Pediatric quality & safety最新文献

{"title":"Establishing a Quality Improvement Program for Pediatric In-hospital Cardiac Arrest.","authors":"Anya J Freedman, Erik C Madsen, Lia Lowrie","doi":"10.1097/pq9.0000000000000706","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000706","url":null,"abstract":"<p><strong>Background: </strong>Pediatric In-hospital Cardiac Arrest (IHCA) is a rare event with a 50-55% mortality rate. Techniques of Cardiopulmonary Resuscitation (CPR), medication and electrical therapy timing, team dynamics, simulation and debriefing programs are associated with improved outcomes. This study aimed to improve outcomes after IHCA by describing and implementing quality improvement processes that cross and coordinate among traditional siloed pediatric resuscitation team structures.</p><p><strong>Methods: </strong>We chose three outcome measures: (1) return of spontaneous circulation (ROSC), (2) 24-hour survival after IHCA, and (3) survival to hospital discharge. Process outcomes include (1) hot debriefs performed with a standardized form, (2) code documentation using a revised form, and (3) formal code team review presented to a central Emergency Management Committee, using a standardized form.</p><p><strong>Results: </strong>One hundred and thirty-two patients experienced 176 events during the 36-month study period. Survival to hospital discharge increased from 33% during year 1 to 60% during year 2 (<i>P</i> < 0.05) but decreased to 45% in year 3. Both hot debrief performance and code documentation process methods did not demonstrate widespread adoption, but formal code team review was documented in 80% of events quite rapidly.</p><p><strong>Conclusions: </strong>There are common traits inherent to effective CPR team response. Ensuring optimal performance of these common tasks and techniques in every pediatric IHCA event in our hospital is being addressed by committee reorganization, task simplification, new technology acquisition and enhanced feedback loops. Early outcome analysis shows initial improvement in survival to hospital discharge after pediatric IHCA.</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/PMC10715786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813799","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 the Time to Action on Bilirubin Results Overnight in a Newborn Nursery.","authors":"Andrew M Beverstock, Lily Rubin, Meredith Akerman, Estela Noyola","doi":"10.1097/pq9.0000000000000707","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000707","url":null,"abstract":"<p><strong>Introduction: </strong>Infants commonly require phototherapy in the nursery to prevent kernicterus, but it can interfere with parent-infant bonding. Minimizing unnecessary phototherapy is important. We noticed frequent delays in initiating and discontinuing phototherapy at our hospital. Our primary aim was to start or stop phototherapy within 3 hours of the intended blood draw time for more than 80% of patients by August 2022. Our secondary aims were to have the bilirubin result available within two hours of the intended draw time and for the result to be actioned upon within 1 hour of becoming available.</p><p><strong>Methods: </strong>We audited all patients requiring phototherapy, from January 2021 to December 2021 (n = 250). In PDSA cycle 1, we used electronic medical record result alerts. In cycle 2, we educated residents on the importance of acting promptly on results. In cycle 3, we asked residents to message the nurse to alert them to any laboratory draws for that shift. In cycle 4, we implemented a standardized laboratory draw policy.</p><p><strong>Results: </strong>We increased the percentage of results acted upon within 3 hours from 56% to more than 80%. We also reduced the mean time from blood draw to action from 184 minutes to 134 minutes. The time from intended draw to result availability decreased from 115 minutes to 95 minutes, and the time to action decreased from 67 minutes to 42 minutes.</p><p><strong>Conclusions: </strong>Combining resident education, electronic medical record result alerts, and policy standardization allowed us to achieve our stated aim and improved care for our neonates.</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/PMC10715789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813976","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":"Multidisciplinary Initiative to Increase Guideline-concordant Antibiotic Prescription at Discharge for Hospitalized Children with Uncomplicated Community-acquired Pneumonia.","authors":"Alexandra B Yonts, Laura B O'Neill, Matthew A Magyar, Michael J Bozzella","doi":"10.1097/pq9.0000000000000711","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000711","url":null,"abstract":"<p><strong>Background: </strong>Clinical practice guidelines recommend using narrow-spectrum antibiotics to treat uncomplicated pneumonia in children. This quality improvement (QI) project aimed to evaluate if QI methods could improve guideline-concordant antibiotic prescribing at hospital discharge for children with uncomplicated pneumonia.</p><p><strong>Methods: </strong>For this single-center QI project, we implemented QI interventions in serial plan-do-study-act cycles, focusing on the key drivers targeting general pediatric inpatient resident teams. Interventions included: (1)Small bimonthly group didactic sessions, (2)Visual job aids posted in resident work areas, and (3) A noon conference session. Balancing measures included postdischarge emergency room visits, readmission and adverse drug reactions.</p><p><strong>Results: </strong>To establish a baseline rate, we conducted a chart review of 112 children diagnosed with uncomplicated community-acquired pneumonia during hospitalization from July 2017 through January 2019. The average monthly percentage of children discharged with guideline-concordant antibiotics was 67%. The intervention period was from February 2019 through February 2020, with 118 children meeting the criteria after a review of 262 charts. After our interventions, the average monthly percentage of children discharged with guideline-concordant antibiotics increased to 87%, with the increase persisting for at least 12 months. There were no significant differences in balancing measures pre- and post-interventions.</p><p><strong>Conclusions: </strong>Our QI initiative sustained increased rates of uncomplicated community-acquired pneumonia guideline-concordant antibiotic prescribing at discharge over 12 months without an increase in balancing measures. The enduring changes in prescribing behavior suggest a lasting impact of our interventions.</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/PMC10715768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813934","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 Project to Improve the Utilization of an Intraoperative Rapid Response System.","authors":"Asheen Rama, Daniel Qian, Ty Forbes, Ellen Wang, Lynda Knight, Marc Berg, Thomas J Caruso","doi":"10.1097/pq9.0000000000000686","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000686","url":null,"abstract":"<p><strong>Introduction: </strong>Rapid response teams (RRTs) improve morbidity by reducing the incidence of cardiac arrests. Although providers commonly activate RRTs on acute care wards, they are infrequently used perioperatively. At our institution, two intraoperative calls for help exist: staff assists (SAs) and code blues (CBs). The SA functions analogously to an RRT, and the CB indicates cardiopulmonary arrest. Given the success of RRTs, this project aimed to increase the use of the SA system. Our primary goal was to increase the ratio of SA to CB alerts by 50% within 6 months.</p><p><strong>Methods: </strong>A quality improvement team led this project at an academic pediatric hospital in Northern California. The team analyzed the current state and identified an achievable goal. After developing key drivers, they implemented monthly simulations to teach providers the signs of clinical deterioration and to practice activating the SA system. In addition to measuring the ratio of SA to CB alerts, the team surveyed the etiologies of SA and measured process satisfaction.</p><p><strong>Results: </strong>Before the introduction of this initiative, the ratio of SA to CB alerts were 1:13.3. These improvements efforts led to an increase of SA to CB alerts to 1.5:1 (<i>P</i> = 0.0003). Twenty-three anesthesiologists provided etiologies for SA, reporting laryngospasm as the most common reason (30.4%). Nineteen nurses completed the SA survey and reported high satisfaction.</p><p><strong>Conclusion: </strong>This project successfully increased the utilization of a rapid response protocol in a pediatric perioperative setting using improvement methodologies and a simulation-based educational program.</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/PMC10715782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813745","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 Pediatric Ovarian Torsion Evaluation in the Pediatric Emergency Department: A Quality Improvement Initiative.","authors":"Brian L Park, Sara Fenstermacher, A Luana Stanescu, Lori Rutman, Lauren Kinneman, Patrick Solari","doi":"10.1097/pq9.0000000000000709","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000709","url":null,"abstract":"<p><strong>Background: </strong>Transabdominal pelvic ultrasound (TPUS) is the diagnostic test of choice for the evaluation of ovarian torsion, a time-sensitive surgical emergency. A full bladder is required to visualize the ovaries. Bladder filling is a time-consuming process leading to delays to TPUS, poor visualization of ovaries requiring repeat studies, and prolonged emergency department length of stay (ED LOS). The primary objective was to decrease the time to TPUS by standardizing the bladder filling process.</p><p><strong>Methods: </strong>This quality improvement initiative occurred at a single, academic, quaternary-care children's hospital ED and utilized the Institute for Healthcare Improvement Model for Improvement with sequential plan-do-study-act cycles. The first set of interventions implemented in August 2021 included a new electronic order set and bladder scan by ED nurses. Subsequent plan-do-study-act cycles aimed to decrease the time to intravenous fluid, decrease fluid requirement, and decrease the need for intravenous fluid. The primary outcome measure was the monthly mean time to TPUS. Secondary outcome measures included monthly mean ED LOS and percentage of repeat TPUS. We performed data analysis with statistical process control charts to assess for system change over time.</p><p><strong>Results: </strong>The preintervention baseline included 292 ED encounters more than 10 months, and postintervention analysis included 526 ED encounters more than 16 months. Time to TPUS decreased (138-120 min), ED LOS decreased (372-335 min), and repeat TPUS decreased (18% to 4%). All changes met the rules for special cause variation.</p><p><strong>Conclusions: </strong>Standardizing the bladder filling process was associated with decreased time to TPUS, ED LOS, and repeat TPUS.</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/PMC10715784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813813","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":"Increasing COVID-19 Immunization Rates through a Vaccination Program for Hospitalized Children.","authors":"Victoria Mattick, Katelyn Cappotelli Nevin, Anne Fallon, Stephanie Northwood Darrow, Suzanne Ramazani, Travis Dick, Tina Sosa","doi":"10.1097/pq9.0000000000000704","DOIUrl":"10.1097/pq9.0000000000000704","url":null,"abstract":"<p><strong>Introduction: </strong>Inpatient coronavirus disease 2019 (COVID-19) vaccination initiatives offer a novel strategy to eliminate barriers to care, provide access to interprofessional teams, and decrease COVID-19 morbidity and mortality. Our inpatient vaccination initiative aimed to triple the baseline rate of eligible hospitalized children vaccinated against COVID-19 from 0.95% to 2.85% from December 2021 to June 2022.</p><p><strong>Methods: </strong>We implemented a COVID-19 vaccination program for pediatric inpatients eligible to receive a dose based on age, current guidelines, and prior doses received. Key drivers included immunization counseling training, identification of eligible patients, and a streamlined workflow. The outcome measure was the percentage of eligible patients who received a vaccine dose during hospitalization. The process measures included the percentage of age-eligible patients who were appropriately screened for prior doses on admission. We designed a clinical decision support system to enhance eligibility identification. The team performed a health equity analysis which stratified patients by social vulnerability index.</p><p><strong>Results: </strong>During the study period, the average percentage of eligible hospitalized patients vaccinated increased from 0.9% to 3.5%, representing special cause variation and a centerline shift. The average percentage of age-eligible patients screened for prior vaccine doses on admission increased from 66.5% to 81.5%. Patients were more likely to be vaccinated if their clinician was exposed to the clinical decision support system (<i>P</i> < 0.01). The social vulnerability index analysis showed no significant differences.</p><p><strong>Conclusions: </strong>This COVID-19 vaccination initiative highlights how an interprofessional approach can increase vaccination rates in hospitalized children; however, overall inpatient COVID-19 vaccination rates in this setting remained low.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500433","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":"Decreasing Blood Culture Collection in Hospitalized Patients with CAP, SSTI, and UTI.","authors":"Monica D Combs, Danica B Liberman, Vivian Lee","doi":"10.1097/pq9.0000000000000705","DOIUrl":"10.1097/pq9.0000000000000705","url":null,"abstract":"<p><strong>Background: </strong>Blood culture collection in pediatric patients with community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) remains high despite evidence of its limited utility. We aimed to decrease the number of cultures collected in children hospitalized for CAP, SSTI, and UTI by 25% over 11 months.</p><p><strong>Methods: </strong>Quality improvement initiative at a children's hospital among well-appearing patients aged 2 months or more to 18 years diagnosed with CAP, SSTI, or UTI. Our primary and secondary outcomes were blood culture collection rate and positivity rate, respectively. Interventions focused on three key drivers: academic detailing, physician awareness of personal performance, and data transparency.</p><p><strong>Results: </strong>Over the 2-year study period, there were 105 blood cultures collected in 223 hospitalized patients. Blood culture collection rates demonstrated special cause variation, decreasing from 63.5% to 24.5%. For patients with UTI, 86% (18/21) of blood cultures were negative, whereas 100% were negative for CAP and SSTI. All three patients with bacteremic UTI had a concurrent urine culture growing the same pathogen. Balancing measures remained unchanged, including escalation to a higher level of care and return to the emergency department or hospital within 14 days for the same infection.</p><p><strong>Conclusions: </strong>A multifaceted quality improvement approach can reduce blood culture collection for hospitalized patients with CAP, SSTI, and UTI without significant changes to balancing measures. Despite the reduction achieved, the near-universal negative culture results suggest continued overutilization and highlight the need for more targeted approaches to blood culture collection.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500421","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":"Decreasing ICU and Hospital Length of Stay through a Standardized Respiratory Therapist-driven Electronic Clinical Care Pathway for Status Asthmaticus.","authors":"Merrick Lopez, Michele Wilson, Ekua Cobbina, Danny Kaufman, Julie Fluitt, Michele Grainger, Robert Ruiz, Gulixian Abudukadier, Michael Tiras, Bronwyn Carlson, Jeane Spaid, Kim Falsone, Invest Cocjin, Anthony Moretti, Chad Vercio, Cynthia Tinsley, Harsha K Chandnani, Carlos Samayoa, Carissa Cianci, James Pappas, Nancy Y Chang","doi":"10.1097/pq9.0000000000000697","DOIUrl":"10.1097/pq9.0000000000000697","url":null,"abstract":"<p><strong>Introduction: </strong>Status asthmaticus (SA) is a cause of many pediatric hospitalizations. This study sought to evaluate how a standardized asthma care pathway (ACP) in the electronic medical record impacted the length of stay (LOS).</p><p><strong>Methods: </strong>An interdisciplinary team internally validated a standardized respiratory score for patients admitted with SA to a 25-bed pediatric intensive care unit (PICU) at a tertiary children's hospital. The respiratory score determined weaning schedules for albuterol and steroid therapies. In addition, pharmacy and information technology staff developed an electronic ACP within our electronic medical record system using best practice alerts. These best practice alerts informed staff to initiate the pathway, wean/escalate treatment, transition to oral steroids, transfer level of care, and complete discharge education. The PICU, stepdown ICU (SD ICU), and acute care units implemented the clinical pathway. Pre- and postintervention metrics were assessed using process control charts and compared using Welch's <i>t</i> tests with a significance level of 0.05.</p><p><strong>Results: </strong>Nine hundred two consecutive patients were analyzed (598 preintervention, 304 postintervention). Order set utilization significantly increased from 68% to 97% (<i>P</i> < 0.001), PICU LOS decreased from 38.4 to 31.1 hours (<i>P</i> = 0.013), and stepdown ICU LOS decreased from 25.7 to 20.9 hours (<i>P</i> = 0.01). Hospital LOS decreased from 59.5 to 50.7 hours (<i>P</i> = 0.003), with cost savings of $1,215,088 for the patient cohort.</p><p><strong>Conclusions: </strong>Implementing a standardized respiratory therapist-driven ACP for children with SA led to significantly increased order set utilization and decreased ICU and hospital LOS. Leveraging information technology and standardized pathways may improve care quality, outcomes, and costs for other common diagnoses.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500422","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 Asthma Action Plan Completion Rates across Five Divisions in an Academic Children's Hospital.","authors":"Maria G Alfieri, Katie Catalano, Tregony Simoneau, Linda Haynes, Patricia Glidden, Sachin N Baxi, Ramy Yim, Benjamin Ethier, Faye F Holder-Niles, Kendall McCarty, Frinny Polanco Walters, Eli Sprecher, Amy Starmer, Jonathan M Gaffin, Jeffrey Durney, Elizabeth Klements, Brittany Esty","doi":"10.1097/pq9.0000000000000700","DOIUrl":"10.1097/pq9.0000000000000700","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma is the most common chronic disease among children. Asthma Action Plans (AAPs) enable asthma self-management tailored to each patient and should be updated annually. At our institution, providers face challenges in creating reliable processes to consistently complete AAPs for patients with asthma. This project's aim was to increase the percentage of patients across five hospital divisions who have an up-to-date AAP from 80% in May 2021 to 85% by October 1, 2021.</p><p><strong>Methods: </strong>We launched a quality improvement (QI) project using the Model for Improvement, focusing on improving AAP completion rates across five hospital divisions providing ambulatory care for asthma patients. The divisions (Adolescent/Young Adult Medicine, Allergy, Pulmonary, and two Primary Care sites) participated in the QI process using tools to understand the problem context. They implemented a cross-divisional AAP completion competition from June to October 2021. Each month during Action Periods, divisions trialed their interventions using Plan-Do-Study-Act cycles. We held monthly Learning Sessions for divisions to collaborate on successful intervention strategies.</p><p><strong>Results: </strong>Statistical process control chart analysis demonstrated that the overall AAP completion rate increased from a baseline of 80% to 87% with the initiation of the competition. All divisions showed improvement in AAP completion rates during the active intervention period, but sustainment varied.</p><p><strong>Conclusions: </strong>The cross-divisional competition motivated five divisions to improve processes to increase AAP completion rates. This approach effectively fostered engagement and idea sharing to boost performance, and may be considered for other QI projects.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500432","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":"Closing the Fluid Gap: Improving Isotonic Maintenance Intravenous Fluid Use in a Community Hospital Network.","authors":"Shraddha Mittal,&nbsp;Sheila Knerr,&nbsp;Julianne Prasto,&nbsp;Jessica Hunt,&nbsp;Carolyn Mattern,&nbsp;Tsae Chang,&nbsp;Ronald Marchese,&nbsp;Morgan Jessee,&nbsp;Lauren Marlowe,&nbsp;Josh Haupt","doi":"10.1097/pq9.0000000000000696","DOIUrl":"10.1097/pq9.0000000000000696","url":null,"abstract":"<p><strong>Introduction: </strong>The American Academy of Pediatrics recommends using isotonic intravenous fluids (IVF) for maintenance needs to decrease the risk of hyponatremia. We conducted a quality improvement project to increase the use of isotonic maintenance IVF in pediatric patients admitted to three sites in a community hospital network to >85% within 12 months.</p><p><strong>Methods: </strong>We used improvement methodology to identify causes of continued hypotonic fluid use, which involved provider behavior and systems factors. We implemented interventions to address these factors including: (1) education; (2) clinical decision support; and (3) stocking automated medication dispensing systems with isotonic IVF. We compared isotonic IVF use before and after interventions in all admitted patients aged 28 days to 18 years who received maintenance IVFs at the rate of at least 10 mL/hour. We excluded admissions of patients with active chronic medical conditions like diabetic ketoacidosis. Balancing measures were the occurrence of adverse events from hypo- or hypernatremia. Data were analyzed using Laney P' statistical process control charts.</p><p><strong>Results: </strong>Isotonic IVF use among patients requiring maintenance fluids at all three sites surpassed the goal of >85% within 12 months. There were no reports of hypo- or hypernatremia or other adverse outcomes related to the use of isotonic IVF.</p><p><strong>Conclusion: </strong>A combination of interventions aimed at provider behavior and systems factors was critical to successfully adopting the American Academy of Pediatrics guideline regarding the use of maintenance isotonic IVF in hospitalized children.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41222824","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}