A Pediatric Intensive Care Checklist for Interprofessional Rounds

The R-PICniC Study

Daniela Fernanda dos Santos Alves, PhD; Érika Sana Moraes, MSc, RN; Patrícia Blau Margosian Conti, MSc, PT; Giselli Cristina Villela Bueno, MSc, RN; Tiago Henrique de Souza, MD, PhD; Elisandra Oliveira Parada Pereira, RN; Marcelo Barciela Brandão, MD, PhD; Maria Angélica Sorgini Peterlini, PhD; Mavilde Luz Gonçalves Pedreira, PhD


Am J Crit Care. 2022;31(5):383-389. 

In This Article

Abstract and Introduction


Background: The use of checklists in the pediatric intensive care unit can help improve the quality of care and patient safety.

Objectives: To build and validate a checklist for use in interprofessional rounds in a pediatric intensive care unit.

Methods: This methodological study was conducted in a 20-bed pediatric intensive care unit serving children up to 14 years old. A checklist prototype was constructed through review of the literature and achievement of consensus among the professionals providing care in the unit. Content validation was performed using a modified Delphi technique involving specialists with more than 5 years of experience in pediatric intensive care, methodological studies, and patient safety. Content validity ratios were calculated for the elements of the checklist, which were considered valid when they reached values greater than 0.78. The checklist was tested for usability, application time, and effects on patient care, and feedback was obtained from potential users.

Results: Before content validation, the checklist contained 11 domains, 32 items, and 6 daily goals. The invitation to validate content was sent to 86 specialists, and content validity was achieved after 2 rounds of evaluation, with the checklist elements having content validity ratios ranging from 0.94 to 0.97. The mean application time of the checklist was 5 minutes. The final version consisted of 11 domains, 33 items, and 8 daily goals.

Conclusions: This study resulted in a useful and valid instrument for application in interprofessional rounds that was tailored to the needs of local health care professionals.


In the pediatric intensive care unit (PICU) and in other health care settings, the use of checklists has been found to improve the quality of care.[1–6] Among other benefits, checklist use may reduce the number of adverse events such as infections related to health care, medication errors, and unplanned extubations, as well as the number of invasive procedures.[7–9] In the PICU, the use of checklists during interprofessional rounds has been reported to result in change in patient care plans more than 50% of the time.[4]

A checklist can be used in several ways in clinical practice, including for decision-making in care, such as during bedside rounds.[10] It can also be used as a tool to facilitate teaching and learning and evaluate the performance of nursing and medical residents, as well as to empower nurses and young physicians during discussions with more experienced professionals.[2]

The application of checklists in the PICU has been described in the literature;[7,8,11–16] however, we did not find any published reports of the development or implementation of these checklists in Brazil. Despite the availability of tools that could be translated and adapted to our situation, we chose to build a new checklist based on our knowledge of the professional practice environment in which the instrument would be used.[1,2]

When checklist items are read out at the patient's bedside, the professionals understand the goals of patient care.

The motivating factors for this study included our understanding of the needs of a multidisciplinary team and experience with pediatric intensive care in a teaching hospital that serves patients with highly complex illnesses. Nursing professionals and physicians report difficulties in the interprofessional communication process, which can contribute to the occurrence of errors of omission. Professionals involved in direct patient care have reported that when checklist items are read out at the patient's bedside, they better understand the goals of patient care.[17,18] Thus, the objectives of this study were to build and validate a care checklist for use in interprofessional rounds in a PICU setting.