Routine Neurological Assessments by Nurses in the Pediatric Intensive Care Unit.

Brain Injuries / diagnosis Child Child, Preschool Critical Care Nursing / methods Diagnostic Tests, Routine Documentation / methods Female Humans Infant Intensive Care Units, Pediatric / organization & administration Male Monitoring, Physiologic / nursing Neurologic Examination / nursing Nursing Assessment / standards Quality Improvement

Journal

Critical care nurse
ISSN: 1940-8250
Titre abrégé: Crit Care Nurse
Pays: United States
ID NLM: 8207799

Informations de publication

Date de publication:
Jun 2019
Historique:
entrez: 3 6 2019
pubmed: 4 6 2019
medline: 10 1 2020
Statut: ppublish

Résumé

Brain injury with changes in clinical neurological signs and symptoms can develop while children are undergoing treatment in the intensive care unit. Critical care nurses routinely screen for neurological decline by using serial bedside neurological assessments. However, assessment components, frequency, and communication thresholds are not standardized. To standardize neurological assessment procedures used by nurses, improve compliance with physicians' ordering and nurses' documentation of neurological assessments, and explore the frequency with which changes from preillness neurological status and previous assessments can be detected by using the assessment tool developed. A quality improvement intervention was implemented during a 1-year period in a 55-bed pediatric intensive care unit with 274 nurses. Procedures for neurological assessment by nurses were standardized, a system for physicians to order neurological assessments by nurses at a frequency based on the patient's risk for brain injury was developed and implemented, and a system to compare patients' current neurological status with their preillness neurological status was developed and implemented. Process metrics that focused on compliance of ordering and documenting the standardized neurological assessments indicated improvement and sustained compliance greater than 80%. Exploratory analyses indicated that 29% of patients had an episode of neurological decline and that these episodes were more common in patients with developmental disabilities than in patients without such disabilities. Compliance with physicians' ordering and nurses' documentation of standardized neurological assessments significantly increased and had excellent sustainability. Further work is needed to determine the sensitivity of standardized nurses' neurological assessment tools for clinically meaningful neurological decline.

Sections du résumé

BACKGROUND BACKGROUND
Brain injury with changes in clinical neurological signs and symptoms can develop while children are undergoing treatment in the intensive care unit. Critical care nurses routinely screen for neurological decline by using serial bedside neurological assessments. However, assessment components, frequency, and communication thresholds are not standardized.
OBJECTIVES OBJECTIVE
To standardize neurological assessment procedures used by nurses, improve compliance with physicians' ordering and nurses' documentation of neurological assessments, and explore the frequency with which changes from preillness neurological status and previous assessments can be detected by using the assessment tool developed.
METHODS METHODS
A quality improvement intervention was implemented during a 1-year period in a 55-bed pediatric intensive care unit with 274 nurses. Procedures for neurological assessment by nurses were standardized, a system for physicians to order neurological assessments by nurses at a frequency based on the patient's risk for brain injury was developed and implemented, and a system to compare patients' current neurological status with their preillness neurological status was developed and implemented.
RESULTS RESULTS
Process metrics that focused on compliance of ordering and documenting the standardized neurological assessments indicated improvement and sustained compliance greater than 80%. Exploratory analyses indicated that 29% of patients had an episode of neurological decline and that these episodes were more common in patients with developmental disabilities than in patients without such disabilities.
CONCLUSIONS CONCLUSIONS
Compliance with physicians' ordering and nurses' documentation of standardized neurological assessments significantly increased and had excellent sustainability. Further work is needed to determine the sensitivity of standardized nurses' neurological assessment tools for clinically meaningful neurological decline.

Identifiants

DOI: 10.4037/ccn2019198 PMID: 31154328
pubmed: 31154328
pii: 39/3/20
doi: 10.4037/ccn2019198
doi:

Types de publication

Journal Article

Langues

eng

Pagination

20-32

Informations de copyright

©2019 American Association of Critical-Care Nurses.

Auteurs

Matthew P Kirschen (MP)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. kirschenm@chop.edu.

Kristen Lourie (K)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia.

Megan Snyder (M)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia.

Kenya Agarwal (K)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia.

Pamela DiDonato (P)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia.

Blair Kraus (B)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia.

Chinonyerem Madu (C)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia.

Kylie Geddes (K)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia.

Vinay Nadkarni (V)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia.

Daniela Davis (D)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia.

Heather Wolfe (H)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia.

Alexis Topjian (A)

Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia.

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Classifications MeSH

questionsmedicales.fr › Plaies et blessures › Traumatismes du système nerveux › Traumatismes cranioencéphaliques › Lésions encéphaliques › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Enfant d'âge préscolaire › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins infirmiers › Soins infirmiers intensifs › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Tests diagnostiques courants › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Sciences de l'information › Sources d'information › Services d'information › Documentation › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Unités de soins intensifs pédiatriques › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Monitorage physiologique › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Examen physique › Examen neurologique › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Démarche de soins infirmiers › Évaluation des besoins en soins infirmiers › Routine Neurological Assessments by Nurses in...
questionsmedicales.fr › Administration des services de santé › Amélioration de la qualité › Routine Neurological Assessments by Nurses in...