Pediatric Nursing Commons^™

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 …

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 …

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 …

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 …

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.