2.50
Hdl Handle:
http://hdl.handle.net/10755/157240
Type:
Presentation
Title:
An Analysis of Clinical Indicators of Shock in Pediatric Patients
Abstract:
An Analysis of Clinical Indicators of Shock in Pediatric Patients
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Hill, Tracy L., RN, MSN
P.I. Institution Name:Primary Children's Medical Center, System Improvement
Title:Clinical Project Consultant
Contact Address:100 N Mario Capecchi Drive, Salt Lake City, UT, 84113, USA
Contact Telephone:801-662-6511
Purposes/Aims:  The purpose of this project was to perform a retrospective chart review of the fourteen shock-related deaths to determine what common clinical indicators might have identified these patients before late or uncompensated shock developed. Once identified, the indicators could be used as criteria in the proposed electronic shock tool. Rationale/Background:  Inadequate detection and/or treatment of shock on the non-ICU units were identified as contributing factors resulting in at least fourteen pediatric patient deaths due to uncompensated shock from October 2000 through October 2007 at PCMC. An in-depth review of the cases identified four types of errors: 1) failure by nurse to recognize shock (or urgent situation), 2) failure by physician to recognize shock, 3) failure by physician to treat shock with appropriate sense of urgency and 4) failure by physician to properly treat shock in complex patients. A clear definition of when a pediatric patient is in shock is subjective. A review of the literature identifies several clinical indicators of shock, but due to the nature of pediatrics they can be difficult to assess, which is further complicated by the subjective nature of some criteria and the need for pediatric age-based vital sign parameters. It can be difficult for nursing staff to put together all of the clinical indicators and identify that the patient is in shock. An electronic tool that would alert the nurse that his/her patient is meeting "shock" criteria could help the staff initiate a focused assessment and goal-directed therapy early and effectively. PCMC has developed an electronic shock tool, but the initial criteria resulted in too many false alarms, and the tool was turned off. Approach/Methods:  I conducted a retrospective review of the fourteen patients' charts. Data on each patient was collected by reviewing the nursing documentation, history and physical, physician progress notes, medication administration record and death summary. Outcomes:  Preliminary analysis of the data does not reveal an identifiable grouping of clinical indicators that would have consistently predicted that these patients were developing uncompensated shock. Most patients had a heart rate and respiratory rate that were outside the age-specific parameters prior to developing uncompensated shock, but using these two criteria alone would sacrifice specificity, resulting in too many false alarms. We were unable to adequately extract data on certain shock clinical criteria, as was reported in another pediatric study. An unexpected finding was twelve of the fourteen patients were medically complex patients. Until all of the patients were reviewed, no one had been aware of this. Conclusions/Recommendations: The fact that most of the shock patients were medically complex might affect our ability to identify criteria that can be applied to all pediatric patients. Further evaluation of the fourteen shock patients, along with chart reviews of the non-ICU patients with a code blue or an unplanned transfer to the ICU, according to various pediatric early warning scores (PEWS) and different pediatric vital sign parameters is currently underway. We will use this data, along with real-time electronic simulations of non-ICU patient data, to test the sensitivity and specificity of the criteria. When clinical indicators have been identified that will provide both high sensitivity and specificity for identifying shock before it develops into uncompensated shock, we plan to implement the electronic shock tool on the non-ICU units. Our clinical parameters will also need to be published for validation and possible use across multiple pediatric centers.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleAn Analysis of Clinical Indicators of Shock in Pediatric Patientsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157240-
dc.description.abstract<table><tr><td colspan="2" class="item-title">An Analysis of Clinical Indicators of Shock in Pediatric Patients</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Hill, Tracy L., RN, MSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Primary Children's Medical Center, System Improvement</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Project Consultant</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">100 N Mario Capecchi Drive, Salt Lake City, UT, 84113, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">801-662-6511</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Tracy.Hill2@imail.org</td></tr><tr><td colspan="2" class="item-abstract">Purposes/Aims:&nbsp; The purpose of this project was to perform a retrospective chart review of the fourteen shock-related deaths to determine what common clinical indicators might have identified these patients before late or uncompensated shock developed. Once identified, the indicators could be used as criteria in the proposed electronic shock tool. Rationale/Background:&nbsp; Inadequate detection and/or treatment of shock on the non-ICU units were identified as contributing factors resulting in at least fourteen pediatric patient deaths due to uncompensated shock from October 2000 through October 2007 at PCMC. An in-depth review of the cases identified four types of errors: 1) failure by nurse to recognize shock (or urgent situation), 2) failure by physician to recognize shock, 3) failure by physician to treat shock with appropriate sense of urgency and 4) failure by physician to properly treat shock in complex patients. A clear definition of when a pediatric patient is in shock is subjective. A review of the literature identifies several clinical indicators of shock, but due to the nature of pediatrics they can be difficult to assess, which is further complicated by the subjective nature of some criteria and the need for pediatric age-based vital sign parameters. It can be difficult for nursing staff to put together all of the clinical indicators and identify that the patient is in shock. An electronic tool that would alert the nurse that his/her patient is meeting &quot;shock&quot; criteria could help the staff initiate a focused assessment and goal-directed therapy early and effectively. PCMC has developed an electronic shock tool, but the initial criteria resulted in too many false alarms, and the tool was turned off. Approach/Methods:&nbsp; I conducted a retrospective review of the fourteen patients' charts. Data on each patient was collected by reviewing the nursing documentation, history and physical, physician progress notes, medication administration record and death summary. Outcomes:&nbsp; Preliminary analysis of the data does not reveal an identifiable grouping of clinical indicators that would have consistently predicted that these patients were developing uncompensated shock. Most patients had a heart rate and respiratory rate that were outside the age-specific parameters prior to developing uncompensated shock, but using these two criteria alone would sacrifice specificity, resulting in too many false alarms. We were unable to adequately extract data on certain shock clinical criteria, as was reported in another pediatric study. An unexpected finding was twelve of the fourteen patients were medically complex patients. Until all of the patients were reviewed, no one had been aware of this. Conclusions/Recommendations: The fact that most of the shock patients were medically complex might affect our ability to identify criteria that can be applied to all pediatric patients. Further evaluation of the fourteen shock patients, along with chart reviews of the non-ICU patients with a code blue or an unplanned transfer to the ICU, according to various pediatric early warning scores (PEWS) and different pediatric vital sign parameters is currently underway. We will use this data, along with real-time electronic simulations of non-ICU patient data, to test the sensitivity and specificity of the criteria. When clinical indicators have been identified that will provide both high sensitivity and specificity for identifying shock before it develops into uncompensated shock, we plan to implement the electronic shock tool on the non-ICU units. Our clinical parameters will also need to be published for validation and possible use across multiple pediatric centers.</td></tr></table>en_GB
dc.date.available2011-10-26T19:41:34Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:41:34Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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