Medicine and Health Sciences Commons^™

Optimizing Antibiotic Management Of Pediatric Acute Otitis Media In An Emergency Department, Alicia Daggett, Alaina N. Burns, Brian R. Lee, Nirav Shastri, Patricia Phillips, Rana E. El Feghaly

Posters

Problem

Children diagnosed with acute otitis media (AOM) at the Children's Mercy Hospital Kansas Emergency Department routinely get antibiotic prescriptions. There is rarely discussion with families about watchful waiting (defined as discussion of observation with parents and providing a safety-net antibiotic prescription that parents can ill if the patient is not improving or is worsening over the next 48 hours).

The aim of this quality improvement project is to increase watchful waiting for AOM at the CMK ED by 20% by March 2020, with an overall goal of decreasing antibiotic use for AOM.

Collaboration Between Rheumatology Clinic And Specialty Pharmacy To Positively Impact Patient Experience And Hospital Stewardship, Alaina Linafelter, Julia G. Harris, Robert Herr, Stephanie Quinn, Ashley M. Cooper

Posters

Biologic medications are commonly utilized to treat pediatric rheumatic diseases. Being high-cost, most third-party payers require dispensing through a specialty pharmacy. Children's Mercy Hospital Specialty Pharmacy (CMH SP) started acceting patients in March 2015.

The number of patients benefited by the superior service of CMH SP has risen steadily, leading to high patient satisfaction and financial benefits for the hospital.

Safe Sleep In The Nicu, Ashley Mirabile, Barb Haney, Dianne Wilderson, Beckie Palmer, Ashley Domsch, Eugenia K. Pallotto

Posters

Goal: To evaluate a staff education program on approach to improve in the rate of eligible NICU infants in safe sleep in a busy 84-bed level IV NICU.

Outcome Measures; Improve safe sleep compliance for eligible patients to 90% or greater by December 2019.

Process Measures: Audits from bedside RNs showing compliance with safe sleep.

Planned Intervention: In December of 2018 a multidisciplinary work group brainstormed and implemented best practice safe sleep education for staff and parents. September 2019 a Safe Sleep Educational Toolkit was made available for staff.

Results: Safe Sleep compliance has gone from 53% to 90% in …

Assessment And Improvement Of Data Collection Errors Through Inter-Departmental Collaboration, Charlott Williams, Kelli L. Behr, Mary Moffatt, Rangaraj Selvarangan

Posters

Specific Aims:

1. To maintain the ED team's high rate of accuracy in data collection
2. To begin team participation in corrective action planning
3. To improve interdepartmental problem solving

Conclusion

Open communication about errors among all collaborating departments, combing with a shared approach to solving them:

• improved morale and perception of error tracking by the team
• led to a decrease in errors overall, and
• increased interdepartmental collaboration

When all members of the interdepartmental team work together with a positive approach to corrective action, improvement in error rates is a natural outcome of the solutions derived.

Improving Malnutrition Identification In The Outpatient Setting, Kristi Thaete, Karen Stephens

Posters

Identification of Pediatric Malnutrition in Outpatient Clinics is the First Step to Allowing Registered Dietitian (RD) Involvement in the Improvement of Patient Care.

Lighting The Way To Ensure Safe Transition Home, Barb Haney, Ashley Mirabile, Dianne Wilderson, Beckie Palmer, Ashley Lewis, Cris Mills, Eugenia K. Pallotto

Posters

All aspects of discharge (education, screenings, appointments, plans and home services" must be completed and appropriately communicated prior to discharge to ensure safe transition to home.

Goal: Standardize all aspects of discharge in a large, busy 84-bed Level IV NICU with >1000 admissions/year and >300 nurses, >60 NNPs, and >25 neonatologists.

• 95% of patients with lengths of stay >3 days have all discharge planning completed prior to discharge/Parent Care Unit overnight stay

Child And Parent Perceptions Of Participating In Multimethod Research In The Acute Aftermath Of Pediatric Injury, Christine Kindler, Nancy Kassam-Adams, Tia Borger, Meghan L. Marsac

Pediatrics Faculty Publications

Background:

Despite growing evidence that participation in psychological trauma research is well tolerated by children and parents, ethics boards may voice concerns regarding research with families with recent acute trauma exposure. Factors impacting child and parent experiences of research participation are not well documented, particularly for methodologies including observational components.

Objectives:

This study describes child and parent perceptions of research participation involving an observational task following an acute traumatic event and explores potential relationships between research experience and selected demographic factors (race/ethnicity, sex, age, prior trauma exposure), and post-traumatic stress symptoms.

Methods:

As part of a larger study on the …

Reflux, Apnea And The Impact On Discharge, Michele Savin, Dnp, Nnp-Bc, Kaitlin Kenaley, Md, Maureen Moffet, Msn, Rula Nassar, Md

College of Nursing Posters

Decisions made about timing of discharge can be subjective. Definitions of significant bradycardia are multiple, and interventions are variable.

This necessitates an informed discussion with parents about the natural course of apnea, bradycardia and reflux.

The physiology of gastroesophageal reflux and respiratory control have intermingled confounding variables.

Critical thinking is required to educate and support families, however a paucity of research exists. Risks and benefits of pharmacologic and nonpharmacologic interventions should be evaluated.

Nurses need increased confidence in understanding how to approach the preterm infant with apnea and/or reflux as well as how to interact with families to support discharge …

Comparison Of Echocardiographic Measurements To Invasive Measurements Of Diastolic Function In Infants With Single Ventricle Physiology: A Report From The Pediatric Heart Network Infant Single Ventricle Trial., Suma P. Goudar, Victor Zak, Andrew M. Atz, Karen Altmann, Steven D. Colan, Christine B. Falkensammer, Mark K. Friedberg, Michele Frommelt, Kevin D. Hill, Daphne T. Hsu, Jami C. Levine, Renee Margossian, Christopher R. Mart, Joshua Sticka, Peter Shrader, Girish S. Shirali, Pediatric Heart Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: While echocardiographic parameters are used to quantify ventricular function in infants with single ventricle physiology, there are few data comparing these to invasive measurements. This study correlates echocardiographic measures of diastolic function with ventricular end-diastolic pressure in infants with single ventricle physiology prior to superior cavopulmonary anastomosis.

METHODS: Data from 173 patients enrolled in the Pediatric Heart Network Infant Single Ventricle enalapril trial were analysed. Those with mixed ventricular types (n = 17) and one outlier (end-diastolic pressure = 32 mmHg) were excluded from the analysis, leaving a total sample size of 155 patients. Echocardiographic measurements were correlated to …

Acetaminophen Protein Adducts In Hospitalized Children Receiving Multiple Doses Of Acetaminophen., Sibo Jiang, Valvanera Vozmediano, Susan M. Abdel-Rahman, Stephan Schmidt, Laura P. James

Manuscripts, Articles, Book Chapters and Other Papers

Previous reports have questioned the safety of multiple doses of acetaminophen administered to ill children. Acetaminophen protein adducts (adducts) are a biomarker of acetaminophen-induced liver injury and reflect the oxidative metabolism of acetaminophen, a known mechanism in acetaminophen toxicity. In this prospective observational study, we analyzed adduct concentrations in 1034 blood samples obtained from 181 hospitalized children (1 to 18 years inclusive) who received 2 or more doses of acetaminophen. Linear regression analysis showed that serum adduct concentrations increased as a function of the cumulative acetaminophen dose, which could be attributed, in part, to a long half-life of adducts (2.17 …

Clabsi Prevention Through Prevention Huddles And Clabsi Risk Assessment And Prevention Form In Electronic Medical Record, Tara Benton, Barb Haney, Lacey Bergerhofer, Yolanda Ballam, Kaitlyn Hoch

Posters

Our aim is to increase the awareness of high risks for central line associated bloodstream infection (CLABSI) and decrease the CLABSI rate with the implementation of CLABSI prevention huddles and an electronic medical record (EMR) "CLABSI Risk Assessment and Prevention" form.

A Multifaceted Approach To Improve Quarterly Visit Rates At A Pediatric Cystic Fibrosis Care Center, Paula Capel, Jessica Banks, Micaela Mckenna, Ashley Andrews, Christopher M. Oermann

Posters

Standard quality improvement methodology was used to improve quarterly visit rates among cystic fibrosis patients at Children's Mercy Kansas City Cystic Fibrosis Center.

• A family-centered, team-based approach was adopted
• A change in culture led to sustained improvement

Improved quarterly visit rates should drive improvement in outcomes including pulmonary function and nutritional status.

Improving End Stage Renal Disease Quality Incentive Payment Total Performance Scores, Shelly Guyer, Gina Gregg, Bradley Warady

Posters

The End Stage Rena Disease (ESRD) Quality Incentive Program (QIP) promotes high quality, transparent, cost-efficient care in outpatient dialysis facilities by establishing performance standards that are linked to payment.

The development of a subject matter expert and the sharing of ESRD QIP knowledge resulted in buy-in from dialysis staff and physicians leading to a higher total performance score and the avoidance of payment reduction.

Improving Women, Infants, And Children Participation Using Quality Improvement Methodology, Samuel Little, Sarah Stone, Jeffrey D. Colvin, Sidney Smith, Brenda Hilboldt, Laura Williams, Patricia Marein, Keith Mann, Kristi Williams

Posters

Food insecurity, when a household is unable to acquire food for one or more of its members due to insufficient resources, has recently been on the decline in the United States, according to official 2017 USDA reports.

Unfortunately, this decline has not been observed to the same extent in the demographic of households with children.

WIC is a federal assistance program that works to alleviate the poor health outcomes associated with food insecurity in this demographic by providing eligible, enrolled families with nutritional aid and education.

The specific aim of the project is to increase the percentage of maximum potential …

Using A Standardized Admission Handoff (I-Pass) To Improve Communication Between Pediatric Urgent Care And Inpatient Providers, Amanda Nedved, Kathleen Berg, Amanda Montalbano

Posters

Ineffective hand-off communication is recognized as a critical patient safety problem in health care. A pre-interventions survey of pediatric urgent care providers and pediatric hospitalists demonstrated an opportunity for improvement of communication during admission handoffs.

Standardized handoffs improve communication without impeding provider workflow. We learned that subjective terms for illness severity ("stable," "watcher," and "unstable") did not translate well from urgent care to inpatient. We are planning on implementing an objective standardized tool (PEWS) to improve the communication of illness severity. We have also updated the I-PASS visual aid based on feedback.

Improving Pneumococcal Vaccination Rates In High Risk Patients Across Multiple Specialty Divisions, Rachel Moran, Julia G. Harris, Claire Olsen, Rana El Feghaly, Liset Olarte, Douglas Blowey, Luke A. Harris

Posters

Pediatric patients with deficient immune systems or certain chronic medical conditions have an increased risk of acquiring invasive pneumococcal disease.

The 23-valent pneumococcal (PPSV23) vaccine provides protection against 23 pneumococcal serotypes and is recommended for patients aged 2 years or older who are high-risk for invasive pneumococcal disease.

Unfortunately, many high-risk patients are not properly vaccinated due to lack of provider knowledge or understanding of accountability between primary care and specialty providers.

The goal of this project was to improve PPSV23 vaccination rates by 10-20% across multiple Children's Mercy Kansas City specialty divisions.

Pediatric Surgery Opioid Prescription Follow-Up, Gadison Quick, Nathaniel Aviles, Gabriel Melgarejo, Hunjung Choi, Elizabeth Edmundson

Posters

This quality improvement project is assisting general and orthopedic surgeons in gaining greater clarity when prescribing opioids for specific surgical procedures. Additional surgical services are being added to the project fall of 2019. Opioid prescribing patterns are, and will continue to be, key to all prescribing providers within our organization.

Decreasing Length Of Stay In Pediatric Urgent Care With Electronic Discharge Instructions, Jennifer Wooster, Aimy Patel, Brian R. Lee, Amanda Nedved

Posters

Time spent waiting in the urgent care clinic is dissatisfying for patient and staff. This "wasted time" accounted for more than 52% of the urgent care visit at our urgent care.

The aim of our project is to decrease length of stay by 10 minutes by April 30, 2019 for all patients discharged from Blue Valley Urgent Care by offering patients a paperless depart process. To be eligible for discharge without paper families must be enrolled in the online patient portal.

Electronic discharge instructions significantly decrease length of stay and is associated with improved patient experience scores. Patients who received …

The Kanga-Croo: Nurse Resident Champions Creating Momentum For Improvement, Brett Butler, Jacob Burden, Carly Creekmore, Blair Griffin, Taylor Godemann, Taylor Hagen, Theresa Koelling, Mary Anne Kucera, Halle Magid, Makenna Miller, Monica Page, Mary Riffel, Madison Stebbins, Sarah Stokes, Skylar Suppes

Posters

Topic Summary:

Kangaroo Care (skin to skin care) is a parent-led, evidence-based intervention which improves outcomes in neonatal patients including: decreased apnea, increased weight gain, increased parent satisfaction and decreased length of stay.

Results:

Nurse resident team interventions to support parent engagement and remove barriers to Kangaroo Care (KC) through iterative PDSA cycles from January 2018 to July 2019 yielded positive results within a subset of ICN patients.

Bridging The Gap On Schistosomiasis: A Cross-Sectional Study Examining The Knowledge Gap And Common Attitudes And Practices Regarding S. Mansoni Infections Among Varying Education Levels In Luanda K’Otieno, Western Kenya, Kathy Zhang

Independent Study Project (ISP) Collection

Background: Schistosomiasis is considered one of the most prevalent neglected tropical diseases in the world. According to the World Health Organization (WHO), the most effective strategy for schistosomiasis control is through preventive chemotherapy with praziquantel (PZQ). In order to successfully control morbidity rates, the WHO recommends mass treatment targeting high risk groups, such as school-age children and adults considered to be at risk.

Methods: This cross-sectional study examined the effects of the National School-Based Deworming Programme (NSBDP) on knowledge of schistosomiasis and subsequent prevalence rates and intensity. A total of 43 residents in Luanda K’Otieno were interviewed, and 34 of …

Use Of Machine Learning Algorithms For Prediction Of Fetal Risk Using Cardiotocographic Data, Zahra Hoodbhoy, Mohammad Noman, Ayesha Shafique, Ali Nasim, Devyani Chowdhury, Babar Hasan

Department of Paediatrics and Child Health

Background: A major contributor to under-five mortality is the death of children in the 1^st month of life. Intrapartum complications are one of the major causes of perinatal mortality. Fetal cardiotocograph (CTGs) can be used as a monitoring tool to identify high-risk women during labor.
Aim: The objective of this study was to study the precision of machine learning algorithm techniques on CTG data in identifying high-risk fetuses.
Methods: CTG data of 2126 pregnant women were obtained from the University of California Irvine Machine Learning Repository. Ten different machine learning classification models were trained using CTG data. Sensitivity, precision, …

A Study Of Scars: Narratives Of Unintentional Childhood Injuries In Cato Manor, Carolyn Fox

Independent Study Project (ISP) Collection

The purpose of this study is to identify the specific types of injuries children experience growing up in Cato Manor, specifically, KwaMasxha, to understand how community members process and make meaning of their injuries over time, and to analyze the social determinants of health in Cato Manor that have been conducive to these injuries.

In order to learn about experiences of unintentional childhood injuries in Cato Manor, data was collected using a qualitative, narrative-based approach. I conducted interviews with young adult community members aged 19 to 27 years, asking about their personal experiences with childhood injuries as someone who grew …

Herbal Medicine And Pediatric Massage: Interning At A Tcm Pediatric Clinic, Yvette Way

Independent Study Project (ISP) Collection

Before entering this program my knowledge of TCM was practically nonexistent. However even from a young age, I had an interest in learning about the healing properties of plants and herbs but, I had no way of exploring this interest of mine. After entering this program, I have learned more about TCM and herbal medicine. Because of the lessons that we have taken in class, it made me want to have a deeper understanding of TCM because of this, I decided to do an internship that would involve TCM. My time at Yang Zhen Er Kang clinic has taught me …

Implementing A Novel Quality Improvement-Based Approach To Data Quality Monitoring And Enhancement In A Multipurpose Clinical Registry, Jesse Pratt, Daniel Jeffers, Eileen C. King, Michael D. Kappelman, Jennifer Collins, Peter Margolis, Howard Baron, Julie A. Bass, Mikelle D. Bassett, Genie L. Beasley, Keith J. Benkov, Jeffrey A. Bornstein, Jose M. Cabrera, Wallace Crandall, Liz D. Dancel, Monica P. Garin-Laflam, John E. Grunow, Barry Z. Hirssch, Edward Hoffenberg, Esther Israel, Traci W. Jester, Fevronia Kiparissi, Arathi Lakhole, Sameer P. Lapsia, Phillip Minar, Fernando A. Navarro, Haley Neef, Kt Park, Dinesh S. Pashankar, Ashish S. Patel, Victor M. Pineiro, Chrles M. Samson, Kelly C. Sandberg, Steven J. Steiner, Jennifer A. Strople, Boris Sudel, Jillian S. Sullivan, David L. Suskind, Vikas Uppal, Prateek D. Wali

Pediatrics Faculty Publications

Objective: To implement a quality improvement based system to measure and improve data quality in an observational clinical registry to support a Learning Healthcare System.

Data Source: ImproveCareNow Network registry, which as of September 2019 contained data from 314,250 visits of 43,305 pediatric Inflammatory Bowel Disease (IBD) patients at 109 participating care centers.

Study Design: The impact of data quality improvement support to care centers was evaluated using statistical process control methodology. Data quality measures were defined, performance feedback of those measures using statistical process control charts was implemented, and reports that identified data items not following data quality checks …

Frequency And Early Complications Of Late Preterm Infants: A Descriptive Analysis From Two Secondary-Care Hospitals Of Karachi, Waqar Khowaja, Abdul Lateef Leghari, Ali Shabbir Hussain, Shabina Ariff, Iqtidar Khan

Department of Paediatrics and Child Health

Introduction: Globally, prematurity accounts for 12.7% of all live births while late preterm accounts for around three-fourth (73%) of these premature births. In Pakistan, the prevalence of prematurity is approximately 18.89%. Late preterm infants often have weight and size similar to some term infants, but they are still metabolically and physiologically immature. Hence, these infants, as compared to term infants, are at a higher risk of developing medical complications, which results in higher morbidity and mortality during the birth hospitalization. We aim to determine the frequency of early complications in late preterm infants during their stay at Aga Khan Secondary-care …

Creating A Molecular Map Of The Pediatric Lung, Quinlen F. Marshall

Forum Lectures

The newborn lung undergoes vast biochemical and physiological changes during adaptation from the intrauterine to the extrauterine environment. Lung morphogenesis continues from birth into early childhood, mediated by dynamic gene expression and a diversity of pulmonary cell types that exhibit remarkable heterogeneity. (Whitsett, JA. et al. Physiol. Rev, 2019). Surprisingly, few studies have solely focused on human lung development during this critical period, and many current studies of lung maturation rely on adult, murine, or diseased samples, limiting their insights and applicability to longitudinal pediatric lung development. Understanding the molecular and physiological nuances of pulmonary development has important clinical relevance, …

Pediatric Poisoning: Overview, Treatment, And Prevention, Margaret Rowland, Taylor Gauthier, Kaitlin Sanders, Caitlin Swann, David Bright

Pharmacy and Wellness Review

Pediatric poisoning remains a common and preventable occurrence in the United States. Every year, prescription and over-the-counter medications account for a significant portion of documented poison exposures. Frequent causes of overdose in children include improper medication storage and caregiver or physician dosing error. As easily accessible medication experts, pharmacists have an opportunity to counsel patients in an effort to decrease these preventable poisoning cases. Because children frequently ingest products prescribed for adult use, pharmacist should relay safety considerations to all patients, regardless of age. This article provides a general review of toxicity concerns, discusses clinical implications of common medications resulting …

You May Be Prepared, But Are You Ready?, Michael Consuelos Md, Mba

Fleming Infection Prevention and Infectious Disease Symposium

Objective:

Explain how planning and preparation is required to achieve readiness for infectious diseases.

Factors Leading To Meconium Aspiration Syndrome In Term- And Post-Term Neonates, Saroop Chand, Aamna Salman, Razia Mustafa Abbassi, Abdul Rehman Siyal, Fayaz Ahmed Memon, Abdul Lateef Leghari, Ashmal Sami Kabani, Sajid Ali

Department of Pathology and Laboratory Medicine

Background:
Meconium aspiration syndrome (MAS) is considered a major cause of respiratory morbidity. It is a common issue encountered in the delivery room and newborn nursery. There is a need to identify the factors that lead to MAS to develop strategies to screen such patients at an early stage to decrease the mortality and morbidity. The objective of this study was to determine the factors leading to MAS in neonates delivered at ≥37 weeks of gestational age.
Methods:
A cross-sectional study was conducted through non-probability consecutive sampling technique at Liaquat University Hospital, Hyderabad from August 2016 to February 2017. All …

Improving Patient Flow By Increasing Early Discharges On A Mother & Baby Unit, Faye Weir, Joy Moody, Kathleen Cyr, Cathy Palleschi, Stephen Tyzik, Joseph East, Heidi Morin, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

Discharging patients early in the day has many advantages amongst which is increased bed availability. However, the experience in a large academic tertiary medical center demonstrated that most discharges occurred early to mid afternoon. A care team on a mother /baby unit established a quality improvement project to increase the number of discharges by 11AM and streamline key discharge planning activities.

A root cause analysis identified multiple barriers to attaining he established goals. To address these barriers, a multi prong approach was instituted to include a discharge education KPI for all unit staff.

Data collection post countermeasure implementation demonstrated some …