2023

Follow

• 

  We’re Not HAPI and We Know It.

  Sarah Baldensperger, Kris Noel, and Emily Jordan Ressman

  In 2021, we noted an increase in hospital acquired pressure injuries (HAPI) in our Pediatric Intensive Care Unit (PICU). In 2021 there were 41 HAPIs resulting in a rate of 3.44 HAPIs per 1000 patient days. In our deep dive into the causative factors, we determined there was a marked increase in respiratory device related pressure injuries from 2021-2022 as well as pressure injuries related to turning and repositioning leading us to believe our current prevention measures should be reviewed. To combat this, we formed an interdisciplinary team aimed at reducing HAPIs. Together with our respiratory therapy department we introduced new products such as gel barriers, new masks for non-invasive positive pressure ventilation, a moisture wicking barrier device, a proning system, and a wedge turning system. We also provided education on currently available products and practices. Because so many of our pressure injuries were related to non-invasive ventilation facemasks, we instituted a new practice in which a second mask of a different size was always kept at the bedside. We worked with our hospital wide HAPI committee to update our prevention bundle and created a turning and repositioning guideline for our high-risk patients. To disseminate this information to bedside staff and providers, we held in-services, roadshows for hands on exposure to new products, and presentations in staff meetings. Our Quality Improvement Nurse aided us in tracking and trending our HAPI numbers as well as correlating the implementation of our interventions to our results. As of the end of June 2023, we have reduced our HAPI rate by 69.5% to a rate of 1.05. The use of a multidisciplinary team to assess the current practice as well as implement changes to our HAPI prevention practices has shown promising results in our goal of decreasing HAPIs in the PICU.

• 

  Shining a Light on Autism Interventions During a Long-Term Medical Hospitalization: A Case Study

  Janna Berg, Jill Hanks, and Tera Holland

  Hospitalized children diagnosed with autism spectrum disorder (ASD), with intellectual disability, are a challenge for nursing and safety assistant staff. A large, metropolitan, pediatric hospital recently struggled while caring for a developmentally delayed, non-verbal teenager with ASD that was hospitalized for a year. Although staff are provided yearly education related to high-risk behavioral health patients, autism-directed education was minimal. A literature search for interventions to execute was unsuccessful due to the lack of articles related to the prolonged medical hospitalization of ASD teens. In response to repeated events related to staff injuries and patient behavioral escalations, a workgroup was formed to address the care provided. A multidisciplinary team offered creative solutions to meet the needs of this long-term hospitalization. Sensory items were introduced. Safety was increased with the implementation of two safety assistants. A psychotropic medication plan was readily available. Although successes were made, others were discarded based on inconclusive results. Permanent outcomes included the creation of a specialized patient care technician with additional training for patients with autism, a behavioral health banner to share information about the patient’s care with all disciplines, and a full-time psychiatric resource registered nurse. The new modalities proved effective as the patient did not require as needed medication during the last three months of hospitalization. Lessons learned were the early identification of patients with ASD that prove difficult to place, and the prompt initiation of interventions to lessen the number of Behavioral Emergency Response Team events.

• 

  Keeping the Trach Safe: Development and Validation of a Risk Assessment Scale

  Rebecca Brooks, Danielle Walker, Stephen Chorney, and Christina Smith

• 

  Standardizing Orthostatic Vital Signs to Align with Best Practices

  Allison Bui, Colin Blackmon, and Erian Brown

  Orthostatic vital signs (OVS) are commonly performed to evaluate for hypovolemia and syncope in the pediatric population. A current practice survey conducted at a pediatric hospital identified a large discrepancy in practice vs current literature available. A total of 94 participants including nurses, paramedics, and patient care technicians revealed two significant variable points: positioning and timing. Most staff members record OVS when the patient is supine, sitting, then standing. The time between each position change also ranges from immediately recorded to waiting over 5 minutes after each position change. In contrast, current literature identifies pediatric patients should assume a supine position for 5 minutes before capturing the initial set of vitals. The patient then moves to a standing position for 1 minute before taking another set of vitals. After an additional 3 minutes standing, a final set of vitals will be recorded to trend how the body is compensating (Elsevier, 2022). Heart rate has also been identified to be a more accurate measurement of compensation, thus should be recorded with each blood pressure (Naccarato et al., 2012). At the studied hospital, no standardized documentation is required in the electronic medical record systems, making the data difficult to view. Current interventions include staff education, designated documentation location, and ease of access to policy-driven practice by linking guidelines to the orders. Future evaluation includes a post-survey to analyze how staff respond to the interventions and determine if accurate and reliable data are utilized when diagnosing orthostasis in order to streamline care.

• 

  Education Surrounding Tonsillectomy Care to Decrease Emergency Department Visits: A Quality Improvement Study

  Emily Carsey, Ashley Sewell, Jordan Gamboa, and Carol Howe

• 

  Implementing Standardized Intravenous Medication Line Labeling to Prevent Errors

  Bailey Cochrum

• 

  Integrated Therapy Unit Home Medication Storage Process

  Yolanda Dario, Ayehubirhan Shenkute, and Christina Smith

• 

  “Bee the Change” Building a Culture of Peer-to-Peer Recognition in the Emergency Room

  Virginia Elizondo, Amber Albiar, and Georgina Hernandez

• 

  Maintaining a QI Process to Decrease Time to Antibiotics in At-Risk Populations in the Emergency Department

  Virginia Elizondo, Nicole Bizzack, and Amber Dayton

• 

  Implementation Strategies to Increase Adoption of Health Literacy Practices in an Ambulatory Clinic Setting

  Jordan Gamboa, Penny Williams, and Carol Howe

• 

  Incorporating the Adaptive Behavior Assessment System Third Edition(ABAS-3) to Follow Cognitive and Developmental Milestones of Patients after ECLS

  Laura Hatton, Erin Tresselt, and Ricardo Merano

• 

  Child Trafficking: The Identification and Intervention of Pediatric Trafficked Victims in the Emergency Room

  Terra Holland

  Human trafficking (HT) is a growing issue not only in third-world countries but is happening in our own backyard in the United States. A major metropolitan pediatric hospital located in one of the top three cities with the highest rates of HT was lacking the tools to identify victims of HT. As individual cases were being informally identified, nurses acknowledged the need for the development of an action plan. The purpose of this study is to successfully identify victims of HT. A literature review showed that utilizing a validated screening tool could identify victims of HT. The validated Greenbaum Screening tool (Greenbaum, et al, 2018) was chosen and piloted in the emergency department (ED) of this pediatric hospital. The screening tool consists of six questions asked of any patients presenting to the ED that were ten years or older with the exception of patients that could not respond. Screening questions ask about previous injuries, previous alcohol or drug use, running away from home, involvement with law enforcement, previous sexually transmitted infections, and a history of multiple sexual partners. The pilot was conducted over a three-month period with twenty-three patients screened. Of these patients, 22% screened positive. A positive screen would prompt an escalation to a social worker who would interview the patient and decide if the medical provider who specializes in evaluation of traumatized or children at risk for abuse and neglect should be consulted. Prior to utilizing the screening tool, no patients were referred to the clinic for evaluation of trafficking. The positivity rate has proven the necessity of this screening tool. Plans include expanding the pilot to more areas of the hospital to increase awareness and increase the potential of identifying HT victims.

• 

  Preliminary results of the Health Literacy CARE study: Implementation of Health Literacy Practices in a Pediatric ENT clinic

  Carol Howe, Emily Carsey, and Ashley Sewell

• 

  Standardizing Access Parameters for Vasoactive Infusions

  Leslie Huntington, Emily Jordan Ressman, and Meredith DeCoy

  Prompt, dependable delivery of vasoactive medications can be life-saving in the pediatric population. Research shows that short-term delivery of vasoactive medications through a peripheral IV (PIV) is safe and effective, yet nurses in our pediatric intensive care unit (PICU) continue to have concerns about the risk of patient harm related to extravasation. The purpose of this project is to develop and incorporate into practice a standardized algorithm to assist in safely administering vasoactive infusions via PIV. After a thorough literature review, we assembled an interdisciplinary team to create a plan to address these concerns. Our team held that the most effective way to listen and combat the underlying issues at hand would be to develop a process map that would support safe PIV vasoactive administration and encourage advocating for a central line for their patient when specific criteria are not met. This process map would provide physicians with evidence-based practice guidelines to support the use of PIVs when administering vasoactives short-term as well as recommend limits to PIV delivery of these high-risk medications. Our work group drafted and distributed a pre-intervention survey to gauge self-identified barriers to PIV vasoactive administration between bedside nursing and providers. We then utilized that feedback in our development of the process map. Because extravasations were a concern from our bedside staff and are a reportable measure of patient safety, our team will continue to track the extravasation rate both pre- and post-intervention. We plan to distribute our post-implementation survey this winter and we are hopeful that this standardized methodology for determining the line access necessary for vasoactive infusions will reduce concerns from bedside nursing staff, align nursing and physician strategy, improve overall knowledge of evidence-based safe practices, and improve patient care. In the future, we plan to expand this project hospital-wide.

• 

  The Effects of “Kids Can” Child Life MRI Outreach on Safety, Quality, and Patient Experience

  Kristen Johnson and Katie Grabowski

• 

  Sustained Reduction of Pressure Injury in the Pediatric Cardiac OR

  Meagan Lombardo and Andrea Torzone

• 

  Preparation with purpose: Child life involvement in the MRI process

  Keeley Machen and Michah Stipp

• 

  A Standardized Approach to Enhance Communication and Collaboration Between Bedside Nurses and Medical Residents

  Nikki Marshall and Misty Daugherty

  Effective communication and collaboration among healthcare providers is a key component in providing safe, high quality patient care. Studies have shown that effective communication between nurses and physicians increase positive patient outcomes, reduce medical errors, and increase understanding of each clinical role (Amudha et al., 2018). With the help of Professional Governance Committees, surveys and questionnaires were utilized to identify knowledge deficits and barriers the medical residents encountered during their rotations on the various inpatient units. The residents identified the following barriers: Lack of understanding on how to collaborate with nursing Lack of confidence when notified of a patient concern by nursing Not aware of the multiple avenues of communication available This information was used to create a standardized educational approach for medical residents rotating to the various inpatient units and served to open lines of communication with nursing staff. The presentation contains standard hospital information, unit specific education, and information on what a nurse needs from the resident. This information is presented on the second day of the resident’s rotation at the “Meet & Greet.” Each unit has an appointed nurse or group of nurses that review the information to bridge the identified information gaps in standard hospital knowledge, to speak about the specifics of the specialty, and to build a professional relationship with the residents. Through surveys and post “Meet & Greet” questionnaires, residents verbalized a better understanding of how they can communicate with nurses and were more confident in responding to calls concerning patients. The appointed nurses became recognized and trusted faces on the unit and resources for the residents during their rotation. The residents felt their communication skills with nurses had increased and subsequently enhanced their collaboration.

• 

  Patient and Family Education: Empowering Families and Improving Care

  Amanda Mercado and Rebecca Barr

• 

  PRESSURE DELIVERY DURING INTRAPULMONARY PERCUSSIVE VENTILATION IN A SPONTANEOUS BREATHING INFANT MODEL

  Gerald Moody

• 

  Postoperative 30-Day National Surgical Quality Improvement Program Follow-Up

  Karisa Price and Kristin Rahman

• 

  End-of-Life Collaborative

  Christina Reyna, Hope Bolstrom, and Hailee Scoggins

• 

  Optimizing Discharges for the Technology-Dependent Pediatric Population

  Christina Reyna, Christina Smith, and Rebecca Barr

• 

  Driving Team Member Engagement Through Competition

  Kendel Richards and Leslie Huntington

  Hospital-acquired condition (HAC) rates were rising within our pediatric ICU. As utilization of contract staff and nurse turnover increased, staff became less engaged in quality initiatives. Nurse-to-patient ratios were adjusted to account for patient acuity and the unit was given additional resources to assist staff. Once resources and equipment were eliminated as barriers to staff engagement and accountability, our leadership team began to look at other ways to motivate staff to engage in hospital initiatives. Understanding that improved nursing engagement leads to better outcomes and staff wellbeing (Saleh & De Jongh Nel, 2022), a year-long team-based competition was created to motivate and create accountability amongst a staff of over 300 people. Teams were created that encompass all disciplines found in the ICU, which increased staff morale by creating an environment of inclusivity. Each team was led by 3-4 nursing team leaders who asked their teammates to pick their team color and name and to help name the overall contest. A scoring system was created by a multidisciplinary leadership team to enable teams to earn points by engaging in unit initiatives or lose points when a HAC or safety event occurred. Data was gathered weekly from various tracking systems the hospital had in place as well as individual reporting and translated into points for each team. Teams were then rewarded with recognition and awards quarterly, with an overall winner and category MVPs. In the first two quarters after game implementation the rate of HACs decreased by 43% compared to the first two quarters of the prior year. Average staff attendance in unit-based HAC committees has increased over 92% from 2022 to 2023. This has led to an increase in staff adherence to evidence-based bundles and the creation of several unit-based HAC reduction initiatives. The execution of this contest offers support that when work engagement is high, quality of patient care will also improve.

• 

  Do you see what I see? Feasibility of Delirium Screening by Pediatric Therapists

  Margaret Scholl, David Wittkower, and Satori Gatling