(759) Pediatric Health Assessment Tracker (PHAT): A QI Initiative to Obtain Weights in the PICU

Introduction: Weights are a vital sign for tracking the health, fluid status, and nutrition of patients admitted to the Pediatric Intensive Care Unit (PICU). Many challenges arise in acquiring weights in critically ill patients including clinical stability, limited staff and resources, and lack of an appropriate weight order. We present a quality improvement project which aimed to ensure patients are weighed at least once per week and more often based on what is appropriate for their age and pathophysiology.

Methods: We implemented Plan-Do-Study-Act cycles that targeted electronic medical record weight orders based on age, clinical nutrition status, acuity, and actual documentation of collected weight. Pre-intervention data was collected from February-March 2023 by recording weight orders and weights obtained for all patients admitted to the PICU with a length of stay of at least 3 days. A survey was sent to PICU nurses to identify barriers to the collection of weights. Interventions included a safety checklist that reinforced appropriate weight orders, signs encouraging obtaining “weights on Wednesdays”, and nursing education. We used control charts to monitor percent of appropriate weight orders and weights obtained. We attributed changes in the data to special cause variation when eight consecutive data points were above or below the center line.

Results: The survey had a 36% response rate. Nurses reported that broken bed scales and patients’ safety and critical illness were major barriers to obtaining weights. However, nurses felt that a designated day and shift would be most helpful to obtain more weights. The mean percent of appropriate weight orders increased from 73.1% to 84.1%. For weights obtained, the mean increased from 34.6% to 61.8%. Both signal changes occurred after the introduction of the initial safety checklist and signs about weekly weights.

Conclusions: Reinforcing the importance of regular weights increased the percent of eligible patients with an appropriate weight order and the percent of weights collected per order. Future cycles will aim to ensure beds have working scales and will make appropriate weight orders a standard part of our admission order sets.