Identification of Pica Behaviors in Youth With Sickle Cell Disease: A Quality Improvement (QI) Project

This article describes a quality improvement (QI) initiative integrated into a pediatric psychology service that focused on improving the standardized assessment of pica behaviors in patients with sickle cell disease (SCD). Pica, the persistent mouthing or eating of nonnutritive substances, can result in serious health complications and is a known problem for patients with SCD. At the time of project initiation, pica behaviors were assessed, on average, in 36% of new consultations completed by psychology providers in patients with SCD across our hospital system. The primary goal for the current project was to increase documented screening for pica behaviors to at least 95% of patients with SCD newly referred for a pediatric psychology consultation. After QI project implementation, assessment of pica behaviors increased to 100% and was maintained at that level for the final 5 months of the 12-month project period. Systematic, standardized assessment of pica behaviors for patients with SCD was deemed feasible and acceptable based on initial uptake and maintenance of the change. Of note, incidence rates of pica behaviors for patients with SCD seen by psychology ranged from 21% to 34% across the hospital system, prompting an expansion of the original project scope to ensure that all patients with SCD with pica behaviors were identified as part of routine clinical care regardless of psychology referral. Our project suggests that quality improvement methods are an effective way to implement systemic changes in regular clinical practice across providers practicing in different settings at multiple hospitals.