Pediatric Nursing Commons^™

Precision In Practice: Subject Matter Expert Integration To Support Excellence In Population-Specific Documentation, Sara Pump, Lauren Spain, Virginia Kasenic, Meagan Talent, Alivia Stewart, Carrin Shaw, Chad Gautreaux, Dori Cousin, Ronesea Allen, Jonathan Rowe

2025

QUALITY IMPROVEMENT

Background: An initial internal pilot audit of patient charts, performed by the Plano psych RN team within the Emergency department in November 2024 revealed significant gaps in documentation compliance for behavioral health patients. Many areas of required charting were found to be incomplete, partially completed, or inconsistently documented across disparate sections of the electronic medical record. This fragmentation not only impedes the ability to efficiently locate critical information but also fails to meet the documentation standards outlined in Children’s Health organizational policies. These deficiencies pose risks to continuity of care, clinical decision-making, regulatory compliance, patient and staff …

Community Health Worker (Chw) Initiative To Address Low Acuity Pediatric Emergency Department Utilization, Jana Neal, Danielle Hayle

2025

INNOVATION & LEADERSHIP

Background: A Medicaid payor-funded collaborative was initiated in partnership with Children’s Health System of Texas to reduce low-acuity emergency department (ED) visits—defined as triage levels 4 or 5—among Medicaid patients, who account for the largest share of ED use, with nearly 50% of visits considered low acuity. To address this, certified Community Health Workers (CHWs) were deployed in the Dallas and Plano EDs to engage eligible caregivers. CHWs provide education on insurance benefits, assist with establishing primary care provider (PCP) relationships, and promote appropriate healthcare utilization. They also work to identify barriers preventing the use of …

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 …

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. …

Addressing Gaps In Breastfeeding Education Among Pediatric Nurses, Bethany Stokes, Shannon Abbott

2025

INNOVATION & LEADERSHIP

Background: Breastfeeding is a modifiable health-related behavior widely recognized for its short-and long-term health benefits (Standish, 2022). The American Academy of Pediatrics (AAP) recommends breastfeeding for at least two years or as long as mutually desired (Meek, 2022). Despite this guidance, pediatric nurses outside of neonatal units often receive minimal breastfeeding education, creating a gap in care for breastfeeding families admitted to other areas of the hospital. This project aimed to assess the breastfeeding knowledge needs of pediatric nursing staff across two hospital campuses. A lack of standardized breastfeeding education was identified. To quantify this gap, …

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 …

Defying Gravity: Fall Prevention Quality Improvement Project, Taylor Ryan, Madeline Bartush

2025

QUALITY IMPROVEMENT

Background: In March of 2025, an increase in inpatient falls led to a hospital-wide containment period. In response, a fall prevention nurse role was created to identify gaps, provide targeted education and lead improvement efforts. Initial surveys of 101 nurses revealed that while 91% reported using the teach-back method of education as part of their practice with patients and families, only 36.6% reported they always use this method, and just 19.8% reported feeling very comfortable doing so. Direct observations revealed families unable to teach-back fall prevention strategies despite nurse documentation of education completion. A gap analysis also …

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 …

Embedding Health Literacy Practices Through A Champion Program: A Strategic Expansion, Diana Montoya, Cameron Stine, Kelli Williams, Leslie Moore, Carol Howe

2025

QUALITY IMPROVEMENT

Background: The importance of becoming a Health-Literate Organization gained momentum in our pediatric organization, driven by the Healthy People 2030 initiative, Social Determinants of Health Screening and organizational strategies focused on enhancing patient outcomes. The Health Literacy Champion Program (HLCP) was expanded in 2024-2025 to embed subject matter experts into inpatient care units, thereby infusing health literacy best practices to enhance patient communication.

Methodology: The initial phase involved aligning the HLCP interventions with organizational strategic priorities and establishing shared goals among stakeholders. The program leads identified key priority indicators and metrics to evaluate the program. The …

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

2025

EBP

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 reducing pain and extubation time.

PICO: In pediatric neurosurgical bedside nurses, does education on lavender essential oil, compared to no education, improve knowledge, confidence and intent to integrate it as a complementary …

Enhancing Sepsis Education And Staff Engagement Through Gamification: A Qi Project Using Escape Rooms In A Pediatric Ed, Angie Rodick, Nicole Bizzack, Virginia Elizondo

2025

QUALITY IMPROVEMENT

Background: Sepsis is a leading cause of morbidity and mortality in hospitals, making early recognition and intervention critical. Traditional education methods often fail to ensure retention of essential knowledge, leaving staff underprepared. To address this gap, a Quality Improvement (QI) project was launched in the Emergency Department (ED) of an urban Level 1 Pediatric Trauma Center. Nursing leaders identified the need for engaging, sustainable education and collaborated with educators to design an escape room training activity. The aim was to evaluate whether gamification could increase engagement, improve understanding of a new sepsis screening tool, and enhance overall …

Got Ebm? Increasing Scanning Compliance With Nursing Led Initiatives, Angela Randles, Rose Dela Cruz, Lily Lawrence

2025

QUALITY IMPROVEMENT

Background: This General Pediatrics unit had just 78% staff compliance in scanning Expressed Breast Milk (EBM) in January 2025, a crucial gap in safe handling and documentation. The risk to patient safety prompted a targeted quality improvement project to improve compliance and workflow. A thorough process mapping exercise and pre-survey bedside nurses helped understand noncompliance. The aim of this project is to identify ways to increase compliance with EBM scanning by understanding the root cause of non-compliance and identifying nurse led initiatives to improve patient outcomes.

Methodology: In April 2025, improper reporting of breast milk pumping …

Hemodynamic Effects Of Bathing In The Pediatric Cardiac Intensive Care Unit, Andrea Torzone, Kuroush , Nezafati, Donghan Yang, Yang Xie, Julia Gerstmann, Joshua Wolovits, Javier J. Lasa

2025

RESEARCH

Purpose: Neonates and infants in a pediatric cardiac intensive care unit (CICU) are particularly susceptible to hemodynamic consequences of environmental exposure, agitation, and increased systemic vascular resistance associated with bathing. Clinical observations have generated significant debate regarding the physiologic changes that may occur related to patient bathing, leading to modified care practices surrounding routine bathing in the CICU. Due to the paucity of evidence surrounding physiologic changes associated with bathing in the CICU, we aim to describe the vital sign and hemodynamic profile of this high risk neonatal and infant population undergoing routine bathing in a pediatric CICU. …

Investigating The Mediated Relationship Of Stress Between Organizational Culture And Emotional Labor In Nurses, Elaine Beardsley

2025

RESEARCH

Purpose: Pediatric critical care nurses provide essential care to severely ill or injured children, yet high stress can impact the nurse’s well-being. Although it is known that exposure to traumatic events can contribute to secondary trauma for the nurse, it is becoming more widely understood how the work environment is a contributing factor on how stress is experienced by the nurse. It is also known that emotion regulation strategies to meet organizational display rules, called emotional labor, can increase or decrease felt stress, but it is not known if this is impacted by organizational culture types. The purpose …

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 …

Oh, My Baby! A Qi Initiative To Improve Neonatal Thermoregulation Compliance Via Nurse-Led Training And Development Of A Resource Binder, Gene Mae Estoya, Rose Dela Cruz, Deb Lathrop

2025

QUALITY IMPROVEMENT

Background: Plan- Problem: Decrease in Neonatal Thermoregulation Compliance (0% in January 2024 to 10-33% in April to December 2024) and Staff comfort level (1- 5 Level) in caring for patients with Neonatal thermoregulation issues and equipment use. Background: In December 2024, the capacity of this pediatric hospital expanded from 72 to 212 beds with more neonate admissions. For effective compliance, the executive leaders decided in January 2025 to train the same group of nurses and cohort neonate admission in a single acute care unit. Goal: Increase in Neonatal Thermoregulation Compliance (above 90% goal) and Staff comfort level …

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. …

Pediatric Nurses’ Perceptions Of The Quality And Usefulness Of Clinical Summaries: Surgeons Versus Generative Ai, Lindsey Patton, Nikki Marshall

2025

RESEARCH

Purpose: The purpose of this study was to compare the performance of AI-generated summaries and physician-written summaries in the pediatric surgery population from nurses’ perspectives.

Methods: The study occurred at a large, academic-affiliated pediatric healthcare system designated as a Level 1 Children’s Surgery Center. Three clinical nurses independently reviewed and compared AI-generated summaries to physician written summaries for patients admitted to the surgery service line utilizing the validated Physician Documentation Quality Instrument (PDQI-9) tool. The nurse evaluation team met prior to scoring to ensure consistency of interpretation and scoring of PDQI-9 domains.

Results: AI-generated and physician …

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 …