Background: Hospitalized children are interrupted at night for many reasons, and these disruptions may inhibit healing and contribute to illness. Through the Choosing Wisely initiative, The American Academy of Nursing advises to only wake patients for routine care overnight if required by their condition. Recent literature questions the necessity of routine vital signs (VS) checks for all pediatric patients, and institutions are trying to move away from this practice. Blood pressure (BP) checks can be especially disruptive, and the clinical value for pediatric inpatients has been questioned outside diagnoses where clinically indicated, thus leading multiple institutions to reduce the frequency of regular BP checks.
Purpose: By reducing unnecessary overnight VS checks, we aimed to promote uninterrupted sleep in pediatric inpatients using EPIC programming changes and clinician education, as outlined by Choosing Wisely’s COST (Culture, Oversight, Systems, and Training) framework.
Description: A needs assessment conducted at University of Chicago Medicine Comer Children’s Hospital showed that caregivers of hospitalized children (n= 162) identify VS checks as the largest sleep disruptor and nurse or physician interruption as the second largest disruptor. Objective room entry data from GOJO hand hygiene system shows an average of ten nightly room entries. Led by a multi-disciplinary team, including medical students, nurses, EPIC programmers, residents, and physicians, we updated the pediatric admission order set to ask providers whether their patients need overnight VS checks, and whether BP checks were also needed (Culture; Systems). Usage of these updated order sets is monitored via monthly reports (Oversight). Concurrent with order set changes, we educated nurses and interns on the evidence-based recommendations of who can forgo overnight VS checks – no overnight BP or temperature checks. Our team created the mnemonic: “Who needs overnight VS monitoring? Do your BEST: BP fluctuations, Erratic VS, Sedating agents, Therapy monitoring,” which was distributed to clinicians on badge cards (Training). After the launch, an average of 46% of patients had no overnight VS checks, and 36% had no BP checks. While no adverse events were reported, concerns regarding widespread usage across inpatient providers outside of pediatric hospital medicine (PHM) teams led to revisions of the order set to more explicitly target the intervention to children admitted to PHM and allow providers to more easily de-escalate VS orders after the initial order placed on admission.
Conclusions: This early widespread adoption highlights the initiative’s broad applicability and far-reaching impact among pediatric inpatients. Over the upcoming year, we intend to continue collecting room entry data as a proxy for overnight disruptions and patient surveys to evaluate the intervention’s impact on patient experience.
To cite this abstract:Anderson, S; Cook, D; Orlov, N; Erondu, A; Peirce, L; Chamberlain, M; Edstrom, E; Ahmed, FN; Kilaru, M; Arora, VM. IMPROVING PEDATRIC INPATIENT SLEEP BY REDUCING EXCESSIVE OVERNIGHT VITAL SIGN MONITORING IN HOSPITALIZED CHILDREN. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 237. https://www.shmabstracts.com/abstract/improving-pedatric-inpatient-sleep-by-reducing-excessive-overnight-vital-sign-monitoring-in-hospitalized-children/. Accessed March 31, 2020.