Pediatric quality & safety最新文献

{"title":"Emergency Department Initiative to Decrease High-flow Nasal Cannula Use for Admitted Patients with Bronchiolitis.","authors":"Courtney E Nelson, Jonathan M Miller, Chalanda Jones, Emily Reese Fingado, Ann-Marie Baker, Julie Fausnaugh, Michael Treut, Leah Graham, Katlyn L Burr, Arezoo Zomorrodi","doi":"10.1097/pq9.0000000000000728","DOIUrl":"10.1097/pq9.0000000000000728","url":null,"abstract":"<p><strong>Background: </strong>Despite limited evidence, a high-flow nasal cannula (HFNC) is often used to treat mild to moderate (m/m) bronchiolitis. We aimed to decrease the rate of HFNC use in the pediatric emergency department (PED) for m/m bronchiolitis from a baseline of 37% to less than 18.5%.</p><p><strong>Methods: </strong>A multidisciplinary team created a bronchiolitis pathway and implemented it in December 2019. A respiratory score (RS) in the electronic medical record objectively classified bronchiolitis severity as mild, moderate, or severe. We tracked HFNC utilization in the PED among patients with m/m bronchiolitis as our primary outcome measure between December 2019 and December 2021. We monitored the percentage of patients with an RS as a process measure. Interventions through four plan-do-study-act cycles included updating the hospital oxygen therapy policy, applying the RS to all patients in respiratory distress, modifying the bronchiolitis order set, and developing a bronchiolitis-specific HFNC order.</p><p><strong>Results: </strong>Three hundred twenty-five patients were admitted from the PED with m/m bronchiolitis during the 11-month baseline period and 600 patients during the 25-month intervention period. The mean rate of HFNC utilization decreased from 37% to 17%. Despite a decrease in bronchiolitis encounters after the pandemic, in the spring of 2021, when volumes returned, we had a sustained HFNC utilization rate of 17%. RS entry increased from 60% to 73% in the intervention period.</p><p><strong>Conclusions: </strong>A clinical pathway for bronchiolitis can lead to decreased use of HFNC for m/m bronchiolitis. Consistent RS, order set development with decision support, and education led to sustained improvement despite pandemic-related volumes.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946648","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":"Synergizing Safety: A Customized Approach to Curtailing Unplanned Extubations through Shared Decision-making in the NICU.","authors":"Parvathy Krishnan, Nilima Jawale, Adam Sodikoff, Susan R Malfa, Kathleen McCarthy, Lisa M Strickrodt, Diana D'Agrosa, Alexandra Pickard, Lance A Parton, Meenakshi Singh","doi":"10.1097/pq9.0000000000000729","DOIUrl":"10.1097/pq9.0000000000000729","url":null,"abstract":"<p><strong>Background: </strong>Unplanned Extubation (UE) remains an important patient safety issue in the Neonatal Intensive Care Unit. Our SMART AIM was to decrease the rate of UE by 10% from the baseline from January to December 2022 by emphasizing collaboration among healthcare professionals and through the use of shared decision-making.</p><p><strong>Methods: </strong>We established an interdisciplinary Quality Improvement team composed of nurses, respiratory therapists, and physicians (MDs). The definition of UE was standardized. UE was audited using an apparent cause analysis form to discern associated causes and pinpoint areas for improvement. Interventions were implemented in a step-by-step fashion and reviewed monthly using the model for improvement. A shared decision-making approach fostered collaborative problem-solving.</p><p><strong>Results: </strong>Our baseline UE rate was 2.3 per 100 ventilator days. Retaping, general bedside care, and position change accounted for over 50% of the UE events in 2022. The rate of UE was reduced by 48% by the end of December 2022. We achieved special-cause variation by the end of March 2023.</p><p><strong>Conclusions: </strong>The sole education of medical and nursing providers about various approaches to decreasing unnecessary retaping was ineffective in reducing UE rates. Shared decision-making incorporating inputs from nurses, respiratory therapists, and MDs led to a substantial reduction in the UE rate and underscores the potential of systematic evaluation of risk factors combined with collaborative best practices.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946627","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":"Telemedicine Quality Improvement during the Corona Virus 2019 Pandemic Increases Pediatric Weight Management Access.","authors":"Monique K Vallabhan, Kathryne Foos, Patricia Roldan, Sylvia Negrete, Janet M Page-Reeves, Elizabeth Y Jimenez, Alberta S Kong","doi":"10.1097/pq9.0000000000000731","DOIUrl":"10.1097/pq9.0000000000000731","url":null,"abstract":"<p><strong>Background: </strong>The corona virus 2019 pandemic disrupted care for pediatric patients with chronic conditions, including those with childhood obesity. Lockdowns forced providers to create new ways of caring for this population. Telemedicine was a promising but previously unavailable solution. This quality improvement report details how the Healthy and Fit Children's Clinic transitioned and improved care via telemedicine.</p><p><strong>Methods: </strong>Between March 2020 and April 2021, the quality improvement project team incorporated the Model for Improvement to transition the clinic to telemedicine. The team tracked Healthy and Fit Children's Clinic appointments, no-shows, billing and reimbursement data, and noted unintended consequences or unanticipated barriers. Patients and their families were given a satisfaction survey at the end of each telemedicine encounter.</p><p><strong>Results: </strong>Compared with pre-telemedicine implementation, there was a 120% increase in completed patient clinic visits per week and a sustained positive shift above the established baseline. Telemedicine no-show rates achieved <10%, with an average sustained rate of <20%, compared with unchanged in-person no-show rates of >50% pre- and post-telemedicine implementation. There was a 74% increase in monthly billing and a sustained positive shift above the pre-telemedicine baseline. On average, patients rated all six satisfaction questions ≥92 on the 100-point scale (compared with 83 pre-telemedicine).</p><p><strong>Conclusions: </strong>This transition to telemedicine was successful and could be translatable to other clinic sites. Patients attended their clinic visits more consistently and were highly satisfied with their care. In a population where continuity of care is paramount, telemedicine shows promise as a tool to treat childhood obesity.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946630","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":"Enhanced Safety and Efficiency of Ambulatory Cardiology Admissions: A Quality Improvement Initiative.","authors":"Mary C McLellan, Mariam Irshad, Katherine C Penny, Michelle Rufo, Sarah Atwood, Heather Dacey, Christina M Ireland, Sarah de Ferranti, Theresa Saia, Anna C Fisk, Susan F Saleeb","doi":"10.1097/pq9.0000000000000726","DOIUrl":"10.1097/pq9.0000000000000726","url":null,"abstract":"<p><strong>Background: </strong>Pediatric cardiac patients have experienced evolving illnesses progressing to instability while awaiting inpatient admission from ambulatory settings. Admission delays and communication breakdowns increase the risk for tenuous patients. This quality improvement initiative aimed to improve safety and efficiency for patients admitted from an ambulatory Clinic to the Acute Cardiac Care Unit (ACCU) using standardized communication and admission processes within one year.</p><p><strong>Methods: </strong>An admission process map, in-clinic nurse monitoring, and communication pathways were developed and implemented. A standardized team handoff occurred via virtual huddle using illness severity, patient summary, action list, situational awareness, and synthesis. Escalation of care events and timeliness were compared pre- and postimplementation.</p><p><strong>Results: </strong>There was a reduction of transfers to the intensive care unit within 24 hours of ACCU admission from 9.2% to 3.8% (<i>P</i> = 0.26), intensive care unit evaluations (without transfer) from 5.6% to 0% (<i>P</i> = 0.06), and arrests from 3.7% to 0% (<i>P</i> = 0.16). After the pilot, clinic nurses monitored 100% of at-risk patients. Overall mean time from admission decision to virtual huddle decreased from 81 to 61 minutes and mean time to admission from 144 to 115 minutes, with 41% (n = 33) arriving ≤ 60 minutes (goal). The COVID-19 pandemic negatively affected admission timeliness while safety metrics remained optimized.</p><p><strong>Conclusions: </strong>Implementing a standardized admission process between the Clinic and ACCU enhanced safety by reducing admission wait time and escalation of care post-admission. Sustainable, reliable handoff processes, in-clinic monitoring, and standardized admission processes were established. The pandemic hindered admission efficiency without compromising safety.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946652","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 Osteopenia of Prematurity-related Fractures in a Level IV NICU: A Quality Improvement Initiative.","authors":"Linsey Cromwell, Katherine Breznak, Megan Young, Anoosha Kasangottu, Sharon Leonardo, Catherine Markel, Andreea Marinescu, Folasade Kehinde, Vilmaris Quinones Cardona","doi":"10.1097/pq9.0000000000000723","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000723","url":null,"abstract":"<p><strong>Background: </strong>Osteopenia of prematurity (OOP) is often a silent disease in the neonatal intensive care unit (NICU). Despite its association with increased neonatal morbidity, such as fractures, wide variation exists in screening, diagnostic, and management practices. We sought to decrease the rate of OOP-related fractures in our level IV NICU by 20% within 1 year.</p><p><strong>Methods: </strong>A multidisciplinary quality improvement team identified inconsistent screening, diagnosis, and management of OOP, as well as handling of at-risk patients, as primary drivers for OOP-related fractures. Using the model for improvement, we implemented sequential interventions, including screening, diagnosis, and a management algorithm as a \"handle-with-care\" bundle in infants at risk for fractures.</p><p><strong>Results: </strong>194 at-risk infants were included, 59 of whom had OOP. There was special cause variation in OOP-related fractures, with a reduction from 0.43 per 1000 patient days to 0.06 per 1000 patient days with our interventions. There was also an improvement in days between fractures from 62 to 337 days. We achieved these improvements despite a similar prevalence of OOP throughout the initiative. We showed special cause variation with increased patients between missed OOP documentation and improved collection of OOP screening laboratories at 4 weeks of life without increased blood testing.</p><p><strong>Conclusion: </strong>A multidisciplinary team approach with standardized OOP screening, diagnosis, and management guidelines, including a handle-with-care bundle, reduces OOP-related fractures in a level IV NICU.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862895","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 Rigid Immobilization for Toddler's Fractures: A Quality Improvement Initiative.","authors":"Stephanie N Chen, Jessica B Holstine, Julie Balch Samora","doi":"10.1097/pq9.0000000000000722","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000722","url":null,"abstract":"<p><strong>Background: </strong>Toddler's fractures are one of the most common orthopedic injuries in young walking-age children. They are defined as nondisplaced spiral-type metaphyseal fractures involving only the tibia without any injury to the fibula and are inherently stable. We aimed to use quality improvement methodology to increase the proportion of patients with toddler's fractures treated without cast immobilization at a large tertiary referral pediatric orthopedic center from a baseline of 45.6%-75%.</p><p><strong>Methods: </strong>Baseline data on patient volume and treatment regimens for toddler's fractures were collected starting in February 2019. Monthly data were collected from the electronic medical record and reviewed to determine treatment (cast versus noncast immobilization) and tracked using statistical process control charts (p-chart). After determining the root causes of treatment using immobilization, interventions tested and adopted included physician alignment of expectations for treatment, sharing unblinded compliance data with providers, updating patient education materials, and updating resident education and reference materials.</p><p><strong>Results: </strong>After interventions were in place, the percentage of patients treated without CAST immobilization increased from 45.6% to 90% (<i>P</i> ≤ 0.001). We also observed improvement in our process measure to increase the percentage of this population receiving boot immobilization during new patient visits in our orthopedic clinics (4.15% to 52%, <i>P</i> ≤ 0.001).</p><p><strong>Conclusions: </strong>By aligning provider and family expectations for treatment, demonstrating no clinical need for cast immobilization, and bringing awareness of compliance to appropriate guidelines, our institution was able to improve care for patients with toddler's fractures and reduce financial and care burdens for families.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857469","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":"Identifying Autism Spectrum Disorder in a High-risk Follow-up Program through Quality Improvement Methodology.","authors":"Christine M Raches, Elesia N Hines, Abbey C Hines, Emily K Scott","doi":"10.1097/pq9.0000000000000717","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000717","url":null,"abstract":"<p><strong>Introduction: </strong>Children born prematurely are at increased risk for autism spectrum disorder (ASD). ASD can be diagnosed between 18 and 24 months of age, but access barriers and medical complexity can delay diagnosis. ASD screening was implemented in a high-risk infant follow-up program using QI methodology. The project aimed to screen 60% of children and refer 90% of those with positive screens.</p><p><strong>Methods: </strong>The team developed a standardized workflow to administer the M-CHAT-R/F to HRIF patients between the ages of 16-22 months. Telehealth ASD assessment, using the TELE-ASD-PEDS, was conducted for those who screened positive. Monthly team meetings were held to implement change cycles and review the impact of the previous month's change.</p><p><strong>Results: </strong>Within 7 months of program implementation, ASD screening exceeded the 60% aim. The program referred 72% of patients who screened as medium/high risk on the M-CHAT-R/F. The remaining patients were not referred per provider discretion. Twenty-seven percent of patients who received an autism evaluation received an ASD diagnosis. The average age at diagnosis was 22.5 months.</p><p><strong>Conclusions: </strong>An ASD screening protocol was implemented for patients enrolled in a high-risk infant follow-up program. Patients identified as at risk for ASD received an expedited telehealth ASD evaluation. The screening protocol was maintained for 13 months and is now part of the standard workflow. Screening has been expanded to other HRIF clinics, and evaluation appointments have been added to meet access needs. QI methodology is an effective tool for implementing ASD screening and referral in multidisciplinary HRIF programs.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862894","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":"Patient Portal Enrollment for Discharged Pediatric Emergency Department Patients: A Multidisciplinary Quality Improvement Project.","authors":"Sarah C Isbey, Sephora N Morrison, Sonya M Burroughs, Jaclyn N Kline","doi":"10.1097/pq9.0000000000000718","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000718","url":null,"abstract":"<p><strong>Introduction: </strong>Patient portal enrollment following pediatric emergency department (ED) visits allows access to critical results, physician documentation, and telehealth follow-up options. Despite these advantages, there are many challenges to portal invitation and enrollment. Our primary objective was to improve patient portal enrollment rates for discharged pediatric ED patients.</p><p><strong>Methods: </strong>A multidisciplinary team of staff from two ED sites developed successful portal enrollment interventions through sequential Plan-Do-Study-Act cycles from October 2020 to October 2021. Interventions included a new invitation process, changes to patient paperwork on ED arrival, staff portal education, and changes to discharge paperwork and the portal website. The team utilized statistical process control charts to track the percentage of eligible discharged patients who received a portal invitation (process measure) and enrolled in the patient portal.</p><p><strong>Results: </strong>Before the study's initiation, less than 1% of eligible patients received patient portal invites or enrolled in the patient portal. Statistical process control charts revealed significant changes in enrollment and baseline shift at both a large academic ED campus and a satellite ED site by May 2021. Improvements in invitation rates were also observed at both campuses. Changes were sustained for over 6 months at both locations.</p><p><strong>Conclusions: </strong>High-reliability interventions and a multidisciplinary approach allowed for significant and sustained improvement in patient portal invitation and enrollment rates in eligible pediatric ED patients. Future study will examine enrollment patterns across patient demographics and further high-reliability interventions.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857468","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 Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations.","authors":"Mohamed Sakr, Mohamed Al Kanjo, Palanikumar Balasundaram, Fernanda Kupferman, Sharef Al-Mulaabed, Sandra Scott, Kusum Viswanathan, Ratna B Basak","doi":"10.1097/pq9.0000000000000721","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000721","url":null,"abstract":"<p><strong>Background: </strong>Current national guidelines recommend against chest X-rays (CXRs) for patients with acute asthma exacerbation (AAE). The overuse of CXRs in AAE has become a concern, prompting the need for a quality improvement (QI) project to decrease CXR usage through guideline-based interventions. We aimed to reduce the percentage of CXRs not adhering to national guidelines obtained for pediatric patients presenting to the Emergency Department (ED) with AAE by 50% within 12 months of project initiation.</p><p><strong>Methods: </strong>We conducted this study at a New York City urban level-2 trauma center. The team was composed of members from the ED and pediatric departments. Electronic medical records of children aged 2 to 18 years presenting with AAE were evaluated. Monthly data on CXR utilization encompassing instances where the ordered CXR did not adhere to guidelines was collected before and after implementing interventions. The interventions included provider education, visual reminders, printed cards, grand-round presentations, and electronic medical records modifications.</p><p><strong>Results: </strong>The study encompassed 887 eligible patients with isolated AAE. Baseline data revealed a mean preintervention CXR noncompliance rate of 37.5% among children presenting to the ED with AAE. The interventions resulted in a notable decrease in unnecessary CXR utilization, reaching 16.7%, a reduction sustained throughout subsequent months.</p><p><strong>Conclusions: </strong>This QI project successfully reduced unnecessary CXR utilization in pediatric AAE. A multi-faceted approach involving education, visual aids, and electronic reminders aligned clinical practice with evidence-based guidelines. This QI initiative is a potential template for other healthcare institutions seeking to curtail unnecessary CXR usage in pediatric AAE.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860953","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":"Formative Evaluation of CLABSI Adoption and Sustainment Interventions in a Pediatric Intensive Care Unit.","authors":"Lindsey J Patton, Angelica Morris, Amanda Nash, Kendel Richards, Leslie Huntington, Lori Batchelor, Jenna Harris, Virginia Young, Carol J Howe","doi":"10.1097/pq9.0000000000000719","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000719","url":null,"abstract":"<p><strong>Background: </strong>Pediatric patients require central venous catheters to maintain adequate hydration, nutritional status, and delivery of life-saving medications in the pediatric intensive care unit. Although central venous catheters provide critical medical therapies, their use increases the risk of severe infection, morbidity, and mortality. Adopting an evidence-based central line-associated bloodstream infection (CLABSI) bundle to guide nursing practice can decrease and sustain low CLABSI rates, but reliable and consistent implementation is challenging. This study aimed to conduct a mixed-methods formative evaluation to explore CLABSI bundle implementation strategies in a PICU.</p><p><strong>Methods: </strong>The team used The Consolidated Framework for Implementation Research to develop the interview guide and data analysis plan.</p><p><strong>Results: </strong>Facilitators and barriers for the CLABSI bundle occurred in four domains: inner setting, process, characteristics of individuals, and innovation characteristics in each cycle that led to recommended implementation strategy opportunities. The <i>champion</i> role was a major implementation strategy that facilitated the adoption and sustainment of the CLABSI bundle.</p><p><strong>Conclusions: </strong>Implementation Science Frameworks, such as Consolidated Framework for Implementation Research (CFIR), can be a beneficial framework to guide quality improvement efforts for evidence-based practices such as the CLABSI bundle. Using a champion role in the critical care setting may be an important implementation strategy for CLABSI bundle adoption and sustainment efforts.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856850","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}