• Matthew P Kirschen, Kristen Lourie, Megan Snyder, Kenya Agarwal, Pamela DiDonato, Blair Kraus, Chinonyerem Madu, Kylie Geddes, Vinay Nadkarni, Daniela Davis, Heather Wolfe, and Alexis Topjian.
• Matthew P. Kirschen is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Kristen Lourie is PICU Nursing Clinical Supervisor, Megan Snyder is Director of Nursing Professional Practice, Kenya Agarwal is a PICU clinical nurse expert, and Pamela DiDonato is a critical care nurse, Department of Nursing, Children's Hospital of Philadelphia; Blair Kraus and Kylie Geddes are senior enterprise improvement advisors, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; Chinonyerem Madu is a data programmer analyst III, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia; Vinay Nadkarni is a professor and Daniela Davis is a clinical professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Heather Wolfe is an assistant professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. She is also the Director of Anesthesia & Critical Care Quality and Safety Programs, Children's Hospital of Philadelphia and the Medical Director of the pediatric intensive care unit; Alexis Topjian is an associate professor, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Children's Hospital of Philadelphia. kirschenm@chop.edu.
• Crit Care Nurse. 2019 Jun 1; 39 (3): 20-32.

BackgroundBrain injury with changes in clinical neurological signs and symptoms can develop while children are undergoing treatment in the intensive care unit. Critical care nurses routinely screen for neurological decline by using serial bedside neurological assessments. However, assessment components, frequency, and communication thresholds are not standardized.ObjectivesTo standardize neurological assessment procedures used by nurses, improve compliance with physicians' ordering and nurses' documentation of neurological assessments, and explore the frequency with which changes from preillness neurological status and previous assessments can be detected by using the assessment tool developed.MethodsA quality improvement intervention was implemented during a 1-year period in a 55-bed pediatric intensive care unit with 274 nurses. Procedures for neurological assessment by nurses were standardized, a system for physicians to order neurological assessments by nurses at a frequency based on the patient's risk for brain injury was developed and implemented, and a system to compare patients' current neurological status with their preillness neurological status was developed and implemented.ResultsProcess metrics that focused on compliance of ordering and documenting the standardized neurological assessments indicated improvement and sustained compliance greater than 80%. Exploratory analyses indicated that 29% of patients had an episode of neurological decline and that these episodes were more common in patients with developmental disabilities than in patients without such disabilities.ConclusionsCompliance with physicians' ordering and nurses' documentation of standardized neurological assessments significantly increased and had excellent sustainability. Further work is needed to determine the sensitivity of standardized nurses' neurological assessment tools for clinically meaningful neurological decline.©2019 American Association of Critical-Care Nurses.

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