Sustaining a Culture of Safety and Quality in our Pediatric Intensive Care Unit

Purpose:
In our Pediatric Intensive Care Unit there was no organized format in which to proactively address safety and quality issues while on patient rounds, bedside report or administrative rounds. Pediatric leadership elected to increase safety awareness in our unit and focused on the acronym of SAFETY.

Significance:
The pediatric mortality rate for nosocomial catheter associated blood stream infections (CABSI)and ventilator associated pneumonia are significant. Catheter associated urinary tract infections also adversely affect hospitalized patients by increasing morbidity and length of stay. All are preventable

Strategy and Implementation:
The elements of the SAFETY acronym are reviewed during patient rounds and incorporated into nursing shift report. Monthly Safety Rounds by administration also use this platform in their review of safety on the unit. The elements of the acronym of Safety are: S: Skin Assessment A: Access F: Family E: Exit T: Therapeutics Y: Your Concerns. Skin: The staff discusses and implements prevention, discusses aberrant findings, and seeks consultants as needed. Access: On rounds the staff considers the necessity of all indwelling devices. We focus on central lines, airways and Foley catheters and any other medical devices that can be a mode for infection. Family: During interdisciplinary rounds the staff addresses any family concerns or issues. Exit: Case Management and Social Service are consulted as needed for discharge planning. Therapeutics: The staff reviews all medications and treatments. Your Concerns: The patients, families and staff concerns and observations are reviewed.

Evaluation:
As a result of using the SAFETY acronym in varying modes of communication, we have not incurred a nosocomial CABSI in over 2 ½ years twice, a Catheter Associated Urinary Tract Infection in over 2½ years and a Ventilator Associated Pneumonia in over 2 years in our Pediatric Intensive Care Unit.

Implications for Practice:
If given an opportunity to present, the audience will be able to easily incorporate the elements of the SAFETY acronym in their daily review of patients during multifaceted levels of communication. Details of these elements will be reviewed with poignant and graphic examples.