(354) An Observational Study: Impact of a Mandatory Nurse Checklist on Evidence-Based ICU Interventions

Introduction: Over the several years there has been a shift in critical care research towards trials that targeted global rather than specific interventions. An example is the research that led to the creation of the ABCDEF bundle which has become the standard of care for critically ill patients. The data supporting these interventions is strong but comes from the strictly controlled research environment which does not always translate to the “real world”. We hypothesized that the implementation of a written checklist including a nurse and respiratory therapist driven SAT/SBT protocol and questions about delirium screening, mobility and nutrition into daily nursing practice would improve compliance with standard of care ICU interventions. We also sought to determine if the posting of how the nurses ranked in performance of the checklist would provide improved adherence.

Methods: We performed an observational study in 2 urban ICUs in Baltimore, MD, one with 26 beds and the other with 18. The study was divided into 3 six-week phases. The study was based on the assessment of the nurse’s adherence to the 4 interventions: Spontaneous awakening trial (SAT), Spontaneous breathing trial (SBT), Delirium screening with the CAM-ICU assessment, and Assessment of mobility. In phase 1, each patient was assessed every day for these interventions. Phase 2 consisted of a daily checklist given to each nurse to be filled out for each patient every day. And in phase 3, we posted on the units a list showing the ranking of each nurse in their adherence to the checklist for each parameter. We compared adherence with each parameter on the checklist between phase 1 and 2; and then between phase 2 and 3.

Results: Data was collected in three separate 6-week phases between July 2022 and January 2023. There were statistically significant improvements in all parameters between phase 1 and phase 2. There was no increase and some decreases between phase 2 and phase 3.

Conclusions: Mandating nurses to fill out a daily checklist was an effective way to improve adherence to evidence-based ICU interventions. Posting the rankings of the nurses did not provide any added benefit.