Pediatric quality & safety最新文献

{"title":"A Quality Improvement Initiative to Improve Pediatric Discharge Medication Safety and Efficiency.","authors":"Lisa M Ring,&nbsp;Jamie Cinotti,&nbsp;Lisa A Hom,&nbsp;Mary Mullenholz,&nbsp;Jordan Mangum,&nbsp;Sameeya Ahmed-Winston,&nbsp;Jenhao Jacob Cheng,&nbsp;Ellie Randolph,&nbsp;Ashraf S Harahsheh","doi":"10.1097/pq9.0000000000000671","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000671","url":null,"abstract":"<p><p>Medication errors are a leading safety concern, especially for families with limited English proficiency and health literacy, and patients discharged on multiple medications with complex schedules. Integration of a multilanguage electronic discharge medication platform may help decrease medication errors. This quality improvement (QI) project's primary aim (process measure) was to increase utilization in the electronic health record (EHR) of the integrated MedActionPlanPro (MAP) for cardiovascular surgery and blood and marrow transplant patients at hospital discharge and for the first clinic follow-up visit to 80% by July 2021.</p><p><strong>Methods: </strong>This QI project occurred between August 2020 and July 2021 on 2 subspecialty pediatric acute care inpatient units and respective outpatient clinics. An interdisciplinary team developed and implemented interventions, including integration of MAP within EHR; the team tracked and analyzed outcomes for discharge medication matching, and efficacy and safety MAP integration occurred with a go-live date of February 1, 2021. Statistical process control charts tracked progress.</p><p><strong>Results: </strong>Following the implementation of the QI interventions, there was an increase from 0% to 73% in the utilization of the integrated MAP in the EHR across the acute care cardiology unit-cardiovascular surgery/blood and marrow transplant units. The average user hours per patient (<i>outcome measure</i>) decreased 70% from the centerline of 0.89 hours during the baseline period to 0.27 hours. In addition, the medication matching between Cerner inpatient and MAP inpatient increased significantly from baseline to postintervention by 25.6% (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>MAP integration into the EHR was associated with improved inpatient discharge medication reconciliation safety and provider efficiency.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/93/3c/pqs-8-e671.PMC10332828.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9869862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Quality Improvement to Design Early Childhood Services Navigation in Primary Care.","authors":"Amy L King,&nbsp;Courtney M Brown,&nbsp;Cynthia C White,&nbsp;Kristen A Copeland","doi":"10.1097/pq9.0000000000000662","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000662","url":null,"abstract":"<p><p>Enrollment in high-quality early childhood education (ECE) improves educational and health outcomes and can mitigate racial and economic disparities. Pediatricians are encouraged to promote ECE yet lack the time and knowledge to assist families effectively. In 2016, our academic primary care center hired an ECE Navigator to promote ECE and help families enroll. Our SMART aims were to increase the number of children with facilitated referrals to high-quality ECE programs from 0 to 15 per month and to confirm enrollment on a subset to achieve an enrollment rate of 50% by December 31, 2020.</p><p><strong>Methods: </strong>We used the Institute for Healthcare Improvement's Model for Improvement. Interventions included system changes in partnership with ECE agencies (eg, interactive map of subsidized preschool options, streamlined enrollment forms), case management with families, and population-based approaches to understand families' needs and the program's overall impact. We plotted the number of monthly facilitated referrals and the percentage of referrals enrolled on run and control charts. We used standard probability-based rules to identify special causes.</p><p><strong>Results: </strong>Facilitated referrals increased from 0 to 29 per month and remained above 15. The percentage of enrolled referrals increased from 30% to 74% in 2018, then decreased to 27% in 2020 when childcare availability declined during the pandemic.</p><p><strong>Conclusions: </strong>Our innovative ECE partnership improved access to high-quality ECE. Interventions could be adopted in part or whole by other clinical practices or WIC offices to equitably improve early childhood experiences for low-income families and racial minorities.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/57/c4/pqs-8-e662.PMC10332832.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10171986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Usability of the Pediatric Code Cart by Combining Lean and Human Factors Principles.","authors":"Maria Frazier,&nbsp;Kristen Webster,&nbsp;Maya Dewan,&nbsp;Tamara Hutson,&nbsp;Kelly Collins,&nbsp;Tina Fettig,&nbsp;Taylor Grooms,&nbsp;Mary Cordray,&nbsp;Ken Tegtmeyer","doi":"10.1097/pq9.0000000000000676","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000676","url":null,"abstract":"<p><p>Cardiac arrests are common in hospitalized children. Well-organized code carts are needed during these events to help staff efficiently find supplies and medications for the patient. This study aimed to improve the efficiency and utilization of the code cart at a major academic pediatric medical center.</p><p><strong>Methods: </strong>This quality improvement project used a phased approach to redesign the code cart. A multidisciplinary team used Lean and Human Factors principles to improve the efficiency and intuitiveness of the redesigned cart. Nurses and respiratory therapists participated in simulations asking for certain supplies with the original and redesigned code cart and filled out surveys for feedback on each code cart. Facilitators measured retrieval times during each simulation.</p><p><strong>Results: </strong>We performed 10 simulations with the original code cart and 13 with the redesigned code cart. Staff could find intraosseous access equipment more quickly (23.9 versus 46.4 seconds; <i>P</i> = 0.003). In addition, staff reported they were less likely to open the wrong drawer or grab the wrong equipment and that the redesigned code cart was overall more well organized than the original code cart. Finally, the redesigned code cart reduced the cost by over 800 dollars per full cart restock.</p><p><strong>Conclusion: </strong>Revising the code cart using Lean and Human Factors improves efficiency and usability and can contribute to cost savings.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10402944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9962145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Quality Improvement Initiative to Screen for Bullying in Pediatric Orthopedic Outpatient Clinics.","authors":"Leslie A Hoover,&nbsp;Jessica B Holstine,&nbsp;Jayme Williamson,&nbsp;Julie B Samora","doi":"10.1097/pq9.0000000000000677","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000677","url":null,"abstract":"<p><p>Bullying annually affects 20%-25% of middle- and high-school children. Persistent bullying can lead to feelings of isolation, rejection, and despair and trigger depression and anxiety. In addition, pediatric patients have presented to outpatient orthopedic clinics with injuries consistent with physical bullying. Due to the high prevalence and negative ramifications of bullying, we developed a quality improvement (QI) initiative to screen for these behaviors. We aimed to increase the screening for bullying in pediatric orthopedic outpatient clinics from 0% to 60% by the end of 2020 and sustain these levels for 6 months.</p><p><strong>Methods: </strong>Using the Institute for Healthcare Improvement Model for Improvement QI methodology, including Plan-Do-Study-Act cycles, we developed a four-question yes/no screening tool that asked patients (ages 5-18) and parents/guardians about bullying experiences in the preceding 3 months. To increase screening rates, we trained staff, integrated the screening form into the electronic medical record, initiated interscreener competitions, and shared unblinded data with screeners.</p><p><strong>Results: </strong>The bullying screen rate of pediatric orthopedic patients increased from 0% to a process mean of 80%. In just over 1 year during the COVID-19 pandemic, clinics screened nearly 8,000 patients for bullying. Two percent of patients reported bullying in the prior 3 months. We offered patients who reported bullying literature and referrals to social work and/or behavioral health.</p><p><strong>Conclusions: </strong>Implementing a QI initiative to provide universal bullying screening and increase bullying awareness in outpatient pediatric orthopedic clinics is feasible and sustainable.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/8a/pqs-8-e677.PMC10402975.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9962135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overdiagnosis of Newborn Hyperbilirubinemia: A Natural Experiment in Quality Improvement Fundamentals.","authors":"Kara J Stirling,&nbsp;Joseph W Kaempf,&nbsp;Lian Wang,&nbsp;Veronica I Luzzi,&nbsp;John V McDonald","doi":"10.1097/pq9.0000000000000675","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000675","url":null,"abstract":"<p><p>Two hospitals noted increased newborn hyperbilirubinemia coinciding with an undisclosed total serum bilirubin (TSB) assay change. Clinicians rapidly applied quality improvement methodologies to ascertain increased jaundice evaluations, readmissions, and possible safety issues.</p><p><strong>Methods: </strong>In January 2020, 2 hospitals (A and B) transitioned to a new method of measuring TSB using a new clinical chemistry analyzer (Siemens Atellica CH), which measured TSB by vanadate oxidase assay instead of the previous diazo assay. Five affiliated hospitals (C-G) continued to utilize the diazo assay. This natural experiment led to a comparison of data across the 7 hospitals. We analyzed: (1) TSB levels, (2) hospital hyperbilirubinemia readmissions, and (3) paired TSB measurements comparing the diazo assay and vanadate oxidase method.</p><p><strong>Results: </strong>Compared to the 2019 baseline, Hospitals A and B had a significant increase in TSBs ≥17.0 mg/dl and TSBs ≥20 mg/dl in 2020; Hospitals C-G did not. Readmissions for phototherapy significantly increased in hospitals A and B in 2020 compared to 2019. Paired blood samples showed bias-elevated TSBs by vanadate assay compared to the diazo method. By 2021, the laboratory resumed processing TSB samples by diazo assay, and the frequency of elevated TSBs and hyperbilirubinemia readmissions returned to 2019 levels.</p><p><strong>Conclusions: </strong>Factitious TSB elevation related to an assay change significantly increased newborn hyperbilirubinemia evaluations and phototherapy readmissions. Imbedded quality improvement methodologies of careful structure, process, and outcomes review hastened resolution.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/ce/pqs-8-e675.PMC10403026.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9962146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Intraoperative Hypothermia in Infants from the Neonatal Intensive Care Unit.","authors":"Abbey Studer,&nbsp;Barbara Fleming,&nbsp;Roderick C Jones,&nbsp;Audrey Rosenblatt,&nbsp;Lisa Sohn,&nbsp;Megan Ivey,&nbsp;Marleta Reynolds,&nbsp;Gustave H Falciglia","doi":"10.1097/pq9.0000000000000665","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000665","url":null,"abstract":"<p><p>Infants from the neonatal intensive care unit (NICU) undergoing surgery in the operating room (OR) are at greater risk for hypothermia during surgery than afterward due to environmental heat loss, anesthesia, and inconsistent temperature monitoring. A multidisciplinary team aimed to reduce hypothermia (<36.1 °C) for infants at a level IV NICU at the beginning of the operation (first OR temperature) or at any time during the operation (lowest OR temperature) by 25%.</p><p><strong>Methods: </strong>The team followed preoperative, intraoperative (first, lowest, and last OR), and postoperative temperatures. It sought to reduce intraoperative hypothermia using the \"Model for Improvement\" by standardizing temperature monitoring, transport, and OR warming, including raising ambient OR temperatures to 74°F. Temperature monitoring was continuous, secure, and automated. The balancing metric was postoperative hyperthermia (>38 °C).</p><p><strong>Results: </strong>Over 4 years, there were 1235 operations: 455 in the baseline and 780 in the intervention period. The percentage of infants experiencing hypothermia upon OR arrival and at any point during the operation decreased from 48.7% to 6.4% and 67.5% to 37.4%, respectively. Upon return to the NICU, the percentage of infants experiencing postoperative hypothermia decreased from 5.8% to 2.1%, while postoperative hyperthermia increased from 0.8% to 2.6%.</p><p><strong>Conclusions: </strong>Intraoperative hypothermia is more prevalent than postoperative hypothermia. Standardizing temperature monitoring, transport, and OR warming reduces both; however, further reduction requires a better understanding of how and when risk factors contribute to hypothermia to avoid further increasing hyperthermia. Continuous, secure, and automated data collection improved temperature management by enhancing situational awareness and facilitating data analysis.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/48/pqs-8-e655.PMC10332830.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10171991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Trauma and Posttraumatic Symptom Screening at Well-child Visits.","authors":"Stephen S DiGiovanni, Rebecca J Hoffmann Frances, Rebecca S Brown, Barrett T Wilkinson, Gillian E Coates, Laura J Faherty, Alexa K Craig, Elizabeth R Andrews, Sarah M B Gabrielson","doi":"10.1097/pq9.0000000000000640","DOIUrl":"10.1097/pq9.0000000000000640","url":null,"abstract":"<p><p>Adverse childhood experiences (ACEs), including abuse or neglect, parental substance abuse, mental illness, or separation, are public health crises that require identification and response. We aimed to increase annual rates of trauma screening during well-child visits from 0% to 70%, post-traumatic stress disorder (PTSD) symptom screening for children with identified trauma from 0% to 30%, and connection to behavioral health for children with symptoms from 0% to 60%.</p><p><strong>Methods: </strong>Our interdisciplinary behavioral and medical health team implemented 3 plan-do-study-act cycles to improve screening and response to pediatric traumatic experiences. Automated reports and chart reviews measured progress toward goals as we changed screening methods and provider training.</p><p><strong>Results: </strong>During plan-do-study-act cycle 1, a chart review of patients with positive trauma screenings identified various trauma types. During cycle 2, a comparison of screening methods demonstrated that written screening identified trauma among more children than verbal screening (8.3% versus 1.7%). During cycle 3, practices completed trauma screenings at 25,287 (89.8%) well-child visits. Among screenings, 2,441 (9.7%) identified trauma. The abbreviated Post Traumatic Stress Disorder Reaction Index was conducted at 907 (37.2%) encounters and identified 520 children (57.3%) with PTSD symptoms. Among a sample of 250, 26.4% were referred to behavioral health, 43.2% were already connected, and 30.4% had no connection.</p><p><strong>Conclusions: </strong>It is feasible to screen and respond to trauma during well-child visits. Screening method and training implementation changes can improve screening and response to pediatric trauma and PTSD. Further work is needed to increase rates of PTSD symptomology screening and connection to behavioral health.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/64/53/pqs-8-e640.PMC10219716.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9599027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal Association of Physician-in-Triage with Improved Pediatric Sepsis Care: A Single-Center, Emergency Department Experience.","authors":"Ganga S Moorthy, Jordan S Pung, Neel Subramanian, B Jason Theiling, Emily C Sterrett","doi":"10.1097/pq9.0000000000000651","DOIUrl":"10.1097/pq9.0000000000000651","url":null,"abstract":"<p><p>Approximately 75,000 children are hospitalized for sepsis yearly in the United States, with 5%-20% mortality estimates. Outcomes are closely related to the timeliness of sepsis recognition and antibiotic administration.</p><p><strong>Methods: </strong>A multidisciplinary sepsis task force formed in the Spring of 2020 aimed to assess and improve pediatric sepsis care in the pediatric emergency department (ED). The electronic medical record identified pediatric sepsis patients from September 2015 to July 2021. Data for time to sepsis recognition and antibiotic delivery were analyzed using statistical process control charts (X̄-S charts). We identified special cause variation, and Bradford-Hill Criteria guided multidisciplinary discussions to identify the most probable cause.</p><p><strong>Results: </strong>In the fall of 2018, the average time from ED arrival to blood culture orders decreased by 1.1 hours, and the time from arrival to antibiotic administration decreased by 1.5 hours. After qualitative review, the task force hypothesized that initiation of attending-level pediatric physician-in-triage (P-PIT) as a part of ED triage was temporally associated with the observed improved sepsis care. P-PIT reduced the average time to the first provider exam by 14 minutes and introduced a process for physician evaluation before ED room assignment.</p><p><strong>Conclusions: </strong>Timely assessment by an attending-level physician improves time to sepsis recognition and antibiotic delivery in children who present to the ED with sepsis. Implementing a P-PIT program with early attending-level physician evaluation is a potential strategy for other institutions.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/20/pqs-8-e651.PMC10219727.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9546974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Establishing Causality in Quality Improvement Studies.","authors":"Lloyd P Provost","doi":"10.1097/pq9.0000000000000653","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000653","url":null,"abstract":"In this Pediatrics Quality and Safety issue, Moorthy et al describe a quality improvement project to improve pediatric sepsis care in their pediatric emergency department (ED) (Causal Association of Physician-in-Triage with Improved Pediatric Sepsis Care: a Singlecenter, Emergency Department Experience). Their approach begins traditionally for an improvement project, collecting baseline data for their key measures for the previous 4 years. However, their plans changed when they noted special cause variation in the fall of 2018. As a result, they quickly pivoted their approach to learning from this special cause. Thus, their article is about this special cause. Shewhart theory of common and special cause variation forms the cornerstone of the Science of Improvement.1 The analysis of baseline data using statistical process control directs our improvement work in 1 of 2 directions2:","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d0/18/pqs-8-e653.PMC10219693.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9599026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eliminating Central Line Associated Bloodstream Infections in Pediatric Oncology Patients: A Quality Improvement Effort.","authors":"Daniel N Willis,&nbsp;Karen Looper,&nbsp;Rema A Malone,&nbsp;Barbara Ricken,&nbsp;Ashley Slater,&nbsp;Amanda Fuller,&nbsp;Meagan McCaughey,&nbsp;Angela Niesen,&nbsp;Joan R Smith,&nbsp;Beverly Brozanski","doi":"10.1097/pq9.0000000000000660","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000660","url":null,"abstract":"<p><p>Central Line-Associated Bloodstream Infections (CLABSI) are the largest contributor to harm across the Children's Hospital's Solutions for Patient Safety network. Pediatric hematology/oncology (PHO) patients are at increased risk for CLABSI due to multiple factors. Consequently, traditional CLABSI prevention strategies are insufficient to eliminate CLABSI in this high-risk population.</p><p><strong>Methods: </strong>Our SMART aim was to reduce the CLABSI rate by 50% from a baseline of 1.89/1000 central line days to less than 0.9/1000 central line days by December 31, 2021. We created a multidisciplinary team being mindful to identify roles and responsibilities upfront. We developed a key driver diagram and designed and implemented interventions to influence our primary outcome.</p><p><strong>Results: </strong>We implemented interventions and conducted Plan-Do-Study-Act cycles concurrently. We found that performing audits by directly observing tasks rather than auditing documentation resulted in more accurate compliance assessments. As a result, our CLABSI rate improved from 1.89/1000 central line days in 2020 with 11 primary CLABSI to 0.73/1000 central line days in 2021 with four primary CLABSI. Average days between events improved from 30 days in 2020 to 73 days in 2021, and we achieved an unprecedented 542 days CLABSI-free, extending into 2022.</p><p><strong>Conclusions: </strong>Through a multimodal approach and utilizing characteristics of high-reliability organizations, we significantly reduced primary CLABSI, approaching zero in our PHO population and doubling the average days between events. Future efforts will focus on the sustained engagement of all stakeholders and improving our safety culture.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10219729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9599025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}