Pediatric quality & safety最新文献

{"title":"It Takes Two: Reduction of Unplanned Extubations in a Pediatric Intensive Care Unit through Continuous Quality Improvement","authors":"Mandeep Chadha, Alex Golchehreh, Anna Konstantin","doi":"10.1097/pq9.0000000000000712","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000712","url":null,"abstract":"Abstract","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140521231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Standard HAC Data Collection, Storage, and Display to Promote Informed Decisions","authors":"John J. Forbus, Giri Jaya Shankar","doi":"10.1097/pq9.0000000000000687","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000687","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140527370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying Safety Science to Sepsis Case Review","authors":"Kate Lucey, Kim Maciorowski, Megan O'Connell, Carolyn Kass, Kim Denicolo, Rebecca J Stephen","doi":"10.1097/pq9.0000000000000703","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000703","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140523158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Integration of an Oral Health Educator Enhances Prevention of Mucosal Barrier Injury Central Line-associated Bloodstream Infections for Pediatric BMT Patients","authors":"Kandice Bledsaw, Zachary D. Prudowsky, J. Dejean, Sharon Staton, Jenell Robins, David Steffin, Claudia X. Harriehausen, Esther Yang, Alexandra M Stevens","doi":"10.1097/pq9.0000000000000683","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000683","url":null,"abstract":"Background: Life-threatening mucosal barrier injury central line-associated bloodstream infections (MBI-CLABSIs) are an especially dangerous complication of inadequate oral healthcare and associated with a 7% 30-day mortality rate. 1 Oral complications among pediatric cancer patients can be due to treatment-induced side effects, limited access to dental care, nonadherence to oral care guidelines, and variations in oral care practices. 1–4 Our innovative approach to addressing oral complications and infection prevention strategies led to hiring a dental hygienist to serve in a novel Oral Health Educator (OHE) role. Methods: This project used MBI-CLABSI and oral hygiene bundle adherence rates from October 2021 to September 2022. MBI-CLABSIs were identified if the causative species was a known oral or GI pathogen and met the National Healthcare Safety Network definition. 5 The aims of this project were to decrease MBI-CLABSI incidence by 25%, improve oral care adherence to remain above 75%, and decrease healthcare-associated costs on the bone marrow transplant (BMT) unit. Results: The overall MBI-CLABSI rate after OHE implementation decreased 59% and decreased consistently to 0/1000-line days for June to September 2022 (Figure 1). Overall MBI-CLABSI events decreased by 56%. Oral care bundle adherence remained consistently above 75% after OHE implementation. We estimate a 6 month associated healthcare cost savings of $","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140526039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All Hands on Deck: How Multidisciplinary Implementation of CLABSI Countermeasures Cut Our Rate in Half","authors":"Elizabeth M. Chang, Sarah Brunner, Lacey D. Bergerhofer","doi":"10.1097/pq9.0000000000000692","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000692","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140519168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin in the Game: Implementation of Weekly Active Surveillance in a Pediatric ICU","authors":"Erica Eberhard, Grace Brooks, Julie LeBlanc, Natalie Lu","doi":"10.1097/pq9.0000000000000701","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000701","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140527325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Central Line-associated Bloodstream Infections Using a Frontline Staff-driven Approach","authors":"Joanne Pasinski, Johanna Young, Nicole Leone, Kaitlyn Philips","doi":"10.1097/pq9.0000000000000685","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000685","url":null,"abstract":"Background: Infections are a major source of morbidity and mortality for infants in the neonatal ICU (NICU). 1 Sustainable improvement in our central line-associated bloodstream infection (CLABSI) rate was challenging, despite adherence to evidence-based best practices. 2–4 Therefore, we leveraged a multidisciplinary approach to reinvigorate our improvement efforts and reduce the CLABSI rate. We aimed to decrease the CLABSI rate from 2.97 to 1.49 infections (a 50% reduction) per 1000 central line days for infants of all birth weights over 36 months. Methods: We used the Model for Improvement and plan, do, study, act cycles as the framework for our improvement effort. 5 Stakeholders from frontline nursing, nursing leadership, physician staff, advanced practitioners, administrators, and families formed a multidisciplinary team. A frontline nurse led this team and held staff accountable. Interventions were multi-factorial, agreed upon by the stakeholder team, and included all staff members taking ownership of line maintenance. Videos demonstrating two-person sterile procedures, such as line and cap changes, standardized practice throughout the unit. Educational materials introduced the importance of central line maintenance and infection prevention to families. Daily verification of occlusive central line dressings by the bedside nurse and neonatologist encouraged multidisciplinary accountability for central line care. A newsletter was created to maintain communication about process changes and provide performance feedback to frontline staff. Aligning our practice with current parenteral nutrition guidelines led to increased frequency of tubing changes, from every 96 to every 24 hours. Staff incorporated new products, such as adhesives and dressings to reduce the number of dressing changes overall. The outcome measure was the CLABSI rate. The process measure was compliance with the CLABSI prevention bundle for line maintenance. These data were collected monthly and analyzed for special cause variation on a statistical process","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140515875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreasing Ambulatory CLABSIs in Oncology Patients","authors":"Angie Blackwell, Brittney K. Anderson","doi":"10.1097/pq9.0000000000000698","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000698","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140525328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting a Sleep-friendly Environment by Minimizing Overnight Room Entries.","authors":"Lauren M McDaniel, Nilesh Seshadri, Elizabeth A Harkins, Megan Keydash, Alice Pan, Laura M Sterni, Shawn L Ralston","doi":"10.1097/pq9.0000000000000668","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000668","url":null,"abstract":"<p><strong>Introduction: </strong>Despite its importance in illness recovery, the sleep of hospitalized children is frequently interrupted. This quality improvement intervention aimed to reduce overnight room entries by minimizing unnecessary interventions.</p><p><strong>Methods: </strong>This study occurred at a university-affiliated children's hospital on the hospital medicine services from March 26, 2021, to April 14, 2022. The intervention included order set changes and the implementation of a rounding checklist designed to address factors most closely associated with sleep disruption and overnight room entries. The outcome measure was overnight (10 pm to 6 am) room entries, counted using room entry sensors. Process measures reflected the intervention targets (overnight vital sign orders, medication administration, and intravenous fluid use). The method of analysis was statistical process control charting.</p><p><strong>Results: </strong>After identifying special cause variation, the average number of overnight room entries decreased from 8.1 to 6.8, a 16% decrease. This decrease corresponded with the implementation of a rounding checklist. However, there continued to be variability in average room entries, suggesting a process lacking ongoing stability. During this period, avoidance of overnight medications and intravenous fluid increased by 28% and 17%, respectively.</p><p><strong>Conclusions: </strong>Implementing a rounding checklist to a broad patient population decreased overnight room entries. However, future work is needed to better understand the factors associated with sustaining such an improvement.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813970","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":"Sustainability Standards in Pediatric Anesthesia: Quality Initiative to Reduce Costly Environmentally Harmful Volatile Anesthetics.","authors":"Andrew T Waberski, Sophie R Pestieau, Caroll Vazquez-Colon, Jessica Cronin, Barbara H Braffett","doi":"10.1097/pq9.0000000000000708","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000708","url":null,"abstract":"<p><strong>Background: </strong>The emission and entrapment of greenhouse gases (GHG) inside the atmosphere is one of the leading causes of global warming. Commonly administered anesthetics have global warming potential up to 2,000 times greater than carbon dioxide. This Quality Improvement (QI) initiative aimed to develop a set of sustainability standards to reduce volatile anesthetic GHG emissions and costs at a children's hospital.</p><p><strong>Methods: </strong>In January 2020, the QI project team implemented education sessions for clinical staff on the environmental impact of volatile anesthetics, bedside clinical reminders, resource guides on sustainable anesthesia practices, preset low-flow gas levels on anesthesia machines, relocated and reduced the number of available vaporizers, and implemented policies to standardize clinical practice. Using hospital pharmacy purchase order data between 2018 and 2022, GHG emissions and costs from three commonly used volatile anesthetics (Isoflurane, Sevoflurane, and Desflurane) were compared using metric ton carbon dioxide equivalents.</p><p><strong>Results: </strong>During 3 years, GHG emissions from volatile anesthetics were significantly reduced by 77%, with most of the reduction attributed to the reduced use and eventual elimination of Desflurane. Purchase costs were also significantly reduced during this period by 41%.</p><p><strong>Conclusions: </strong>This QI project successfully decreased GHG emissions over 3 years by simultaneously reducing the use of costly and environmentally harmful volatile anesthetic, Desflurane, and increasing the use of low-flow anesthesia. This study addresses our anesthesia practices and healthcare system's impact on the pediatric population and proposes simple interventions to mitigate the negative consequences of current practices.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813981","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}