Describing drug and fluid therapy in the paediatric intensive care unit: A pilot study

J Crit Care. 2019 Aug;52:53-57. doi: 10.1016/j.jcrc.2019.04.004. Epub 2019 Apr 2.


Purpose: Care in the paediatric intensive care unit (PICU) involves many clinical activities. The objectives of this study were to evaluate the feasibility of a novel observation method, the reliability of data abstraction, and to report the initial findings from application of this approach.

Materials and methods: Bedside activities of patients and clinical staff were recorded by direct observational study using video recording and audio annotation. Data were abstracted into 9 broad clinical activities and 12 specific drug-fluid activities. Enrolment rates, agreement between abstractors, clinical activity durations and interruptions are reported.

Results: We enrolled 42 healthcare professionals, 12 family members of 13 patients, and recorded 12 patients (consent rates of 70%-92%). There were 884 clinical activity episodes. Each hour was comprised of a median (IQR) of 11.9 (4.8-16.5) minutes of drug and fluid related tasks. The 682 drug and fluid related activities were mainly preparation and administration. Interruptions occurred on average 7 times per hour. Data abstraction for 8 h had intra-class correlation co-efficient (95% CI) of 0.91 (079-0.96).

Conclusions: Real-time recording of clinical tasks in the PICU using a direct observation model combined with video recording is feasible. Preliminary results suggest abundant and diverse activity is routine.

Keywords: Medication safety; Task analysis; Workload.

Publication types

  • Observational Study

MeSH terms

  • Child, Preschool
  • Drug Therapy / statistics & numerical data*
  • Efficiency, Organizational
  • Family
  • Fluid Therapy / statistics & numerical data*
  • Humans
  • Infant
  • Intensive Care Units, Pediatric / statistics & numerical data*
  • Nurses
  • Nursing / statistics & numerical data*
  • Pilot Projects
  • Prospective Studies
  • Reproducibility of Results
  • Video Recording
  • Workflow
  • Workload
  • Workplace / statistics & numerical data