431: Using Kamishibai Cards to Prevent Pediatric Ventilator-Associated Events: A Single-Center Study

Wu, Anhua; Lehane, Renee; Bullock, Kevin; Ormsby, Jennifer; Yuen, Jenny Chan; Sandora, Thomas J.; Priebe, Gregory P.

doi:10.1097/01.ccm.0000907452.39271.02

Cited by 2 publications

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“…These guidelines specifically include conducting spontaneous breathing trials in patients without contraindications, minimizing sedation, taking steps to reduce reintubation risk, and using caffeine for apnea of prematurity within 72 hours of birth . Additionally, the test factors used in this study did not include traditional VAP bundle elements, which have been suggested in recent single-center studies to be associated with decreased PedVAE rates and infection-associated PedVAE . However, PedVAE and pediatric VAP are distinct entities .…”

Section: Discussionmentioning

confidence: 99%

“…24 Additionally, the test factors used in this study did not include traditional VAP bundle elements, which have been suggested in recent single-center studies to be associated with decreased PedVAE rates and infection-associated PedVAE. 25,26 However, PedVAE and pediatric VAP are distinct entities. 27 Patients with more severe illness are included in the PedVAE definition compared with those identified by the prior VAP definitions.…”

Section: Limitationsmentioning

confidence: 99%

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Pediatric Ventilator-Associated Events Before and After a Multicenter Quality Improvement Initiative

Wu,

Madhavan,

Deakins

et al. 2023

JAMA Netw Open

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ImportancePediatric ventilator-associated events (PedVAEs, defined as a sustained worsening in oxygenation after a baseline period of stability or improvement) are useful for surveillance of complications from mechanical ventilation. It is unclear whether interventions to mitigate known risk factors can reduce PedVAE rates.ObjectiveTo assess whether adherence to 1 or more test factors in a quality improvement bundle was associated with a reduction in PedVAE rates.Design, Setting, and ParticipantsThis multicenter quality improvement study obtained data from 2017 to 2020 for patients who were mechanically ventilated and cared for in neonatal, pediatric, and cardiac intensive care units (ICUs). These ICUs were located in 95 hospitals participating in the Children’s Hospitals’ Solutions for Patient Safety (SPS) network in North America. Data analyses were performed between September 2021 and April 2023.InterventionA quality improvement bundle consisted of 3 test factors: multidisciplinary apparent cause analysis, daily discussion of extubation readiness, and daily discussion of fluid balance goals. This bundle was distributed to a subgroup of hospitals that volunteered to participate in a collaborative PedVAE prevention initiative under the SPS network guidance in July 2018.Main Outcomes and MeasuresEach SPS network hospital submitted monthly PedVAE rates from January 1, 2017, to May 31, 2020, and test factor data were submitted from July 1, 2018, to May 31, 2020. Analyses focused on hospitals that reliably submitted PedVAE rate data, defined as outcomes data submission through May 31, 2020, for at least 80% of the baseline and postbaseline periods.ResultsOf the 95 hospitals in the SPS network that reported PedVAE data, 21 were grouped in the Pioneer cohort and 74 in the non-Pioneer cohort. Only 12 hospitals (57%) from the 21 Pioneer hospitals and 33 (45%) from the 74 non-Pioneer hospitals were considered to be reliable reporters of outcome data. Among the 12 hospitals, the PedVAE rate decreased from 1.9 to 1.4 events per 1000 ventilator days (absolute rate difference, −0.6; 95% CI, −0.5 to −0.7; P &lt; .001). No significant change in the PedVAE rate was seen among the 33 hospitals that reliably submitted PedVAE rates but did not implement the bundle. Of the 12 hospitals, 3 that reliably performed daily discussion of extubation readiness had a decrease in PedVAE rate from 2.6 to 1.2 events per 1000 ventilator days (absolute rate difference, −1.4; 95% CI, −1.0 to −1.7; P &lt; .001), whereas the other 9 hospitals that did not implement this discussion did not have a decrease.Conclusions and RelevanceThis study found that a multicenter quality improvement intervention targeting PedVAE risk factors was associated with a substantial reduction in the rate of PedVAEs in hospital ICUs. The findings suggest that ICU teams seeking to reduce PedVAEs incorporate daily discussion of extubation readiness during morning rounds.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Pediatric Ventilator-Associated Events Before and After a Multicenter Quality Improvement Initiative

Wu,

Madhavan,

Deakins

et al. 2023

JAMA Netw Open

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Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles’ compliance

Saavedra Bravo,

Santos,

Petenate

et al. 2023

International Journal for Quality in Health Care

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Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles’ adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool—Kamishibai board (K-board)—during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles’ compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles’ compliance was addressed in the K-board. Audit data were recorded in ‘SimpleQI’. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.

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431: Using Kamishibai Cards to Prevent Pediatric Ventilator-Associated Events: A Single-Center Study

Cited by 2 publications

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Pediatric Ventilator-Associated Events Before and After a Multicenter Quality Improvement Initiative

Pediatric Ventilator-Associated Events Before and After a Multicenter Quality Improvement Initiative

Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles’ compliance

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