Pediatric Nursing Commons^™

Engaging The Night Shift To Sustain A Healthy Work Environment, Kelsey Walsh, Delaney Dewolf, Annie Tolliver

2025

INNOVATION & LEADERSHIP

Background: Night shift nurses often feel overlooked, leading to disengagement and higher turnover. The common question, “What about for the night shift?” highlights gaps in recognition, communication, and collaboration. In 2024, a large pediatric health system launched a Night Shift Forum (NSF) to improve the work environment for this critical group. Results from the AACN Healthy Work Environment Assessment Tool (HWEAT) showed true collaboration (3.41) and meaningful recognition (3.73) as the lowest-scoring areas. Recent studies show that night-shift nurses consistently report lower scores on healthy work environment domains, while organizations with dedicated night councils demonstrate stronger …

Blinatumomab Without Borders: Taking Life-Saving Treatment Home, Susan Mccollom, Tami Beaudin, Shareta Jackson, Jamie Gebhard

2025

INNOVATION & LEADERSHIP

Background: Blinatumomab administration has become a standard treatment for acute lymphoblastic leukemia (ALL), following promising early outcomes from the AALL1731 study. The randomized groups in this trial demonstrated a 3-year disease-free survival (DFS) rate of 96% in those receiving blinatumomab, compared to 87.9% in the non-blinatumomab arms. Blinatumomab is administered in two non-consecutive 28-day blocks with ideally approximately 24 days of treatment at home.

Implementation: The staff at the Center for Cancer and Blood Disorders (CCBD) at Children’s Health faced a significant challenge due to the volume and urgency of the therapy to start. We …

A Nurse-Led Investigation Into Rising Cardiology Clinic Admission Holds And A Multidisciplinary Strategy To Reduce Them, Jennifer Dickson, Haley Byrne, Katherine Harris, Leah K. Toombs

2025

INNOVATION & LEADERSHIP

Background: The Dallas Cardiology Clinic, the only hospital-based clinic within the Heart Center’s outpatient network, serves specialized, high-acuity cardiac patients who often require direct admission. Due to inpatient bed constraints in the Acute Care Cardiology Unit and Cardiac ICU, rising patient complexity, patients are increasingly held in the ambulatory space, not intended for, or equipped for prolonged care. In 2024, average admission wait times rose to 118 minutes (often taking 200+ minutes) up from 97 minutes in 2022. Long admit wait times can lead to treatment delays, raise nursing concerns about safety, and disrupt outpatient flow. …

Peripherally Inserted Central Catheter Use And Complications In A Pediatric Heart Center, Melanie Walsh, Alexandra Birely, Lynn Clark, Jared Young, David Lee, Sonali S. Patel

2025

RESEARCH

Purpose: To identify patient and device-related factors associated with PICC complications in the CICU and ACCU at Children's Health Dallas

Methods: - Single center, retrospective study using data abstracted from electronic medical records (EMR). - All PICCs inserted in HC during January 2022 through November 2024 were analyzed. - Retrospective review completed to identify patient physiology (at time of insertion), tip terminating location, tPA doses given (if applicable), and removal reason. - Univariate analysis conducted to determine risk factors associated with line occlusion and tPA usage.

Results: - Occlusion was the most frequent indication for early …

Revolutionizing Ed Transitions: Cutting Low-Acuity Visits Through Resource Optimization And Addressing Social Determinants Of Health, Crystal Salazar, Christa Combs

2025

INNOVATION & LEADERSHIP

Background: Frequent emergency department (ED) visits for non-emergent issues contribute to overcrowding, strain healthcare resources, and raise costs for families and the system. Many of these low-acuity visits—non-urgent cases manageable in primary care—worsen ED congestion and delay care for critical patients. A major factor is caregivers’ lack of awareness about alternatives like primary care, urgent care, and telemedicine. This leads to unnecessary ED use and further system strain. To address this, a family-centered care coordination program was created to reduce low-acuity ED visits by tackling care barriers, offering illness-specific education, and providing ongoing RN-led caregiver support. …

Improving Confidence And Competence In Treating Pediatric Peripheral Intravenous (Piv) Extravasation, Ann Gosdin, Hector Murillo, Taffi Marchand, Brook Warren

2025

EBP

Literature Review: Targeted nursing education has demonstrated it may lead to improved nursing care and patient safety. Nurses who received high-fidelity simulation and targeted traditional education on extravasation treatment had higher competency scores than those who did not received this education. Specific nursing education classes have demonstrated statistically significant improvement on nurses' knowledge, practice and minimized patients' complications of extravasations.

PICO: In hospitalized pediatric patients can additional education and training by the Vascular Access Team (VAT) for Peripheral IV Infiltration and Extravasation (PIVIE) on extravasation treatment increase knowledge, confidence, and competence in providing the appropriate treatment and increase the …

Development Of A Continuous Renal Replacement Therapies (Crrt) Team, Lainey Segovia, Taelor Pena, David Zolezzi, Tami Turrubiarte, Keri Drake

2025

INNOVATION & LEADERSHIP

Background: Our organization identified an opportunity to provide Continuous Renal Replacement therapy (CRRT) to more patients while simultaneously reducing time to initiation by building a dedicated CRRT team. Although CRRT has been provided for years, it lacked formal standardized education and oversight.

Implementation: Recognizing these gaps in care we formed a CRRT team in May 2024, consisting of three RN coordinators, one Advanced Practice Provider (APP), a nursing director, and a nephrology medical director. The aim was to improve CRRT delivery by authoring guidelines, providing formal in-person education for nurses and providers, creating a centralized …

Shorter Stays, Collaborative Care: Tackling Bronchiolitis Together, Alyssa Gestring, Sharmila Chowdary Kanuru

2025

QUALITY IMPROVEMENT

Background: Bronchiolitis is a leading cause of pediatric hospitalization. Despite American Academy of Pediatrics recommendations to reduce unnecessary care and costs, management variation persists. Modest reductions in length of stay (LOS) can meaningfully impact cost and hospital throughput. During our baseline period (Aug 2021-Dec 2022), our average LOS for bronchiolitis admissions was 51 hours, in comparison to 40.8 hours (1.7 days) for the 10th percentile of Children’s Hospital Association peer hospitals. Our aim was to reduce the average LOS of patients with uncomplicated bronchiolitis by 12 hours between January 2023 and the end of 2024, without increasing …

The Development And Implementation Of On-Demand Nsqip Visualization Tools In A Pediatric Health System, Tess Davis, Karisa Price, Courtney Russ

2025

INNOVATION & LEADERSHIP

Background: Children’s Health System of Texas (CHST) is comprised of campuses in Dallas and Plano. Located thirty miles apart, the distance places a strain on communication within the enterprise. While Semiannual Reports (SARs) provide retrospective data, our surgeons frequently voiced a desire to visualize timely postoperative occurrences in an attempt to provide on-time interventions.

Implementation: Surgical Clinical Reviewers (SCRs) queried available resources including National Surgical Quality Improvement Program (NSQIP) surgeon champions, an otolaryngologist, and our perioperative data analyst. Each player brought a unique perspective and assisted in prioritizing metrics. As a team, the Tableau educational …

Munch N’ Learn: Building Competence And Confidence In Pediatric Hematology Oncology Nurses, Shareta N. Jackson, Jaime N. Gebhard

2025

INNOVATION & LEADERSHIP

Background: As clinical nurse educators, we have observed a significant gap in continuing education opportunities for experienced nurses, particularly in the wake of the COVID-19 pandemic. Lifelong learning is essential for enhancing personal development and professional responsibility, enabling nurses to stay updated with evolving medical practices and improve patient care. The COVID-19 pandemic shifted nursing education priorities toward onboarding new hires and graduate nurses, leaving experienced nurses with limited continuing education opportunities. This gap has created a need for educational programs that cater specifically to the needs of seasoned nurses, helping them stay current with evolving …

Importance Of Expressed Breast Milk Verification And Patient Identification, Deb Lathrop

2025

QUALITY IMPROVEMENT

Background: Due to changes in Texas reimbursement, the Plano campus was transferring neonates, infants under 28 days of life, to the Dallas campus. It was decided in 2023 to obtain a neonatal designation for the Plano campus. A Program Manager was hired as part of the requirements and a quality and Patient Safety committee was formed. As part of the program, quality data collection was required. As a Level I designated facility, expressed breastmilk verification was one of the required data sets to be collected. It was discovered that staff at the Plano campus were not scanning …

Comparing In-Person Discussions Versus Online Learning Modules On Post-Pda Ligation Care Knowledge Retention Among Night Shift Nurses In A Level 4 Nicu, Jeffrey Canlas, Olga Deleon, Sharon Summers, Jerithea Tidwell, Noorjahan Ali

2025

QUALITY IMPROVEMENT

Background: Postoperative management of neonates following patent ductus arteriosus (PDA) ligation is critical in a Level 4 Neonatal Intensive Care Unit (NICU). Night shift nurses are faced with unique challenges when caring for these patients. The night shift NICU leaders wanted to determine the most effective educational method to enhance learning retention and clinical competency. The purpose of this quality improvement project was to evaluate whether in-person discussions lead to better retention and understanding of post-PDA ligation management among night shift NICU nurses compared to online learning modules.

Methodology: A comparative, quasi-experimental design was used to …

Epilogue: Postoperative 30-Day Follow-Up, Tess Davis, Karisa Price, Courtney Russ

2025

INNOVATION & LEADERSHIP

Background: The NSQIP-P Surgical Clinical Reviewers (SCR) of Children’s Health of Texas initiated a quality project with the goal of maintaining an 80% postoperative follow-up rate. To remain relevant in the ever-changing landscape of healthcare, we recognize the need for thoughtful and individualized approaches to follow-up. Unprecedented growth in the healthcare sector creates a demand for innovative solutions to address the ever-changing needs of the pediatric surgical population. Patient expectations have driven the desire for organizational transparency and robust approaches to ensure optimal, holistic outcomes. This has been accomplished using tailored follow-up strategies to meet organizational …

I Don’T Want To Be Alone: The Impact Of Cohorting Neonates On One Unit, Deb Lathrop, Rose Dela Cruz

2025

INNOVATION & LEADERSHIP

Background: The hospital has been caring for neonates since it opened in 2005. To comply with state regulations, a state designation for neonatal care is required. The facility hired a program manager to address specific needs and to apply for the state designation. A designation of Level 1 neonatal care was obtained at the end of 2023. The facility does not possess a Neonatal Intensive Care Unit. The program manager started collecting historical data on thermoregulation who are located on every unit of the facility in October 2023. It became evident that neonates in the hospital …

Ask Me 3® In Action: Advancing Health Literacy In Pediatric Acute Care, Yaseming Medina

2025

EBP

Literature Review: Parents and caregivers’ understanding of how to provide safe and effective care at home is vital. However, elevated levels of stress and limited health literacy face significant challenges in understanding discharge instructions. Patients who understand heath instructions make fewer mistakes when they take their medicine, follow treatment plans, and prepare for medical appointments. Patients have reported higher satisfaction and found that the use of Ask Me 3 was helpful in learning more about their medical condition.

PICO: For parents of pediatric patients seen in an acute perioperative setting, how will the use of the Ask Me 3 …

Increasing Clinical Internal Mobility Through A Student Nurse Technician Program, Radiance G. Bean

EBP Fellowship

Practice Problem: Currently 67% of internal applicants are hired into our nurse residency program. Feedback from nursing leadership suggests internal candidates often fall short in areas like interviewing skills and professionalism, making external candidates stronger. Given the higher education resources provided to team members and our organization’s commitment to internal mobility, identifying ways to support employees and retaining top nursing talent is a priority. Our EBP question is: Will participation in a Student Nurse Technician (SNT) program increase the percentage of Patient Care Technicians (PCTs) in good standing that are accepted into the nurse residency compared to the current …

Elevating Nursing Leadership: How Nurse Managers Empower Unit Practice Councils, Katie Fields

EBP Fellowship

Problem: Unit Practice Councils (UPCs) are foundational to Nursing Professional Governance (NPG), a structure that is designed to foster autonomy, accountability and authority for nurses. These councils are vital for empowering nurses to engage in decision-making and implementing practice changes. At one large pediatric hospital, UPC effectiveness varied across units, largely due to differences in nurse manager engagement and support. This variation highlighted a critical gap in how nurse managers were supporting UPCs within their unit. To close this gap, it was important to identify leadership best practices and behaviors that lead to successful UPCs. The following PICOT question …

Empowering Nurses: A Training Initiative On Essential Oils For Pediatric Neurosurgery Patients, Sheri Sacks

EBP Fellowship

PICO Question: In pediatric neurosurgical bedside nurses, does education on lavender essential oil, compared to no education, improve knowledge, confidence and intent to integrateit as a complementary therapy for TBI patients?

Literature Review: Pediatric neurosurgery patients often face increased anxiety and agitation. Nurses may lack knowledge of non-pharmacological interventions to reduce agitation and anxiety in their patients. Literature review used MeSH Headings and keywords to find recent English articles. Evidence shows EO reduces anxiety. Lavender inhalation lowers anxiety, pain, and vital signs in pediatric dental patients. In adults, aromatherapy decreases anxiety, pain, blood pressure, and improves sleep, also …

Fierce And Focused - Virtual Reality Support For Pediatric Oncology Patients, Javarius Barber-Esparza

EBP Fellowship

Practice Problem: Pediatric oncology patients often experience anxiety during needle procedures. Even with anesthetic pain management in place, visually encountering the needle can be more distressing than the procedure itself. Virtual Reality (VR) has emerged as a nonpharmacological tool that provides immersive distraction, effectively lowering pain perception and anxiety. Studies show VR reduces anxiety during medical procedures, including accessing Implanted venous access devices (IVAD). Yet, its adoption in pediatric oncology settings remains limited.

Literature/Evidence: Search strategy in the CINAHL (EBSCOhost) database used MeSH headings and keywords, including English articles published within the last five years. Studies show that …

Improving Confidence And Competence In Treating Pediatric Peripheral Intravenous Extravasation, Ann Gosdin

EBP Fellowship

Practice Problem: Peripheral Intravenous Infiltrations and Extravasation (PIVIE) can cause severe skin and tissue damage. Prompt intervention helps prevent moderate or severe skin tissue damage. In the U.S. PIVIE complications can cost $10,895 versus $7,009 per patient without PIVIE. An Australian ED estimated the annual cost of PIV occlusion/infiltration and dislodgement of $14.01 million Australian dollars.

Quality event reviews demonstrated a staff knowledge deficit of treating extravasations per guidelines. Treatment could be delayed if the Vascular Access Team (VAT) was not available. Education on treatment of IV extravasation was needed to address this practice gap.

PICO(T) Question: In …

Ask Me 3® In Action Advancing Health Literacy In Pediatric Acute Care, Yaseming Medina

EBP Fellowship

Background: Parents and caregivers’ understanding of how to provide safe and effective care at home is vital. However, elevated levels of stress and limited health literacy face significant challenges in understanding discharge instructions.

For parents of pediatric patients seen in an acute perioperative setting, how will the use of the Ask Me 3® health literacy tool impact understanding of medical information and communication with healthcare providers?

Literature Evidence: Patients who understand heath instructions make fewer mistakes when they take their medicine, follow treatment plans, and prepare for medical appointments (Six-Means, Amy, et al, May 2012). Patients have reported …

Seeing Clearly: The Impact Of Standardized Skin Assessments In Pediatrics, Hadley Brewer, Kristalyn Brown, Citlali Delgado, Sarah Irion, Riley Rice, Breyana Smith

2024

No abstract provided.

Safe Steps: Protecting Pediatric Patients From Falls, Sydney Richter, Generra Okello, Adaeze Ndulue, Megan Bauman, Robert Riegler

2024

No abstract provided.

Need A Buddy? A Mentorship Program For New Graduate Nurses, Makenzie Smith, Clarissa Leal, Danae Jones, Tram Anh Tran, Serenity Helaire

2024

No abstract provided.

It’S Yappy Hour! Standardized Rounding That Keeps Patient Families In The Loop, Brittany Culp, Audrey Hinchey, Bronwen Seidel, Michelle Aboagye, Dileen Bilbas, Cheyanne Dias

2024

No abstract provided.

Bridging The Gap: Strategies To Minimize Medication Delays And Enhance Interdisciplinary Collaboration In Hospital Settings, James Greenalch, Hector Murillo, Nantz Shelby Olson, Emma Putnam, Heidi Rodriguez, Jenna Stehly

2024

No abstract provided.

Bridging The Gap: A Cross-Unit Approach To Thermoregulation In A Large Pediatric Hospital, Isabelle Hernandez, Hernandez Velasco, Samuel Casu, Angel Castillo, Loree Sword, Noe Garcia

2024

No abstract provided.

Did You Clean It? - An Evidence-Based Project To Improve Environmental High Touch Area Cleaning Practices, Lauren Hagglund, Hailey Holt, Ainsley Ingebrigtsen, Emily Keller, Stuti Khadka, Kit Mallari, Gavin Martinez, Sahira Monroy, Hannah Pendarvis, T.A. Stockton

2024

No abstract provided.

Rolling With The Bss: Standardizing Stool Assessments In Pediatric Care, Herlinda Cardenas Arce, Allison Hoffman, Hannah Holmes, Sierrah Martinez, Cinthya Mondragon

2024

No abstract provided.

Improving Ambulation And Safety Related To Complex Medical Equipment In Inpatient Settings, Kellie Chin, Allie Fox, Destiny Gaines, Luke Hernandez, Natalie Kauppila, Taylor Potraza

2024

No abstract provided.