Safe paediatric intensive care. Part 2: workplace organisation, critical incident monitoring and guidelines.

In order to optimise safety within the paediatric intensive care unit (PICU), it is essential to optimise organisation, identify problem areas and implement standards and guidelines for safe practice (with appropriate monitoring). Organisational issues have a major impact on safety: the introduction and-recently-centralisation of paediatric intensive care, the appointment of dedicated paediatric intensivists, nursing staffing, handovers, rounds, the number of work hours and night shifts with the associated problems of disturbed circadian rhythms. The technique of voluntary, anonymous, non-punitive critical incident reporting has the potential to identify incidents and latent errors before they become self-evident through a major incident. This systems approach focuses on organisational and communication problems. Standards and guidelines may help in weighing up the benefits and risks of invasive procedures, and interventional studies have shown that implementation of standards and guidelines can improve outcome. Mortality prediction models enable us to monitor quality of care and, thus, to investigate the best ways of organising intensive care and monitoring the effects of changes in practice.