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Journal Cover Pediatric Quality & Safety
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  This is an Open Access Journal Open Access journal
   ISSN (Online) 2472-0054
   Published by LWW Wolters Kluwer Homepage  [290 journals]
  • Reducing Blood Testing in Pediatric Patients after Heart Surgery: Proving
           Sustainability

    • Authors: Bodily; Stephanie A.; Delgado-Corcoran, Claudia; Wolpert, Katherine; Lucas, Kathryn; Presson, Angela P.; Bratton, Susan L.
      Abstract: Introduction: Frequent blood testing increases risk of iatrogenic anemia, infection, and blood transfusion. This study describes 3 years of sustained blood testing reduction from a quality improvement (QI) initiative which began in 2011.Methods: The cohort consisted of postop children whose surgery had a Risk Adjustment for Congenital Heart Surgery (RACHS) classification consecutively admitted to a tertiary Cardiac Intensive Care Unit. Data were collected for a 2010 preintervention, 2011 intervention, and 2012–13 postintervention periods, tabulating common laboratory studies per patient (labs/pt) and adjusted for length of stay (labs/pt/d). The QI initiative eliminated standing laboratory orders and changed to testing based on individualized patient condition. Adverse outcomes data were collected including reintubation, central line–associated bloodstream infections and hospital mortality. Safety was measured by the number of abnormal laboratory studies, electrolyte replacements, code blue events, and arrhythmias.Results: A total of 1169 patients were enrolled (303 preintervention, 315 intervention, and 551 postintervention periods). The number of labs/pt after the QI intervention was sustained (38 vs. 23 vs. 23) and labs/pt/d (15 vs. 11 vs. 10). The postintervention group had greater surgical complexity (P = 0.002), were significantly younger (P = 0.002) and smaller (P = 0.008). Children with RACHS 3–4 classification in the postintervention phase had significant increased risk of reintubation and arrhythmias.Conclusions: After the implementation of a QI initiative, blood testing was reduced and sustained in young, complex children after heart surgery. This may or may not have contributed to greater reintubation and arrhythmias among patients with RACHS 3–4 category procedures.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Published online December 7, 2017Presented as Poster Board at Cardiology 2015 in 18th Annual Update of Pediatric and Congenital Cardiovascular Diseases, February 11–15, 2015, Scottsdale, Ariz.Supplemental digital content is available for this article. Clickable URL citations appear in the text.To Cite: Bodily SA, Delgado-Corcoran C, Wolpert K, Lucas K, Presson AP, Bratton SL. Reducing Blood Testing in Pediatric Patients after Heart Surgery: Proving Sustainability. Pediatr Qual Saf 2017;2:e047.Received for publication November 3, 2016; Accepted October 21, 2017.*Corresponding Author: Address: Stephanie Bodily, MSN, NP, Department of Pediatric Critical Care, Primary Children’s Hospital, 100 N. Mario Capecchi Dr, Salt Lake City, UT 84113, PH: 801-662-2445; Fax: 801-662-2469 Email: stephanie.bodily@imail.orgCopyright © 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Thu, 07 Dec 2017 00:00:00 GMT-
       
  • Increasing Patient Portal Activation in a Pediatric Subspecialty Clinic

    • Authors: Ratliff-Schaub; Karen; Valleru, Jahnavi
      Abstract: Background: Online patient portals are not widely used, despite their advantages for efficient communication, especially for patients with chronic conditions. A hospital-based group practice of Developmental-Behavioral Pediatricians initiated this quality improvement (QI) project with a goal to increase the percentage of patients with an active MyChart (Epic Systems Corporation’s patient portal) account and ultimately improve efficiency of communication between families and clinical staff.Methods: Using QI methodology, we identified staff commitment, workflow issues, and family awareness as gaps and implemented progressive Plan, Do, Study, Act cycles aimed at developing standard processes for activating families on MyChart. We tracked our project measures with statistical process control methodology and sustained our progress with improving awareness and regular feedback.Results: Patient portal activations increased from 1.8% to 30% in a 6-month time period. Highly successful interventions included development and implementation of a standard process for activation, staff education to ensure comfort and commitment, having families opt out instead of opt in, and completed activation of accounts before families leaving clinic.Conclusions: Patient portal activation can be significantly increased through systematic application of QI methodology to address staff training and workflow in a busy subspecialty clinic. Engagement of operations staff and completion of the activation process while the family is still in clinic seemed to be effective in getting families activated in MyChart. It is possible to improve patient portal activation with minimal impact to workflow.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Published online December 5, 2017To cite: Ratliff-Schaub K, Valleru J. Increasing Patient Portal Activation in a Pediatric Subspecialty Clinic. Pediatr Qual Saf 2017;2:e049.Received for publication May 12, 2017; Accepted November 2, 2017.*Corresponding author. Address: Karen Ratliff-Schaub, MD, MBOE, Developmental Behavioral Pediatrics, 700 Children’s Drive, Columbus, OH 43205 PH: 614-722-2460; FAX: 614-722-4451, Email: Karen.Ratliff-Schaub@nationwidechildrens.orgCopyright © 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Thu, 07 Dec 2017 00:00:00 GMT-
       
  • Improving Human Papilloma Virus Vaccination Rates: Quality Improvement

    • Authors: Bowden; Michelle; Yaun, Jason; Bagga, Bindiya
      Abstract: Background: Human papilloma virus (HPV) is a sexually transmitted infection with a national prevalence of greater than 70 million. Most infections are among persons 15–24 years of age. The HPV vaccine has nearly 100% efficacy when administered before natural exposure. However, national vaccination rates remain less than 50%. Our objective was to improve the rate of initiation of the HPV vaccination series in a resident teaching practice.Methods: We used the Plan Do Study Act methodology for quality improvement. Eligible patients included children 9 through 13 years of age who presented to a general pediatric clinic. We established baseline data by reviewing HPV immunization rates taken from a convenience sample of ≤20 patients per month over 7 months. A key driver diagram guided interventions including resident communication, nursing staff education, family knowledge, and an electronic medical record prompt beginning at age 9. Using standard run chart rules, we plotted monthly postintervention vaccination rates over 7 months of data collection.Results: Baseline data included 136 patients age 9–13. Run chart monitoring revealed an increase in our HPV vaccination rate from 53% at baseline to 62% by October 2015. Additionally, we observed a statistically significant increase in mean vaccination rates from 50% to 69% (odds ratio 2.071; P = 0.0042). We noted an increase in vaccination rates after resident education initiatives and after implementation of an electronic medical record prompt.Conclusions: Simple and practical interventions involving residents led to a marked increase in HPV vaccination in our patient population.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Published online December 4, 2017To Cite: Bowden M, Yaun J, Bagga B. Improving Human Papilloma Virus Vaccination Rates: Quality Improvement. Pediatr Qual Saf 2017;2:e048.Received for publication March 29, 2017; Accepted October 15, 2017.*Corresponding author. Address: Michelle Bowden, MD, Le Bonheur Children’s Hospital, 49 N. Dunlap, Memphis, TN 38103, PH: 901-287-6292; Fax: 901-287-5387, E-mail: mroark3@uthsc.eduCopyright © 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Thu, 07 Dec 2017 00:00:00 GMT-
       
  • Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality
           Improvement Approach to Antimicrobial Stewardship

    • Authors: Quintos-Alagheband; Maria Lyn; Noyola, Estela; Makvana, Sejal; El-Chaar, Gladys; Wang, Shan; Calixte, Rose; Krilov, Leonard R.
      Abstract: Objective: The increased incidence of multidrug-resistant organisms is associated with increased morbidity, mortality, hospital length of stay, and cost. Estimates show that up to 50% of antimicrobial use is inappropriate. This initiative focuses on inappropriate use of antibiotics in respiratory syncytial virus (RSV) infections. This virus is the most common cause of bronchiolitis during childhood.Methods: Baseline data from the 2011–2012 RSV season showed that 56.2% of our RSV-positive patients received antibiotics. To decrease inappropriate antibiotic use in RSV infections, we established an antimicrobial stewardship program (ASP). This process improvement initiative aimed to decrease exposure to antibiotics and days of antibiotic therapy per 1,000 patient days (DOT/1000PD) in hospitalized RSV-positive patients by 25%. Key drivers included building health-care knowledge, proactive interventions using prospective audit and feedback, emergency department engagement, and performance dashboards.Results: We included a total of 290 children in the final analysis. After full implementation of the ASP, there was a significant reduction of antibiotic exposure from 56.2% to 30.9% (P < 0.001), an absolute reduction of 25% and a relative reduction of 45%. There was also a significant decrease in DOT/1000PD from 432.7 to 268.1 days (P = 0.017). This change represents a reduction of 164.6 DOT/1000PD from baseline after full ASP implementation.Conclusion: Despite the lack of a unified hospitalist group in our institution, we were successful in reducing inappropriate antibiotic use by focusing on standardizing care among different private pediatricians in the community. A multifaceted strategy and well-designed quality improvement methodology led to a sustained reduction in antibiotic use.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Published online December 1, 2017Supplemental digital content is available for this article. Clickable URL citations appear in the text.What’s known on this subject: 50% of antimicrobial utilization is inappropriate, which includes misuse in viral infections. RSV is the most common cause of pediatric bronchiolitis. Per AAP guidelines, antibiotics should only be used if there are specific indications of coexisting bacterial infection in RSV.What this study adds: Utilization of antibiotics in RSV is common, despite published guidelines. Implementation of ASP through ramping PDSA cycles led to a safe reduction in antibiotic utilization in RSV. This article demonstrates that by narrowing the scope of the project to RSV initially, foundation for a successful and sustained formal ASP is possible.To Cite: Quintos-Alagheband ML, Noyola E, Makvana S, El-Chaar G, Wang S, Calixte S, Krilov LR. Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality Improvement Approach to Antimicrobial Stewardship. Pediatr Qual Saf 2017;2:e046*Corresponding author. Address: Maria Lyn Quintos-Alagheband, MD, Department of Pediatrics, Children’s Medical Center, NYU Winthrop University Hospital, 259 First Street, Mineola, NY 11501, PH: 516 663 6920; Fax: 516 663 8955, Email: lquintos@nyuwinthrop.orgReceived for publication January 19, 2017; Accepted October 15, 2017.Copyright © 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Thu, 07 Dec 2017 00:00:00 GMT-
       
  • WE CARE 4 KIDS: Use of a Rounding Tool in the Pediatric Intensive Care
           Unit.

    • Authors: Ganesan; Rani; Rajakumar, Priya; Fogg, Louis; Silvestri, Jean; Kane, Jason M.
      Abstract: Objective: To implement a daily rounding tool in a pediatric intensive care unit (PICU) to improve the discussion performance of identified clinical elements. We hypothesized that a semi-structured rounding tool created by a multidisciplinary team would be successfully implemented and sustained in the PICU.Patients and Methods: A pre-post interventional study was conducted in a multidisciplinary medical-surgical PICU. Baseline data collection of undisclosed clinical elements was performed by covert observers, which resulted in the development of a comprehensive, nurse-driven rounding checklist. Frequencies of pre- and postintervention metrics were assessed after implementation, and sustainability was assessed at 5 years.Results: Six months after implementation, 70% (7/10) of checklist elements demonstrated significant improvement. Five years after implementation, 172 of a possible 222 (74%) checklists were collected. Eighty percentage (8/10) of the measures sustained discussion frequency after 5 years of use. Nursing presence significantly improved at year 5 compared with the preimplementation period. Nursing satisfaction surveys distributed at year 5 showed that the rounding tool was useful and nurses were confident in understanding care plans at the end of rounds. Ninety-eight percentage of checklists revealed discrete transcription of qualitative daily goals.Conclusions: A semi-structured rounding tool created by a multidisciplinary team was successfully implemented, and performance was sustained at 5 years. This initiative led to improved bedside nursing presence during patient care rounds.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Copyright (C) 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 17 Nov 2017 00:00:00 GMT-
       
  • SAFEST: Use of a Rubric to Teach Safety Reporting to Pediatric House
           Officers.

    • Authors: Keefer; Patricia; Helms, Lauren; Warrier, Kavita; Vredeveld, Jennifer; Burrows, Heather; Orringer, Kelly
      Abstract: Background: Among the many modalities of error detection in academic pediatric hospitals, patient safety reporting is an important component, particularly for unexpected events. Residents recognize the importance of reporting but cite some barriers to doing so. A rubric was developed to guide resident reporting and streamline information gathering in patient safety reports. The rubric used the acronym SAFEST as a reminder to include 6 key elements: 1. Staff involved in the incident. 2. Actual event description. 3. Follow-up initiated. 4. Effect on patient. 5. Standard of care described. 6. To-do/suggestions for improvement.Objectives: This study was designed to determine if the addition of this educational rubric into a standard quality improvement curriculum improves the consistency of information documented in patient safety reports as a subset of a larger quality improvement project aimed at improving safety reporting.Methods: A team of faculty members analyzed individual resident error reports for adherence to the 6 tenets of the SAFEST mnemonic.Results: From April to October of 2014, 2015, and 2016, a convenience sample of 131, 110, and 132 reports, respectively, were extracted and analyzed. For the rates of reporting "staff involved" and "standard of care," the differences over time were significant, both with P values < 0.001. After training, residents were 2.2 times more likely to report on the "staff involved" in the error and 1.8 times more likely to report the "standard of care."Discussion: These results describe successful education on a rubric designed to improve the content of patient safety reports.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Copyright (C) 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Wed, 08 Nov 2017 00:00:00 GMT-
       
  • Implementation of an Outcome Measure in Pediatric Behavioral Health: A
           Process Improvement Initiative.

    • Authors: Butz; Catherine; Valleru, Jahnavi; Castillo, Anthony; Butter, Eric M.
      Abstract: Introduction: Efforts to monitor outcomes in pediatric behavioral health are becoming a quality, financial, and regulatory imperative. The implementation of a broad-based measure to assess patient functioning at the start of pediatric psychology services, as well as at subsequent visits, has not been demonstrated. This article describes the systematic implementation of a measure of health-related quality of life (HRQOL) to assess functional impairment across an entire clinic population using quality improvement science and methodologies.Methods: The Pediatric Quality of Life Inventory Generic Core 4.0 (PedsQL) was administered at initial and subsequent visits for all patients seeking treatment at a large, tertiary care pediatric psychology clinic in an academic pediatric medical center (Nationwide Children's Hospital, Columbus, Ohio). The goal of this project was to design a process change to support a 90% completion rate of this measurement tool by all clinicians.Results: Within 16 months, the completion rate of the PedsQL increased from a baseline of 39% to the identified goal of 90%. This process change was within control limits (over 80%) for over 12 months.Conclusion: This study demonstrates the implementation of a systematic process for collection of outcome measures in a pediatric behavioral health care setting. Successful administration of an outcome measure at multiple time points during the care of children and adolescents in a large psychology clinic can allow for quantitative assessment of treatment progress and identify a pathway for administration of additional measures.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Copyright (C) 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 20 Oct 2017 00:00:00 GMT-
       
 
 
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