Document Detail


Impact of a computerized note template/checklist on documented adherence to institutional criteria for determination of neurologic death in a pediatric intensive care unit.
MedLine Citation:
PMID:  21037506     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: : Variability exists in the documentation of death by neurologic criteria in children. We hypothesized that the use of a note template/checklist, which included directive (educational) prompts based on institutional neurologic determination of death criteria, improved thoroughness of documentation within our institutional guidelines for the neurologic determination of death.
DESIGN: : Retrospective chart review.
SETTING: : Twenty-one bed pediatric intensive care unit in a freestanding pediatric teaching hospital.
PATIENTS: : Children 0-18 yrs undergoing evaluation for cessation of neurologic function from May 2000 to June 2006.
INTERVENTIONS: : Introduction of a computerized note template/checklist with educational prompts to document cessation of neurologic function.
MEASUREMENTS AND MAIN RESULTS: : Documentation of 15 specific elements derived from our institution's neurologic determination of death guidelines was evaluated. Age, gender, primary diagnosis, observation interval between examinations, the use of appropriate ancillary testing, and apnea test element documentation were also studied. There were 490 deaths in the pediatric intensive care unit, of which 82 (16.7%) had at least one examination for cessation of neurologic function. Neurologic determination of death examination was performed 136 times in 78 patients (mean 1.74 examinations/patient); four charts were missing. Life support was withdrawn before the second examination in 14.1% of patients. Documentation was handwritten for 37.5% of the notes. The mean number of examination elements documented by handwritten note was 11.1 ± 2.2 vs. 14.9 ± 0.7 in the template/checklist group (p < .0001). Use of a template/checklist was associated with neurologic determination of death documentation of 98.6% of essential elements compared with 73.9% of the elements in handwritten notes (p < .0001). Compliance with intervals between examinations conformed to guidelines in 64.0% of cases. Documentation of apnea duration and pco2 increase was significantly greater with the template/checklist (p < .025 and p < .001, respectively).
CONCLUSIONS: : Use of a note template/checklist to guide and document neurologic determination of death improved adherence to institutional criteria for assessment of cessation of neurologic function.
Authors:
Jana A Stockwell; Nga Pham; James D Fortenberry
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  12     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-06-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  271-6     Citation Subset:  IM    
Affiliation:
From the Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA.
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