Pediatric quality & safety最新文献

{"title":"Enhancing Pediatric Obesity Management through Quality Improvement: A Hybrid Approach to Intensive Health Behavior and Lifestyle Treatment in Primary Care.","authors":"Emily T Skrocki, Cristian Sarabia, Shengh Xiong, Ayelet Talmi","doi":"10.1097/pq9.0000000000000892","DOIUrl":"10.1097/pq9.0000000000000892","url":null,"abstract":"<p><strong>Introduction: </strong>Intensive health behavior and lifestyle treatment (IHBLT) programs can improve weight and reduce comorbidities for children with obesity, but implementation in primary care remains limited. Baseline performance at our institution showed low referral volume, limited participation, and insufficient treatment intensity, indicating gaps in program reach and adoption.</p><p><strong>Methods: </strong>Utilizing the model for improvement, we led a quality improvement initiative in a large urban academic primary care clinic to increase IHBLT referrals, participation, and treatment intensity. Sequential plan-do-study-act cycles tested provider education, standardized and culturally tailored materials, a hybrid in-person-and-virtual program structure, and engagement strategies. We tracked three process measures: referrals, participation, and program intensity. We tracked outcomes using individuals-moving-range (X-mR) statistical process control charts.</p><p><strong>Results: </strong>Statistical process control analysis demonstrated that program participation and intervention intensity met Provost criteria for a sustained shift, whereas referral volume demonstrated primarily common-cause variation. Improvements in participation and intervention intensity were maintained over time, with centerlines recalculated to reflect updated process performance. Moving range charts indicated stable variation across all measures.</p><p><strong>Conclusions: </strong>An iterative, context-responsive system redesign improved the delivery of evidence-based pediatric obesity treatment in our primary care setting. The hybrid IHBLT model, combining in-person visits and technology-supported touchpoints, was associated with sustained gains in participation and treatment intensity, whereas referral volume remained stable. This pragmatic approach leverages existing resources and offers a feasible pathway for primary care clinics seeking to implement guideline-concordant IHBLT while addressing common logistical and equity-related barriers.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e892"},"PeriodicalIF":1.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622923","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":"Implementation of the Baxter Animated Retching Faces Nausea Assessment Scale in Pediatric Oncology: A Quality Improvement Project.","authors":"Carina Braeutigam, Jennifer Young, Jessica Shaw, Kristen Laswell, Kathleen Demmel","doi":"10.1097/pq9.0000000000000894","DOIUrl":"10.1097/pq9.0000000000000894","url":null,"abstract":"<p><strong>Introduction: </strong>Chemotherapy-induced nausea in the pediatric oncology population can be uniquely challenging to assess and manage. Adequate assessment and documentation of a patient's nausea can be used to evaluate the efficacy of antiemetic interventions and to optimize patient management. This project aimed to introduce a pediatric nausea assessment tool and develop a standardized process to improve the frequency of nursing documentation of nausea.</p><p><strong>Methods: </strong>This single-institution quality improvement project utilized a stepwise process to introduce the Baxter Animated Retching Faces (BARF) scale as a new tool to the pediatric oncology unit, educated staff on the use of the tool, and ultimately facilitated documentation of BARF scales within the patient's electronic medical record. Plan-do-study-act methodology was used to evaluate the effectiveness of each incremental change.</p><p><strong>Results: </strong>The percentage of oncology patients with at least three documented nausea assessments on active chemotherapy days increased from 5% at baseline to 75% within the first month following implementation into the electronic medical record, peaked at 94% in September 2022, and remained above the project goal of 75% for two years after completion of the active project.</p><p><strong>Conclusions: </strong>The BARF scale was readily integrated into routine care in a pediatric oncology service. This documentation helped bridge the gap between bedside evaluations and treatment decisions, improving patient care.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e894"},"PeriodicalIF":1.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622883","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":"Preventing Perioperative Hypothermia in Neonatal Surgical Patients: A Phased Quality Improvement Initiative within the Wake Up Safe Collaborative.","authors":"Lance S Patak, Imelda M Tjia, Thomas L Shaw, Lynne Bedre","doi":"10.1097/pq9.0000000000000895","DOIUrl":"10.1097/pq9.0000000000000895","url":null,"abstract":"<p><strong>Background: </strong>Neonates are at high risk for perioperative hypothermia, which is associated with increased morbidity and mortality. A serious safety event involving profound postoperative hypothermia prompted a quality improvement initiative to prevent perioperative hypothermia in neonatal intensive care unit surgical patients.</p><p><strong>Problem: </strong>A review of prior cases at our institution demonstrated that only 50% of neonates returned from surgery normothermic.</p><p><strong>Methods: </strong>A three-phase intervention was implemented: (1) a multidisciplinary hypothermia prevention checklist with standardized warming and transport processes; (2) assignment of a dedicated intraoperative \"temperature guardian\" responsible for continuous monitoring and team communication; and (3) implementation of dual-source intraoperative temperature monitoring. We collected perioperative temperature data across 39 consecutive surgical events.</p><p><strong>Interventions: </strong>Focused on standardizing preparation, clarifying team roles, enhancing intraoperative vigilance, and improving temperature measurement accuracy.</p><p><strong>Results: </strong>Implementation of phased interventions was associated with a reduction in hypothermia from 50% at baseline to 0% in subsequent phases, with elimination of hypothermia events and low rates of mild hyperthermia (≤20%), with 2 outlier events: 1 hypothermia emergency bedside procedure and 1 hyperthermia event with a falsely low core temperature reading during bowel irrigation. Checklist compliance improved to 92%. Intraoperative temperature monitoring compliance reached 100%.</p><p><strong>Conclusions: </strong>A structured, phased quality improvement approach emphasizing team accountability, standardized workflows, and validated monitoring reliably maintained perioperative normothermia in high-risk neonatal patients and offers a reproducible model for improving neonatal surgical safety.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e895"},"PeriodicalIF":1.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622907","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 Workflow to Integrate Psychoeducational Data into the Electronic Medical Record and National Spina Bifida Registry.","authors":"Alexandra Carloni, Anita Kamal, Emily Kennedy, Lauren Palicki, Jonathan Castillo, Heidi Castillo, Nienke P Dosa","doi":"10.1097/pq9.0000000000000901","DOIUrl":"10.1097/pq9.0000000000000901","url":null,"abstract":"<p><strong>Introduction: </strong>Although learning challenges are common in spina bifida (SB), psychoeducational data are not systematically collected by most SB centers.</p><p><strong>Methods: </strong>We developed a workflow to obtain psychoeducational data directly from schools, thereby improving the integration of intelligence quotient (IQ) scores into the electronic medical records and the National Spina Bifida Patient Registry (NSBPR) at the Spina Bifida Center of Central New York. Outcome measures included the percentage of psychoeducational records integrated into the electronic medical record and the percentage of IQ scores entered into the NSBPR. Process measures included timestamp data to track the time required to retrieve records. Process control charts were used to measure our monthly record collection.</p><p><strong>Results: </strong>We obtained records for 29 of 57 consecutive school-aged patients who were seen at our SB center for more than 6 months (50% return rate). IQ scores were present in 18 of 29 records (62% yield). The percentage of IQ scores entered into the NSBPR increased from 5.4% to 29.7%. Most schools responded to record requests within 1 week. Record return rates dropped in September. Clerical support staff managed most of the workflow, spending an average of 14.5 minutes per patient.</p><p><strong>Conclusions: </strong>The workflow increased our ability to advocate for educational accommodations for our patients. We plan to share the workflow with other centers to facilitate the integration of cognitive data into the NSBPR, thereby improving our understanding of health and social outcomes for individuals with SB.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e901"},"PeriodicalIF":1.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622897","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 Rates of Routine Vaccinations in Adolescents at an Academic Children's Hospital.","authors":"Maria G Biancarelli, Hannah Rauchle, Kathleen Waddicor, Benjamin Ethier, Sara F Forman, Gabriela Vargas, Joshua Borus","doi":"10.1097/pq9.0000000000000902","DOIUrl":"10.1097/pq9.0000000000000902","url":null,"abstract":"<p><strong>Introduction: </strong>This project sought to increase the vaccination completion rate to 95% in an adolescent medicine practice. We aimed to increase the percentage of individuals who were up to date on their meningococcal, human papillomavirus, and tetanus, diphtheria, and pertussis vaccinations to 80% and to verify that these efforts led to more equitable care.</p><p><strong>Methods: </strong>We used the Model for Improvement. After a current-state analysis, the team implemented a bundled intervention that included obtaining missing records, notifying providers about patients who needed vaccinations, and providing electronic medical record alerts when vaccinations were due. Patients received vaccine education, and nurses offered a numbing spray to mitigate needle-related vaccine hesitancy.</p><p><strong>Results: </strong>Statistical process control charts showed a shift in the percentage of complete vaccination records from 88% to 95%. There was a mean shift for the combined meningococcal, human papillomavirus, and tetanus, diphtheria, and pertussis completion percentage from 70% to 76%. All race and payer subgroups improved with the interventions. Racial disparity analysis for the completion percentage pre- and postintervention showed that there were 2 disparities observed between the reference group, Hispanic patients, and other racial groups. No disparities were observed between publicly and privately insured patients before or after the interventions.</p><p><strong>Conclusions: </strong>The bundled intervention was associated with higher rates of vaccine documentation and administration. The highly engaged nursing staff and innovative technology drove success.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e902"},"PeriodicalIF":1.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622938","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 Time to Antibiotic Administration in Open Fractures.","authors":"Fiona A Fimmel, Emily M Rheaume, Kelly S Falcone, Vincent R Alexander, Sean Bartlett, Laurie H Johnson, Adam A Vukovic","doi":"10.1097/pq9.0000000000000890","DOIUrl":"10.1097/pq9.0000000000000890","url":null,"abstract":"<p><strong>Introduction: </strong>Timely antibiotic treatment for pediatric open long-bone fractures is associated with a reduced risk of infection. National guidelines recommend administering intravenous antibiotics within 60 minutes of presentation to the emergency department (ED). Historically, this study's level 1 pediatric trauma center has not met this benchmark. The objective of this study was to improve antibiotic administration time for pediatric patients with open long-bone fractures from a baseline of 113 to 60 minutes or less.</p><p><strong>Methods: </strong>A multidisciplinary team used serial Plan-Do-Study-Act cycles to implement and refine ED processes. Key interventions included targeted education for stakeholders, an updated order set with standardized antibiotic recommendations, modification of the existing orthopedic triage workflow, and quality review of eligible cases with feedback provided to treatment teams. Data were analyzed using X-moving range control charts to identify signals of change. The primary outcome measure was the time to appropriate antibiotic administration after arrival at the ED. Use of the newly introduced order set was tracked as a process measure, and time to analgesic and fracture reduction were balancing measures.</p><p><strong>Results: </strong>Data collected from September 2020 to March 2025 included 111 patients, 60 of whom were seen postintervention (starting in April 2023). Time to antibiotic administration improved from 113 to 36 minutes. There was a modest improvement in order set usage. Balancing measure times were not negatively impacted.</p><p><strong>Conclusions: </strong>The use of an iterative multimodal quality improvement package reduced the time to antibiotic administration and improved adherence to evidence-based protocols for the initial treatment of pediatric open long-bone fractures.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e890"},"PeriodicalIF":1.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622878","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 Communication Around Discharge Readiness at a Satellite Children's Hospital: A Single-site Improvement Initiative.","authors":"Brittany B Hubbell, Stephanie Allen, Yamini Kuchipudi, Emily Schmidlin, Deanna Verdin, Madison Archer, Jennifer Albrecht, Eric Mailloux, Christine M White, Angela M Statile, Lisa E Herrmann","doi":"10.1097/pq9.0000000000000897","DOIUrl":"10.1097/pq9.0000000000000897","url":null,"abstract":"<p><strong>Introduction: </strong>Discharge efficiency enhances hospital throughput, enabling timely, appropriate care while improving patient/caregiver experience and provider satisfaction. Prior efforts at our institution focused on implementing a discharge workflow based on the early identification of medical discharge goals. However, our satellite hospital team lacked consistent nurse-driven discharge activation when patients met these goals, which could delay the identification of discharge readiness. We aimed to increase the percentage of patients for whom nurses identified discharge readiness and activated the discharge process from 28% to 60% within 6 months.</p><p><strong>Methods: </strong>A multidisciplinary team applied quality improvement methods to identify key drivers and implement targeted interventions. Interventions included process education, structured communication during rounds, targeted feedback and email reminders, scheduled rounding times, and use of conditional discharge orders. We tracked the primary measure, the percentage of patients with nurse-driven discharge activation, using a statistical process control chart. Secondary measures included the percentage of patients with nurse-documented discharge readiness, the percentage of patients discharged within 2 hours of meeting medical discharge goals, and hospital length of stay. We monitored 7-day readmission rates as a balancing measure.</p><p><strong>Results: </strong>The mean percentage of patients with nurse-driven discharge activation increased to 67% and remained above this level for more than 8 months. The percentage of patients with nurse-documented discharge readiness improved from 71% to 86%; the mean percentage of patients discharged within 2 hours of nurse-identified readiness increased from 85% to 89%. Length of stay and 7-day readmission rates were unchanged.</p><p><strong>Conclusions: </strong>Through multidisciplinary efforts to improve process transparency and collaborative communication frameworks, we enhanced nurse-driven discharge activation at a satellite children's hospital.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e897"},"PeriodicalIF":1.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622909","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 Skin-to-Skin Contact During the Golden Hour for Neonates ≥34 Weeks: Single-Site Quality-Improvement Initiative Study.","authors":"Jithin Chittethu Shaji, Nalina Amuji, Tinu Krishna Vilasam Reghunath, Suman Rao Pn","doi":"10.1097/pq9.0000000000000888","DOIUrl":"10.1097/pq9.0000000000000888","url":null,"abstract":"<p><strong>Introduction: </strong>Early skin-to-skin contact (SSC) during the golden hour after birth offers multiple benefits for newborns and mothers. Despite World Health Organization and United Nations Children's Fund recommendations, baseline SSC rates in our unit were only 7% for vaginal deliveries and 10% for cesarean deliveries. We therefore aimed to increase the early SSC rate to more than 80% from baseline within 10 weeks.</p><p><strong>Methods: </strong>A multidisciplinary team of doctors and nurses conducted this quality improvement initiative in Southern India over 10 months (September 2023-June 2024) using the point-of-care quality improvement model (POCQI_learner_manual_ver 03_2020.pdf). Stable neonates of 34weeks or older included, measured baseline rates during 4 weeks, and tested 4 change ideas during the next 10 weeks. We assessed sustainability for 6 months after the intervention.</p><p><strong>Results: </strong>Out 1312 neonates of gestation age 34 weeks or older, 854 were eligible (513 vaginal deliveries and 341 cesarean deliveries). The mean gestational age was 37 ± 1 weeks (mean ± SD), and the mean birth weight was 2,929 ± 445 g (mean ± SD). Implementation of change ideas-including standardized documentation, simulation-based training, and task-sharing with nursing students and aides-improved SSC rates to 85% for vaginal deliveries and 91% for cesarean deliveries. We sustained these gains, with rates consistently remaining more than 85% during the sustainability period.</p><p><strong>Conclusions: </strong>This quality improvement initiative enhanced healthcare providers' knowledge, competence, and confidence in facilitating SSC, resulting in a marked and sustained change in practice. Future studies should explore scalability across diverse healthcare settings.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e888"},"PeriodicalIF":1.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474578","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":"Continuous Aerosolized Albuterol Treatment for Status Asthmaticus on the General Care Floor: A Quality Improvement Initiative.","authors":"Kailey A Remien, Charles Hardy, Karen Allen, Matthew Wysong, Morgan Zlotolow, Gerd McGwire, Courtney Whitacre, Renae Forsythe, Tara Dinh, Lisa Ulrich, Adjoa A Andoh, Samantha W Gee, Shauna Schord","doi":"10.1097/pq9.0000000000000896","DOIUrl":"10.1097/pq9.0000000000000896","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma, a leading cause of pediatric hospitalization, affects more than 6 million US children and costs more than $5 billion annually. Continuous aerosolized albuterol (CAA) effectively treats severe exacerbations but is typically reserved for intensive care or emergency settings. This quality improvement project aimed to safely expand CAA use on the general care floor (GCF) by monitoring treatment uptake, protocol adherence, and safety outcomes.</p><p><strong>Methods: </strong>This single-center quality improvement project, led by a multidisciplinary team, included children aged 2-18 years with status asthmaticus on CAA who met the inclusion criteria. Interventions involved protocol development, staff education, electronic health record updates, and a resident-led handoff huddle. Primary outcomes were non-pediatric intensive care unit (PICU) CAA hours and the proportion of patients treated on the GCF. Process measures included protocol use and handoff huddles. Balancing metrics included PICU and emergency transfers, fluid-refractory hypotension, and ED length of stay.</p><p><strong>Results: </strong>From June 2024 to October 2025, GCF CAA accounted for 17% of total hospital CAA, surpassing the 10% target. ED length of stay remained unchanged, indicating no disruption to workflow. We safely treated 72 patients on the GCF (average CAA duration of 21.6 h); 22 (31%) required PICU transfer; none were emergent transfer. This intervention saved 1,017 PICU hours (42.4 PICU bed-days), equivalent to $275,600 in room-and-board costs. These savings represent a substantial reduction in PICU resource use; however, we did not conduct a formal cost-effectiveness analysis.</p><p><strong>Conclusions: </strong>CAA can be safely administered in the GCF following a structured protocol, reducing the need for PICU resources without adversely affecting ED care efficiency.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e896"},"PeriodicalIF":1.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474552","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":"Parent-administered Metered-dose Inhalers Improves Medication Administration Time in the Children's Emergency.","authors":"Nur Nasiha B M Bahrudin, Cherie Tan, Germaine R Eu, Qian Wen Sng","doi":"10.1097/pq9.0000000000000889","DOIUrl":"10.1097/pq9.0000000000000889","url":null,"abstract":"<p><strong>Introduction: </strong>Prompt administration of bronchodilator therapy via metered-dose inhalers (MDIs) is critical to optimizing clinical outcomes in children with bronchospasm. At our children's emergency department, baseline data indicated that the average interval between the first and second MDI bronchodilator cycles was 44.4 minutes, highlighting delays in bronchodilator therapy. The primary objective was to achieve a 30% reduction in the time interval between the first and second bronchodilator MDI cycles within 1 year.</p><p><strong>Methods: </strong>This multidisciplinary quality improvement project was conducted using the Plan-Do-Study-Act model. Children aged 4-13 years presenting with clinical symptoms requiring bronchodilator therapy via MDI (salbutamol ± ipratropium) were included. Key interventions included revising the workflow to allow nurse-supervised parent administration of MDI, supported by information leaflets, educational videos, nurse-led demonstrations, competency checks, and a designated space for MDI administration. Our primary outcome measure was the time taken to administer the second cycle. Secondary outcome measures focused on parental competency and parent and nurse satisfaction.</p><p><strong>Results: </strong>From August 2022 to June 2023, our educational program reduced the mean time to administer the second MDI cycle from 44.3 (SD 31.3) to 27.6 (SD 8.1) minutes (<i>P</i> < 0.001). Ninety-eight percent of parents were competent on their first attempt. Both parents and nurses reported high satisfaction with the initiative and perceived it as safe.</p><p><strong>Conclusions: </strong>Parent-administered MDI significantly reduced the time interval between the first and second cycles and was highly accepted by parents and nurses, demonstrating an effective, sustainable approach to reducing delays in MDI administration in the emergency department.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e889"},"PeriodicalIF":1.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474609","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}