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The Egyptian Pediatic Advanced Life Support
- Monitoring and evaluating the impact of the guideline
A. Facility based indicators:
Pediatric Resuscitation Audit Checklist
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Hospital |
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Department |
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Date |
|
Auditor |
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Case/Code Number |
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|
Comments |
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1. Recognition of Clinical Deterioration
|
Audit Item |
Yes
|
No |
N/A |
|
1-Rapid response team |
☐ |
☐ |
☐ |
|
2-Vital signs documented regularly (age-appropriate) |
☐ |
☐ |
☐ |
|
3-Structured deterioration recognition system if available (PEWS) or equivalent(Abnormal vital signs identified and documented) |
☐ |
☐ |
☐ |
|
4-Escalation pathway activated according to hospital policy (Senior clinician notified) (ASA) |
☐ |
☐ |
☐ |
|
5-Time from deterioration recognition to escalation recorded |
☐ |
☐ |
☐ |
|
6-Reassessment documented after intervention |
☐ |
☐ |
☐ |
2. Initial Response
|
Audit Item |
Yes |
No |
N/A |
|
7-Airway assessed promptly |
☐ |
☐ |
☐ |
|
8-Oxygen administered when indicated |
☐ |
☐ |
☐ |
|
9-Monitoring attached (ECG, SpO₂, BP) |
☐ |
☐ |
☐ |
|
10-IV access obtained promptly or IO( if available and when IV access difficult) |
☐ |
☐ |
☐ |
|
11-VBG &Blood glucose measured |
☐ |
☐ |
☐ |
3.Cardiac Arrest Management
|
Audit Item |
Yes |
No |
N/A |
|
12-Code blue team |
☐ |
☐ |
☐ |
|
13-Cardiac arrest recognized promptly |
☐ |
☐ |
☐ |
|
14-CPR started immediately of arrest recognition |
☐ |
☐ |
☐ |
|
15-Correct compression rate to ventilation (15:2) |
☐ |
☐ |
☐ |
|
16-Rhythm and pulse checks limited to ≤10 seconds |
☐ |
☐ |
☐ |
|
17-Defibrillator attached rapidly when indicated |
☐ |
☐ |
☐ |
|
18-Shock joules delivered according to guidelines |
☐ |
☐ |
☐ |
|
19-CPR resumed immediately after shock delivery for 2 min. |
☐ |
☐ |
☐ |
|
20-Adrenaline administered according to guidelines |
☐ |
☐ |
☐ |
|
21-Reversible causes (4Hs & 4Ts) considered |
☐ |
☐ |
☐ |
|
22-Time elapsed from starting chest compression until rhythm check 2min |
☐ |
☐ |
☐ |
4.Post-ROSC Care
|
Audit Item |
Yes |
No |
N/A |
|
23-Return of spontaneous circulation (ROSC) documented |
☐ |
☐ |
☐ |
|
24-Airway: Oxygenation optimized; target SpO2 94-98% |
☐ |
☐ |
☐ |
|
25-Breathing: Ventilation optimized;co2 35-45mmHg |
☐ |
☐ |
☐ |
|
26-Circulation: Blood pressure monitored aim MAP>10th percentile |
☐ |
☐ |
☐ |
|
27-Blood glucose monitored (normoglycemic) |
☐ |
☐ |
☐ |
|
28-Temperature monitored(36-37.5) |
☐ |
☐ |
☐ |
|
29-Neurological status assessed and documented GCS |
☐ |
☐ |
☐ |
|
30-Family informed appropriately |
☐ |
☐ |
☐ |
5. Equipment and Medication Readiness
|
Audit Item |
Yes |
No |
N/A |
|
31-Pediatric resuscitation trolley available |
☐ |
☐ |
☐ |
|
32-Daily equipment check documented |
☐ |
☐ |
☐ |
|
33-Defibrillator functional checked daily |
☐ |
☐ |
☐ |
|
34-Oxygen source available and functional |
☐ |
☐ |
☐ |
|
35-Bag-mask devices available in pediatric size |
☐ |
☐ |
☐ |
|
36-Airway equipment available in appropriate pediatric sizes |
☐ |
☐ |
☐ |
|
37-Emergency drugs available and not expired |
☐ |
☐ |
☐ |
Documentation and Debriefing
|
Audit Item |
Yes |
No |
N/A |
|
38-Arrest record completed |
☐ |
☐ |
☐ |
|
39-Critical interventions timed and documented |
☐ |
☐ |
☐ |
|
40-Drugs documented accurately |
☐ |
☐ |
☐ |
Compliance Summary
Total Applicable Items: __________
Total Yes Responses: __________
Compliance Score (%) = (Yes ÷ Applicable Items) × 100
Overall Rating: __________________
B. High authority based indicators
1. System
Performance Indicators (RRS/RRT)
1. System Performance Indicators (RRS/RRT)
|
Indicator |
Definition |
Target |
|
RRT activation rate |
Number of RRT calls per 1000 admissions |
Institution-specific benchmark |
|
Time from trigger to RRT arrival |
Minutes from call to bedside response |
≤ 5–10 min |
|
Appropriate activation rate |
% of RRT calls meeting PEWS/criteria |
>80% |
|
Missed deterioration cases |
Patients who arrested without prior RRT activation |
Should decrease over time |
|
Repeat RRT calls within 24h |
Recurrent instability after first RRT |
Monitor trend ↓ |
2. Early Recognition of Deterioration
|
Indicator |
Definition |
Target |
|
PEWS compliance rate |
% of patients with documented PEWS |
>90% |
|
Escalation compliance |
% of abnormal PEWS with documented escalation |
>85–90% |
|
Time from abnormal vitals to action |
Delay in response to deterioration |
<30–60 min |
|
Unplanned ICU transfer |
Transfer from ward without prior ICU planning |
Decrease over time |
3. Cardiac Arrest Quality Indicators
|
Indicator |
Definition |
Target |
|
Time to CPR initiation |
Collapse → first chest compression |
<1 minute |
|
Time to first defibrillation (VF/pVT) |
Collapse → shock delivery |
<3–5 minutes in monitored patients |
|
CPR quality compliance |
Adequate rate, depth, recoil |
>80–90% adherence |
|
Chest compression fraction |
% time compressions delivered |
>80% |
|
EtCO₂ during CPR (if available) |
Marker of CPR quality |
Documented in ≥80% of arrests |
|
ROSC rate |
Return of spontaneous circulation |
Institution benchmark |
4. Medication & Advanced Intervention Indicators
|
Indicator |
Definition |
Target |
|
Epinephrine timing compliance |
Given within recommended interval |
>80% compliance |
|
Correct dosing accuracy |
Weight-based drug accuracy |
>90% |
|
Airway success rate |
Successful advanced airway placement |
Documented + first-pass success tracked |
|
Interruption time during advanced airway insertion (ETT, LMA) |
CPR pause during intubation |
<10 seconds |
5. Post–Cardiac Arrest Care Indicators
|
Indicator |
Definition |
Target |
|
Oxygen titration compliance |
Avoidance of hyperoxia/hypoxia |
>85% |
|
Hemodynamic stability achieved |
SBP appropriate for age after ROSC |
Increasing trend |
|
Time to vasoactive support |
ROSC → vasopressor start in shock |
<15–30 min |
|
Fever prevention compliance |
Temperature maintained <38°C |
>90% |
|
Neurological monitoring use |
EEG / neuro assessment documented |
Increasing utilization |
|
Seizure detection and treatment |
Documented seizure management after ROSC |
>90% treated promptly |
6. Outcome Measures (Clinical Impact)
|
Outcome |
Definition |
Target |
|
Survival to ROSC |
Any sustained ROSC after arrest |
Improve over baseline |
|
Survival to ICU discharge |
Survival after arrest admission |
Increase trend |
|
Survival to hospital discharge |
Final survival outcome |
Increase trend |
|
Neurologically favorable survival |
CPC 1–2 or age-appropriate function |
Key quality endpoint |
|
Pediatric in-hospital cardiac arrest rate |
Arrests per 1000 admissions |
Decrease over time |
