Improved energy goal documentation in pediatric intensive care unit with standardized electronic health records: A quality improvement initiative

We conducted a quality improvement (QI) initiative to increase documentation of energy goals within 48 h of admission to the pediatric intensive care unit (PICU) for all children. Malnutrition remains one of the most prevalent issues in the PICU. Research shows early estimation and documentation of energy goals in the electronic health record (EHR) is associated with higher daily energy intake. Energy goals are often not documented early in patient admission, which can be improved. By revising critical care progress notes to prompt providers to estimate an energy goal when no goal has been documented within the first 48 h we expected an increased rate of goal documentation. A QI initiative was performed from May 2021 to April 2022 using the Plan-Do-Study-Act methodology. Interventions included (1) an automated smart-text element on the EHR progress note template and (2) a review of calculated and documented energy goals in calories by registered dietitians. A review team monitored the rate of documentation of energy goals monthly. Before the QI interventions, the baseline rate of documentation of an estimated energy goal was 44%. After adding standardized prompts to the EHR system, the rate of a documented energy intake goal within 48 h of admission by critical care providers increased to >90%. Using automated prompts in EHRs resulted in an increased frequency of energy goal documentation exceeding 90% monthly. Establishing a standardized prompting system within the EHR directly led to an overall increased frequency of energy goals documented in calories.