Pediatric quality & safety最新文献

{"title":"A Quality Improvement Initiative to Control a Gram-negative Sepsis Outbreak in a Resource-limited Neonatal Intensive Care Unit Using Systems Engineering Initiative for Patient Safety and a Modified Donabedian Framework.","authors":"Kedar Sawleshwarkar, Mahtab Singh, Ramesh Bajaj, Saumya Sawleshwarkar, Chintamani Dande","doi":"10.1097/pq9.0000000000000869","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000869","url":null,"abstract":"<p><strong>Introduction: </strong>Each year, 2.6 million newborns die globally, making up 46% of mortality in children younger than 5 years. Most of these deaths (96%) occur in low- and middle-income countries, with India accounting for approximately 25% of global neonatal mortality. Healthcare-associated infections (HCAIs) are a major cause of morbidity and mortality in neonatal intensive care units across low- and middle-income countries, with incidence rates ranging from 15.2 to 62.0 per 1,000 patient-days. A simplified and scalable framework is required to reduce neonatal mortality from sepsis.</p><p><strong>Methods: </strong>We experienced a Gram-negative sepsis outbreak in our neonatal intensive care unit beginning in July 2021, with HCAI peaks reaching 30-40 per 1,000 patient-days and a case fatality of approximately 30%. The outbreak was contained through a strategic combination of the Modified Donabedian approach and the application of the Systems Engineering Initiative for Patient Safety model.</p><p><strong>Results: </strong>HCAIs decreased from a mean of 14 and a peak of 38.7 per 1,000 patient-days to a sustained mean of 2.9, and antibiotic use decreased by 50%. Late-onset sepsis-related mortality fell from 27.3% in 2021 and 40% in 2022 to 12% in 2023 and 0% in 2024.</p><p><strong>Conclusions: </strong>Effective outbreak control requires a holistic, structured approach that encompasses all components of the Systems Engineering Initiative for Patient Safety model, namely studying the work system (structure), processes, and outcomes. Activating agency and fostering psychological safety transform healthcare workers from being recipients of policy into active participants in implementing solutions. Strong leadership galvanizes teams toward a shared purpose and overcomes significant challenges to improve care.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 1","pages":"e869"},"PeriodicalIF":1.1,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12928865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286610","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":"Variation in the Management of Test Results after Hospital Discharge: A Pediatric Safety Concern.","authors":"Meenu Krishnasamy, Rhiya Sharma, Lydia Nashed, Khoa Luong, Courtney Port","doi":"10.1097/pq9.0000000000000871","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000871","url":null,"abstract":"<p><strong>Introduction: </strong>Delay or failure to follow up tests pending at discharge (TPAD) is a major safety concern and a focus in the literature, but few studies exist in the pediatric context. We aimed to explore pediatric hospital medicine physicians' practices and perceptions of the management of TPAD.</p><p><strong>Methods: </strong>Surveys were provided to hospitalists and residents at a single institution using selected questions from a published national adult primary care survey and newly developed questions. Results were analyzed using descriptive statistics and Fisher's exact tests.</p><p><strong>Results: </strong>Surveys were completed by 25 hospitalists (89%) and 25 residents (68%). Forty-four percent (n = 11) of hospitalists reported missing test results, yet only 18% (n = 2) agreed that this error led to a delay in care. Seventy-six percent (n = 19) of hospitalists reported lacking adequate assistance to manage TPAD. There is uncertainty about who is responsible for managing TPAD among 88% (n = 22) of hospitalists and 92% (n = 23) of residents. Hospitalists were more likely than residents to use cognitive reminders (72% versus 20%, <i>P</i> = 0.0005). Many hospitalists (80%, n = 20) and residents (80%, n = 20) agreed that TPAD management is a safety issue, and nearly all hospitalists (88%, n = 22) and residents (96%, n = 24) want a standardized process. Residents were more likely to desire a shared responsibility (68% versus 32%, <i>P</i> = 0.02). Only 56% (n = 14) of hospitalists had formal education in result management; 76% (n = 19) of residents desired training.</p><p><strong>Conclusions: </strong>Pediatric hospitalists and residents are concerned about TPAD management, and there is considerable variability in current practices. Developing a standard process is supported by nearly all.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 1","pages":"e871"},"PeriodicalIF":1.1,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12928903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286554","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 Teletherapy Enrollment Using Quality Improvement Methodology for Psychiatry Patients Boarding on Acute Care Services.","authors":"Katherine A Ritter, Mahdieh Bodaghi, Padmaja Pavuluri, Stacey Stokes","doi":"10.1097/pq9.0000000000000872","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000872","url":null,"abstract":"<p><strong>Introduction: </strong>In 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declared a state of emergency in children's mental health. Responding to this emergency, our freestanding children's hospital began a novel teletherapy program to provide teletherapy services to patients admitted to acute care units while awaiting inpatient psychiatric care. The global aim of this quality improvement project was to improve access to inpatient teletherapy. The specific aim was to increase the number of patients who completed at least 1 teletherapy session from a median of 2-4 per month and sustain this increase for 3 months.</p><p><strong>Methods: </strong>Using the Model for Improvement framework, multidisciplinary stakeholders created process maps and Ishikawa diagrams, followed by key driver diagrams, to outline areas for improvement in the teletherapy enrollment process. Interventions included staff education, improved communication techniques, and enhancements to the electronic health record (EHR). We implemented interventions as Plan-Do-Study-Act cycles, collected data via a custom EHR report, and analyzed data using a run chart.</p><p><strong>Results: </strong>After completing 3 Plan-Do-Study-Act cycles, the median number of patients with teletherapy orders increased from 2 to 4 per month, a level we sustained for 5 months.</p><p><strong>Conclusions: </strong>Implementing and sustaining a novel group teletherapy workflow on acute care units is a multidisciplinary and complex process that requires multistakeholder coordination. We achieved a sustained increase in teletherapy enrollment through staff engagement, team member education, and EHR clinical decision support.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 1","pages":"e872"},"PeriodicalIF":1.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12928855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286520","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 Structured Handoff Documentation in a Pediatric Emergency Department.","authors":"Deborah Hammett, Rebecca Matta, Jody Kieffer, Jillian Savage, Courtney Nelson","doi":"10.1097/pq9.0000000000000870","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000870","url":null,"abstract":"<p><strong>Introduction: </strong>The I-PASS handoff tool guides provider handoffs and reduces adverse events in the inpatient setting. Transitions of care occur frequently in the emergency department (ED), and the unpredictable environment can lead to less structured handoffs. Our goal was to increase the percentage of handoff notes that include all 4 I-PASS components by 20% within 6 months.</p><p><strong>Methods: </strong>We developed a handoff note template for the pediatric ED that included 4 key I-PASS elements: illness severity, patient care summary, action list, and situational awareness/contingency planning. Our primary outcome measure was the percentage of handoff notes that contained all 4 I-PASS elements. Our process measure was the percentage of handoff notes that used the template. Our balancing measure was the percentage of handoffs with no note. We analyzed a random sample of 20 charts monthly during our preimplementation (August 2021-July 2022) and postimplementation (August 2022-January 2024) phases. We completed monthly Plan-Do-Study-Act cycles to review note usage and identify obstacles to use. Process improvements included modifying the note template, enhancing accessibility within the electronic medical record, and designating computer workstations for completing handoff notes.</p><p><strong>Results: </strong>We assessed 240 handoff notes to determine the preimplementation baseline and evaluated 360 handoff notes postimplementation. Following implementation, 63.0% of handoff notes contained 4 I-PASS elements, compared with 0% before our intervention. Similarly, use of handoff templates increased to 82.0% from 0%. There was no change in handoffs without documentation.</p><p><strong>Conclusions: </strong>Using a standardized note template for provider handoff improved adherence with the I-PASS handoff tool in the pediatric ED.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 1","pages":"e870"},"PeriodicalIF":1.1,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12928866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286584","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 Clinical Care for Children with Congenital Hypothyroidism.","authors":"Shadi Bakjaji, Kathryn Anglin, Trish Clotts, Bethany Dorsten, Kaitlyn Jones, Cindy Young, Samira Zoofan, Malak Abdel-Hadi, Cecilia Damilano, Kathryn Obrynba","doi":"10.1097/pq9.0000000000000844","DOIUrl":"10.1097/pq9.0000000000000844","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital hypothyroidism (CH) is a common endocrine disorder that requires optimal management and intensive follow-up to prevent neurocognitive impairment, especially within the first 3 years of life.</p><p><strong>Methods: </strong>We implemented a quality improvement (QI) initiative to standardize care and reduce loss to follow-up for children younger than 3 years with CH. The project was conducted in a pediatric endocrinology clinic at a large tertiary hospital in the Midwestern United States from January 2021 to December 2024. The primary aim was to increase the percentage of patients younger than 3 years with CH who achieved 2 or more normal thyroid-stimulating hormone (TSH) levels within a rolling 12-month period, from a baseline of 77% to a goal of greater than 95%. A multidisciplinary QI team-endocrinologists, nurses, social workers, administrative staff, a certified QI specialist, and care coordinators-used Plan-Do-Study-Act cycles to optimize care. Data were collected monthly from the electronic medical record to identify patients who did not meet TSH targets or missed clinic visits. Key interventions included case management, standardized caregiver education, and identification of high-risk patients. The monthly cohort consisted of 74-124 children younger than 3 years with CH.</p><p><strong>Results: </strong>After 12 months of intervention, this initiative increased the percentage of unique patients younger than 3 years with CH who achieved 2 normal TSH values within a rolling 12-month period, from a baseline of 77%-94%-an improvement that has been sustained.</p><p><strong>Conclusions: </strong>This QI initiative highlights the importance of interdisciplinary collaboration in improving the clinical care of pediatric patients with CH.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 5","pages":"e844"},"PeriodicalIF":1.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066670","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":"Survey of Well-being of Young Children: Implementation and Impact on Care Quality.","authors":"Yusuke Matsuura, Felix Richter, Gabrielle Block, Carolyn Rosen, Cynthia Katz","doi":"10.1097/pq9.0000000000000843","DOIUrl":"10.1097/pq9.0000000000000843","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the American Academy of Pediatrics recommendations to use validated developmental screening tools, national adoption remains low. To address this, we launched a quality improvement project to implement the Survey of Well-being of Young Children (SWYC) in our residency clinic and assess its impact. Our primary aim was to achieve more than 50% screening coverage for early childhood well visits, with equitable implementation across both English-speaking and non-English primary speaking families. We also hypothesized that the implementation of SWYC would equitably increase early intervention (EI) referral rates across language groups.</p><p><strong>Methods: </strong>We included children aged 8-33 months attending well-child visits. Interventions included staff education, daily huddles, and the SWYC integration into the electronic health record. Social work (SW) referrals, though not exclusive to EI, were used as an imperfect proxy, as a designated SW initiates EI referrals in our clinic. We compared referral rates before and after implementation using chi-square tests.</p><p><strong>Results: </strong>SWYC usage reached 50% within 4 months of implementation. There was no significant difference in SWYC use between English and non-English primary speakers (<i>P</i> = 0.131). SW referral rates increased by 2.9 percentage points after implementation (<i>P</i> = 0.009), with no significant difference in SW referral rates between language groups (<i>P</i> = 0.922).</p><p><strong>Conclusions: </strong>This quality improvement project highlighted the rapid adoption of a standardized developmental screening tool, resulting in increased SW referrals, which suggests improved identification of developmental concerns with language equity between English and non-English primary speaking families. Standardized screening is an important step in improving developmental outcomes and supporting care equity.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 5","pages":"e843"},"PeriodicalIF":1.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12384848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981724","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":"Thyroid Monitoring following Intravenous Iodinated Contrast Administration in Children: A Quality Improvement Initiative.","authors":"Christine Klingaman, Christa Callahan, Stephanie DeVeau-Rosen, Cynthia Gibson, Oksana Lazareva, Katherine Moyer, Courtney Port","doi":"10.1097/pq9.0000000000000841","DOIUrl":"10.1097/pq9.0000000000000841","url":null,"abstract":"<p><strong>Introduction: </strong>As of March 30, 2022, the Food and Drug Administration recommended thyroid function testing for children less than 4 years of age within 3 weeks of receiving intravenous iodinated contrast due to an increased risk of thyroid dysfunction. Multifaceted solutions are needed to identify patients at risk of hypothyroidism, ensure timely testing, interpret results, and communicate information to primary care providers and caregivers. Our objective was to increase compliance with thyroid function test (TFT) completion or communication of the need for TFTs to 20% within 3 months and to 75% within 12 months.</p><p><strong>Methods: </strong>We identified patients using the following inclusion criteria: age less than 4 years and receipt of intravenous iodinated contrast. Electronic medical record tools, including conditional and automated SmartText in radiology reports, discharge summaries, and after-visit summaries, were used to identify patients and improve cross-encounter communication.</p><p><strong>Results: </strong>We identified 446 children who met the inclusion criteria. Of these, 42% (n = 189) had high-risk comorbidities. Compliance with communicating the need for TFTs to primary care providers through discharge summaries increased from a mean of 5% to 60% and with caregivers through after-visit summaries from a mean of 5% to 81% in 13 months. The percentage of TFTs completed increased from a mean of 10% to 22%, of which 22% (n = 22) were abnormal. Four patients received thyroid hormone supplementation.</p><p><strong>Conclusions: </strong>This project has successfully achieved its aim. Although this recommendation is unique to a small cohort of patients, similar strategies could be used to identify patients and coordinate follow-up testing across encounters.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 5","pages":"e841"},"PeriodicalIF":1.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981739","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":"Project BREATHE: A Quality Improvement Initiative.","authors":"Kara Oliver, Xilei Xu Chen, Jamie Wooldridge, Brinda Prasanna Kumar, Lalina Sunuwar, Samantha Eng, Matthew Swatski, Daniel Hamilton, Geovanny F Perez","doi":"10.1097/pq9.0000000000000829","DOIUrl":"10.1097/pq9.0000000000000829","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma is the most common chronic illness in pediatrics, placing a significant burden on patients and the healthcare system. The lack of standardization in screening, diagnosis, and treatment remains a key challenge in pediatric asthma management. This project used the Project BREATHE toolkit, supplied through the New York State Department of Health, to implement a care process for children with asthma receiving care at our institution. Our primary objective was to enhance asthma care through a quality improvement framework to optimize outcomes and reduce healthcare usage.</p><p><strong>Methods: </strong>Following identifying key drivers contributing to suboptimal asthma care in our region, our transdisciplinary team developed a standardized asthma care process. From July 2020 to June 2021, the process was systematically applied to all patients admitted with a diagnosis of asthma. Control charts were reviewed monthly to assess adherence and uptake of care process components, facilitating continuous quality improvement and data-driven modifications.</p><p><strong>Results: </strong>Following implementation, inhaled corticosteroid prescriptions increased from 50% to 81%, whereas subspecialist consults rose from 8.3% to 77%. The proportion of patients receiving asthma severity assessments ranged from 71% to 90%, and the rates of asthma education fluctuated from 50% to 89%. Additionally, the rate of emergency department visits declined from 5.2% to 4.7% and hospitalizations from 12.7% to 10.1% following implementation.</p><p><strong>Conclusions: </strong>Implementing a transdisciplinary asthma care process resulted in sustained improvements in asthma management and reduced asthma-related emergency department visits and hospitalizations. These findings highlight the effectiveness of a structured, team-based approach in optimizing pediatric asthma care.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 6","pages":"e829"},"PeriodicalIF":1.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12348406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857202","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 Involvement of Families of Small Babies through Family Education, Family Integration, and Multidisciplinary Teamwork: A Quality Improvement Initiative.","authors":"Kris Nicole D Mendoza, Hyacinth Lewis, Lynsey Garver, Laura Koegst, Elaine Kong, Molly Roberts, Jean Shirley, Devin Stoklosa, Christina Tryon, Tricia White, Colby Day","doi":"10.1097/pq9.0000000000000828","DOIUrl":"10.1097/pq9.0000000000000828","url":null,"abstract":"<p><strong>Introduction: </strong>Partnering with and educating families in the neonatal intensive care unit (NICU) is critical for infant neurodevelopment, parent wellness, and family support. Early family integration in care improves both short-term and long-term outcomes. This quality improvement project has 2 specific aims: (1) increase the percentage of small babies (born at <28 wk of gestation or <1000 g) whose families participated in a multidisciplinary family-centered care conference (FCCC) from 0% to 50%, and (2) increase family attendance at the first NICU follow-up clinic from 74% to 90%.</p><p><strong>Methods: </strong>Using the model for improvement, we conducted plan-do-study-act cycles with iterative interventions to achieve our aims. The FCCCs focused on promoting family involvement at the bedside, infant neurodevelopment, skin-to-skin care, family support, and transitions within the NICU and after discharge. Outcome, process, and balancing measures were tracked and analyzed for special cause variation using statistical process control charts.</p><p><strong>Results: </strong>Within 18 months, the percentage of infants whose families participated in an FCCC increased from 0% to 39% (48/123). Based on the post-FCCC survey, families found the FCCC helpful in providing information on how they can be involved in their infant's care. They recommended the FCCC to other families, and they expressed interest in a second FCCC focused on preparing for the transition home.</p><p><strong>Conclusions: </strong>Family participation in a multidisciplinary FCCC increased over time but has not yet achieved the stated goal. We anticipate that further plan-do-study-act cycles will improve adherence to a robust FCCC program by integrating families into their infants' care during critical developmental stages.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 4","pages":"e828"},"PeriodicalIF":1.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755309","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":"Assessment of a Stepwise Intervention to Improve Nurse-administered Penicillin Allergy Screening and De-labeling in Pediatric Inpatients.","authors":"Victoria J L Konold, Filmon Emnetu, Daniel Pak, Gabriel Mendoza, Adam W Brothers, Derry McDonald, Hector Valdivia, Scott J Weissman, Matthew P Kronman, Lori Rutman, Karyn Yonekawa","doi":"10.1097/pq9.0000000000000825","DOIUrl":"10.1097/pq9.0000000000000825","url":null,"abstract":"<p><strong>Introduction: </strong>Penicillins are first-line treatments for many childhood infections, but providers avoid them when patients report a penicillin allergy, although approximately 94% of these patients may tolerate penicillin. Patients with penicillin allergy labels often receive second-line antibiotics, which increases the risk of treatment failure and adverse events. To address this, programs to implement penicillin allergy de-labeling have increased; however, strategies to accomplish de-labeling most efficiently through guideline dissemination have not been well-studied.</p><p><strong>Methods: </strong>A multidisciplinary team created an evidence-based screening algorithm and standard protocol to screen eligible pediatric inpatients and de-label documented penicillin allergies. Plan-do-study-act cycles identified opportunities for improvement to the standard protocol.</p><p><strong>Results: </strong>We developed a screening tool to assess the risk of penicillin allergy and integrated it into the electronic health record for administration by clinical nurses. Follow-up actions, including de-labeling or further testing, are automatically communicated to the provider. Nurse-initiated screening increased from 3.8% to 28.1% after adding an electronic \"worklist task\" reminder. Allergy de-labeling demonstrated special cause variation following the dissemination of a standardized amoxicillin challenge order set and then again after a brief period of audit and feedback; however, the increases were not sustained.</p><p><strong>Conclusions: </strong>A nurse-administered screening questionnaire and protocolized follow-up actions can help achieve safe de-labeling at hospitals without a dedicated penicillin allergy service.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 4","pages":"e825"},"PeriodicalIF":1.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638872","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}