Adherence to quality of care measures in critically ill cancer patients: a pilot study

Abstract

Introduction: In recent years several interventions to increase the quality of care and patient safety in the ICU have been proposed. Daily checklists have been introduced and are feasible and straightforward instruments to measure adherence to quality of care. Critically ill cancer patients are especially susceptible to ICU- acquired complications such as thrombosis, infection and delirium among several other morbid conditions. We developed and implemented a checklist to evaluate the process of care measures in this specific group of patients. Methods: We prospectively performed a daily checklist for consecutive patients admitted to the ICU between 1 January and 15 February 2009. The checklist included: feeding, analgesia, DVT prophylaxis, elevated head of the bed (HOB), stress ulcer (SU) prophylaxis and delirium. Data were inserted into an electronic database and automatic real-time reports were generated. Results: One hundred and four patients were evaluated, 52 (50%) scheduled surgery, 43 (41.3%) medical patients and 9 (8.6%) emergency surgery. The SAPS3 score was 49.3 (plus or minus) 23.2. Global ICU mortality was 22.1%. The main reasons for ICU admission were postoperative monitoring (n = 52/50%) and sepsis (n = 28/26.9%). The frequency of adherence to the measured processes of care was: nutrition = 85.1%, analgesia = 92.7%, DVT prophylaxis = 72.3%, HOB = 55.3%, SU prophylaxis = 78.2%, and delirium was detected in 12.8%. Conclusions: The use of a daily checklist is useful for the detection of adherence rates to process of care measures. Despite the use of a systematic approach, some evidence-based quality measures are not fully translated into clinical practice. The identification of such measures provides a potential target for future research and educational interventions.