Pediatric Nursing Commons^™

Residency Resources To The Rescue!, Jill Hesler, Martha Shaw

2024

INNOVATION

Collaboration and communication between residency facilitators and residency coordinators is imperative to overall nurse residency program and individual resident success. Increased cohort sizes and the lasting impact of a global pandemic to academia continued to contribute to a noticeable trend in nurse residents’ failure to progress. Failure to progress is defined as an inability to move forward during unit level orientation. Signs of failure to progress may include inability to perform new tasks or tasks previously completed, lack of interest in new opportunities, and anxiety disproportionate to the situation. This upward trend was made evident by an increase in …

Development Of Ecls Transport Checklist, Laura Hatton, Lakshmi Raman, Donna Taylor, Margarita Ramos

2024

QUALITY

Purpose: To develop a tool that will prevent complications related to transporting patients on ECLS thereby improving positive outcomes.

Background: In 2021, a patient on ECLS was transported from the unit to acquire imaging. The usual practice was to obtain an X-ray to confirm cannula placement after a transport. However, the X-ray was not obtained when the patient got back to the unit and unbeknownst to the team, the patient’s cannula had significantly moved despite visualization of intact sutures. The change in cannula position was not discovered until the morning X-ray that was taken several hours later. When the …

Got Questions? Call Us: Utilizing Telephone Triage To Help Pediatric Patients After Discharge, Susan Webber, Ann Gosdin

2024

EBP

Background: Discharge follow-up programs help to reduce avoidable readmissions and unnecessary returns to the emergency department. Our organization lacked a clearly defined post-inpatient discharge process for patients on the hospitalist service. Information on the after-visit summary (AVS) includes follow-up appointment instructions and lists the main hospital phone number. Primary care providers often refer patients back to the hospital for questions related to the hospital stay. Post-discharge follow-up phone calls are labor-intensive, hard to sustain, and may not meet the patient’s needs. We sought a technology solution to assist and engage families post-discharge.

Purpose: This project aims to determine if …

Evaluation Of Supplemental Oxygen Use In The Acute Care Cardiology Unit And Opportunities For Standardizing Practice, Melanie Walsh, Alexandra Birely, Sarah Mahmalji, Sonali S. Patel

2024

RESEARCH

Purpose:
Oxygen delivery via nasal cannula is a standard therapy in hospitalized pediatric patients; however, it can have adverse effects in certain populations, such as infants with cardiac shunting physiology1,2. An oxygen-air blender can be used via standard nasal cannula to provide the lowest amount of fraction of inspired oxygen (FiO2) in order to reduce harm2. A recent Pediatric Acute Care Cardiology Collaborative (PAC3) Hospital Survey indicates that 88% of participating acute care cardiology units (ACCU) provide blended oxygen to patients, however, indications for use are not well-established3,4. A local ACCU nursing staff survey revealed mixed use of blended …

Timeliness Of “Red Event” Reviews: Optimizing “Cardiac-Multidisciplinary Assessment Of Performance” (C-Map) Rounds With Morbidity And Mortality Review, Andrea Torzone, Glenda Moate, Linn Groom, Mary Hart, Erin Hunter-Mcphan, Christa Conley, Kimberly Moore, Sarah Zoretic, Priya Bhaskar, Nicholas Andersen, Ryan Butts, Yousef Arar

2024

QUALITY

Background:
/="/">Review of Morbidity and Mortality (M&M) events within Heart Centers (HC) is critical for improving patient care. Timely review is important to maintain transparency and accuracy in recall and produce actionable items to reduce the likelihood for similar occurrences. Cardiac-Multidisciplinary Assessment of Performance (C-MAP) rounds and M&M Selection Committee were initiated July 2020 to review surgical patient outcomes, team performance, and events deviating from expected course. M&M selection committee consists of physicians, advanced practice nurses, and quality improvement consultants to determine patients appropriate for review at M&M conference. We aim to analyze timeliness of review following patient …

High Reliability Pediatric Heart Centers: Always Working Toward Getting Better, Andrea Torzone, Alexandra Birely

2024

QUALITY

Background
As provision of care reaches a new complexity in pediatric cardiology, programs are called upon to evaluate how they can bring their teams into the future of pediatric cardiac care. High reliability principles support high-quality care and improve outcomes, thus should be embraced to guide continuous improvement. Although much has been written about high reliability in healthcare, it has not been explored within pediatric heart centers. The purpose of this review is to examine high reliability through the lens of a contemporary pediatric heart center, elaborating on key concepts and proposed considerations for maintaining a high reliability heart …

Management Of Failure To Thrive In An Infant With Unrepaired Congenital Heart Disease: A Case Study On Energy And Nutrient Dense Formula, Alexandra Birely, Sarah Dundas

2024

EBP

Introduction: Infants with congenital heart disease (CHD) are at risk for malnutrition and failure to thrive (FTT). Preoperative nutritional status impacts postoperative outcomes; thus nutrition should be optimized before surgery. Unrepaired infants have higher energy requirements & fluid restrictions, posing challenges in promoting growth for surgery. Energy and nutrient-dense formula has successfully treated FTT in the postoperative phase, however, evidence is limited in unrepaired infants.

Case Description: The case presented is a 4-month ex-36 week infant, past medical history significant for CHD with large ventricular septal defect (VSD), atrial septal defect (ASD), pulmonary stenosis and solitary kidney. Following discharge …

Owning Your Practice Through Evidence-Based Practice (Ebp) - Transformational Leadership Strategies That Create The Foundation For Ebp Enculturation, Sara Moore, Kathleen Ellis, Zara Sajwani-Merchant, Lindsey Patton

2024

INNOVATION

Background: Nursing Research and Evidence-Based Practice (NREBP) is central to advancing nursing science and integrating nursing practices supported by scientific inquiry to improve health outcomes and quality of care^1,4. The gap between what nurses know and what they do can have life-altering consequences^2,7 . The degree to which nurses base their practice behaviors on research, EBP competence, and use of EBP skills is sub-optimal and is directly influenced by organizational and institutional barriers³. Common barriers to implementing EPB behavior change include organizational culture, leadership, networks and communication, resources, evaluation, monitoring and feedback, and availability …

Optimized Pain Management Protocol For Pediatric Needlestick Procedures: Boosting Team Coordination And Pain Relief, Dhanu N. Bhandari

2024

EBP

PICOT Question:Among clinical staff in the Integrated Therapy Unit (ITU), how does the implementation and education of a standardized set of topical anesthetic agents affect staff consistency with the new pain management procedure over six months compared to existing inconsistent practices?

Background:Effective pain management during pediatric needlestick procedures is critical but often neglected, leading to immediate distress and long-term issues like needle phobia. Research shows that proper pain management not only reduces pain but also improves patient satisfaction and clinical outcomes. However, inconsistent use of strategies like topical anesthetics has hindered optimal care. This project aimed to …

From Identification To Action: Nurses Respond To Human Trafficking, Misty Daugherty, Jill Hanks, Alison Kell, Annie Tolliver, Katie Fields, Lily Velez

2024

INNOVATION

Background: In 2022, nurses from a pediatric healthcare system hosted a Human Trafficking Conference to educate healthcare providers on the identification of human trafficking victims. In post-conference surveys, participants reported a gap in their ability to respond once a human trafficking victim was identified. The conference planning committee reconvened in 2023 to address this gap and shifted from a didactic presentation to application and simulation.

Purpose: Research shows in our home state, there are about 313,000 people being trafficked, up to 50% of them being youth. It is estimated that up to 88% of human trafficking victims encounter healthcare …

Exploring Parent/Child Peri-Anesthesia Anxiety And Anesthesia Effects On Children, Ann Johnson, Alejandra Lozano, Pauline Chen

2024

RESEARCH

Approximately four million children undergo procedures with anesthesia yearly. For children and parents, this can be anxiety-provoking. In extant literature, level and timing of pre-anesthesia anxiety in children are not adequately studied; associated factors are largely unknown in humans. Preparing for anesthesia and its effects may cause parental worry, and little is known about these effects on school-age children in the weeks following a procedure. The purpose of this study was to explore longitudinal peri-anesthesia factors of anxiety and behavior in children ages 7 through 12. Spanish and English-speaking dyads consented to four data collection points beginning at the …

Nurse Manager Hiring Practices And The Experience Of New Graduate Nurses, Tiffany Montgomery, Zara Sajwani-Merchant

2024

RESEARCH

Purpose
/="/">Hiring decisions have implications for the hiring unit and the healthcare organization, including nursing retention, orientation costs, and organizational culture. Despite available literature, hiring practices, and diversity, equity, and inclusion practices are unknown within nurse residency programs. This study explores the experiences of nursing hiring managers and newly hired nurse candidates with the interview and hiring process into residency programs within the DFW metroplex.
/="/">Methods
/="/">A qualitative phenomenological study was conducted to describe the nursing manager experiences and thoughts through the hiring process and how they compare to nurse candidate’s perspective hired into an established …

Fall Prevention Strategies In A Pediatric Epilepsy Monitoring Unit, Bailey Cochrum

2024

EBP

Practice Problem: In 2023, our Epilepsy Monitoring Unit (EMU) had 8 falls, 5 with injuries, up from zero falls with injury in 2022. Enhancing patient and family education on fall risks and prevention is crucial for improving safety and reducing falls.

Literature: Falls in an EMU are common adverse events. Patients with epilepsy are at increased risk of falls due to seizures. In the EMU, seizures are provoked by changing medications, sleep patterns, and stimulation, increasing fall risk and possible injury.

Practice Change(s): For planned EMU admissions, we developed additional seizure-specific education for patients and families, sent prior …

Improving The Lactation Journey: Empowering Moms’ Utilization Of Breast Milk From Admission To Discharge In A Level Iv Neonatal Intensive Care Unit, Rebecca Palmer, Jerithea Tidwell, Traci Hankins, Sharetha Hollier, Nicole Jenkins, Dawn Schindler, Jeanne Gaines

2024

INNOVATION

Background
The benefits of MBM is well-known in literature, especially for infants admitted to the NICU. There is difficulty in engaging and empowering NICU mothers due to multiple barriers including holding limitations, inability to feed orally, and separation of mother and infant for extended periods. Opportunities for improving MBM utilization throughout admission include oral immune therapy (OIT) and/or oral care with MBM, skin to skin (STS), and non-nutritive attempts at breast. Access to lactation education, support, and resources throughout admission is imperative.

Methodology
Utilization of the plan-do-study-act (PDSA) cycle of quality improvement (QI) has improved our overall lactation processes …

Reducing The Burden Of Tracking Age Of Majority (Aom) Research Participant Consents, Beena Pappen, Lindsay Therrian, Bobby Lawrence

2024

QUALITY

Background
/="/">Reconsenting research participants when they reach Age of Majority (AOM) – age 18 in the state of Texas – is a vital responsibility of the pediatric research world. It requires tracking and planning for an activity that may not happen until months, years, or over a decade later. Not obtaining AOM consent may violate the rights of the research participant, as well as impede the ongoing collection and usage of their research data. At the Center for Cancer and Blood Disorders (CCBD) Clinical Research Office (CRO), a very manual process was being used to identify and notify …

Bridging The Gap: Leveraging Cnap To Enhance Professional Development, Align With Organization Goals And Create A Culture Of Safety, Marissa Crosley, Brooke Harris, Gwenetta Hicks, Cornelius Metili

2024

INNOVATION

Abstract: As our organization strives for its fifth Magnet designation, enhancing nurse professional development has become a clear priority. Currently, only half of our nursing staff participate in the Clinical Nurse Achievement Program (CNAP), highlighting a need for increased engagement. Additionally, feedback from the latest Experience, Inclusion, and Engagement (EIE) Survey identified an opportunity to improve nurse recognition within our department. These insights prompted an exploration of how the Team Lead role, uniquely positioned between frontline nurses and leadership, could be more effectively utilized.

A key challenge identified is the time-consuming process of documenting CNAP achievements. Nurses often defer …

A Transformative Leadership Approach To Reducing Nursing Turnover In A Pediatric Cardiac Intensive Care Unit, Deniro Brown, Lindsey Daigle, Brandi Brown, Julia Gerstmann, Emily Hernandez, Delaney O’Brien, Casey Conrad, Christina Whittington, Lindsey Wren, Gustavo Barbero

2024

INNOVATION

Introduction/Objective:
Retention of nurses in the pediatric cardiac intensive care unit (CICU) is essential for optimal patient outcomes, as nurse experience significantly impacts patient mortality and hospital-acquired conditions. In April 2022, our CICU faced high voluntary turnover among direct bedside nurses. Our immediate goal was to reduce this turnover, with a longer-term objective of improving overall nurse retention.

Methods:|
We established global and SMART aims by comparing organizational benchmarks for nurse turnover with unit-specific data from human resources. Co-managers and eight nurse team leaders conducted stay interviews with direct bedside nurses during the first half of 2022. These …

Ready, Set, Code! Investigating The Use Of Two Standardized Resuscitation Algorithms To Improve Outcomes In Patients In A Level 4 Nicu, Lauren Ayala, Grace Farina, Shelby Hudson, Anna Nguyen, Mireya Ortiz, Luke Wuesthoff

2024

EBP

Background:
Resuscitation efforts can be challenging in a Level IV NICU. Most Heath Care Providers in pediatric hospitals are Pediatric Advanced Life Support (PALS) certified. Some NICU providers are certified in both Neonatal Resuscitation Program (NRP) & PALS. There is concern regarding use of NRP vs PALS for Level IV NICU patients who are up to one year of age. Strategies need to be identified to assist nurses in determining which resuscitation algorithm (PALS or NRP) to utilize during a code/peri-arrest event involving patients in a Level IV NICU.

PICO:
Will designing a resuscitation tool improve outcomes and effectiveness …

Cease The Alarms: A Nurse-Led Bundled Approach To Alarm Management, Annie Tolliver

2024

EBP

Practice Problem:The use of audible alarms to monitor pediatric patients is crucial to patient care. Alarms notify nurses of potentially life-threatening situations. However, increasing non-actionable alarms can cause desensitization. This leads to ignoring and mismanaging alarms, ultimately putting patients at serious risk. For those caring for the sickest pediatric patients, strategies for reducing non-actionable alarms to mitigate alarm fatigue are needed to enhance patient safety.

Literature/Evidence:A review of the literature highlighted emerging evidence-based practice supporting the use of the CEASE bundle for nurse-led alarm management, as outlined in a quasi-experimental research study. Multiple systematic reviews substantiate the …

Little Lungs, Big Care: Prevent Unplanned Extubation, Leslie Huntington, Emily Jordan Ressman, Carmen Yearego

2024

QUALITY

Background: The pediatric critical care unit in a large medical center benchmarks a variety of quality metrics to ensure we are providing our patients with the best care. At the end of 2023, the unit rate of 0.58 was higher than the national benchmark rate of 0.33 for unplanned extubation (UE). Additionally, the unit was lower for failed extubation rate than the national benchmark which led to questioning if the unit was too conservative with when patients are deemed ready to extubate.

Objectives: The primary goal is to lower the rate of UE while maintaining a failed extubation rate …

Improving Sepsis Response, Awareness, And Engagement In The Emergency Department, Virginia Elizondo, Nicole Bizzack, Amber Dayton, Angie Rodick, Ashley Collins, Georgina Hernandez, Amber Albiar

2024

QUALITY

Sepsis background:
Sepsis is the leading cause of death in children² and a global health problem³. The primary source of infection is often not apparent¹, making early patient identification, initiation of sepsis protocols, and continued awareness crucial to improve outcomes and prevent mortality in patients at risk for sepsis.

Purpose:
An emergency department (ED) Sepsis Response Team (SRT) and other initiatives were designed to enhance workflow efficiency, improve time to antibiotic administration (TTA) tominutes, improve sepsis recognition, and uphold standards by maintaining staff engagement.

Implementations:
Once a patient screens positive for sepsis risk, an …

Ironing Out The Details: Early Detection And Treatment Of Iron Deficiency In A Level 4 Nicu, Rachel Mills

2024

EBP

Practice Problem: In a level 4 neonatal intensive care unit (NICU), no standardized method existed for identifying and treating iron deficiency (ID) in preterm or low birth weight (LBW) infants. Common practice was to adjust iron supplementation based on hematocrit levels, though this was not based on any formal protocol or guideline. ID of the brain in neonates may be associated with neurologic and developmental deficits. Thus, it is prudent to identify and treat early. In a recent survey, providers reported a lack of familiarity with biomarkers for early identification of ID.

Literature/Evidence: A comprehensive review of the literature …

Standardization Of Adult Transition Across Ambulatory, Virginia Vecchio, Monica Fuller

2024

QUALITY

Background:

Historically, at Children’s Health initiatives involving patient transition to adult care have been focused on the clinics which are ranked in U.S. News & World Report’s Best Children’s Hospitals. Other clinics had no process for transition and were unaware of available resources.

Purpose:

A subgroup from the Ambulatory Clinical Practice Council identified the need for a standardized framework and EPIC documentation that every clinic could utilize.

Methodology:

The Office of Patient Transition (OPT) was onboard with revamping the current program and allowing nurses to drive the changes. A knowledge assessment was performed with nurses in 2022. The results …

Caring For Manes: Creating Diverse Hair Care Guidelines For A Large Pediatric Hospital, Jeri Tidwell, Tiffany Montgomery, Phyllis Carter-Riles, Victoria Washington, Kym Lanehart, Jesse Leos

2024

QUALITY

Background
Hair care products should be available to all patients regardless of hair type and texture. Recent movements like the Crown Project sparked pediatric hospitals across the country to focus efforts on ensuring hair care equity for their patients. Children’s health joined the movement by sanctioning a multidisciplinary, multidepartment task force to address BIPOC hair concerns. A smaller group was tasked with aligning practices and policies to address the gaps in education and resources available to assist nurses in caring for ethnic hair.

Methodology
Review of literature was conducted. Limited published work was found. The workgroup benchmarked and consulted …

A Methodical And Multidisciplinary Approach To Reducing Unplanned Extubationin A Level Iv Nicu, Rebecca Palmer, Ashley Reed, Reed Graham, Nimrod Otieno, Veronica Contreras, Jeanne Gaines, Jerithea Tidwell, Alice Figueroa, Travis Reynolds, Syed Ahmed, Sushmita Yallapragada

2024

QUALITY

Background: Unplanned extubations (UE) in neonates can result in severe consequences such as airway obstruction, hypoxia, respiratory distress, and even death. It is crucial to prevent UEs to maintain stable breathing, minimize the need for reintubation, and improve outcomes for neonates in the neonatal intensive care unit (NICU). The multidisciplinary NICU UE team has been working to prevent UEs since 2017. After an increase in 2022, the team conducted an evaluation to identify potential gaps and discovered over 50% of patients were not being reintubated post-event. Identified factors that contributed to UE events were: infants with weight < 4 kilograms; unadjusted high endotracheal tubes (ETT) per x-ray; inadequate sedation; lack of extubation readiness trial; and inadequate taping of the ETT. In 2022, our UE rate spiked to 0.50 UEs/100 vent days which prompted our multidisciplinary team to reinvigorate our work.

Methodology: A …

Mindful Cleanliness: Resetting Expectations For Environmental And Personal Hygiene To Reduce The Clabsi Rate In A Level Iv Nicu, Rebecca Palmer, Kymeyone Lanehart, Jerithea Tidwell, Sushmita Yallapragada, Jeanne Gaines, Courtney Campbell

2024

QUALITY

Background
/="/">CLABSIs place patients at high risk for mortality and morbidity, increasing length of stay, and additional costly and detrimental therapeutic interventions. Our NICU historically had a better than national average CLABSI rate, however, since 2022, our CLABSI rate spiked to above average. During this timeframe the unit experience higher census and acuity leading to increased workload and needs of patients and staff. In 2022, the CLABSI rate spiked from 0.53 in 2021 to 1.04 and 1.12 CLABSIs/1000 line days in 2022 and 2023, respectively.

Methodology
/="/">Utilizing Quality Improvement methodology allowed identification of the root cause of …

Nicu Team Nursing Model: Purposeful Collaborative For Positive Outcomes, Kymeyone Lanehart, Rebecca Palmer, Jerithea Tidwell, Lisa Mason, Sharica Whitten, Katie Doerge, Sushmita Yallapragada

2024

INNOVATION

Background: In 2013, an elevated CLABSI rate as high as 3.4 indicated that a specialized team approach would be necessary to improve quality care and patient outcomes. Development of a unique blood stream infection (BSI) team, that focused specifically on managing central lines, was successful and later expanded in to focus on other quality metrics. In 2015, the team was re-named safety and quality (SAQ). In 2016, the NICU utilized the team model by developing an internal transport team (ITT) to complete internal transports for procedures. The SAQ and ITT groups merged in 2019 to improve efficiency in the …

Rise Of The New Grad: Early Engagement Of New Graduate Nurses In Professional Governance, Annie Tolliver, Katie Fields

2024

INNOVATION

Background: Traditionally, new graduate nurses (GNs) are advised to gain experience before participating in Nursing Professional Governance (NPG). NPG is a structure that empowers nurses to be decision-makers regarding the nursing practice environment. We identified GNs had minimal knowledge of and engagement in NPG. An innovative process was developed to involve GNs in NPG, challenging the traditional approach.

Literature: Substantial evidence supports that nurses engaged in NPG are empowered to make decisions, leading to better patient outcomes and increased professional satisfaction. Research shows GNs’ dedication and professional satisfaction are tied to their ability to embed into the organizational culture …

Exploration Of Central Venous Catheter Protective Devices In The Pediatric Population: A Mixed Methods Study, Lindsey Flores, Quineka Smith, Maria Leal, Melissa Ruffini

2024

RESEARCH

Purpose:
/="/">In the pediatric population, about 25% of the catheters are reported to have issues such as CLABSI, line dislodgement, contamination, or catheter breaks. The primary purpose of this study is to explore caregiver and nurse satisfaction of pediatric patients with CVCs that utilize a wearable protective device with specific aims to determine parent’s perception of the feasibility while wearing the device. Wearable devices are an extra measure utilized among pediatric patients for nurses and parents to further protect the CVC dressing and catheter from complications. A single site study found that utilizing a wearable device reduced line …

New Approach To Professional Governance In Ambulatory, Brittney Saldierna, Katelyn Tinkey, Diana Sarmiento

2024

INNOVATION

Shared Governance Committees have involved frontline staff in driving change for many years. However, they often involve significant input from leaders, making frontline staff feel like their opinions don't matter as much. Professional Governance Committees emphasize that frontline staff should be the primary drivers of change without significant influence from leaders. Leaders should focus on removing barriers to the frontline staff's vision and ensuring that all changes comply with policies and regulations.

This Ambulatory System has created a unique structure in which the Ambulatory Council (AC) is the overarching structure for nine other councils. These councils meet monthly and …