TY - JOUR
T1 - Targeted temperature management protocol in a pediatric intensive care unit
T2 - A quality improvement project
AU - Prendergast, Erica
AU - Allen, Kiona Yasmin
AU - Mills, Michele Grimason
AU - Moran, Thomas
AU - Harris, Zena Leah
AU - Malakooti, Marcelo
AU - Smith, Craig M.
AU - Wainwright, Mark
AU - McCarthy-Kowols, Maureen
N1 - Funding Information:
This work was funded by an Ann & Robert H. Lurie Children’s Hospital of Chicago Prince Nurse Scholar Grant. Erica Prendergast and Maureen McCarthy-Kowols were the recipients of this grant.
Publisher Copyright:
© 2021 American Association of Critical-Care Nurses.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Background In patients with acute neurological injury, abrupt temperature change exacerbates increased intracranial pressures and negatively affects perfusion pressure and cerebral blood flow. Critical care nurses must provide coordinated and effective interventions to maintain normothermia without precipitating shivering immediately after acute neurological injury in pediatric patients. Objective To improve hyperthermia management in a 40-bed pediatric intensive care unit, an inter-disciplinary pediatric critical care team developed, implemented, and evaluated a targeted temperature management protocol. Methods The project was guided by the organization’s plan-do-study-act quality improvement process. Quality improvement was assessed retrospectively using electronic medical records of patients meeting eligibility criteria. Samples of pediatric patients who received temperature interventions were compared before and after protocol implementation. The protocol included environmental, pharmacological, and body surface cooling device interventions, as well as use of a bedside shivering assessment scale and step-wise interventions to prevent and control shivering. Results Before implementation of the targeted temperature management protocol, 64% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 10% of patients. After protocol implementation, more than 80% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 62% of patients. Four patients (6%) before and 5 patients (31%) after protocol implementation were treated with body surface cooling without requiring use of neuromuscular blockade. Conclusions Creation and implementation of a targeted temperature management protocol increased nurses’ documented use of body surface cooling to manage hyperthermia in pediatric intensive care unit patients with acute neurological injury. (Critical Care Nurse. 2021;41[5]:41-51).
AB - Background In patients with acute neurological injury, abrupt temperature change exacerbates increased intracranial pressures and negatively affects perfusion pressure and cerebral blood flow. Critical care nurses must provide coordinated and effective interventions to maintain normothermia without precipitating shivering immediately after acute neurological injury in pediatric patients. Objective To improve hyperthermia management in a 40-bed pediatric intensive care unit, an inter-disciplinary pediatric critical care team developed, implemented, and evaluated a targeted temperature management protocol. Methods The project was guided by the organization’s plan-do-study-act quality improvement process. Quality improvement was assessed retrospectively using electronic medical records of patients meeting eligibility criteria. Samples of pediatric patients who received temperature interventions were compared before and after protocol implementation. The protocol included environmental, pharmacological, and body surface cooling device interventions, as well as use of a bedside shivering assessment scale and step-wise interventions to prevent and control shivering. Results Before implementation of the targeted temperature management protocol, 64% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 10% of patients. After protocol implementation, more than 80% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 62% of patients. Four patients (6%) before and 5 patients (31%) after protocol implementation were treated with body surface cooling without requiring use of neuromuscular blockade. Conclusions Creation and implementation of a targeted temperature management protocol increased nurses’ documented use of body surface cooling to manage hyperthermia in pediatric intensive care unit patients with acute neurological injury. (Critical Care Nurse. 2021;41[5]:41-51).
UR - https://www.scopus.com/pages/publications/85117560059
UR - https://www.scopus.com/inward/citedby.url?scp=85117560059&partnerID=8YFLogxK
U2 - 10.4037/CCN2021554
DO - 10.4037/CCN2021554
M3 - Article
C2 - 34595494
AN - SCOPUS:85117560059
SN - 0279-5442
VL - 41
SP - 41
EP - 51
JO - Critical Care Nurse
JF - Critical Care Nurse
IS - 5
ER -