Pediatric Nursing Commons^™

Managing Pediatric Atopic Dermatitis In The Allergy Clinic: Use Of An Eczema Action Plan To Improve Caregiver Understanding And Self-Efficacy, A Pilot Study, Danielle Hubacek

Doctor of Nursing Practice Final Manuscripts

Eczema, or atopic dermatitis, is a complex and chronic condition that affects approximately 10% of children throughout the United States (Brown et al., 2018). The American Academy of Allergy Asthma & Immunology (AAAAI) (2017) estimates the average cost of eczema management for each patient is approximately $3,302 per year. The complex nature of atopic dermatitis indicates a need for individualized treatment plans. Research has shown that standardized patient teaching, written education materials, and Eczema Action Plans (EAP) reinforce patient teaching, parental understanding, and improve quality of life. This evidence-based practice (EBP) project introduces the use of a written Eczema Action …

Treatment Anxiety Education For Pediatric Cardiac Neurodevelopmental Patients, An Evidence Based Project, Mary Nagel

Doctor of Nursing Practice Final Manuscripts

Abstract

Background

Congenital heart disease (CHD) is the most common birth defect and affects almost 1% of all live births. Treatment anxiety is common among children with CHD who undergo multiple procedures early in their lifetime. Dramatically increased life spans for this cardiac population has led to a shift from focusing on survival to their long-term health outcomes.

Methods:

Administration of the Peds QL Cardiac Module 3.0 assesses health related quality of life (HRQOL) during annual visits to a Cardiac Neurodevelopmental (ND) Clinic by evaluating the level of Treatment Anxiety a patient experiences during healthcare appointments. The questionnaire scores are …

Overcoming Obesity: Provider Reminders And Education In Pediatrics, Michelle Warren

Evidence-Based Practice Project Reports

The prevalence of pediatric overweight and obesity is rising globally (Di Cesare et al., 2019) and results in lifelong chronic health problems and an estimated annual healthcare cost of $14.1 billion (Trasande & Chatterjee, 2009). The purpose of this evidence-based practice project was to address overweight and obesity in patients between the ages of five and 12 years through the provision of provider reminders, education, and guidelines. Primary outcomes included frequency of diagnosis, frequency of patient referrals, return to see times, and frequency of patient nutrition and activity education while secondary outcomes included patient weight, body mass index (BMI), and …

Evidence-Based Practice: Delaying Infant Bathing, Gabrielle Wadle, Grace Frankland

Scholars Week

A hospital's policy regarding infant bathing is currently not congruent with best nursing practice. The hospital’s current policy is to bathe an infant once they are stable and their rectal temperature is at or above 98.6 °F. Although the infant may become stable within the first 24-hours of birth, the World Health Organization recommends that, “Bathing should be delayed until 24 hours after birth.” (2013, p. 4). Research has been completed to support delaying infant bathing until 24 hours post-delivery, suggesting potential modifications to current policy.

Pediatric Wound Care: Establishing A Consensus Group To Develop Clinical Practice Guidelines, Ryan Krasnosky, Geran Barton, Linda Highfield, Sheila Martinez, Stephen Linder, Edward Buchanan, Angelo P. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. Wound care practices for neonatal and pediatric patients have created a lack of standardized evidence-based guidelines for treatments in clinical practices. Unfortunately, published clinical guidelines for the evaluation and management of wounds in pediatric populations is limited. Consensus groups are used to develop clinical guidelines which define key aspects of the quality of health care, particularly appropriate indications for interventions. The aim of this initiative was to conduct the first two steps of the guideline development process, and to report on the findings from the expert consensus group for pediatric wound care.

Methods. The goal was to recruit a …

A Practice Innovation To Improve Staff Vaccination Knowledge And Skills, Ijeoma Ugochukwu

Nursing Posters

Abstract:

The practice improvement project explored the best practices for equipping CentraCare Health System's (CCHS) Licensed Practical Nurses (LPNs) and Certified Medical Assistants' (CMAs) with childhood vaccination knowledge and communication skills necessary to educate hesitant patients and parents about the benefits of vaccination compliance. Innovative computer-based education (CBE) was identified and developed to empower LPNs and CMAs working in the ambulatory setting with childhood vaccination knowledge and communication skills to improve their ability to educate hesitant patients and parents about the benefits of vaccination. The CBE module was guided by the Theory of Planned Behavior in identifying vaccination knowledge and …

Optimizing A Pediatric Dka Protocol In A Tertiary Care Hospital System In Northern West Virginia, Jennifer L. Burky

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when the body compensates for insufficient insulin, producing dangerously high levels of ketones. Without proper treatment, DKA can be fatal. For that reason, staff in the pediatric intensive care unit (PICU) at a tertiary care hospital in northern West Virginia expressed concerns about the complexity of and lack of adherence to a poorly referenced and dated DKA treatment protocol.

Objective: The purpose of this project was to assess the feasibility and sustainability of optimizing the DKA protocol in the PICU. The primary objective was to implement an updated, …

Perceptions Of Paediatric Surgeons On The Selection & Admission Processes In Master Of Paediatric Surgery : A Qualitative Study, Anand Sanmugam

Student Works (2020-2029)

The selection and intake criteria for the paediatric training surgery training program (Master of Paediatric Surgery) has undergone changes. Changes were instituted to ensure a more robust selection system to ensure that the best candidates were selected into the program. However, there has not been any data to show that these changes have resulted in selection of candidates that could graduate on time and possess the attributes that predicted the development of competencies required. The aim of this study aim was to explore the perspectives of senior paediatric surgeons on the Master of Paediatric Surgery selection and intake process. The …

Screening And Referring For Postpartum Depression In Pediatric Primary Care, Melissa Harkins

Dissertations

Problem

Postpartum depression (PPD) can lead to increased risk of child abuse, delays in infant development, and increased medical costs (Earls et al., 2019). The American Academy of Pediatrics (AAP) recommends all mothers of infants 0-6 months be screened for PPD during well-child visits. Despite these recommendations, many pediatric offices have no PPD screening process.

Methods

This quality improvement project utilized a standardized tool to screen mothers of infants 0-6 months for PPD during their infants’ well-child visits. Mothers who screened positive for PPD were offered referrals to treatment resources and given the opportunity to participate in two follow-up telephone …

Accuracy Of Rn Visual Quantification Of Emesis Volumes In The Neonatal Intensive Care Unit, Stephen Stoever

Seton Hall University DNP Final Projects

An important component of nursing assessment of feeding tolerance in the neonatal intensive care unit (NICU) for both low-risk and high-risk babies, is the quantification of emesis volumes. While some nurses attempt to weigh the items saturated in emesis in order to quantify volume loss (QEV), there is no or limited consistency in this practice across nurses in this unit. Rather, volumes are “best-guessed” or estimated (EEV) and reported to the practitioner for decision-making. Often feed advances are paused or limited due to perceived feeding intolerance connected to emesis events in neonates.

For this project, 158 NICU nurses at a …

Unplugging: An Evidence-Based Project To Reduce Screen Time And Improve Healthy Media Use In The Adolescent Population, Erica Persichetti

Doctor of Nursing Practice Final Manuscripts

Abstract

Background:Excessive media use is an emerging health concern amongst the pediatric population. The American Academy of Pediatrics (AAP) recommends less than 2 hours per day of recreational screen time, yet the national average is between 7 to 9 hours per day for adolescents. A media-saturated lifestyle has consequences on a child’s mental, physical, and emotional health. Despite guidelines stating media use should be assessed at annual well-visits, only 16% of providers are following this recommendation. This gap in care leaves many families with a limited understanding of the impact of media on their child's health and represents a …

You're Not Forgotten: Effects Of Screening For Postpartum Depression Within A Pediatric Setting, Marrisa S. Culver

Evidence-Based Practice Project Reports

Postpartum depression (PPD) is depression that occurs in women following childbirth occurring during the postpartum period and affects 1 in 7 women (The United States Preventive Services Task Force, 2019). The American Academy of Pediatrics [AAP] (2019), recommends that pediatric healthcare providers utilize their position to screen for PPD. The purpose of this evidence-based practice (EBP) project was to implement a PPD screening intervention within a pediatric healthcare setting using the Edinburgh Postnatal Depression Scale (EPDS). The Academic Center for Evidence-Based (ACE) Practice Star Model guided this EBP project with evidence-based interventions developed after a comprehensive literature search. Implementation of …

What's All The Buzzy About? Using Cryotherapy And Vibration For Pain During Vaccinations In Children, Marta L. Byma

Evidence-Based Practice Project Reports

Vaccinations are the most common painful needle procedure, with an estimated 12 billion injections given per year (CDC, 2019). The usual method for administration of vaccinations is through needle puncture, which is often painful. Children often report receiving a shot as one of the most feared and painful experiences (McMurtry et al., 2015). The purpose of this evidence-based practice (EBP) project was to improve patient experiences by decreasing the pain that is associated with vaccinations through the use of a nonpharmacological method for comfort via the Buzzy® device. After thorough analysis and synthesis of the literature, the Buzzy® device that …

Effectiveness Of A Multi-Component Intervention Program For Treating Childhood Obesity, Suzy Free

Evidence-Based Practice Project Reports

Childhood obesity is one of the most chronic childhood illness worldwide (Centers for Disease Control and Prevention [CDC], 2019; World Health Organization [WHO], 2019). The prevalence of childhood obesity has been described as one of the most common chronic childhood conditions (CDC). The purpose of this evidence-based practice (EBP) project was to reduce the BMI scores of obese children using a multi-component intervention program that incorporates healthy eating, physical activity, and family involvement. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model was used to facilitate the implementation of this EBP project. The synthesis of the appraised literature established that utilizing …

Evaluation Of An Advanced Quality Improvement Program, Arjun M. Dangre Bds Mph, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Texas Children’s Hospital implemented the Advanced Quality Improvement and Patient Safety Program (AQI) in 2009, designed to train clinicians and staff to develop leaders in quality improvement to improve patient care, lower costs, change culture, and lead improvement initiatives at the organization. Evaluations of the AQI programs measured the program’s effectiveness in achieving its goals and objectives. This paper describes the Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety program (AQI,) the program’s evaluation processes, and show the results of the evaluation of the AQI programs using evaluation surveys completed by QI participants over the span of 13 successful …

Chloraprep Dry Time, Nikki Jones, Chelsea Dennison, Becca Millard, Kristin Sapp

Nurse Presentations

Describes a project to increase the dry time compliance for solutions used in general surgery in the operating room.

Impact Of Nicu Design On Feeding-Related Outcomes In Preterm Infants, Emma Kate Calvert

Theses and Dissertations--Communication Sciences and Disorders

Many NICUs around the country are moving away from traditional open-bay designs in favor of single-family rooms (SFRs) as more is understood about the impact of the sensory environment on neurodevelopment in preterm infants. SFRs house one infant and their family for the length of the infant’s stay and are associated with improvements in numerous outcomes, including increased milk intake and weight gain and earlier transition to enteral feeding. Oral feeding remains a critical requirement for NICU discharge; however, the impact of NICU design on feeding outcomes remains unknown.

The purpose of this study was to compare feeding outcomes between …

The Effect Of A Virtual Child Passenger Safety Educational Intervention On Uk Pediatric Residents' Self-Reported Knowledge, Confidence, And Anticipatory Guidance Beliefs, Brooklyn Johnson

DNP Projects

Background: Motor vehicle crashes are the leading cause of death in children. Car safety seats (CSS), when used properly, have been proven to reduce injuries and deaths in children during motor vehicle accidents. The leading cause of car seat misuse is parental lack of knowledge about proper car seat use and best practice recommendations. Studies have shown that pediatric primary care providers have variable knowledge of the most updated car safety seat recommendations and are not consistently educating parents about child passenger safety during well child checks.

Objective: To evaluate UK pediatric residents' self-reported knowledge, confidence, and anticipatory guidance beliefs …

Picture Perfect: Pediatric Ct Utilization In Trauma, Laura Strickland, Christa Zino Md

Pediatrics

No abstract provided.

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.

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.

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 …

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

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.

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.

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 …