Adaptation and Validation of a Multidisciplinary Checklist for Rounds in the Intensive Care Unit

Abstract

Objective: to perform the adaptation, content validation and semantic analysis of a Multidisciplinary Checklist used in rounds in Intensive Care Units for adults. Method: a methodological study, consisting of three stages: Adaptation of the checklist, performed by one of the authors; Content validation, performed by seven judges/health professionals from a public teaching hospital in Paraná; and Semantic analysis, performed in a philanthropic hospital in the same state. Agreement of the judges and of the target audience in the content validation and semantic analysis stages was calculated using the Content Validity Index and the Agreement Index, respectively, with a minimum acceptable value of 0.80. Results: in the content validation stage, the checklist obtained a total agreement of 0.84. Of the 16 items included in the instrument, 11 (68.75%) were readjusted and four (25%) were excluded for not reaching the minimum agreement. The readjusted items referred to sedation; analgesia; nutrition; glycemic control; headboard elevation; gastric ulcer prophylaxis; prophylaxis for venous thromboembolism; indwelling urinary catheter, central venous catheter; protective mechanical ventilation and spontaneous breathing test. Regarding the items excluded, they referred to the cuff pressure of the orotracheal tube and to Nursing care measures such as taking the patient out of the bed, pressure injury prophylaxis, and ophthalmoprotection. In the semantic analysis, the final agreement of the instrument's items was 0.96. Conclusion: after two evaluation rounds by the judges, testing in critically-ill patients and high inter-evaluator agreement index, the Multidisciplinary Checklist is found with validated content suitable for use in rounds in intensive care.

Effects of multidisciplinary rounds and checklist in an Intensive Care Unit: a mixed methods study

“…The ICU multidisciplinary team performed daily rounds, but checklist 1 was completed on alternate days. This multidisciplinary team intervention with the clinical/therapeutic discussion of patients directed by checklist 1 in only a few days of the week lasted two years; period 3: round post-implementation using the "Multidisciplinary Checklist for ICU Rounds" -version 2 (13) , validated by one of the authors. During this period, the ICU performed the rounds daily and completed checklist 2.…”

“…This daily intervention of the round directed by checklist 2 was maintained in the ICU, even after the end of data collection for this study. Checklists 1 and 2 include 16 and 12 items of intervention/care to critically ill patients, respectively, based on best practices in health: prophylaxis for gastric ulcer; prophylaxis for venous thromboembolism (VTE); headboard elevation 30 0 ; adequate analgesia; adequate sedation; adequate nutrition; removal of indwelling urinary catheter (IUC); removal of central venous catheter (CVC); extubation/spontaneous breathing test (SBT); airway pressure/ protective mechanical ventilation; suspension/adjustment of antimicrobial doses; glycemic control; prophylaxis for pressure injury; removal from the bed; (oro)tracheal cannula cuff pressure; and ophthalmoprotection (12)(13) . It is noteworthy that the first 12 intervention items were common between checklists 1 and 2.…”

Multiprofessional round with checklist: association with the improvement in patient safety in intensive care

“…This intervention lasted for two years. Regarding the third period, the rounds were performed daily and checklist 2-'Multidisciplinary' (12) , validated by one of the authors, was completed. In this last period, the researcher together with the coordinator responsible for the ICU proposed the systematic use of the validated checklist (12) during the rounds and this strategy of multidisciplinary care remains in the ICU, even with the end of this study.…”

Efeitos de rounds multidisciplinares e checklist em Unidade de Terapia Intensiva: estudo de método misto

“…A equipe multidisciplinar da UTI realizava rounds diários, porém o preenchimento do checklist 1 ocorria em dias intercalados. Esta intervenção da equipe multiprofissional com a discussão clínica/terapêutica do paciente direcionado pelo checklist 1 em apenas alguns dias da semana se estendeu por dois anos; período 3: pós-implementação do round com uso do "Checklist Multidisciplinar para Rounds em UTI" -versão 2 (13) , validado por uma das autoras. Neste período, a UTI realizava diariamente os rounds e o preenchimento do checklist 2.…”

“…Os checklists 1 e 2 contemplam 16 e 12 itens de intervenção/ cuidado ao paciente crítico, respectivamente, pautados nas melhores práticas em saúde: profilaxia para úlcera gástrica; profilaxia para tromboembolia venosa (TEV); elevação da cabeceira 30 0 ; analgesia adequada; sedação adequada; nutrição adequada; retirada de sonda vesical de demora (SVD); retirada de cateter venoso central (CVC); extubação/teste de respiração espontânea (TRE); pressão das vias aéreas/ventilação mecânica protetora; suspensão/ajuste de doses de antimicrobiano; controle glicêmico; profilaxia para lesão por pressão; retirada do leito; pressão do balonete da cânula (oro)traqueal; e oftalmoproteção (12)(13) . Destaca-se que os primeiros 12 itens de intervenção eram comuns entre os checklists 1 e 2.…”