Medical Specialties Commons^™

Overview Of Kalydeco® (Ivacaftor) For Treatment Of Cystic Fibrosis, Andrew Skouby, Kayti Kintner, Kimberly Loughlin, Emily Blum, Michael Rush

Pharmacy and Wellness Review

Cystic fibrosis (CF) is a genetic disease associated with specific gene mutations that presents with pulmonary inflammation and frequent lung infections, exocrine pancreatic insufficiency, altered sweat composition and declining lung function. Ivacaftor (Kalydeco®) was approved for treatment of cystic fibrosis in patients 6 years of age and older with a G551D mutation on the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Ivacaftor is a CFTR potentiator and does not work in patients with a mutation of the F508del. Efficacy has been demonstrated in several trials with a primary outcome of improved FEV1, improvements in pulmonary exacerbations, patient-reported decrease in respiratory …

And The Emmy Goes To... Inside Pediatrics!, Children's Mercy Hospital

Our Story Continues

Once again, Inside Pediatrics was awarded an Emmy for excellence in programming at this weekend's celebration of the best in television broadcasting. This is the third win in three seasons for the documentary series featuring Children's Mercy patients, families and staff. The series is now seen in six countries and also airs on Florida PBS

https://www.childrensmercy.org/in-the-community/inside-pediatrics-landing-page/

Improving Nicu Discharge Readiness Through Standardization Of Preparatory Practices, David Carola

Department of Pediatrics Posters

Global Aim

Critical transitions of care for every newborn will meet the Institute of Medicine STEEEPS criteria: Safe, Timely, Efficient, Effective, Equitable, Patient and Family Centered1, and Socially Responsible

SMART Aim

We aim to increase our average discharge readiness score by 4 points by August 1st of 2020

Methicillin Resistant Staphylococcus Aureus Outbreak In A Neonatal Intensive Care Unit, Seema Irfan, Imran Ahmed, Farida Lalani, Naureen Anjum, Nadia Mohammad, Maria Owais, Afia Zafar

Department of Pathology and Laboratory Medicine

The global and national burden of communicable and noncommunicable diseases continues to rise, thus making access to Healthcare workers (HCWs) colonized with methicillin-resistant Staphylococcus aureus (MRSA) may pose transmission risk to vulnerable patients including neonates. This study reports an MRSA outbreak in a level-II neonatal intensive care unit (NICU) of a secondary care hospital in Pakistan. Once identified, an infection control team from the parent hospital visited the facility, risk factors were listed and infection control measures taken to control the outbreak. Screening cultures of NICU staff and environmental cultures from NICU were obtained for the presence of MRSA. Five …

Antibiotic Treatment Of Suspected And Confirmed Neonatal Sepsis Within 28 Days Of Birth: A Retrospective Analysis, Jadon S. Wagstaff, Robert J. Durrant, Michael G. Newman, Rachael Eason, Robert M. Ward, Catherine M.T. Sherwin, Elena Y. Enioutina

Pediatrics Faculty Publications

Neonatal sepsis causes significant mortality and morbidity worldwide. Diagnosis is usually confirmed via blood culture results. Blood culture sepsis confirmation can take days and suffer from contamination and false negatives. Empiric therapy with antibiotics is common. This study aims to retrospectively describe and compare treatments of blood culture-confirmed and unconfirmed, but suspected, sepsis within the University of Utah Hospital system. Electronic health records were obtained from 1,248 neonates from January 1, 2006, to December 31, 2017. Sepsis was categorized into early-onset (≤3 days of birth, EOS) and late-onset (>3 and ≤28 days of birth, LOS) and categorized as culture-confirmed …

Implementing Treat To Target Approach In The Care Of Children With Juvenile Idiopathic Arthritis, Julia G. Harris, Jamie Holland, Emily Fox, Leslie Favier, Ashley M. Cooper

Posters

Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory disease seen in pediatric rheumatology. Despite advances in biologic therapy, many children with JIA will experience morbidity. Treat to Target is a treatment paradigm that involves setting a target of disease activity, using shared decision making, and incorporating clinical decision support. Our clinic aimed to set a treatment target on 50% of eligible JIA patients by December 31, 2019.

Improving Care Of The Small Baby, Beckie Palmer, Abdebayo Oshodi, Brandy Huitt, Kaylee Hurt, Pamela Kliethermes, Trudy Koons, Patricia Lanzer, Ashley Mirabile, Allyson Owen, Christian Anthony Schneider, Betsi Anderson, Steven Olsen

Posters

Hierarchy of Aims:

• Global Aim: Create a Small Baby Unit for infants admitted to our NICU that arebirth, in which 90% of our patients are admitted to F pod on day of admission, by March 2019
• Interim Aim: Staff 80% of our micropremie patients with a Small Baby Team nurse from admission until >32 weeks by May 2019.
• Sub Aim: Increase rates of developmentally appropriate care (2 person cares, kangaroo care compliance) by 50% by August 2019.

Increasing Kangaroo Care In A New Small Baby Unit, Dianne Wilderson, Barb Haney, Ashley Mirabile, Beckie Palmer, Jenny Heltzer, Erin Keith-Chancy Bsn,Ccrn, Brooke Smith, Christian Anthony Schneider, Abdebayo Oshodi

Posters

Project Aim: Increase the percent of eligible patients receiving kangaroo care from 19% to 30% by September 2019.

Results:

113 staff completed education

OT consults completed on all SBU patients

20 kangaroo wraps purchased

Kangaroo care rate in NICU increased from 19% (prior to SBU) to 36% (Post SBU opening).

Conclusion: Due to increased multidisciplinary awareness of importance of kangaroo care in the SBU more parents are completing kangaroo care.

Burden And Risk Of Neurological And Cognitive Impairment In Pediatric Sickle Cell Anemia In Uganda (Brain Safe): Final Results Of The Cross-Sectional Analysis, Nancy Green, Deogratias Munube, Paul Bangirana, Linda Buluma, Bridget Kebirungi, Robert Opoka, Ezekiel Mupere, Philip Kasirye, Sarah Kiguli, Annet Birabwa

Paediatrics and Child Health, East Africa

Background: Children with sickle cell anemia (SCA) are highly susceptible to stroke and other manifestations of pediatric cerebral vasculopathy. Detailed evaluations in sub-Saharan Africa are limited.

Methods: We aimed to establish the frequency and types of pediatric brain injury in a cross-sectional study at a large SCA clinic in Kampala, Uganda in a randomly selected sample of 265 patients with HbSS ages 1–12 years. Brain injury was defined as one or more abnormality on standardized testing: neurocognitive impairment using an age-appropriate test battery, prior stroke by examination or transcranial Doppler (TCD) velocities associated with stroke risk in children with …

Intestinal Permeability And Inflammation Mediate The Association Between Nutrient Density Of Complementary Foods And Biochemical Measures Of Micronutrient Status In Young Children: Results From The Mal-Ed Study, Benjamin J J. Mccormick, Laura E. Murray-Kolb, Gwenyth O. Lee, Kerry J. Schulze, A Catharine Ross, Aubrey Bauck, Aldo A M. Lima, Bruna L L. Maciel, Ali Turab, Zulfiqar Ahmed Bhutta, Mal-Ed Network Investigators, Shahida Qureshi, Muneera Rasheed, Sajid Bashir Soofi, Anita K. M. Zaidi

Woman and Child Health

Background: Environmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation.
Objective: We tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status.
Methods: Using data from 1283 children in the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort we evaluated the risk of anemia, low retinol, zinc, and ferritin, and high transferrin receptor (TfR) at 15 mo. We …

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 …

"Will Using Telemedicine With Medical Command During Situational Awareness Escalation Add Value To Patient Care?", Kathy Farrell, Bradley Bishop, Lisa Carney, Matthew B. Johnson, Natalie Masters, Lisa Pruitt, Sherry Mccool, Laura Fitzmaurice

Posters

No abstract provided.

Making The Management Of Acute Otitis Media A Snap, Cassandra Newell, Donna Wyly, Tanis Stewart, Alaina N. Burns, Brian R. Lee, Rana El Feghaly

Posters

AIM:

To improve Watchful Waiting or Safety Net Antibiotic Prescription (WW/SNAP) in children >6 months old diagnosed with acute otitis media by Advanced Practice Nurses in the Emergency Department by May 2020.

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.

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 …

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 …

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

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 …

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 …