1076: QUALITY IMPROVEMENT INITIATIVE TO PREVENT FLUID OVERLOAD IN PEDIATRIC INTENSIVE CARE UNIT PATIENTS

Abstract

Introduction: Fluid administration for critically ill children frequently exceeds hydration requirements and is associated with increased morbidity and mortality. The global aim of this ongoing single-center quality improvement (QI) initiative is to standardize and implement process improvement tools to detect and prevent fluid overload (FO) in patients admitted to the Pediatric Intensive Care Unit (PICU). Our SMART aim is to reduce the incidence of percent fluid overload (%FO) >/= 10% at 72 hours of PICU admission by 20% in the first 6 months. Methods: In collaboration with key stakeholders, we used Plan-Do-Study Act (PDSA) QI methodology to develop electronic health record (EHR)-based tools and education sessions to help providers detect and prevent FO in PICU patients. We conducted a retrospective chart review with a convenience sample to obtain baseline metrics. We assessed current FO understanding and perceptions of proposed interventions with anonymous surveys distributed to PICU attendings, fellows, residents, advanced practice providers and nurses. In April 2022, we implemented a single screen “Fluid Management accordion” within our EHR that displays all clinical markers used to evaluate a patient’s fluid status, and an EHR-based %FO calculator. In July 2022, we added PICU admission order set modifications to include a total fluid goal. Outcome metrics are collected monthly. Quarterly follow up surveys began in July 2022 and will trend intervention impact and perceptions. Results: Chart review (n=562) revealed a 40% baseline incidence of %FO >/= 10% at 72 hours of PICU admission. Pre-implementation, most respondents (n=115) agreed that we could improve our awareness to patients’ fluid status (92%) and that using standardized EHR orders and tools would be helpful (76%). Few (27%) reported knowing how to calculate %FO. Three months after initial EHR tool launch, many survey respondents (n=49) reported using the fluid management accordion at least once (40%) and 43% reported knowing how to calculate %FO. Six-month implementation data will be available in October 2022. Conclusions: To date we have standardized EHR-based tools for FO detection. We suspect that with continued education and feedback we will likely see a reduction in %FO incidence in our PICU population.