Pediatric Nursing Commons^™

Improving Fluoride Varnish Application Rates In A Pediatric Primary Care Microsystem, Roman G. Roxas

Master's Projects and Capstones

Problem

Childhood caries is a preventable public health issue disproportionately affecting the underserved. National guidelines recommend fluoride varnish (FV) application during well‑child visits. In California, fewer than 15% of children under age six received FV. In a pediatric primary care clinic, baseline performance was 11% in 2025.

Context

A six‑month quality improvement project was implemented. Key barriers included reduced team cohesion, workflow variability, unclear roles, and underutilized electronic health record (EHR) prompts.

Interventions

The change package standardized medical assistant–led workflows, activated EHR prompts, and provided targeted education. Leadership reinforcement through regular huddles supported adoption, consistency, and team engagement.

Measures

Outcome …

Standardizing Care: Strengthening Dka Protocol Implementation Among Emergency Department Nurses, Toni Joy Angelique Biliran Miculob

Master's Projects and Capstones

Objective: The objective of this project was to address the inconsistent understanding and utilization of the Diabetic Ketoacidosis (DKA) protocol in a high-acuity emergency department within a large hospital system, where baseline survey results showed that 84% of nurses found the DKA order set confusing and only 15% felt “very comfortable” applying it.

Aim: The aim was to improve nurse clarity, confidence, and consistency in using the DKA protocol to support timely, evidence-based management of this high-risk, time-sensitive condition.

Methods: The intervention consisted of brief, targeted education delivered during pre-shift huddles across day and night shifts, focusing …

Kid Power: Mastering Asthma Management To Keep Hospitals Away!, Kriste L. Moret

Master's Projects and Capstones

Problem: Pediatric asthma remains a leading cause of preventable hospitalizations, particularly in California’s Central Valley, where environmental and health disparities worsen symptoms. Many children are discharged without understanding their Asthma Action Plan (AAP) or feeling confident in symptom management.

Context: On a unit in a community hospital in this high-risk region, asthma-related admissions persisted. Gaps in discharge education highlighted the need for a structured intervention. The Institute for Healthcare Improvement (IHI) Model for Improvement (MFI) guided this effort.

Intervention: A nurse-led, developmentally appropriate asthma education bundle was implemented. Teaching began on admission and was reinforced using teach-back, color-coded AAPs, culturally …

Optimizing Pediatric Peri-Anesthesia Care: A Donna Wright Nursing Competency Framework, Marisa Elise Gauna

Master's Projects and Capstones

Problem: Preventable hospital errors are often associated with inconsistent nursing competency, especially in high-acuity areas such as pediatric peri-anesthesia units. Traditional evaluation tools like checklists have limited effectiveness, as they frequently fail to engage staff or adapt to changing clinical demands (Wright, 2005). Context: At a Bay Area children’s hospital, baseline data from August 2024 revealed that only 65% of peri-anesthesia nurses reported feeling “very” or “somewhat” comfortable with key clinical skills. To address this, a quality improvement project was launched with the goal of increasing comfort levels by 15% using the Donna Wright Competency Model, which emphasizes staff engagement, …

The Wright Way: Advancing Pediatric Perianesthetia Nursing Competencies, Marisela E. Acevedo-Padilla

Master's Projects and Capstones

Objective Implementing the Donna Wright Competency Model at a Bay Area Children’s Hospital in its peri-anesthesia units. Throughout available literature it was possible to observe the positive effects of implementing a competency model such as the DWCM has on the confidence of nursing staff and patient outcomes. An important point shown by literature was addressing more than technical skills and incorporating critical thinking and ethical considerations regarding patient care. Aim We aim to improve nurse competency in pediatric peri-anesthesia units at a Bay Area Children's Hospital by implementing Donna Wright’s Competency Model. Data obtained in August 2024 from a series …

Improving Mood Scores With Social Robot Dog ‘Pupper’ In Pediatric Cardiovascular Patients, Alyssa Lopez

Master's Projects and Capstones

Objective Pediatric hospitalization has been shown to increase the risk of developmental delays, social isolation, and mental health disorders. Consequently, decreased happiness also results from hospitalization, leading to reduced motivation and less engagement in their care. Aim The aim of this project is to improve the mood of pediatric patients aged 3-25 years by 50% from the patient’s baseline level within one month, from October 16, 2024 to November 13, 2024, on a pediatric cardiac step down unit by utilizing a social robot dog to motivate patients in engaging in their care. Methods Twelve participants between the ages 4-18 years …

Implementing The Donna Wright Competency Model In Pediatric Perioperative Units For Nursing Professional Development, Benjamin Amezcua

Master's Projects and Capstones

Background Each year, preventable adverse events in hospitals lead to numerous deaths. Research consistently indicates a strong correlation between nurse competency and improved patient outcomes, emphasizing the importance of healthcare organizations prioritizing the continuous development of their staff's skills. Bay Area Children’s Hospital A is taking a proactive step by adopting the Donna Wright Competency Model (DWCM), changing from the traditional approach competencies to a collaborative, shared governance model that incorporates the input and perspectives of the nursing staff. Objectives The project aims to utilize the DWCM to enhance the competencies of 90 nurses in the pediatric perioperative units at …

Utilizing Pupper, A Social Robot Dog, To Increase Happiness And Improve Mood In Pediatric Patients Of A Cardiac Step-Down Unit, Angela Feng Wu

Master's Projects and Capstones

Objective The usage of social robots in pediatrics is an emerging field of study. Preliminary research shows that they are effective at improving the psychosocial well-being of pediatric patients. This quality improvement project focuses on Pupper, a newly developed quadruped social robot dog, and its ability in improving mood and happiness in pediatric patients of a cardiac step-down unit. Aim The aim of this project is to increase average mood scores of pediatric cardiac patients aged 3-25 years by 50% from their baseline of 3.75 to 5.63 on a six-point scale within a one-month time frame. Methods Before intervention and …

The Donna Wright Competency Model In Pediatric Perioperative Nursing Development, Nadia Hamid

Master's Projects and Capstones

Abstract

Background Preventable adverse patient events occur daily in hospitals across the United States which can be significantly decreased by effective nurse competency assessment. Bay Area Children’s Hospital X has adopted the Donna Wright Competency Model (DWCM) to support their institutional goal of Magnet status for excellent nursing care. With the goal of changing the traditional approach of competency achievements by engaging nurses through shared governance. Objective The project seeks to attain a higher level of performance for 90 nurses employed on the perioperative unit (PPU) to provide a safer environment to support patient centered care. Aim By December 1, …

Implementing The "Baby Drop Bundle", Natalie Aguirre

Master's Projects and Capstones

Problem: Falls are a preventable type of trauma that may lead to serious injury, prolonged hospital stays, and non-reimbursable costs to the organization. While there are established fall prevention policies for ambulatory patients, infants dropped by their caregivers are largely excluded.

Context: This quality improvement project aims to decrease newborn drops by implementing the “Baby Drop Bundle”. The bundle allows caregivers and bedside providers to partner in creating a safe environment for the patient.

Interventions: The Clinical Nurse Leader (CNL) will provide a brief in-service during the morning safety huddle to introduce the bundle to staff. The bundle includes educational …

Educating Pediatric Registered Nurses On The Administration Of Prolonged Intravenous Antibiotics, Kasandra Rezler

Master's Projects and Capstones

Abstract

Problem According to Children’s Hospital A's incident reporting system, 50% of problems related to prolonged intravenous antibiotics were classified as administration issues. When mistakes are made in this process, the antibiotic is then delivered at the wrong rate or the wrong time, which is problematic. Additionally, findings from a needs assessment survey highlight a critical need for targeted interventions, such as an educational video, to reduce administration errors associated with prolonged IV antibiotics. Context Within Children’s Hospital A, the microsystems targeted by this quality improvement project consist of inpatient pediatric patient care units (PCU) 300, 360, and 400. Children’s …

Educating Inpatient Pediatric Registered Nurses On The Setup And Administration Of Prolonged Intravenous Antibiotics And The Reduction Of Medication Errors, Kiara Hayden

Master's Projects and Capstones

Problem The acute care unit microsystem of a California children’s hospital encounters issues involving the incorrect set up and administration of prolonged intravenous (IV) antibiotics and medication errors, such as delivery at the wrong rate or time. These problems can result in negative patient health outcomes, delayed healing, antibiotic resistance, and increased length of hospital stay and costs. Context A collaborative quality improvement (QI) project was launched to target the pediatric population of this particular microsystem. The aim of this project was to standardize prolonged IV antibiotic practices, disseminate knowledge while using evidence-based practice (EBP), and improve patient outcomes. Interventions …

Improving Prolonged Antibiotics Education In A Pediatric Unit, Zerena S. Silva Villamonte

Master's Projects and Capstones

Problem Children’s Hospital A's incidence report tool, iCares, demonstrates that 50% of the issues related to prolonged intravenous (IV) antibiotics are categorized as administration issues. This leads to the medication being delivered at the wrong time or rate. Having these issues increases patient length of stay, increasing hospital costs. Context The microsystems for this quality improvement project include inpatient pediatric patient care units (PCU) 300, 360, and 400. Children’s Hospital A is a 361-bed San Francisco Bay Area hospital. Interventions The Clinical Nurse Leader students implemented a presentation defining prolonged IV antibiotics, their rationale, and a video demonstrating the correct …

Reduce Extended Length Of Stay By Reducing In-Hospital Falls, Norberto Benitez

Master's Projects and Capstones

Abstract

Problem: Every year, there are many in-hospital falls (IHFs). Nationally there are between 700,000 to 1 million falls recorded each year. Hospital falls financially burden our healthcare industry, costing approximately 34 billion annually. Context: In a local hospital in Northern California, Marin County, the microsystem has had an extraordinary number of in-hospital falls (IHFs). To date (June 2023), 13 falls have been recorded thus far; the microsystem is on track to beat the previous year's record number of 21 falls in a calendar year. Interventions: The MSN–CNL student proposed re-educating staff, resetting expectations, and reestablishing workflow. We also sought …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Implementation Of Aidet And Commit To Sit In Pediatric Outpatient Setting, Shibani Dhir

Master's Projects and Capstones

Problem: This quality improvement project implements AIDET (Acknowledge, Introduce, Duration, Explain, and Thank You), Commit to Sit, and cultural-competent care to improve patient satisfaction and communication between multidisciplinary health care team members and patients in a microsystem of a pediatric outpatient setting. The National Research Company (NRC) scores from the microsystem are below the 85th percentile, and this microsystem strives for excellence in the care provided to patients. The detractors from the patient satisfaction scores include patients scoring low on staff needing to work together, care providers not taking enough time to explain and listen, wanting to trust providers with …

Increasing Patient Satisfaction In A Pediatric Perioperative Outpatient Setting, Ailen Revuelta

Master's Projects and Capstones

Problem: Effective and therapeutic communication in the healthcare setting is multidisciplinary, complex, and has its unique challenges for each microsystem. This quality improvement project implements two communication tools AIDET and Commit to Sit and incorporates cultural competency to improve communication and increase patient satisfaction in a pediatric outpatient perioperative microsystem. A microsystem assessment reflected some challenges that staff were facing when communicating with their patients and family members. A patient satisfaction assessment revealed that the microsystem is scoring below the target goal of the 85th percentile.

Context: The microsystem being addressed by this quality improvement project is an outpatient perioperative …

Implementation Of Aidet, Commit To Sit, And Culturally-Competent Care In Pediatric Outpatient Setting, Melanie T. Wine

Master's Projects and Capstones

Problem: This quality improvement project implements AIDET, Commit to Sit, and culturally-competent care to improve patient satisfaction and communication between providers and patients in a diverse pediatric outpatient surgery microsystem setting. The microsystem’s NRC patient satisfaction scores from September to September is below the 85th percentile, and there is an immense desire to improve the overall scores by the staff. The detractors of the overall performance derived from the patients feeling that the staff needs to work together to meet patients’ needs, care providers not taking enough time to explain and listen, wanting to trust providers with care, procedures …

Improving Quality Of Communication In Pediatric Perioperative Outpatient Setting Using Aidet And Commit To Sit, Hyo Ryung Kim

Master's Projects and Capstones

Abstract

Problem: Effective and therapeutic communication in the health care setting is multidisciplinary,

complex, and has unique challenges for each microsystem. The perioperative setting is an

especially challenging environment for healthcare workers to provide therapeutic

communication, as uniquely high-risk and time-sensitive information must be disseminated in a

language that is understandable for the patient(Osborne-Smith & Kyle Hodgen, 2017). A

microsystem assessment of an outpatient pediatric perioperative setting reflected some of the

challenges the healthcare workers were facing when communicating with their patients and

family members. Upon evaluation of the monthly NRC (National Research Corporation) score

prior to implementation of two …

Implementing Aidet And Commit To Sit To Increase Patient Satisfaction In The Pediatric Outpatient Setting, Tiffany Nguyen

Master's Projects and Capstones

Problem: This quality improvement initiative aims to implement AIDET, Commit to Sit, and culturally competent care in a pediatric outpatient surgery clinic to increase patient satisfaction. The microsystem falls beneath the 85th percentile of patient satisfaction scores on their unit. They have a pre-intervention Net Promoter Score (NPS) of 80.7, indicating about 80% of patients were "promoters" and would likely return to the clinic, and 20% of patients were "detractors" and unlikely to return (Appendix F). "Detractors" were found in areas including patients trusting providers with care, care providers listening, care providers explaining things, and patients recommending the facility to …

Employee Engagement And Increasing Patient Satisfaction In The Pediatric Outpatient Setting, Carol Liang

Master's Projects and Capstones

Problem: An ambulatory pediatric surgical center in the San Francisco Bay Area has an organizational goal of reaching the 85th percentile in NRC patient satisfaction scores. The annual compliance report states the current score is at 80.7 as of September 2021. These NRC findings indicate several areas for improvement including: (1) trust providers with care, (2) care providers listened, (3) was told when could leave, (4) got help as soon as wanted, (5) care provider explain things, (6) NPS: facility would recommend, and (7) procedure began on time.

Context: Priorities include implementing strategies to increase employee engagement and patient satisfaction. …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Optimizing Pediatric Preoperative Experiences In The Mri, Ryan Jann

Master's Projects and Capstones

Problem: Over the past decade, the prevalence of children with sensory processing disorders has had a steep upward trend. Youth with hyposensitivity and hypersensitivity conditions often develop enhanced stress and anxiety during the pre-operative admission process in preparation for MRI procedures.

Context: Specialized interventions and accommodations are a necessity for this population however, no preventative measures have been utilized within the outpatient surgical center.

Interventions: Resources were created to better prepare patients and guardians for their MRI visits including: a Social Story Video, Picture & Activity Book, as well as an MRI Toolkit. In addition, a one …

Optimizing Pediatric Experiences In Mri, Ryan Jann

Master's Projects and Capstones

Problem: Over the past decade, the prevalence of children with sensory processing disorders has had a steep upward trend. Youth with hyposensitivity and hypersensitivity conditions often develop enhanced stress and anxiety during the pre-operative admission process in preparation for MRI procedures.

Context: Specialized interventions and accommodations are a necessity for this population however, no preventative measures have been utilized within the outpatient surgical center.

Interventions: Resources were created to better prepare patients and guardians for their MRI visits including: a Social Story Video, Picture & Activity Book, as well as an MRI Toolkit. In addition, a one hour staff inservice …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

Standardization Of Postoperative Care Guidelines For Pediatric Cleft Palate Patients, Julie Barragan, Macy Andrada, Mercedes Greenberg, Tatiana Grib, Samantha Gerber, Amanda Dailor

Master's Projects and Capstones

At a large, community-based pediatric hospital in Southern California, a quality improvement project commenced with a goal to improve patient outcomes by decreasing length of stay and pain levels, while increasing toleration of feeds. Implementing a standardized guideline would ensure safe practice across the continuum and allow providers to use a systematic tool for postoperative care, including nursing care interventions and medications. The Root-Cause-Analysis tool was used to assess the microsystem and determine the contributing factors to the identified problem. A SWOT analysis was then performed, followed by a plan to collect data from all pediatric cleft palate procedures performed …

Standardization Of Postoperative Care Guidelines For Pediatric Cleft Palate Patients, Amanda Dailor, Macy Therese G. Andrada, Julie C. Barragan, Samantha T. Gerber, Mercedes S. Greenberg, Tatyana Grib

Master's Projects and Capstones

At a large, community-based pediatric hospital in Southern California, a quality improvement project commenced with a goal to improve patient outcomes by decreasing length of stay and pain levels, while increasing toleration of feeds. Implementing a standardized guideline would ensure safe practice across the continuum and allow providers to use a systematic tool for postoperative care, including nursing care interventions and medications. The Root-Cause-Analysis tool was used to assess the microsystem and determine the contributing factors to the identified problem. A SWOT analysis was then performed, followed by a plan to collect data from all pediatric cleft palate procedures performed …

Implementation Of A Pediatric Post-Operative Hand-Off Tool: A Patient Safety Project, Kaye Remo

Master's Projects and Capstones

Abstract

Problem: The clinical nurse leader (CNL) performed a microsystem assessment using the Dartmouth assessment tool to evaluate the microsystem’s readiness to provide safe care for pediatric post-operative cardiovascular patients. The microsystem is a 12-bed unit caring for critically ill pediatric patients requiring intensive monitoring and therapy. The microsystem’s interdisciplinary team is comprised of medical doctors, nurses, respiratory therapists, social workers, nutritionists, child life specialists, and pharmacists. During assessment and gap analysis, the CNL identified gaps in nursing knowledge and skills to deliver safe care for this patient population during the immediate post-operative phase of recovery. There is a …

Educational Prevention Program Of Surgical Site Infections (Ssi), Carena Leung

Master's Projects and Capstones

Surgical site infections (SSI) cause negative health care effects to patients and hospitals. SSI is one of the most common types of healthcare-associated infections (HAI) accounting for 31% among hospitalized patients (Centers for Disease Control and Prevention [CDC], 2012). It is associated with prolonged length of stays (LOS), higher morbidity and mortality, and increased healthcare costs. The purpose of this quality improvement project is to decrease SSI rates by enhancing patient education and engagement in preoperative care and hygiene before surgery. In a metropolitan pediatric hospital, a microsystem analysis of the preoperative unit was conducted before generating the SSI Prevention …

Admission Criteria For The Pediatric Acute Care Unit To Reduce Length Of Stay In The Emergency Department, Peter G. Campbell

Master's Projects and Capstones

Abstract

The primary objective as outlined in this prospectus is to develop pediatric admission criteria to reduce length of stay (LOS) in the emergency department for patients being admitted to the pediatric acute care unit. The pediatric acute care unit is a 25-bed licensed bed at a tertiary hospital in San Francisco serving patients from 1 day to 21 years of age. Methods included both qualitative and quantitative data to determine relevance of quality improvement project related to LOS, patient safety, patient satisfaction, and nurse to physician communication. Data collected indicated that average LOS in the ED was significantly higher …