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Pediatric Quality & Safety
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2472-0054
Published by LWW Wolters Kluwer Homepage  [285 journals]
  • Impact of a Hands-free Wireless Communication Device on Communication and
           Clinical Outcomes in a Pediatric Intensive Care

    • Authors: Cooney; Hannah J.; Banbury, Hannah E.; Plunkett, Adrian C.
      Abstract: Introduction: Timely communication is essential in the intensive care environment. Delays may occur if communication relies on identification of individuals through line of sight, or use of telephones and pagers. We measured communication delays, staff perceptions, and clinical outcomes before and after implementation of a hands-free wireless communication device (HWCD) in a pediatric intensive care unit (PICU).Methods: Single-center study comprising 3 components: observational study of verbal communication among PICU staff; staff survey regarding perceptions of communication delays; analysis of clinical data (length of stay, risk adjusted mortality, emergency events). All components were conducted before and after implementation of the HWCD.Results: Four hundred sixteen hours of staff working time were observed (210 pre- and 206 postimplementation). These data showed significant reduction in communication delays—most notably among roaming staff [median time to response to verbal queries before and after implementation 120 seconds (interquartile range, 6–255) and 9 seconds (interquartile range, 7–30), respectively: P < 0.001]. The results of the staff survey showed significant improvements in staff perceptions of communication delays in all roaming staff groups utilizing the HWCD. The survey response rate was 205/361: 56.8%. There were no differences in clinical outcomes from the routinely collected clinical data. There was a significant reduction in emergency event rate—emergency summoning of assistance to bedside (per 100 bed-days)—before and after implementation, 2.17 and 1.69, respectively: rate ratio = 0.78 (95% confidence interval, 0.63–0.95; P < 0.05).Conclusions: Implementation of a HWCD was associated with significant reduction in communication delays among roaming staff members in PICU.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-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 April 10, 2018.Preliminary data from this study was presented (by A.P., corresponding author) at the Pediatric Intensive Care Society (United Kingdom) annual meeting in Birmingham, United Kingdom, 2016.Supported by a research grant of £8,000 for research nurse salaries during the time and motion study was provided by Vocera Communications, San Jose, Calif. Vocera the company were not involved in the study design, were not party to the results of the study until the study was completed, and did not contribute to the writing or authorship of the article.To Cite: Cooney HJ, Banbury HE, Plunkett AC. Impact of a Hands-free Wireless Communication Device on Verbal Communication and Clinical Outcomes in Pediatric Intensive Care: An Observational Study in a Single Center. Pediatr Qual Saf 2018;3:074.Adrian C. Plunkett, MBBS Pediatric Intensive Care Unit Birmingham Women’s and Children’s NHS Foundation Trust Steelhouse Lane Birmingham B4 6NH, United Kingdom, E-mail: adrianplunkett@nhs.netReceived for publication September 19, 2017; Accepted February 28, 2018.Copyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 00:00:00 GMT-
       
  • 10,000 Good Catches: Increasing Safety Event Reporting In A Pediatric
           Health Care System

    • Authors: Crandall; Kristen M.; Almuhanna, Ahmed; Cady, Rebecca; Fahey, Lisbeth; Floyd, Tara Taylor; Freiburg, Debbie; Hilliard, Mary Anne; Kalburgi, Sonal; Khan, Nafis I.; Patrick, DiAnthia; Pavuluri, Padmaja; Potter, Kelvin; Scafidi, Lisa; Sigman, Laura; Shah, Rahul K.
      Abstract: Background: In 2014, Children’s National Health System’s executive leadership team challenged the organization to double the number of voluntary safety event reports submitted over a 3-year period; the intent was to increase reliability and promote our safety culture by hardwiring employee event reporting.Methods: Following a Donabedian quality improvement framework of structure, process, and outcomes, a multidisciplinary team was formed and areas for improvement were identified. The multidisciplinary team focused on 3 major areas: the perceived ease of reporting (ie, how difficult is it to report an event'); the perceived safety of reporting (ie, will I get in trouble for reporting'); and the perceived impact of reporting (ie, does my report make a difference') technology, making it safe to report, and how reporting makes a difference. The team developed a key driver diagram and implemented interventions designed to impact the key drivers and to increase reporting.Results: Children’s National increased the number of safety event reports from 4,668 in fiscal year 2014 to 10,971 safety event reports in fiscal year 2017. Median event report submission time was decreased by nearly 30%, anonymous reporting decreased by 69%, the number of submitting departments increased by 94%, and the number of reports submitted as “other” decreased from a baseline of 6% to 2%.Conclusions: Children’s National Health System’s focus on increasing safety event reporting resulted in increased organizational engagement and attention. This initiative served as a tangible step to improve organizational reliability and the culture of safety and is readily generalizable to other hospitals.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-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 April 9, 2018.Presented at the Institute for Healthcare Improvement 28th Annual National Forum on Quality Improvement in December 2016 in a workshop rapid-fire session format titled “Makes A Difference: Increasing Event Reporting”.To Cite: Crandall KM, Almuhanna A, Cady R, Fahey L, Floyd TT, Freiburg D, Hilliard MA, Kalburgi S, Khan NI, Patrick D, Pavuluri P, Potter K, Scafidi L, Sigman L, Shah RK. Ten Thousand Good Catches: Increasing Safety Event Reporting In A Pediatric Health Care System. Pediatr Qual Saf 2018;3:072.*Corresponding author. Address: Kristen M. Crandall, MSN, RN, CPN, 111 Michigan Ave NW, Washington, DC 20010, PH: 610) 800–6139, Email: kristenmcrandall@gmail.comReceived for publication September 13, 2017; Accepted February 22, 2018.Copyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 00:00:00 GMT-
       
  • The Effect of Operating Room Temperature on the Performance of Clinical
           and Cognitive Tasks

    • Authors: Hakim; Mumin; Walia, Hina; Dellinger, Heather L.; Balaban, Onur; Saadat, Haleh; Kirschner, Richard E.; Tobias, Joseph D.; Raman, Vidya T.
      Abstract: Introduction: Operating room (OR) temperature may impact the performance of health care providers. This study assesses whether hot or cold room temperature diminishes the performance of OR personnel measured by psychomotor vigilance testing (PVT) and self-report scales.Methods: This prospective observational study enrolled surgical/anesthesia trainees, student registered nurse anesthetists, and certified registered nurse anesthetists. Each provider participated in a test of psychomotor function and a questionnaire using a self-report scale of personal comfort and well-being. The PVT and questionnaires were completed after 30 minutes of exposure to 3 different conditions (temperature of 21oC, 23oC, and 26oC).Results: The cohort of 22 personnel included 9 certified registered nurse anesthetists, 7 anesthesia/surgical trainees, and 6 student registered nurse anesthetists. Mean reaction time on the PVT was comparable among baseline (280 ± 47 ms), hot (286 ± 55 ms; P = 0.171), and cold (303 ± 114 ms; P = 0.378) conditions. On the self-report score (range, 1–21), there was no difference in the self-rated subjective performance between baseline and cold conditions. However, the self-rated subjective performance scale was lower (12 ± 6, P = 0.003) during hot conditions.Discussion: No difference was noted in reaction time depending on the temperature; however, excessive heat in the OR environment was associated with worse self-rated subjective performance among health care providers. Particularly, self-rated subjective physical demand and frustration were greater under hot condition.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 April 9, 2018.*Corresponding author. Address: Hina Walia, MBBS, Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, PH: 614-722-4192; Fax: 614-722-4203, E-mail: hina.walia@nationwidechildrens.orgTo Cite: Hakim M, Walia H, Dellinger HL, Balaban O, Saadat H, Kirschner RE, Tobias JD, Raman VT. The Effect of Operating Room Temperature on the Performance of Clinical and Cognitive Tasks. Pediatr Qual Saf 2018;3:069.Received for publication August 10, 2017; Accepted February 12, 2018.Copyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 00:00:00 GMT-
       
  • There’s an App for That; Improving Communication during Pediatric
           Cardiothoracic Surgery

    • Authors: Hodge; Ashley B.; Joy, Brian F.; Cox, Virginia K.; Naguib, Aymen N.; Tumin, Dmitry; Galantowicz, Mark E.
      Abstract: Introduction: Waiting while a loved one is in surgery can be a very stressful time. Current processes for updating families vary from institution to institution. Providing timely and relevant updates, while important to the family, may strain a surgical team’s operational system. In our initial experience with the Electronic Access for Surgical Events (EASE) application (app), we tested the extent to which its implementation improved communication with patient families.Methods: We compared compliance data collected pre-EASE (December 2013 through September 2014) and post-EASE implementation (October 2014 until December 2015).Results: Although the pre-EASE compliance rate for bi-hourly updates was 46% (118/255) of cases, post-EASE implementation achieved a compliance rate of 97% (171/176). A 2-sample test of proportions confirmed a significant improvement in compliance after the introduction of EASE technology (P < 0.001). Analysis of the 177 noncompliant cases in the pre-EASE period indicated that noncompliance occurred most frequently at the end of the case (97/177, 55%) when the patient remained in the operating room> 2 hours after the last update to the family. We also observed noncompliance at the beginning of the case (46/177, 26%), when the patient arrived in the operating room> 2 hours before the time of the first update. Family satisfaction scores that rated their experience during surgery as “Very Good” improved from 80% pre-EASE implementation to 97% postimplementation. We sustained this improvement for 1 year.Conclusions: A mobile technology app (EASE) improved both frequency and compliance with surgical updates to families, which resulted in a statistically significant increase in family satisfaction scores.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 March 29, 2018.Supplemental digital content is available for this article. Clickable URL citations appear in the text.To Cite: Hodge AB, Joy BF, Cox VK, Naguib AN, Tumin D, Galantowicz ME. There’s an App for That; Improving Communication during Pediatric Cardiothoracic Surgery. Pediatr Qual Saf 2018;3:055.*Corresponding author. Address: Ashley B. Hodge, MBA, CCP, FPP, The Heart Center at Nationwide Children’s Hospital, T2286, 700 Children’s Dr, Columbus, OH 43205. PH: 614-722-6145., Email: Ashley.Hodge@nationwidechildrens.orgReceived for publication March 31, 2017; Accepted January 16, 2018.Copyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 00:00:00 GMT-
       
  • Tackling the Social Determinants of Health: A Critical Component of Safe
           and Effective Healthcare

    • Authors: Hensley; Caroline G.; Real, Francis J.; Walsh, Kathleen E.; Klein, Melissa D.; Beck, Andrew F.
      Abstract: No abstract available
      PubDate: Tue, 10 Apr 2018 00:00:00 GMT-
       
  • A Quality Initiative for Optimal Therapeutic Hypothermia during Transport
           for Neonates with Neonatal Encephalopathy

    • Authors: Bourque; Stephanie L.; Meier, Stephanie A.; Palmer, Claire; Melara, Diane L.; Grover, Theresa R.; Delaney, Cassidy A.
      Abstract: Introduction: Neuroprotection with therapeutic hypothermia (TH) is standard of care for neonatal encephalopathy (NE) and decreases death and neurodevelopmental disability. TH initiated shortly after birth insult results in greater neuroprotection compared with delayed initiation.Methods: Quality improvement methodology was used to improve temperature control during transport to a level IV neonatal intensive care unit. We included neonates with NE transported to a single institution for TH from 2010 to 2016. The quality improvement interventions were 2-fold. Review of the Transport Body Cooling Protocol revealed a suboptimal temperature goal of 34–35°C; this protocol was revised to 33–34°C. The second intervention was the implementation of an active cooling protocol. Clinical characteristics were compared using 2-sample t tests for continuous variables and Fisher’s exact tests for categorical variables; statistical process control chart was used to monitor admission temperatures.Results: We obtained baseline data for 78 neonates admitted from 2010 to 2014. These data were compared with postintervention data for 26 patients admitted between 2015 and 2016. Distance transported, NE severity, and seizures were similar between the 2 groups. The use of active cooling increased from 8% preimplementation to 31% postimplementation (P < 0.01). After implementation of the 2 interventions, more infants were admitted within the goal temperature of 33–34°C, 58% versus 22% (P < 0.01), and the average neonatal intensive care unit admission temperature improved from 34.4±0.8°C to 33.8±0.8°C (P < 0.01).Conclusion: Increased utilization of active cooling during transport for TH improves the percentage of neonates admitted within the target temperature range. However, 42% of neonates remained outside the target temperature range, supporting the need for additional tools to improve admission temperatures.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 February 15, 2018Preliminary data presented at the Western Society for Pediatric Research, January 2017, Carmel, Calif., as an oral presentation and at the Pediatric Academic Societies, May 2017, San Francisco, Calif., in poster format.Supported by the National Institutes of Health (5T32HD007186-37 to Bourque, SL, trainee).To Cite: Bourque SL, Meier SA, Palmer C, Melara DL, Grover TR, Delaney CA. A Quality Initiative to Achieve Optimal Therapeutic Hypothermia during Transport for Neonates with Neonatal Encephalopathy. Pediatr Qual Saf 2018;3:056.*Corresponding author. Address: Stephanie L. Bourque, MD, Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Neonatology MS 8402, 13121 E. 17th Ave., Aurora, CO 80045, Email: stephanie.bourque@childrenscolorado.org. PH: 303-724-2855; FAX: 720-777-7323.Received for publication July 20, 2017; Accepted January 19, 2018.Copyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 00:00:00 GMT-
       
  • 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 © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 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 © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 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 © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 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 © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 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.Published online November 17, 2017Received for publication February 22, 2017; Accepted August 29, 2017.To Cite: Ganesan R, Rajakumar P, Fogg L, Silvestri J, Kane JM. WE CARE 4 KIDS: Use of a Rounding Tool in the Pediatric Intensive Care Unit. Pediatr Qual Saf 2017;2:e044.Supplemental digital content is available for this article. Clickable URL citations appear in the text.Assistance with the study: Ruth Kleinpell, PhD, RN, FAAN, FCCM, Professor, Rush University College of Nursing, Director, Center for Clinical Research and Scholarship, Rush University Medical Center, Chicago, Ill.Poster presented at American Academy of Pediatrics Annual National Conference and Exhibition, October 2011, Boston, Mass. (Ganesan R, Conley L, Kane J: Development of “WE CARE 4 KIDS” Rounding Checklist in the Pediatric Intensive Care Unit); and at the Society of Critical Care Congress, February 2012, Houston, Tex. (Ganesan R, Rajakumar P, Conley L, Nelson S, Kane J: Structured Rounding Checklist Improves Quality of Care in the PICU).*Corresponding author. Address: Rani Ganesan, MD, Department of Pediatrics, Rush University Medical Center, 1653 West Congress Parkway Pavilion 565, Chicago, IL 60612, PH: 312 942 6194; FAX: 312 942-6145, E-mail: Rani_Ganesan@rush.eduCopyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 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.Published online November 8, 2017Disclosure: The authors have no financial interest to declare in relation to the content of this article.To Cite: Keefer P, Helms L, Warrier K, Vredeveld J, Burrows H, Orringer K. SAFEST: Use of a Rubric to Teach Safety Reporting to Pediatric House Officers. Pediatr Qual Saf 2017;2:e045.*Corresponding author. Address: Patricia Keefer, 1540 E Hospital Drive, SPC 4280, Ann Arbor, MI 48109, PH: 734-615-7845; FAX: 734-647-5624, Email: pkeefer@med.umich.eduReceived for publication January 10, 2017; Accepted September 12, 2017.Copyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 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.Published online October 20, 2017To Cite: Butz C, Valleru J, Castillo A, Butter EM. Implementation of an Outcome Measure in Pediatric Behavioral Health: A Process Improvement Initiative. Pediatr Qual Saf 2017;2:e043.*Corresponding author. Address: Catherine Butz, PhD, Division of Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205 PH: 614-722-4700; FAX: 614-722-4718, Email: Catherine.Butz@nationwidechildrens.orgReceived for publication February 24, 2017; Accepted August 29, 2017.Copyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 10 Apr 2018 00:00:00 GMT-
       
 
 
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