P0052 / #780: A MULTIFACETED QUALITY IMPROVEMENT INITIATIVE TO DECREASE IATROGENIC WITHDRAWAL SYNDROME IN CHILDREN NEEDING INTUBATION AND VENTILATION

Abstract

Aims & Objectives: Iatrogenic withdrawal syndrome (IWS) is still a common complication in pediatric critical care. The objectives of this study were to improve the assessment of iatrogenic withdrawal syndrome (IWS) and to reduce its incidence and severity in children that were intubated and ventilated in a tertiary medical-surgical pediatric intensive care unit (PICU). Methods: This quality improvement (QI) study describes the effect of 4 interventions on IWS: a non-pharmacological bundle of measures for pain and agitation; education through simulation, newsletters, and posters; and the introduction of order sets reflecting the pain and agitation management protocol. The team monitored sedation, analgesia, and withdrawal scores biweekly, utilizing an electronic medical record report and direct observation. Interviews with frontline staff helped to optimize the interventions. Data were analyzed with process control charts, and the progress was displayed in a QI board in the PICU. Results: 293 intubated and ventilated patients, admitted from January 2018 to December 2019 were included, 211 of them assessed for IWS. The proportion of intubated patients assessed for withdrawal increased from 40% to 100%. The incidence of IWS did not change significantly with the interventions, oscillating around the mean of 83% in the high-risk population. The severity of withdrawal was reduced and sustained to 4, from 6 before the intervention. Unplanned extubation, severe pain or under sedation episodes were not affected by the interventions. Conclusions: This QI project was able to improve assessment and sustain a reduction in the severity of withdrawal, without compromising patient comfort and safety.