Pediatric Nursing Commons^™

Preventing Patient Deterioration By Creating A Reassessment And Escalation Process For The Ed Waiting Room, Virginia Elizondo, Amanda Caipo, Cory Carlos

2024

EBP

Practice Problem:

Long wait times in the emergency department (ED) waiting room significantly impact patient outcomes. Waiting times increase the risk of deterioration, the number of patients leaving without being seen (LWBS), and lead to dissatisfaction with care. 1,2,3 The urgency and significance of early recognition of abnormal vital signs and the appropriate responses cannot be overstated.3 Current ED practices lack a structured process for regular reassessment and escalation in the waiting room.

Literature/Evidence:

A comprehensive literature search was conducted, utilizing EBSCOhost, PubMed, and Ovid. The literature supports continuous reassessment to enhance safety and satisfaction in the waiting room. …

Closing The Gap For Psychiatric Resource Nurse Orientation, Kelly Bonilla, Madison Mcqueen, Cornelius Metili, Annietra Udoh

2024

EBP

A nursing orientation program can positively impact new nurses that are joining the organization (Nobles, 2022). The implementation of a new psychiatric nurse role within the hospital system developed the necessity for an orientation program that would provide quality, safe, and positive outcomes. Psychiatric Resource Nurse roles were created within the organization to provide support and education to staff regarding patients with behavioral or mental health needs. An orientation program was created to support the specific role of the Psychiatric Resource Nurse role to fulfill the need for patient centered care.

A need for an orientation program for Psychiatric …

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 …

Emergent Medication Labels In The Pediatric Intensive Care Unit, Christine Hajovsky

2024

EBP

PICOT: In emergent situations in a pediatric ICU requiring nurses to draw up emergent doses of medication, is it safer to use color coded, pre-printed fill-in-the-dose medication labels vs. our current practice of white handwritten labels? In our pediatric ICUs, nurses use handwritten labels for emergent drug administration, which can lead to illegibility and increased risks of adverse events. This project assessed whether pre-printed, color-coded, fill-in-the-blank labels enhance nurse confidence and nurses’ perceptions of patient safety during emergent drug procedures.

Literature/Evidence: Search strategy in the CINAHL (EBSCOhost) database used MeSH headings and keywords, including English articles published within the …

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 …

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 …

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 …

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 …

Midline Catheter Implementation: Expanding Vascular Access Options In A Level Iv Nicu To Decrease Vascular Injury, Kymeyone Lanehart, Rebecca Palmer, Jeri Tidwell, Sushmita Yallapragada, Courtney Campbell, Lebanon David, Katie Doerge

2024

EBP

Background: PIV catheters are the most placed device in the NICU requiring frequent attempts, with a brief duration due to complications which indicate removal before completion of treatment. PIVs used for treatment have a patient safety risk of PIVIE; the severity can be mild, moderate, or severe depending on the swelling and tissue damage. PIVIE rates are one of the patient quality outcomes and are increasing in the NICU. Considering the increased risks of long-term consequences from tissue injury associated with PIVs, MCD may improve quality and patient outcomes.

Problem: PICOT question: (P)For eligible neonates in a level IV …

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 …

The Use Of Storybook Implementation For Patient Education Tools, Jennifer Brown

2024

EBP

Practice Problem: For children with growth delay and their parents, how can implementation of storybooks with images, compared to disease specific handouts, increase understanding and knowledge of the disease and treatment as well as decrease anxiety? It was identified that parents and patients coming to the Endocrine Clinic for growth delay, did not always fully understand the reasons for the growth evaluation or causes of growth delay.

Literature/Evidence: Literature was retrieved, appraised, and synthesized to define best practices to create storybooks. Best practices included, using storybooks that include images, co-creation with intended audience. Using storybooks for patient education …

Breathe In Breathe Out...Now What? Improved Pediatric Asthma Outcomes Through Improved Inhaler Technique, Gina M. Nickels-Nelson

DNP Final Reports

Asthma is a chronic disease affecting families in the United States; especially pediatric patients aged 5-18. In Pittsfield, Massachusetts the local prevalence of asthma is 14.4% versus 12.1% statewide and 8.4% nationally. These patients miss school days thus causing parental workday loss. In 2016, 14.4 million missed school days occurred due to asthma (Alexander et al., 2016). Unexpected clinic visits, as well as emergency room visits due to asthma, can contribute to rising healthcare costs both locally and nationally. Unexpected asthma visits are a leading reason for visits to this author’s clinic.

Asthma is treated with inhaled medications through a …