Pub Date : 2023-05-01DOI: 10.1097/pq9.0000000000000648
Denise D. Quigley, M. Slaughter, Ron D. Hays
INTRODUCTION Improving patient care experiences is integral to the quality of care for hospitalized patients, including children and their families.1–3 Effective quality improvement (QI) requires incremental changes guided by measurement, monitoring, and performance feedback,4 all of which were challenged or disrupted by the 2019 coronavirus pandemic (COVID-19).5–7 In response to the COVID-19 pandemic, many, if not all, hospital processes were impacted. As part of a larger study,8–11 we had the opportunity to compare quality leaders’ perceptions of using patient experience surveys before and during COVID-19. This commentary aims to share the perspectives of inpatient pediatric leaders before and during COVID-19, as these data highlight the need to re-engage in efforts to improve pediatric care experiences.
{"title":"Pediatric Inpatient Leaders, Views Changed with COVID-19: A Call to Re-engage in Quality Improvement","authors":"Denise D. Quigley, M. Slaughter, Ron D. Hays","doi":"10.1097/pq9.0000000000000648","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000648","url":null,"abstract":"INTRODUCTION Improving patient care experiences is integral to the quality of care for hospitalized patients, including children and their families.1–3 Effective quality improvement (QI) requires incremental changes guided by measurement, monitoring, and performance feedback,4 all of which were challenged or disrupted by the 2019 coronavirus pandemic (COVID-19).5–7 In response to the COVID-19 pandemic, many, if not all, hospital processes were impacted. As part of a larger study,8–11 we had the opportunity to compare quality leaders’ perceptions of using patient experience surveys before and during COVID-19. This commentary aims to share the perspectives of inpatient pediatric leaders before and during COVID-19, as these data highlight the need to re-engage in efforts to improve pediatric care experiences.","PeriodicalId":343243,"journal":{"name":"Pediatric Quality and Safety","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116040977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/pq9.0000000000000654
Jaclyn N Kline, Lauren N Powell, Jonathan Albert, Amy C Bishara, J. Heffren, G. Badolato, Deena D. Berkowitz
Introduction: Uncomplicated urinary tract infections (uUTIs) are among the more common pediatric bacterial infections. Despite their prevalence, significant variability exists in the treatment duration and antibiotic selection for uUTI. Our first aim was to improve adherence to a three-day course of antibiotic treatment for uUTI in children over 24 months old. Our second aim was to increase the selection of cephalexin in this population. Methods: We conducted a single-center quality improvement study from March 2021 to March 2022. One thousand four hundred thirty-five patients were included across our baseline and intervention periods. We created an order set with embedded discharge prescriptions and followed this with education and provider feedback. The outcome measures for this study were percent of children receiving 3 days of antibiotic treatment and percent of children prescribed cephalexin. In addition, we tracked order set use as a process measure, and 7-day emergency department revisit as a balancing measure. Results: Rates of 3-day prescriptions for uUTI demonstrated special cause variation with an increase from 3% to 44%. Prescription rates of cephalexin for uUTI demonstrated special cause variation with an increase from 49% to 74%. The process measure of order set use improved from 0% to 49% after implementation. No change occurred in 7-day emergency department revisits. Conclusion: We demonstrated improved use of shorter course therapy for uUTI with a first-generation cephalosporin throughout this project without adverse events. We leveraged an order set with embedded discharge prescriptions to achieve our goals.
{"title":"Improving Adherence to Evidence-based Practice for Uncomplicated UTI in a Pediatric Emergency Department","authors":"Jaclyn N Kline, Lauren N Powell, Jonathan Albert, Amy C Bishara, J. Heffren, G. Badolato, Deena D. Berkowitz","doi":"10.1097/pq9.0000000000000654","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000654","url":null,"abstract":"Introduction: Uncomplicated urinary tract infections (uUTIs) are among the more common pediatric bacterial infections. Despite their prevalence, significant variability exists in the treatment duration and antibiotic selection for uUTI. Our first aim was to improve adherence to a three-day course of antibiotic treatment for uUTI in children over 24 months old. Our second aim was to increase the selection of cephalexin in this population. Methods: We conducted a single-center quality improvement study from March 2021 to March 2022. One thousand four hundred thirty-five patients were included across our baseline and intervention periods. We created an order set with embedded discharge prescriptions and followed this with education and provider feedback. The outcome measures for this study were percent of children receiving 3 days of antibiotic treatment and percent of children prescribed cephalexin. In addition, we tracked order set use as a process measure, and 7-day emergency department revisit as a balancing measure. Results: Rates of 3-day prescriptions for uUTI demonstrated special cause variation with an increase from 3% to 44%. Prescription rates of cephalexin for uUTI demonstrated special cause variation with an increase from 49% to 74%. The process measure of order set use improved from 0% to 49% after implementation. No change occurred in 7-day emergency department revisits. Conclusion: We demonstrated improved use of shorter course therapy for uUTI with a first-generation cephalosporin throughout this project without adverse events. We leveraged an order set with embedded discharge prescriptions to achieve our goals.","PeriodicalId":343243,"journal":{"name":"Pediatric Quality and Safety","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129367546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/pq9.0000000000000615
J. Cronin, Brenda J Satterthwaite, G. Robalino, D. Casella, M. Hsieh, Md Sohel Rana, Alia Fink, S. Pestieau
Introduction: Spinal anesthesia has a long history as an effective and safe technique to avoid general anesthesia in infants undergoing surgery. However, spinal anesthesia was rarely used as the primary anesthetic in this population at our institution. This healthcare improvement initiative aimed to increase the percentage of successful spinal placements as the primary anesthetic in infants undergoing circumcision, open orchidopexy, or hernia repair from 11% to 50% by December 31, 2019, and sustain that rate for 6 months. Methods: An interdisciplinary team created a key driver diagram and implemented the following interventions: education of nurses, surgeons, and patient families; focused anesthesiologist training on the infant spinal procedure; premedication; availability of supplies; and surgical schedule optimization. The team collected data retrospectively by reviewing electronic medical records (Cerner, North Kansas City, Mo.). The primary outcome was the percentage of infants undergoing circumcision, open orchidopexy, or hernia repair who received a successful spinal as the primary anesthetic. The team tracked this measure and evaluated using a statistical process control chart. Results: Between August 1, 2018, and February 29, 2020, researchers identified 470 infants (235 preintervention and 235 postintervention) who underwent circumcision, open orchidopexy, or inguinal hernia repair. Following the interventions in this project, there was a statistically significant increase in successful spinal placement from 11% to 45% (P < 0.0001). Conclusion: This quality improvement project successfully increased the percentage of patients receiving spinal anesthesia for specific surgical procedures by increasing the number of patients who underwent successful spinal anesthesia placement.
{"title":"Improving Outcomes through Implementation of an Infant Spinal Anesthesia Program for Urologic Surgery Patients","authors":"J. Cronin, Brenda J Satterthwaite, G. Robalino, D. Casella, M. Hsieh, Md Sohel Rana, Alia Fink, S. Pestieau","doi":"10.1097/pq9.0000000000000615","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000615","url":null,"abstract":"Introduction: Spinal anesthesia has a long history as an effective and safe technique to avoid general anesthesia in infants undergoing surgery. However, spinal anesthesia was rarely used as the primary anesthetic in this population at our institution. This healthcare improvement initiative aimed to increase the percentage of successful spinal placements as the primary anesthetic in infants undergoing circumcision, open orchidopexy, or hernia repair from 11% to 50% by December 31, 2019, and sustain that rate for 6 months. Methods: An interdisciplinary team created a key driver diagram and implemented the following interventions: education of nurses, surgeons, and patient families; focused anesthesiologist training on the infant spinal procedure; premedication; availability of supplies; and surgical schedule optimization. The team collected data retrospectively by reviewing electronic medical records (Cerner, North Kansas City, Mo.). The primary outcome was the percentage of infants undergoing circumcision, open orchidopexy, or hernia repair who received a successful spinal as the primary anesthetic. The team tracked this measure and evaluated using a statistical process control chart. Results: Between August 1, 2018, and February 29, 2020, researchers identified 470 infants (235 preintervention and 235 postintervention) who underwent circumcision, open orchidopexy, or inguinal hernia repair. Following the interventions in this project, there was a statistically significant increase in successful spinal placement from 11% to 45% (P < 0.0001). Conclusion: This quality improvement project successfully increased the percentage of patients receiving spinal anesthesia for specific surgical procedures by increasing the number of patients who underwent successful spinal anesthesia placement.","PeriodicalId":343243,"journal":{"name":"Pediatric Quality and Safety","volume":"163 7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129280021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/pq9.0000000000000645
Stacy Kuehn, J. Melvin, Pamela S. Creech, J. Fitch, G. Noritz, Michael F. Perry, Claire A Stewart, Ryan S. Bode
Introduction: Emergency transfers are associated with increased inpatient pediatric mortality. Therefore, interventions to improve system-level situational awareness were utilized to decrease a subset of emergency transfers that occurred within four hours of admission to an inpatient medical-surgical unit called very rapid emergency transfers (VRET). Specifically, we aimed to increase the days between VRET from non-ICU inpatient units from every 10 days to every 25 days over 1 year. Methods: Using the Model for Improvement, we developed an interdisciplinary team to reduce VRET. The key drivers targeted were the admission process from the emergency department and ambulatory clinics, sepsis recognition and communication, and expansion of our situational awareness framework. Days between VRET defined the primary outcome metric for this improvement project. Results: After six months of interventions, our baseline improved from a VRET every 10 days to every 79 days, followed by another shift to 177 days, which we sustained for 3 years peaking at 468 days between events. Conclusion: Interventions targeting multiple admission sources to improve early recognition and communication of potential clinical deterioration effectively reduced and nearly eliminated VRET at our organization.
{"title":"Reduction of Very Rapid Emergency Transfers to the Pediatric Intensive Care Unit","authors":"Stacy Kuehn, J. Melvin, Pamela S. Creech, J. Fitch, G. Noritz, Michael F. Perry, Claire A Stewart, Ryan S. Bode","doi":"10.1097/pq9.0000000000000645","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000645","url":null,"abstract":"Introduction: Emergency transfers are associated with increased inpatient pediatric mortality. Therefore, interventions to improve system-level situational awareness were utilized to decrease a subset of emergency transfers that occurred within four hours of admission to an inpatient medical-surgical unit called very rapid emergency transfers (VRET). Specifically, we aimed to increase the days between VRET from non-ICU inpatient units from every 10 days to every 25 days over 1 year. Methods: Using the Model for Improvement, we developed an interdisciplinary team to reduce VRET. The key drivers targeted were the admission process from the emergency department and ambulatory clinics, sepsis recognition and communication, and expansion of our situational awareness framework. Days between VRET defined the primary outcome metric for this improvement project. Results: After six months of interventions, our baseline improved from a VRET every 10 days to every 79 days, followed by another shift to 177 days, which we sustained for 3 years peaking at 468 days between events. Conclusion: Interventions targeting multiple admission sources to improve early recognition and communication of potential clinical deterioration effectively reduced and nearly eliminated VRET at our organization.","PeriodicalId":343243,"journal":{"name":"Pediatric Quality and Safety","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130383789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/pq9.0000000000000657
Brooke E. Maletic, Alex Swick, Leanne J. Murray, Mahmoud Abdel-Rasoul, Ashley Braughton, Kayla Petkus
Introduction: Poor adherence to medication regimens accounts for the substantial worsening of disease, death, and increased healthcare costs of approximately $100 billion annually in the United States. Patients participating in medication synchronization had 3.4 to 6.1 times increased odds of adherence, depending on the drug class. Abundant literature supports medication synchronization within the adult population. This IRB-exempt, prospective quality improvement project is an example of implementing and assessing medication synchronization inclusive of the pediatric setting. Methods: This study is a single-center, prospective, quality improvement project for patients seen at Nationwide Children’s Hospital (NCH) Complex Care Clinic that also fill prescriptions at NCH Outpatient Pharmacies. The project assessed patient medication adherence using the Proportion of Days Covered and the number of trips to the pharmacy 90 days before and 90 days postimplementation. We also assessed patient and pharmacy staff satisfaction 3 months after project implementation. Results: There was a statistically significant increase in the number of days covered for patients 90 days postimplementation compared to 90 days before implementation (Difference: 3.60; 95% confidence interval: 1.87, 5.33; P = 0.001). Additionally, there was a statistically significant decrease in pharmacy trips pre- and postimplementation (Difference: 2.17; 95% confidence interval: 1.26, 3.07; P < 0.001). Overall, pharmacy staff and patients reported satisfaction with the service. Conclusions: Implementing a medication synchronization service improved medication adherence and decreased trips to the pharmacy within the pediatric population.
{"title":"The Impact of Medication Synchronization on Proportion of Days Covered within the Pediatric Setting","authors":"Brooke E. Maletic, Alex Swick, Leanne J. Murray, Mahmoud Abdel-Rasoul, Ashley Braughton, Kayla Petkus","doi":"10.1097/pq9.0000000000000657","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000657","url":null,"abstract":"Introduction: Poor adherence to medication regimens accounts for the substantial worsening of disease, death, and increased healthcare costs of approximately $100 billion annually in the United States. Patients participating in medication synchronization had 3.4 to 6.1 times increased odds of adherence, depending on the drug class. Abundant literature supports medication synchronization within the adult population. This IRB-exempt, prospective quality improvement project is an example of implementing and assessing medication synchronization inclusive of the pediatric setting. Methods: This study is a single-center, prospective, quality improvement project for patients seen at Nationwide Children’s Hospital (NCH) Complex Care Clinic that also fill prescriptions at NCH Outpatient Pharmacies. The project assessed patient medication adherence using the Proportion of Days Covered and the number of trips to the pharmacy 90 days before and 90 days postimplementation. We also assessed patient and pharmacy staff satisfaction 3 months after project implementation. Results: There was a statistically significant increase in the number of days covered for patients 90 days postimplementation compared to 90 days before implementation (Difference: 3.60; 95% confidence interval: 1.87, 5.33; P = 0.001). Additionally, there was a statistically significant decrease in pharmacy trips pre- and postimplementation (Difference: 2.17; 95% confidence interval: 1.26, 3.07; P < 0.001). Overall, pharmacy staff and patients reported satisfaction with the service. Conclusions: Implementing a medication synchronization service improved medication adherence and decreased trips to the pharmacy within the pediatric population.","PeriodicalId":343243,"journal":{"name":"Pediatric Quality and Safety","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133927809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/pq9.0000000000000650
J. Greenberg, Anita R. Schmidt, Todd P. Chang, A. Rake
Introduction: A rapid response team (RRT) evaluates and manages patients at risk of clinical deterioration. There is limited literature on the structure of the rapid response encounter from the floor to the intensive care unit team. We aimed to define this encounter and examine provider experiences to elucidate what information healthcare staff need to safely manage patients during an RRT evaluation. Methods: This phenomenological qualitative study included 6 focus groups (3 in-person and 3 virtually) organized by provider type (nurses, residents, fellows, attendings), which took place until thematic saturation was reached. Two authors inductively coded transcripts and used a quota sampling strategy to ensure that the focus groups represented key stakeholders. Transcripts were then analyzed to identify themes that providers believe influence the RRT’s quality, efficacy, and efficiency and their ability to manage and treat the acutely decompensating pediatric patient on the floor. Results: Transcript coding yielded 38 factors organized into 8 themes. These themes are a summary statement or recap, closed-loop communication, interpersonal communication, preparation, duration, emotional validation, contingency planning, and role definition. Conclusions: The principal themes of utmost importance at our institution during an RRT encounter are preparation, a brief and concise handoff from the floor team, and a summary statement from the intensive care unit team with contingency planning at the end of the encounter. Our data suggest that some standardization may be beneficial during the handoff.
{"title":"Qualitative Study on Safe and Effective Handover Information during a Rapid Response Team Encounter","authors":"J. Greenberg, Anita R. Schmidt, Todd P. Chang, A. Rake","doi":"10.1097/pq9.0000000000000650","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000650","url":null,"abstract":"Introduction: A rapid response team (RRT) evaluates and manages patients at risk of clinical deterioration. There is limited literature on the structure of the rapid response encounter from the floor to the intensive care unit team. We aimed to define this encounter and examine provider experiences to elucidate what information healthcare staff need to safely manage patients during an RRT evaluation. Methods: This phenomenological qualitative study included 6 focus groups (3 in-person and 3 virtually) organized by provider type (nurses, residents, fellows, attendings), which took place until thematic saturation was reached. Two authors inductively coded transcripts and used a quota sampling strategy to ensure that the focus groups represented key stakeholders. Transcripts were then analyzed to identify themes that providers believe influence the RRT’s quality, efficacy, and efficiency and their ability to manage and treat the acutely decompensating pediatric patient on the floor. Results: Transcript coding yielded 38 factors organized into 8 themes. These themes are a summary statement or recap, closed-loop communication, interpersonal communication, preparation, duration, emotional validation, contingency planning, and role definition. Conclusions: The principal themes of utmost importance at our institution during an RRT encounter are preparation, a brief and concise handoff from the floor team, and a summary statement from the intensive care unit team with contingency planning at the end of the encounter. Our data suggest that some standardization may be beneficial during the handoff.","PeriodicalId":343243,"journal":{"name":"Pediatric Quality and Safety","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122108929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/pq9.0000000000000656
Gisella Valderrama, G. Badolato, P. Diaz, D. Berkowitz
Introduction: In our pediatric emergency department (ED), children triaged as low acuity who presented with Spanish-speaking caregivers with limited English proficiency (SSLEP) experienced disparately longer wait times than similarly triaged children with English-proficient caretakers. Although inequities in ED care based on language preference exist, little is known about effective interventions to eliminate the disparity. This quality improvement study aimed to eliminate the disparity in wait times and share effective interventions. Methods: A multidisciplinary team incorporating clinicians, professional interpreters, and data analysts utilized quality improvement methodology to introduce early identification of SSLEP children, standardize physician workflow, and optimize the interpreter process. The primary outcome was the length of stay. The secondary outcome was time to the provider. The balancing measures were revisits and non-LEP length of stay and time to the provider. Secondary analyses distinguished between the effect of our QI intervention and secular trends. Results: The mean length of stay for SSLEP children decreased from a mean of 178 to 142 minutes, a 36-minute (20%) decrease. Mean time to provider for SSLEP decreased from 92.8 to 55.5 minutes, a 37-minute improvement (40%). The 72-hour-revisit rates did not increase for SSLEP children throughout the project. Conclusions: We identified feasible interventions to improve wait times for children with SSLEP. Future directions include addressing components of the entire ED visit to decrease the length of stay discrepancies between populations. We hope to extend our findings to benefit all LEP communities.
{"title":"Improving Wait Times for Children with Caregivers with Limited English Proficiency in the Emergency Department","authors":"Gisella Valderrama, G. Badolato, P. Diaz, D. Berkowitz","doi":"10.1097/pq9.0000000000000656","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000656","url":null,"abstract":"Introduction: In our pediatric emergency department (ED), children triaged as low acuity who presented with Spanish-speaking caregivers with limited English proficiency (SSLEP) experienced disparately longer wait times than similarly triaged children with English-proficient caretakers. Although inequities in ED care based on language preference exist, little is known about effective interventions to eliminate the disparity. This quality improvement study aimed to eliminate the disparity in wait times and share effective interventions. Methods: A multidisciplinary team incorporating clinicians, professional interpreters, and data analysts utilized quality improvement methodology to introduce early identification of SSLEP children, standardize physician workflow, and optimize the interpreter process. The primary outcome was the length of stay. The secondary outcome was time to the provider. The balancing measures were revisits and non-LEP length of stay and time to the provider. Secondary analyses distinguished between the effect of our QI intervention and secular trends. Results: The mean length of stay for SSLEP children decreased from a mean of 178 to 142 minutes, a 36-minute (20%) decrease. Mean time to provider for SSLEP decreased from 92.8 to 55.5 minutes, a 37-minute improvement (40%). The 72-hour-revisit rates did not increase for SSLEP children throughout the project. Conclusions: We identified feasible interventions to improve wait times for children with SSLEP. Future directions include addressing components of the entire ED visit to decrease the length of stay discrepancies between populations. We hope to extend our findings to benefit all LEP communities.","PeriodicalId":343243,"journal":{"name":"Pediatric Quality and Safety","volume":"234 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114541279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/pq9.0000000000000659
A. Pantoja, Scott Sveum, Sandra Frost, Amanda Duran, Jeanne Burks, Christi Schernecke, M. Feinberg
Introduction: Early-onset sepsis (EOS) and late-onset Sepsis (LOS) are common diagnoses entertained in sick newborns treated in neonatal intensive care units (NICUs), and antibiotics are the medications most prescribed in NICUs. Antibiotic stewardship programs have an important impact on limiting unnecessary antibiotic use. Methods: Following the Model for Improvement, between 2/1/16 and 1/31/17, at a level 3 NICU, a multidisciplinary team implemented PDSA cycles to promote antibiotic stewardship practices for newborns at risk of EOS and LOS. The main goal was to decrease the antibiotic usage rate (AUR) safely. Primary strategies included discontinuing antibiotics within 24 hours of life if the newborn was stable, and the blood culture was negative for EOS and implementing an “antibiotic time-out” during rounds. Results: For all newborns admitted to our NICU, the AUR decreased, for EOS from 137 to 32 days per 1000 patient days (77% reduction) and for LOS from 277 to 121 days per 1000 patient days (56% reduction). We demonstrated the sustainability of both EOS-AUR and LOS-AUR during the 2 years postcompletion of the intervention period. There were no adverse effects of reducing the AUR. Conclusion: Interventions that reduce unnecessary antibiotic use in the NICU are safe and prevent excessive antibiotic exposure.
{"title":"New strategies to Reduce Unnecessary Antibiotic Use in the NICU: A Quality Improvement Initiative","authors":"A. Pantoja, Scott Sveum, Sandra Frost, Amanda Duran, Jeanne Burks, Christi Schernecke, M. Feinberg","doi":"10.1097/pq9.0000000000000659","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000659","url":null,"abstract":"Introduction: Early-onset sepsis (EOS) and late-onset Sepsis (LOS) are common diagnoses entertained in sick newborns treated in neonatal intensive care units (NICUs), and antibiotics are the medications most prescribed in NICUs. Antibiotic stewardship programs have an important impact on limiting unnecessary antibiotic use. Methods: Following the Model for Improvement, between 2/1/16 and 1/31/17, at a level 3 NICU, a multidisciplinary team implemented PDSA cycles to promote antibiotic stewardship practices for newborns at risk of EOS and LOS. The main goal was to decrease the antibiotic usage rate (AUR) safely. Primary strategies included discontinuing antibiotics within 24 hours of life if the newborn was stable, and the blood culture was negative for EOS and implementing an “antibiotic time-out” during rounds. Results: For all newborns admitted to our NICU, the AUR decreased, for EOS from 137 to 32 days per 1000 patient days (77% reduction) and for LOS from 277 to 121 days per 1000 patient days (56% reduction). We demonstrated the sustainability of both EOS-AUR and LOS-AUR during the 2 years postcompletion of the intervention period. There were no adverse effects of reducing the AUR. Conclusion: Interventions that reduce unnecessary antibiotic use in the NICU are safe and prevent excessive antibiotic exposure.","PeriodicalId":343243,"journal":{"name":"Pediatric Quality and Safety","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123682542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/pq9.0000000000000652
S. Anvari, V. Szafron, Tanya J. Hilliard, L. Forbes-Satter, Mona D. Shah
INTRODUCTION Anaphylaxis is a severe, rapid-onset hypersensitivity reaction with multisystem organ involvement.1 The reported lifetime prevalence of anaphylaxis is estimated to range from 1.6% to 5.1%.2,3 Despite established medical guidelines,1,2,4 misconceptions regarding the recognition and treatment of anaphylaxis continue to persist among healthcare providers, patients, and their caregivers, leading to delays in care and inadequate treatment.5 The most common cause of anaphylaxis in children and adults includes food, medication, and venom hypersensitivity.6 Approximately 20% of anaphylaxis-related fatalities are due to medications.5 Delayed or inappropriate treatment of anaphylaxis can be fatal. Intramuscular (IM) epinephrine is the first-line treatment for the management of anaphylaxis.4 IM epinephrine [administered at 0.01 mg/kg of a 1:1,000 concentration (maximum dose: 0.5 mg in adults and 0.3 mg in children)] be administered in the mid-anterolateral thigh is recommended for any episode of anaphylaxis.4 Antihistamines have a slow onset of action and are never used as the first-line treatment of anaphylaxis.2,7 There is limited evidence regarding the clinical benefit of glucocorticoids, which should also be avoided in the first-line treatment of anaphylaxis.2,8 Shaker et al2 describe the diagnosis of anaphylaxis based on clinical criteria (Table 1). Prompt assessment and early recognition of the signs and symptoms of anaphylaxis will ensure accurate diagnosis and timely administration of epinephrine, which can be life-saving by preventing progression to a fatal reaction. Anaphylaxis has been reported with the use of biologics and chemotherapeutic agents.9,10 Because third-party payers may deny an inpatient admission for these therapies, clinicians often administer them in the outpatient setting. Two unique cases of anaphylaxis led to the creation of the Anaphylaxis Work Group (AWG) at our center. Both cases took place in our outpatient infusion center. Case 1 involved a pediatric patient who experienced difficulty breathing and urticaria during a chemotherapy infusion with an agent known to cause anaphylaxis). The staff initially administered diphenhydramine, but symptoms persisted. At the time, the monitoring staff were unclear about whether to administer intravenous (IV) or IM epinephrine to treat anaphylaxis. In addition, when retrieving the epinephrine from the Omnicell (Omnicell, Santa Clara, Calif.), the appropriate needle gauge required for medication administration was unavailable. This issue led to further delays in emergent care. Ultimately, the staff administered IM Epinephrine, and the patient recovered without further complications. Case 2 involved a pediatric patient who experienced symptoms of cough and rash during a chemotherapy infusion. The staff identified this as a case of anaphylaxis, but they administered an inadequate dose of IV epinephrine. Persistent symptoms led to transfer to the intensive care unit, where the pa
{"title":"Standardizing Anaphylaxis Treatment in Pediatric Care Settings","authors":"S. Anvari, V. Szafron, Tanya J. Hilliard, L. Forbes-Satter, Mona D. Shah","doi":"10.1097/pq9.0000000000000652","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000652","url":null,"abstract":"INTRODUCTION Anaphylaxis is a severe, rapid-onset hypersensitivity reaction with multisystem organ involvement.1 The reported lifetime prevalence of anaphylaxis is estimated to range from 1.6% to 5.1%.2,3 Despite established medical guidelines,1,2,4 misconceptions regarding the recognition and treatment of anaphylaxis continue to persist among healthcare providers, patients, and their caregivers, leading to delays in care and inadequate treatment.5 The most common cause of anaphylaxis in children and adults includes food, medication, and venom hypersensitivity.6 Approximately 20% of anaphylaxis-related fatalities are due to medications.5 Delayed or inappropriate treatment of anaphylaxis can be fatal. Intramuscular (IM) epinephrine is the first-line treatment for the management of anaphylaxis.4 IM epinephrine [administered at 0.01 mg/kg of a 1:1,000 concentration (maximum dose: 0.5 mg in adults and 0.3 mg in children)] be administered in the mid-anterolateral thigh is recommended for any episode of anaphylaxis.4 Antihistamines have a slow onset of action and are never used as the first-line treatment of anaphylaxis.2,7 There is limited evidence regarding the clinical benefit of glucocorticoids, which should also be avoided in the first-line treatment of anaphylaxis.2,8 Shaker et al2 describe the diagnosis of anaphylaxis based on clinical criteria (Table 1). Prompt assessment and early recognition of the signs and symptoms of anaphylaxis will ensure accurate diagnosis and timely administration of epinephrine, which can be life-saving by preventing progression to a fatal reaction. Anaphylaxis has been reported with the use of biologics and chemotherapeutic agents.9,10 Because third-party payers may deny an inpatient admission for these therapies, clinicians often administer them in the outpatient setting. Two unique cases of anaphylaxis led to the creation of the Anaphylaxis Work Group (AWG) at our center. Both cases took place in our outpatient infusion center. Case 1 involved a pediatric patient who experienced difficulty breathing and urticaria during a chemotherapy infusion with an agent known to cause anaphylaxis). The staff initially administered diphenhydramine, but symptoms persisted. At the time, the monitoring staff were unclear about whether to administer intravenous (IV) or IM epinephrine to treat anaphylaxis. In addition, when retrieving the epinephrine from the Omnicell (Omnicell, Santa Clara, Calif.), the appropriate needle gauge required for medication administration was unavailable. This issue led to further delays in emergent care. Ultimately, the staff administered IM Epinephrine, and the patient recovered without further complications. Case 2 involved a pediatric patient who experienced symptoms of cough and rash during a chemotherapy infusion. The staff identified this as a case of anaphylaxis, but they administered an inadequate dose of IV epinephrine. Persistent symptoms led to transfer to the intensive care unit, where the pa","PeriodicalId":343243,"journal":{"name":"Pediatric Quality and Safety","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126415852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/pq9.0000000000000649
E. Kirkendall, Patrick W. Brady, Sarah D. Corathers, R. Ruddy, Catherine Fox, Hailee Nelson, Tosha B. Wetterneck, Isabelle M Rodgers, K. Walsh
Introduction: The limited data indicate that pediatric medical errors in the outpatient setting, including at home, are common. This study is the first step of our Ambulatory Pediatric Patient Safety Learning Lab to address medication errors and treatment delays among children with T1D in the outpatient setting. We aimed to identify failures and potential solutions associated with medication errors and treatment delays among outpatient children with T1D. Methods: A transdisciplinary team of parents, safety researchers, and clinicians used Systems Engineering Initiative for Patient Safety (SEIPS) based process mapping of data we collected through in-home medication review, observation of administration, chart reviews, parent surveys, and failure modes and effects analysis (FMEA). Results: Eight (57%) of the 14 children who had home visits experienced 18 errors (31 per 100 medications). Four errors in two children resulted in harm, and 13 had the potential for harm. Two injuries occurred when parents failed to treat severe hypoglycemia and lethargy, and two were due to repeated failures to administer insulin at home properly. In SEIPS-based process maps, high-risk errors occurred during communication between the clinic and home or in management at home. Two FMEAs identified interventions to better communicate with families and support home care, especially during evolving illness. Conclusion: Using SEIPS-based process maps informed by multimodal methods to identify medication errors and treatment delays, we found errors were common. Better support for managing acute illness at home and improved communication between the clinic and home are potentially high-yield interventions.
{"title":"Safer Type 1 Diabetes Care at Home: SEIPS-based Process Mapping with Parents and Clinicians","authors":"E. Kirkendall, Patrick W. Brady, Sarah D. Corathers, R. Ruddy, Catherine Fox, Hailee Nelson, Tosha B. Wetterneck, Isabelle M Rodgers, K. Walsh","doi":"10.1097/pq9.0000000000000649","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000649","url":null,"abstract":"Introduction: The limited data indicate that pediatric medical errors in the outpatient setting, including at home, are common. This study is the first step of our Ambulatory Pediatric Patient Safety Learning Lab to address medication errors and treatment delays among children with T1D in the outpatient setting. We aimed to identify failures and potential solutions associated with medication errors and treatment delays among outpatient children with T1D. Methods: A transdisciplinary team of parents, safety researchers, and clinicians used Systems Engineering Initiative for Patient Safety (SEIPS) based process mapping of data we collected through in-home medication review, observation of administration, chart reviews, parent surveys, and failure modes and effects analysis (FMEA). Results: Eight (57%) of the 14 children who had home visits experienced 18 errors (31 per 100 medications). Four errors in two children resulted in harm, and 13 had the potential for harm. Two injuries occurred when parents failed to treat severe hypoglycemia and lethargy, and two were due to repeated failures to administer insulin at home properly. In SEIPS-based process maps, high-risk errors occurred during communication between the clinic and home or in management at home. Two FMEAs identified interventions to better communicate with families and support home care, especially during evolving illness. Conclusion: Using SEIPS-based process maps informed by multimodal methods to identify medication errors and treatment delays, we found errors were common. Better support for managing acute illness at home and improved communication between the clinic and home are potentially high-yield interventions.","PeriodicalId":343243,"journal":{"name":"Pediatric Quality and Safety","volume":"133 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134161853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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