"Safety by DEFAULT": introduction and impact of a paediatric ward round checklist

Introduction Poor communication is a source of risk. This can be particularly significant in areas of high clinical acuity such as intensive care. Ward rounds are points where large amounts of information must be communicated in a time-limited environment with many competing interests. This has the potential to reduce effective communication and risk patient safety. Checklists have been used in many industries to improve communication and mitigate risk. We describe the introduction of a ward round safety checklist 'DEFAULT' on a paediatric intensive care unit. Methods A non-blinded, pre- and post-intervention observational study was undertaken in a 12 bedded Level 3 tertiary PICU between July 2009 and December 2011. Results Ward round stakeholders subjectively liked the checklist and felt it improved communication. Introduction of the ward round checklist was associated with an increase in median days between accidental extubations from 14 (range 2--86) to 150 (56 -- 365) (Mann Whitney p < 0.0001). The ward round checklist was also associated with an increase in the proportion of invasively ventilated patients with target tidal volumes of <8ml/kg which fell from 35 of 71 patients at 08.00 representing a proportion of 0.49 (95%CI 0.38--0.60) to 23 of 38 (0.61, 0.45--0.74). This represented a trend towards an increased proportion of cases in the target range (z = 1.68, p = 0.09). Conclusions The introduction of a ward round safety checklist was associated with improved communication and patient safety

Might children rust? What are the risks of supplemental oxygen in acute illness

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Survey of Oxygen Delivery Practices in UK Paediatric Intensive Care Units.

Purpose. Administration of supplemental oxygen is common in paediatric intensive care. We explored the current practice of oxygen administration using a case vignette in paediatric intensive care units (PICU) in the united kingdom. Methods. We conducted an online survey of Paediatric Intensive Care Society members in the UK. The survey outlined a clinical scenario followed by questions on oxygenation targets for 5 common diagnoses seen in critically ill children. Results. Fifty-three paediatric intensive care unit members from 10 institutions completed the survey. In a child with moderate ventilatory requirements, 21 respondents (42%) did not follow arterial partial pressure of oxygen (PaO2) targets. In acute respiratory distress syndrome, cardiac arrest, and sepsis, there was a trend to aim for lower PaO2 as the fraction of inspired oxygen (FiO2) increased. Conversely, in traumatic brain injury and pulmonary hypertension, respondents aimed for normal PaO2 even as the FiO2 increased. Conclusions. In this sample of clinicians PaO2 targets were not commonly used. Clinicians target lower PaO2 as FiO2 increases in acute respiratory distress syndrome, cardiac arrest, and sepsis whilst targeting normal range irrespective of FiO2 in traumatic brain injury and pulmonary hypertension

Risks and benefits of oxygen therapy

Mootha and Chinnery review the risks and benefits of oxygen administration in mitochondrial disease. They highlight probable harm from hyperoxia and possible benefit from hypoxia. At first sight this is counter-intuitive. It seems improbable that reducing the availability of a substrate that enables high-energy phosphate production via oxidative phosphorylation would be of benefit. But recent clinical data beyond the field of inherited metabolic disease support this approach