Pediatric Nursing Commons^™

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

Administration Of Naxitamab In High-Risk Neuroblastoma Patients To Manage Adverse Reactions, Lauren Brown, Nikki Marshall, Diamond Wright

2024

INNOVATION

Neuroblastoma is the most common extracranial solid tumor in children with approximately 700 cases diagnosed yearly. Children treated with traditional therapies experience a recurrence rate over 50%, increasing the chances of poor clinical outcomes. Integrating anti-disialoganglioside-2 (GD2) monoclonal antibodies like Naxitimab have significantly improved patient outcomes. However, there is no standardized process between pediatric institutions to administer the drug while managing adverse drug reactions. Naxitimab received accelerated approval from the US Food and Drug Administration for children over age one with relapsed/refractory high-risk Neuroblastoma. Approximately half of the patients receiving Naxitimab encountered acute adverse events (AEs). Different institutions manage …

Exploration Of Decedent Care Practices Among Pediatric Hospitals In The United States, Mayra Garcia, Kim Mccarthy, Kiele Samuel, Kathleen Ellis, Lisa Jones, Joe Don Cavender, Ryan Campbell, Chelsea Reynolds, Jesse Leos, Pauline Chen

2024

RESEARCH

Purpose:
Pediatric deaths in hospitals profoundly affect both staff and families, underscoring the need for clear decedent care processes and specialized training to navigate emotional and procedural challenges. Cooling rooms and reflection spaces, which provide families with more time for memory-making and help ease the emotional burden of separation, have been shown to offer significant support. However, these facilities are less common in the U.S., highlighting the necessity for further research in this area. The purpose of this study was to explore the decedent care (DC) practices in pediatric hospitals in the United States.

Methods:
Participants were recruited via …

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 …

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 …

We All Fall Down - Fall Prevention On An Inpatient Pediatric Unit, Jennifer Watt

EBP Fellowship

No abstract provided.

Using Storybooks With Images To Improve Diagnosis Understanding And Decrease Anxiety Among Patients And Parents, Jennifer Brown

EBP Fellowship

No abstract provided.

Training Nurses To Practice Within A Wellness Model - A Rn’S Role In Using Social Determinants Of Health To Improve Patient Outcomes, Brittney Saldierna

EBP Fellowship

No abstract provided.

Remain Calm - Decreasing Perceived Stress Levels Through Implementation Of A Quiet Room, Chelsea Reynolds

EBP Fellowship

No abstract provided.

Reduce Unplanned Extubations In Seven Questions Or Less, Leslie Huntington

EBP Fellowship

No abstract provided.

Preventing Patient Deterioration And Increasing Family Satisfaction By Creating A Reassessment And Escalation Process For The Emergency Department Waiting Room, Virginia Elizondo

EBP Fellowship

No abstract provided.

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

EBP Fellowship

No abstract provided.

Implementation Of A Standardized Pre- Procedure Pain Management Agents, Dhanu N. Bhandari

EBP Fellowship

No abstract provided.

Identify Best Preceptor Strategies For New Graduate Pediatric Float Pool Nurses With Learning Disabilities, Janna Berg

EBP Fellowship

No abstract provided.

From Hospital To Home - Health Literacy Champions Empowering Caregivers Of Medically Complex Children, Sarah Clark

EBP Fellowship

No abstract provided.

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

EBP Fellowship

No abstract provided.

Empowering Unit Council Leaders To Expand Professional Governance Engagement - An Ebp Project, Misty Daugherty

EBP Fellowship

No abstract provided.

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

EBP Fellowship

No abstract provided.