A Pediatric Critical Care Practice Group: Use of Expertise and Evidence-Based Practice in Identifying and Establishing “Best” Practice

Abstract

Mary-Jeanne Manning and Susan Hamilton are clinical nurse specialists in the medical-surgical intensive care unit, Michelle Labreque and Denise Casey are clinical nurse specialists in the neonatal intensive care unit, Heather Kennedy is a clinical nurse specialist in the medicine intensive care unit, and Katherine C. Penny is a nurse practitioner in the cardiovascular program at Boston Children’s Hospital in Boston, Massachusetts. Martha A. Q. Curley is the Ellen and Robert Kapito professor in nursing science in the school of nursing at the University of Pennsylvania in Philadelphia and a nurse scientist in the cardiovascular and critical care program at Boston Children’s Hospital. For questions related to this article, contact Patricia Lincoln at patricia.lincoln@ childrens.harvard.edu. and meets monthly to move best practices into the clinical setting. Clinical concerns are identified and prioritized for completion. Problems are addressed by using an evidence-based process. This approach involves review of the literature and obtaining expert opinion through shared conversations with practitioners both within the hospital and at other similar institutions. Once information has been gathered, it is used to assist in developing strategies to plan and implement practice changes. In this article, we describe our process and discuss 3 large-scale projects that resulted in practice changes throughout the critical care areas with further dissemination to other units in the hospital. These include standardization of continuous infusions of medications, formation of a multidisciplinary group to evaluate continuous renal replacement therapy (CRRT), and development of a risk-screening tool for venous thromboemboli. Nursing leaders from 4 different intensive care units (ICUs) at Boston Children’s Hospital noted wide variation in nursing practices. These variations were obvious to nursing staff and the discrepancies in practice created a source of frustration for parents of children cared for in these units. Practice variation that is unnecessary has been linked to patient safety concerns. Collaboration to explore discrepancies in nursing practice was needed. Through this initiative, the Critical Care Practice Group (CCPG) was established to determine “best” practice and standardize nursing policy and practice guidelines across the clinical areas (cardiac ICU, neonatal ICU, medical ICU, and medical-surgical ICU). Clinical nurse specialists and staff nurses from each critical care area were invited to participate. The CCPG sets a yearly strategic plan