P0554 / #1652: LIBERATION FROM PICU-ACQUIRED COMPLICATIONS: BI-CENTER IMPLEMENTATION STUDY

Abstract

Aims & Objectives: To determine the feasibility and acceptability of implementing an early rehabilitation bundle “PICULiber8” at 2 tertiary care PICUs, McMaster’s Children Hospital and London Health Sciences Centre and to determine if “PICULiber8” reduce Pediatric ICU aquired complications (PACs) and long-term patient outcomes and is it cost effective. Methods: We used Pronovost’s 4 E’s Framework to implement the “PICULiber8 Bundle”. It consists of evidence-based practices to reduce sedatives, prevent withdrawal, manage delirium, optimize sleep, implement early mobilization, and engage families in the process. Engagement consisted of a pre-implementation survey followed by focus group interviews. A Bundle Development and Bundle Implementation teams were developed. A Delphi process was used. Evaluation will consist of assessing the impact of the bundle on the process of care, family satisfaction, clinical and patient-centered outcomes, and the cost using mixed methods and run chart. Results: Engagement was conducted in 3-months. Main key knowledge gaps were: awareness of delirium, under appreciation of PACs, practice variations with respect to sedation and goals in intubated children. Engagement data demonstrated the need for goal directed, evidence based and user-friendly guidelines and more consistency in approach to sedation amongst attending staff. Evidence-based Bundles were developed over a 4-month and an educational roll out plan was developed over the subsequent 3-months. Sequential roll-out of the guidelines were implemented over 2-months. Conclusions: It is feasible to implement an early rehabilitation bundle over a 12-month period in 2 sites using a clear implementation framework. Ongoing evaluation will measure the uptake of the bundle and its impact on process of care and patient outcomes.