Student Dissertation

Agency : Quality Assurance; PICU Department; 150 Bedded Hospital; Tertiary Care Hospital; Quality of Care

Objective : Quality Assurance of PICU in a 150 bedded Tertiary Care Hospital in Hyderabad • To identify level of care provided on a time scale. Trend analysis of such data helps in quantifying the standard of care offered in the same setup and compares the same with selected benchmarks. • To analyze the incidents reported.

Background : Quality indicators provide insight in the structure and process aspects of care that are related to outcome that serve as instruments to improve health care. Thus, it is important to identify ways of more efficiently managing Pediatric Intensive Care Unit and reducing the variation in patient outcomes

Methodology : The study is an analytical study. Primary data was collected from PICU department in the hospital. Secondary data was collected by studying relevant records in the Hospital.

Findings : The study shows that the errors and the patient safety when assessed showed results lesser than the international benchmarks but re-intubation rate were found to be higher than the benchmark i.e., 15%. Process indicators such as length of ICU stay was found to be 4.08 days, duration of mechanical ventilation 1.55 days for the month of April. The outcome indicators showed good results, i.e., mortality rate was 3.48% for March. After Root Cause Analysis it was found that errors that took place were due to lack of knowledge or lack of qualification of nursing staff.

Recommendations : Non-invasive positive pressure ventilation (NPPV), sedation holidays, weaning trials, avoiding re-intubation, and early tracheotomy to decrease the risk of VAP, improve the management of weaning and extubation, Provider Order Management (POM) to eliminate medication errors, Pressure relief, moisture management, and nutrition support to prevent pressure sore. Not more than 20% of junior nursing staff should be recruited.