity, does not increase adverse outcomes. Research examining ‘Kangaroo care’ in the neonatal intensive care unit (NICU) has demonstrated shortened recovery time and earlier discharges. Our goal was to increase holding of pediatric intensive care unit (PICU) patients < 2 years old by family members from 28% to 50% by December 2024.

Methods: PICU Up!™ was implemented in our single-center, University tertiary care 12-bed PICU in November 2023. Between December 2023 and April 2024, the PICU census data was intermittently queried to identify the mobility level (1 – 3) of each admitted infant < 2 years of age. Patients were considered safe to hold if mobility level was determined to be 2 or 3. For those infants, information was collected from bedside nursing regarding whether the infant was held by family members or other hospital staff in the preceding 24-hours. Additionally, perceived barriers to holding were identified with the balancing measure of adverse outcomes such as unplanned extubations or hemodynamic instability.

Results: Twenty-nine infants were identified during the study period, from which 44 different encounters were studied: Level 1, L1 (N = 11), Level 2, L2 (N = 9), Level 3, L3 (N = 19) and 5 encounters met exclusion criteria for early mobility and were not assigned a level. Of the 28 encounters that qualified for holding, 17 (60%) were held (4/9 (44%) L2, 13/19 (68%) L3), with only 8 (28%) of those being by family members (3/9 (33%) L2, 5/13 (26%) L3). Common barriers identified across both mobility levels were a lack of: 1) discussion regarding mobility level on rounds 2) updating of orders by the primary team and 3) conversations with family members regarding their ability to hold their child. Among Level 3 encounters, family was absent from the bedside more frequently than among Level 2 encounters. No adverse outcomes during holding were identified.

Conclusions: Despite implementation of PICU Up!™, the number of infants held in our unit did not yet meet our goal. Multiple potential areas for improvement were identified. Additional effort to identify and mitigate barriers to family members’ bedside presence in less acute patients is warranted.