(1332) Development of a Best Practice Checklist to Improve Nutritional Plans on PICU Rounds

Introduction: Malnutrition is prevalent and associated with worse outcomes in critically ill children. Early enteral nutrition, caloric goal identification, and multidisciplinary rounds with nutrition plans are best practices associated with improved outcomes in the pediatric critical care unit (PICU). Instituting these practices is challenging due to acuity and time constraints. We found that nutritional assessments on rounds in our PICU was inadequate. The aim of this study was to improve the number of patients that had complete nutrition plans developed during PICU rounds by 30% before 12/31/23 through implementation of quality improvement (QI) champions prompting a checklist on rounds.

Methods: This QI study was completed in a 24-bed quaternary care children’s hospital PICU. Problem identification was accomplished via gap analysis of nutritional metrics by stakeholders. A rounding dietary plan checklist was the greatest deficiency on multilevel vote. Baseline process data was collected on rounds by secret shopping for 80 patient encounters. Data collected included members present, duration, and if each component of the nutritional assessment was discussed. Two improvement changes were implemented thereafter for 681 encounters. Improvement change one was a general nutrition prompt to the team from the QI champions and change two was prompts from a checklist.

Results: Baseline data revealed nutrition was discussed on rounds for 87% (mean) of encounters. Nutrition plan details and goals were discussed for 18% and 28% (mean) of encounters respectively. After improvement implementation, the mean occurrence rate for nutrition discussion improved to 90%, nutrition detail discussion to 92%, and if the patient was at the nutrition goal or not to 86%. Compliance with best of care practice nutrition metrics improved by 74% for nutrition detail discussion and by 58% for the patient being at the nutrition goal.

Conclusions: Prompting PICU teams with a nutrition checklist by QI champions on rounds improved the percentage that a daily nutrition assessment and plan for each patient was completed. Continuing this intervention may improve outcomes for critically ill children by initiating discussions related to nutrition early during admission. Further studies are needed to delineate long-term effects of this initiative.