Weight in Kilograms: Intervention Bundle

Gathering data when implementing change to your system is important to both track how your implementation is going and also to assess whether your changes are moving towards your process measure goal. Data can help give insight into how the changes are being accepted or not accepted into your system.

There are a variety of ways to assess how your implementation project is progressing,

some include:

• Chart audits to evaluate any of the process measures above:
  • Can be conducted in real time or retrospectively.
  • Can be all charts or some charts selected for surveillance using a sampling such as a random sample or systematic approach (e.g., every 5th pediatric patient over 10 years old), or all pediatric patients evaluated over a given time period.
• Survey staff on usage and/or comfort.
• Consider adding “survey staff experience/satisfaction” as a layer related to the implementation of any of your intervention strategies.
• Create a brief survey for families for any of the process measures above:

Some example numerical metrics you can calculate for each process measure are listed in the table below:

Below you will find suggested possible interventions, also called change strategies, for the process measure. These are suggestions on different steps that may assist your team in accomplishing the aim you are focusing on. Interventions or change strategies are often grouped into “Guidelines/Protocols, Education, Electronic Medical Records Optimization, and Resources (inclusive of personnel and equipment)”. As the local expert, you may have other ideas regarding how to best implement change in your hospital or ED. You should always feel free to reach out to your team leader and/or brainstorm these ideas with the other ED team leaders or participants working on similar aims in this collaborative.

Quality Measure: Percentage of pediatric patients with their weight documented only in kilograms

Policy statement

• Sites should define age range for pediatric population
• Weight should be recorded at every ED encounter
• Ensure that either an actual weight (i.e., gurney weight) or weight based on patient length (i.e., using the length-based tape) is used for all resuscitations
• Frequency that ED pharmacists attend a pediatric resuscitation and assist with medication administration

Infrastructure changes

• Utilize a scale that only weighs pediatric patients in kilograms or can be locked in kilograms mode
• Utilize gurney weights on all patients for whom staff are unable to get a scale weight
• Utilize a length-based tape and ensure that it is available/secured in resuscitation bay as well
• Utilize a single formulation for each medication

Electronic medical record (EMR) optimization

• EMR alerts care team when weight is not recorded in correct unit
• EMR alerts care team that weight does not coincide with patient’s height and age
• For resuscitation, weight is a required entry in the patient’s medical record
• Consider using standard weight nomograms (e.g., World Health Organization)
• EMR automatically calculates medication dosing based on weight recorded in kilograms in medical record

Education

• Integrate ED pharmacists into the healthcare team
• Develop training/educational content for care team
  • Learning objectives should include: proper use of length-based tape, necessity of weight measurement required in cases of resuscitation, safety issues (e.g., number of reported medication errors), methods of measuring weight, nomograms, family engagement, your site’s policy; PRQC change strategies)
• Identify training modality (e.g., online, in-person, staff-meetings, peer to peer, EMR alerts)
• Identify strategies to increase families’ engagement
• Weight should not be estimated but measured

Knowledge reinforcement for care team

• Posters in triage area
• Direct feedback to care team following chart audits
• Develop script for use by triage nurse

Prescribing Patterns (deep dive for outcome measure)

• Manually track the number of incidences when an incorrect dose of a medication was ordered for a patient based on their weight
• Track high risk conditions with common errors in prescribing and administration medication administration (deep dive for outcome measure)
• Integrate a tool that nurses can reference to ensure that medication dosing is appropriate (use standard nomograms as reference)
• Integrate a nurse-to-nurse cross-check to ensure that medication dosing is appropriate. If site has bandwidth to accommodate this effort, consider cross-check for high-risk patients/medications or cross-checks during off-peak hours in the ED.
• Work with pharmacy team to develop notification system in the event that a prescribed medication does not coincide with standard practice

Patient & Family Engagement

• Include a process where families who ask about their child’s weight in pounds could be handed a preprinted chart and their child’s weight in kilograms and corresponding pounds could be circled
• Include process where family are advised of medication and dose prior to administration
• Disseminate weight infographic/conversion chart to empower caregiver engagement

Disclaimer: The views and responses to these FAQ’s are recommendations from the subject matter experts who presented during the Suicide Fireside Chat on August 8, 2023. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government

If you have any additional questions, please email collaboratives@emscimprovement.center.

References​​

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