Paediatric High Dependency Unit Research Articles

Paediatric Early Warning Score to Detect Deterioration in Paediatric Patients at a Tertiary Care Hospital of a Developing Country: A Validation Study.

To test the validity of the paediatric early warning score (PEWS) and to identify the patients with deteriorating clinical conditions who were reviewed by a rapid response team (RRT) and were advised higher level of care. Observational study. Place and Duration of the Study: Paediatric ward and high dependency unit (HDU) of The Aga Khan University Hospital (AKUH), Karachi, Pakistan, from January 2021 to March 2022. All children aged 1 month to 18 years, admitted with non-surgical diagnoses at AKUH and referred for an RRT consultation were identified by non-probability consecutive sampling. The bedside nurse assessed the PEWS and alerted the clinical team. The patient's further course of action was decided based on the PEWS, detailed systemic examination, and laboratory workup. This aided in deciding the level of care (General ward, HDU, Paediatric Intensive Care Unit) required by the patients. Patients with length of stay >24 hours were included and those withdid not resuscitate orders were excluded. Overall 10,032 patients were admitted to the ward and high dependency unit (HDU). Out of which, 323 (3.2%) patients had an RRT call and were included in the study. The median age of the study population was 3.15 years during the study period, and 30.3% were <1 year. System-wise admission diagnoses included respiratory (33.2%) and neurological diseases (16.1%). Median [interquartile range (IQR)] PEWS at RRT call was 2 (IQR, 1-2) on median admission day 2 (IQR, 1-3). The cumulative data at PEWS ≥3 demonstrated an area under the curve of 63% with a sensitivity of 90% and a specificity of 30%. PEWS >3 can probably identify the patients at risk of deterioration with excellent sensitivity. Paediatrics, Rapid response team, Early warning score.

Is postoperative high dependency care really needed for children undergoing supratentorial brain tumour surgery?

Purpose We present our analysis of the existing Paediatric High Dependency Unit (HDU) admission policy at our institution and discuss our thoughts for its revision in the context of paediatric supratentorial tumour surgery. Materials and methods We screened our prospectively maintained database of all children undergoing supratentorial craniotomy for resection of paediatric brain tumours over a fifteen-year period. The post-operative course of each patient was reviewed, assessing the number of patients who had true HDU needs in the immediate post-operative period, and the relative depth of input from paediatric HDU specialists that each patient received. Results Forty-three patients underwent craniotomy for supratentorial tumour resections during the study period. The median age of the children was 8 years old. Forty-two patients in the study cohort did not require any HDU-level monitoring or treatment post-operatively; all these patients were able to be discharged from HDU to a standard ward bed very rapidly post-operatively. Only one patient (2%) from the study cohort had any tangible HDU needs in the acute post-operative period, comprising of invasive cardiovascular monitoring and repeated blood transfusions. This child’s tumour was known to be large, highly vascular, and invasive pre-operatively. Conclusions We would advocate a rational and nuanced approach with regards to predicting which children are most likely need paediatric HDU care following supratentorial craniotomy for resection of a brain tumour. This rationalisation could improve resource availability and reduce financial burdens upon paediatric neurosurgical units.

The role of healthcare providers and caregivers in monitoring critically ill children: a qualitative study in a tertiary hospital, southern Malawi

BackgroundCritically ill children require close monitoring to facilitate timely interventions throughout their hospitalisation. In low- and middle-income countries with a high disease burden, scarce paediatric critical care resources complicates effective monitoring. This study describes the monitoring practices for critically ill children in a paediatric high-dependency unit (HDU) in Malawi and examines factors affecting this vital process.MethodsA formative qualitative study based on 21 in-depth interviews of healthcare providers (n = 12) and caregivers of critically ill children (n = 9) in the HDU along with structured observations of the monitoring process. Interviews were transcribed and translated for thematic content analysis.ResultsThe monitoring of critically ill children admitted to the HDU was intermittent, using devices and through clinical observations. Healthcare providers prioritised the most critically ill children for more frequent monitoring. The ward layout, power outages, lack of human resources and limited familiarity with available monitoring devices, affected monitoring. Caregivers, who were present throughout admission, were involved informally in monitoring and flagging possible deterioration of their child to the healthcare staff.ConclusionBarriers to the monitoring of critically ill children in the HDU were related to ward layout and infrastructure, availability of accurate monitoring devices and limited human resources. Potential interventions include training healthcare providers to prioritise the most critically ill children, allocate and effectively employ available devices, and supporting caregivers to play a more formal role in escalation.

A long-term observational study of paediatric snakebite in Kilifi County, south-east Kenya.

Estimates suggest that one-third of snakebite cases in sub-Saharan Africa affect children. Despite children being at a greater risk of disability and death, there are limited published data. This study has determined the: population-incidence and mortality rate of hospital-attended paediatric snakebite; clinical syndromes of snakebite envenoming; and predictors of severe local tissue damage. All children presenting to Kilifi County Hospital, Kenya with snakebite were identified through the Kilifi Health and Demographic Surveillance System (KHDSS). Cases were prospectively registered, admitted for at least 24-hours, and managed on a paediatric high dependency unit (HDU). Households within the KHDSS study area have been included in 4-monthly surveillance and verbal autopsy, enabling calculation of population-incidence and mortality. Predictors of severe local tissue damage were identified using a multivariate logistic regression analysis. Between 2003 and 2021, there were 19,606 admissions to the paediatric HDU, of which 584 were due to snakebite. Amongst young children (≤5-years age) the population-incidence of hospital-attended snakebite was 11.3/100,000 person-years; for children aged 6-12 years this was 29.1/100,000 person-years. Incidence remained consistent over the study period despite the population size increasing (98,967 person-years in 2006; and 153,453 person-years in 2021). Most cases had local envenoming alone, but there were five snakebite associated deaths. Low haemoglobin; raised white blood cell count; low serum sodium; high systolic blood pressure; and an upper limb bite-site were independently associated with the development of severe local tissue damage. There is a substantial burden of disease due to paediatric snakebite, and the annual number of cases has increased in-line with population growth. The mortality rate was low, which may reflect the species causing snakebite in this region. The identification of independent predictors of severe local tissue damage can help to inform future research to better understand the pathophysiology of this important complication.

Pediatric High Dependency Unit (HDU): Pattern of Admission, Length of Stay (LoS) and Outcome

Patients admitted to the HDU usually need medical care more than the capacity of general pediatric ward and less than Pediatric Intensive Care Unit (PICU) and they are usually children with acute medical problems necessitate close observation, monitoring and management. Objectives: To determine the pattern of admissions, length of stay (LoS) and outcome of patients admitted to pediatric high dependency (PHDU) in Elobied Pediatrics Teaching Hospital. Methods: It is a retrospective cross-sectional hospital-based study where data including age, sex, origin, length of stay (LoS), diagnosis and outcome were retrieved from pediatric HDU and hospital records for a 2-year period. All cases were individually reviewed by two pediatricians to identify the cause of admission along with LoS and outcome. Results: During the study period; 519 children were admitted with age ranging from 1 day to 17 years with the median age of 7 months. Males were 295 (56.8%) and females were 224 (43.1%). It was found that most patient 323 (62.2%) were from rural area and 196 (37.7%) were from urban area. Pattern of admission was as follows: neonatal Sepsis 123 (23.7%), severe malaria 52 (10%), cardiovascular diseases 51 (9.8%) of which heart failure in 29 (5.5%) due to anemia or congenital heart disease, diabetic ketoacidosis (DKA) 49 (9.4%), respiratory diseases 49 (9.4%) of which pneumonia 33 (6.3%) meningoencephalitis 49 (9.4%), renal diseases 33 (6.3%), neurological diseases 18 (3.4%), gastrointestinal diseases 13 (2.5%), septic shock 11 (2.1%), surgical cases 18 (3.4%) of which intestinal obstruction was 9 (1.7%) and others 53 (10.2%). The length of stay (LoS) was ranging from 1 day to 40 days with the median of 4 days. Regarding the outcome; 192 (37%) were discharged from HDU in good condition, 215 (41.4%) died out of them; 121 (23.3% died within 48 hours after admission to hospital and 101(19.8%) died after 48 hours after admission), 81 (15.6%) referred to higher centres and 31 (6%) left against medical advice (LAMA). Conclusion: It was obvious that communicable and preventable diseases are the most prevalent causes for morbidity and mortality among children admitted to HDU with high mortality rate.

Introduction of a high dependency unit at a large paediatric and adolescent medicine department.

A goal has been set to establish paediatric high dependency units (PHDUs) in Norwegian hospitals. We sought to describe the patient population in one such unit, and to investigate whether the need for admission to an intensive care unit (ICU) changed after the unit was established. Information was obtained from electronic patient records, patient administration systems and the quality register for the PHDU at the Department of Paediatrics and Adolescent Medicine at Haukeland University Hospital. All patients admitted to the PHDU within five years of its opening in 2017 were included. A comparison was made between ICU patients in the five years before and the five years after the establishment of the PHDU. The PHDU had a total of 851 patient admissions in the period 2017-2021, increasing from 125 in 2017 to 247 in 2021. This accounted for 3.5% and 7.6% of the total number of patients admitted to the Department of Paediatrics and Adolescent Medicine in these years, respectively. The ICU had 185 paediatric patient admissions in the period 2012-2016 and 187 in the period 2017-2021, which constituted 0.9% and 1.1% of all patients admitted to the Department of Paediatrics and Adolescent Medicine during the periods, respectively. After the start-up of the PHDU, a lower proportion of patients were admitted to the ICU in the diagnostic groups diabetic ketoacidosis (15% in 2017-2021 versus 20% in 2012-2016) and sepsis (12% in 2017-2021 versus 19% in 2012-2016). The introduction of a PHDU was not associated with a simultaneous reduction in the number of ICU admissions overall. For diabetic ketoacidosis and sepsis, however, the proportion of transfers to the ICU was reduced.

OP033 [Medical Workforce &amp; Education » Staff well being /health (Stress, burnout, moral distress, spirituality)]: INTRODUCTION OF WELLBEING CHAMPIONS IN A PAEDIATRIC HIGH DEPENDENCY UNIT (HDU)

OP033 [Medical Workforce &amp; Education » Staff well being /health (Stress, burnout, moral distress, spirituality)]: INTRODUCTION OF WELLBEING CHAMPIONS IN A PAEDIATRIC HIGH DEPENDENCY UNIT (HDU)

68 The confounder in time of confusion: a case report on Multisystem Inflammatory Syndrome in Children (MIS-C)

68 The confounder in time of confusion: a case report on Multisystem Inflammatory Syndrome in Children (MIS-C)

Nonthyroidal illness syndrome as marker of severity in pediatric high dependency units: A single-center prospective cross-sectional observation study from Brazil

Background: Limited data is available in children with nonthyroidal illness syndrome (NTIS) and its association with prognosis in acute illness. This study was conducted to compare thyroid function as marker of severity with pediatric risk of mortality (PRISM) and pediatric index of mortality (PIM) in pediatric high dependency unit (PHDU).Subjects and Methods: This was a prospective, cross-sectional observational study of 225 patients, aged 1–14 years with respiratory symptoms, admitted to a PHDU in a secondary care hospital in Brazil. PRISM-IV and PIM-2 scores were calculated and serum thyroid-stimulating hormone (TSH), free T4, T3, and T4 levels were measured on admission. The presence of NTIS was considered in patients with total T3 below reference values, which may be associated with normal or low levels of total T4.Results: The mean age of the study population was 52.9 ± 35.9 months; Male-to-female ratio is was 1.2. All patients had normal free T4 levels. In 65.9% of cases, TSH remained within normal limits, while 34.1% were below the reference range for age. The prevalence of NTIS was 45.8%. Total T3 was normal in 54.2% and total T4 was normal in 90.2% of cases. Low total T3 with normal total T4 was found in 36% of patients while both total T3 and T4 were low in 9.8% of cases. Lower PRISM IV scores (P = 0.0014) and lower PIM-2 scores (P < 0.0001) were significantly correlated with absence of NTIS.Conclusions: Patients without evidence of NTIS have lower disease severity scores and a better prognosis.

Rationalising requests for preoperative sleep studies and postoperative HDU beds: a quality improvement project in paediatric ENT patients undergoing elective surgery

BackgroundSleep disordered breathing represents a spectrum of upper airway obstruction including snoring, increased respiratory effort and obstructive sleep apnoea. An increasing demand for paediatric preoperative sleep studies and postoperative high...

A newly established pediatric high dependency unit in Norway – Interaction with existing pediatric intensive care

BackgroundIn October 2018, our university hospital opened a 2-bed pediatric high dependency unit. We report interactions between this new unit and existing pediatric intensive care. MethodsWe included patients who met the requirements for extended monitoring and treatment in a retrospective review of ward admissions 29.10.18-28.10.19. Results271 children with 354 ward admissions (’episodes’) with extended monitoring and treatment were admitted to the pediatric high dependency unit (77%), the general pediatric ward, neonatal and adult intensive care, post-operative, and adult high dependency units. Frequent diagnoses were bronchiolitis, epilepsy, pneumonia, diabetic ketoacidosis and therapeutic drug overdose. In 37% of the episodes, non-invasive ventilation was provided. Median (interquartile range) age was 2.2 (0.3-14.2) years and 40% was <1 year. Median length of stay was 29 (15-74) hours and the average bed occupancy in the pediatric high dependency unit 1.6. ConclusionOur results indicate that equipment and staff training should focus on children <1 year of age in need for non-invasive ventilation. There is a potential for more children needing extended monitoring and treatment to be cared for at the pediatric high dependency unit instead of the neonatal and adult intensive care units.

Parents’ Satisfaction with Nursing Care Provided to their Child in Three Tertiary Care Hospitals, Peshawar

&#x0D; &#x0D; &#x0D; &#x0D; OBJECTIVES: &#x0D; To study the satisfaction of parents regarding their child with nursing care in government tertiary care hospitals in Peshawar, KPK.&#x0D; METHODOLOGY:&#x0D; A cross sectional study was done in three tertiary care hospitals in Peshawar District, KPK. Data was collected from 306 participants as a convenient sample size. Parents of children admitted in three units consisting of Pediatric Ward, Pediatric Intensive Care Unit (ICU) and Pediatric High Dependency Unit (HDU) for at least 2 days in these units were included. Whereas, those who have stayed less than 2 days were excluded. Data was collected from 306 participants through a structured questionnaire. Informed consent was taken from the participants. The data was recorded and analyzed on SPSS version 20.0. &#x0D; RESULTS:&#x0D; The result of this study shows more satisfaction from parents toward nursing care provided to their child. But in some areas i.e. providing informational care and following hygienic conditions, the parents’ satisfaction was not positive. &#x0D; CONCLUSION:&#x0D; Parents as well as patient satisfaction are the key factors in relation to nursing care. Our study’s finding show great satisfaction toward nursing care.&#x0D; &#x0D; &#x0D; &#x0D;

O23 Pulmonary emboli in a teenager with GPA: management dilemmas

Case report - Introduction15 year old girl with the diagnosis of granulomatosis polyangiitis (GPA) managed with induction regimen of intravenous cyclophosphamide and whilst on maintenance mycophenolate mofetil (MMF) developed multiple cavitating lung lesions with the large cavity abutting pulmonary vein and bilateral segmental pulmonary embolism (PE) posing complex management dilemmas.Case report - Case description15-year-old girl presented with being unwell for 3 months with malaise, lethargy, joint pains, significant weight loss (10 kg), mouth ulcer and significant hearing loss. Investigations showed anaemia, raised inflammatory markers, and impaired kidney function (estimated glomerular filtration rate eGFR 40). Her ANCA was positive, hearing test showed significant mixed hearing loss and CXR was normal. The renal biopsy confirmed pauci-immune ANCA associated glomerulonephritis with 70% crescents. She was initially managed with intravenous pulse of steroids followed by oral weaning regime, double filtration plasmapheresis and commenced on induction regimen of intravenous cyclophosphamide. She received 6 doses of cyclophosphamide 500 mg/m2 and following good recovery with normalising kidney function; was commenced on maintenance MMF.At this point she developed new onset earache, sore throat, and hoarseness of voice with raised inflammatory markers and worsening symptoms despite antibiotics. This was presumed to a flare of vasculitis and hence was given further pulse of steroids and increased the dose of MMF. The ENT assessment did not reveal any subglottic stenosis. After few weeks, symptoms recurred with cough/hoarseness of voice and associated tiredness. Bloods showed raised inflammatory markers; CXR revealed cavitating lung lesions and a CT chest was arranged.CT chest showed apical sub pleural lung nodule and a large thick-walled cavity measuring 6.6x 4.4 cm abutting the pulmonary vein on the right side and bilateral segmental pulmonary emboli. The child was systemically stable with no respiratory distress and oxygen saturations were 100% in air.Case report - DiscussionThe management of GPA was further complicated by the pulmonary embolism and cavitating lung lesions abutting pulmonary vein.The management included escalation of immunosuppression with pulse of steroids, further dose of cyclophosphamide and commence Rituximab .The key challenges with the immediate management were risk of bleeding associated with the anticoagulation, treating the pulmonary embolism, risk of diffuse alveolar haemorrhage and managing the patient in a safe setting equipped with all the expertise required.The child was screened for cardiolipin antibodies on multiple occasions and these were negative. An ECHO was done to look for evidence of clot at the end of central line tip, but this was normal. Deep venous thrombosis of legs was ruled out by Doppler scanning. There was no clear source of emboli identified.Although there is emerging evidence for increased incidence of vascular events in GPA adult patients, the data on vascular events in children with GPA is scarce. Merkel and co-workers reported a high occurrence of pulmonary embolism (PE) and deep venous thrombosis (DVT) among GPA patients included in a randomized therapeutic trial (WeCLOT study) 1 .FAURSCHOU et al. reported that GPA was associated with a much lower relative risk of stroke than of pulmonary embolism and deep venous thrombosis; the risk of venous thromboembolic events among GPA patients was increased during early as well as late follow up periods. Currently there are no significant data on the use of antiplatelet and/or anticoagulant therapy in AAV. Following extensive multidisciplinary discussion with respiratory, haematology, cardiology, cardiothoracic surgical and paediatric intensive care teams, and the child was anticoagulated with close monitoring in paediatric high dependency unit and immunosuppression escalated alongside. Case report - Key learning points This case highlights the risk of thromboembolic events in children with GPAProposed mechanisms in the literature for thrombosis in vasculitis at molecular level would probably explain the episode in the absence of source identifiedMultidisciplinary team approach is crucial for management of complex patientsThere were few challenges due to geographical location of the patient and the regional variation of subspecialty cover provided for their local District General HospitalFor discussion- Role of Rituximab early in GPA?

Paediatric Adenotonsillectomy: Its Safety and Outcome in a Malaysian Tertiary Medical Center.

Adenotonsillectomy is the commonest otorhinolaryngology surgery for paediatrics. The purpose of this study was to determine the safety and outcome of adenotonsillectomy in a tertiary center in Malaysia. This was achieved by studying the demographics, indications, co-morbidities of patients and its association with the complications of the procedure. This retrospective study was conducted from November 2011 until October 2016. Medical records of patients aged 2-12years old who had adenotonsillectomy done in our center were retrieved for data collection. A total of 143 patients who fulfilled the inclusion and exclusion criteria were recruited. Median age was 7.52 (± 2.98 SD) years old. Allergic rhinitis was the commonest co-morbidity (40%). Recurrent tonsillitis was the main indication (60%), followed by sleep disordered breathing (SDB) without apnea (29%), obstructive sleep apnea (OSA) (7%) and other indications (4%). Post-operative paediatric intensive care unit (PICU) admission was very low (1.4%) and was reserved for those with severe OSA with complications. None of the patients admitted to PICU post-operative had respiratory complications. The prevalence of post-tonsillectomy bleeding was only 2.1%. There was no significant association between patient's co-morbidity with operative complications (p = 0.269). Adenotonsillectomy is indicated for children with recurrent tonsillitis and paediatric SDB. The two most severe complications, namely post-tonsillectomy haemorrhage and respiratory complications occurred but incidence was low. Criteria of post-operative PICU or paediatric high dependency unit admission for paediatric SDB has to be based on multiple clinical and logistics factors and not only patients co-morbidity and indication of surgery.

Pandemic: Presentation of non‐Covid cases – Delay in emergencies in children

<scp>Pandemic</scp>: Presentation of non‐Covid cases – Delay in emergencies in children

Severe and fatal forms of COVID-19 in children

ObjectivesThe aim of this study was to describe severe forms of novel coronavirus disease 2019 in children, including patient characteristics, clinical, laboratory, and imaging findings, as well as the disease management and outcomes. MethodsThis was a retrospective, single-center, observational study conducted in a pediatric intensive and high-dependency care unit (PICU, HDU) in an urban hospital in Paris. All patients, aged from 1 month to 18 years, admitted for confirmed or highly suspected SARS-CoV-2 were included. ResultsWe analyzed the data of 27 children. Comorbidities (n=19, 70%) were mainly neurological (n=7), respiratory, (n=4), or sickle cell disease (n=4). SARS-CoV-2 PCR results were positive in 24 children (nasopharyngeal swabs). The three remaining children had a chest CT scan consistent with COVID-19. Respiratory involvement was observed in 24 patients (89%). Supportive treatments were invasive mechanical ventilation (n=9), catecholamine (n=4), erythropheresis (n=4), renal replacement therapy (n=1), and extracorporeal membrane oxygenation (n=1). Five children died, of whom three were without past medical history. ConclusionThis study highlighted the large spectrum of clinical presentation and time course of disease progression as well as the non-negligible occurrence of pediatric life-threatening and fatal cases of COVID-19 mostly in patients with comorbidities. Additional laboratory investigations are needed to further analyze the mechanism underlying the variability of SARS-Cov-2 pathogenicity in children.

A nationwide survey on the use of heated humidified high flow oxygen therapy on the paediatric wards in the UK: current practice and research priorities

BackgroundHeated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research.MethodsWe carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Descriptive analysis of their geographical, and organizational characteristics, their specialties, and their level of experience was investigated. Reasons for HHFNC initiation, weaning criteria, patients’ characteristics and their primary pathologies were also analysed.ResultsParticipation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1–11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%); less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6, 95%CI:22.6–50.4%, P < .001). HHFNC was reported by nearly two-thirds (68%) of the practitioners who used it on the wards to be as effective or superior to CPAP (Continuous Positive Airway Pressure) with fewer complications. Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1, and 28% respectively).ConclusionThis survey showed support for developing paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.

Evaluation of antibiotics use in a tertiary care pediatric intensive care and high-dependency unit

Objectives: Widespread antimicrobial use, both appropriate and inappropriate is prevalent in intensive care units (ICU) leading to antimicrobial resistance. Literature from adult ICUs revealed that 68% to 80% of patients receive antibiotics. Although less documented in pediatric intensive care units (PICU) results are similar; 56% to 100% of patients receive antibiotics. We evaluated the antibiotic usage in our PICU.Methods: This is a retrospective study carried out in pediatric intensive care and high dependency unit from September 2014 to February 2017. All case records of admitted children were analysed for antibiotic usage and categorized into no antibiotic group, 1st line antibiotic group and 2nd line antibiotic group. Rational antibiotic usage was assessed in those who received antibiotics. Antibiotic usage in major disease subgroups was assessed. All the positive cultures along with their sensitivity patterns were collected and reported. Results: Out of 1760 children no, 1st line and 2nd line antibiotics were prescribed in 882(50.1%), 794(45.1) and 84(4.78%) respectively. Most commonly used antibiotics were ceftriaxone, amoxicillin-clavulanic acid, glyopeptides and meropenem. Appropriate cultures were sent in 821(93.5%) and rational antibiotic usage was found in 825(94%). An overwhelming 63% (53/84) of patients were culture positive in 2nd line antibiotic group. A total 118 (13.4%) cultures were positive.Conclusion: We found high level of rational antibiotic usage at our centre. Strategies such as, following an evidence based antibiotic policy and empowering the designated persons for every antibiotic prescription ensures rational antibiotic usage in PICU.

Gaps in Knowledge Related to Equipment use in Pediatric Intensive Care and High Dependency Units

Medical equipment has an important role in pediatric critical care. Health care professionals need to maintain their competency which is in-turn needed to ensure patient safety and provide safe care. With increased burden on health care in PICU and HDU and due to lack of time to upgrade knowledge, nurses may have possible gap in knowledge related to equipment use in PICU and HDU. This non-experimental descriptive cross-sectional study has been conducted to identify gaps in the knowledge of nurses related to equipment use in pediatric critical care units in which 22 Nursing Officers working in 6 pediatric critical care and high dependency units of a tertiary care facility were enrolled using random sampling technique. Tools consisting of demographic datasheet and 27 items structured knowledge questionnaire were administered after taking written informed consent from the participants. The results showed that majority of the participants had poor knowledge related to equipment used in oxygenation therapy (86.4%), infusion therapy (90.9%), hemodynamic monitoring (100%) and resuscitation (50.0%). Overall equipment knowledge of the participants was poor related to equipment use in Pediatric Intensive Care and High Dependency Unit requiring periodic educational programs, in-service education and workshops.

A prospective, mixed-methods, before and after study to identify the evidence base for the core components of an effective Paediatric Early Warning System and the development of an implementation package containing those core recommendations for use in the UK: Paediatric early warning system \u2013 utilisation and mortality avoidance\u2013 the PUMA study protocol

BackgroundIn hospital, staff need to routinely monitor patients to identify those who are seriously ill, so that they receive timely treatment to improve their condition. A Paediatric Early Warning System is a multi-faceted socio-technical system to detect deterioration in children, which may or may not include a track and trigger tool. It functions to monitor, detect and prompt an urgent response to signs of deterioration, with the aim of preventing morbidity and mortality. The purpose of this study is to develop an evidence-based improvement programme to optimise the effectiveness of Paediatric Early Warning Systems in different inpatient contexts, and to evaluate the feasibility and potential effectiveness of the programme in predicting deterioration and triggering timely interventions.MethodsThis study will be conducted in two district and two specialist children’s hospitals. It deploys an Interrupted Time Series (ITS) design in conjunction with ethnographic cases studies with embedded process evaluation. Informed by Translational Mobilisation Theory and Normalisation Process Theory, the study is underpinned by a functions based approach to improvement. Workstream (1) will develop an evidence-based improvement programme to optimise Paediatric Early Warning System based on systematic reviews. Workstream (2) consists of observation and recording outcomes in current practice in the four sites, implementation of the improvement programme and concurrent process evaluation, and evaluation of the impact of the programme. Outcomes will be mortality and critical events, unplanned admission to Paediatric Intensive Care (PICU) or Paediatric High Dependency Unit (PHDU), cardiac arrest, respiratory arrest, medical emergencies requiring immediate assistance, reviews by PICU staff, and critical deterioration, with qualitative evidence of the impact of the intervention on Paediatric Early Warning System and learning from the implementation process.DiscussionThis paper presents the background, rationale and design for this mixed methods study. This will be the most comprehensive study of Paediatric Early Warning Systems and the first to deploy a functions-based approach to improvement in the UK with the aim to improve paediatric patient safety and reduce mortality. Our findings will inform recommendations about the safety processes for every hospital treating paediatric in-patients across the NHS.Trial registrationSponsor: Cardiff University, 30–36 Newport Road, Cardiff, CF24 0DE Sponsor ref.: SPON1362–14.Funder: National Institute for Health Research, Health Services & Delivery Research Programme (NIHR HS&DR) Funder reference: 12/178/17.Research Ethics Committee reference: 15/SW/0084 [13/04/2015].PROSPERO reference: CRD42015015326 [23/01/2015].ISRCTN: 94228292 https://doi.org/10.1186/ISRCTN94228292 [date of application 13/05/2015; date of registration: 18/08/2015]. Prospective registration prior to data collection and participant consent commencing in September 2014.