Pediatric quality & safety最新文献_第8页

Impact of a Clinical Decision Support Alert on Informed Consent Documentation in the Neonatal Intensive Care Unit. 临床决策支持警报对新生儿重症监护室知情同意文件的影响。

IF 1.2

Pediatric quality & safety Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI: 10.1097/pq9.0000000000000713

Emily Sangillo, Neena Jube-Desai, Dina El-Metwally, Colleen Hughes Driscoll

{"title":"Impact of a Clinical Decision Support Alert on Informed Consent Documentation in the Neonatal Intensive Care Unit.","authors":"Emily Sangillo, Neena Jube-Desai, Dina El-Metwally, Colleen Hughes Driscoll","doi":"10.1097/pq9.0000000000000713","DOIUrl":"10.1097/pq9.0000000000000713","url":null,"abstract":"Background: Informed consent is necessary to preserve patient autonomy and shared decision-making, yet compliant consent documentation is suboptimal in the intensive care unit (ICU). We aimed to increase compliance with bundled consent documentation, which provides consent for a predefined set of common procedures in the neonatal ICU from 0% to 50% over 1 year.Methods: We used the Plan-Do-Study-Act model for quality improvement. Interventions included education and performance awareness, delineation of the preferred consenting process, consent form revision, overlay tool creation, and clinical decision support (CDS) alert use within the electronic health record. Monthly audits categorized consent forms as missing, present but noncompliant, or compliant. We analyzed consent compliance on a run chart using standard run chart interpretation rules and obtained feedback on the CDS as a countermeasure.Results: We conducted 564 audits over 37 months. Overall, median consent compliance increased from 0% to 86.6%. Upon initiating the CDS alert, we observed the highest monthly compliance of 93.3%, followed by a decrease to 33.3% with an inadvertent discontinuation of the CDS. Compliance subsequently increased to 73.3% after the restoration of the alert. We created a consultant opt-out selection to address negative feedback associated with CDS. There were no missing consent forms within the last 7 months of monitoring.Conclusions: A multi-faceted approach led to sustained improvement in bundled consent documentation compliance in our neonatal intensive care unit, with the direct contribution of the CDS observed. A CDS intervention directed at the informed consenting process may similarly benefit other ICUs.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 1","pages":"e713"},"PeriodicalIF":1.2,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10843373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699110","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}

引用次数: 0

Implementation of an Anterior Mediastinal Mass Pathway to Improve Time to Biopsy and Multidisciplinary Communication. 实施前纵隔肿块路径，改善活检时间和多学科沟通。

Pediatric quality & safety Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI: 10.1097/pq9.0000000000000715

Rachel E Gahagen, William C Gaylord, Meghan D Drayton Jackson, Anne E McCallister, Riad Lutfi, Jennifer A Belsky

{"title":"Implementation of an Anterior Mediastinal Mass Pathway to Improve Time to Biopsy and Multidisciplinary Communication.","authors":"Rachel E Gahagen, William C Gaylord, Meghan D Drayton Jackson, Anne E McCallister, Riad Lutfi, Jennifer A Belsky","doi":"10.1097/pq9.0000000000000715","DOIUrl":"10.1097/pq9.0000000000000715","url":null,"abstract":"Background: Mediastinal masses in children with cancer present unique challenges, including the risk of respiratory and hemodynamic compromise due to the complex anatomy of the mediastinum. Multidisciplinary communication is often a challenge in the management of these patients. After a series of patients with mediastinal masses were admitted to Riley Hospital for Children Pediatric Intensive Care Unit, the time from presentation to biopsy and pathology was greater than expected. We aimed to reduce the time to biopsy by 25% and demonstrate improved multidisciplinary communication within 6 months of protocol implementation for patients presenting to Riley Hospital for Children Emergency Department with an anterior mediastinal mass.Methods: Quality improvement methodology created a pathway that included early multidisciplinary communication. The pathway includes communication between the emergency department and multiple surgical and medical teams via a HIPPA-compliant texting platform. Based on patient stability, imaging findings, and sedation risks, the approach and timing of the biopsy were determined.Results: The pathway has been used 20 times to date. We successfully reduced the time to biopsy by 38%, from 25.1 hours to 15.4 hours. There was no statistically significant reduction in time to pathology. The multidisciplinary team reported improved communication from a baseline Likert score of 3.24 to 4.Conclusions: By initiating early multidisciplinary communication, we reduced the time to biopsy and pathology results, improving care for our patients presenting with anterior mediastinal masses.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 1","pages":"e715"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10843474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699111","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}

引用次数: 0

Impact of a Bronchiolitis Clinical Pathway on Management Decisions by Preferred Language. 支气管炎临床路径对首选语言管理决策的影响。

Pediatric quality & safety Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI: 10.1097/pq9.0000000000000714

Robert H Rosen, Michael C Monuteaux, Anne M Stack, Kenneth A Michelson, Andrew M Fine

{"title":"Impact of a Bronchiolitis Clinical Pathway on Management Decisions by Preferred Language.","authors":"Robert H Rosen, Michael C Monuteaux, Anne M Stack, Kenneth A Michelson, Andrew M Fine","doi":"10.1097/pq9.0000000000000714","DOIUrl":"10.1097/pq9.0000000000000714","url":null,"abstract":"Background: Clinical pathways standardize healthcare utilization, but their impact on healthcare equity is poorly understood. This study aims to measure the effect of a bronchiolitis pathway on management decisions by preferred language for care.Methods: We included all emergency department encounters for patients aged 1-12 months with bronchiolitis from 1/1/2010 to 10/31/2020. The prepathway period ended 10/31/2011, and the postpathway period was 1/1/2012-10/31/2020. We performed retrospective interrupted time series analyses to assess the impact of the clinical pathway by English versus non-English preferred language on the following outcomes: chest radiography (CXR), albuterol use, 7-day return visit, 72-hour return to admission, antibiotic use, and corticosteroid use. Analyses were adjusted for presence of a complex chronic condition.Results: There were 1485 encounters in the preperiod (77% English, 14% non-English, 8% missing) and 7840 encounters in the postperiod (79% English, 15% non-English, 6% missing). CXR, antibiotic, and albuterol utilization exhibited sustained decreases over the study period. Pathway impact did not differ by preferred language for any outcome except albuterol utilization. The prepost slope effect of albuterol utilization was 10% greater in the non-English versus the English group (p for the difference by language = 0.022).Conclusions: A clinical pathway was associated with improvements in care regardless of preferred language. More extensive studies involving multiple pathways and care settings are needed to assess the impact of clinical pathways on health equity.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 1","pages":"e714"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10843310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699109","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}

引用次数: 0

Antimicrobial Stewardship and Improved Antibiotic Utilization in the Pediatric Cardiac Intensive Care Unit. 儿科心脏重症监护病房的抗菌药物管理和抗生素使用改进。

IF 1.2

Pediatric quality & safety Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI: 10.1097/pq9.0000000000000710

Margot M Hillyer, Preeti Jaggi, Nikhil K Chanani, Alfred J Fernandez, Hania Zaki, Michael P Fundora

{"title":"Antimicrobial Stewardship and Improved Antibiotic Utilization in the Pediatric Cardiac Intensive Care Unit.","authors":"Margot M Hillyer, Preeti Jaggi, Nikhil K Chanani, Alfred J Fernandez, Hania Zaki, Michael P Fundora","doi":"10.1097/pq9.0000000000000710","DOIUrl":"10.1097/pq9.0000000000000710","url":null,"abstract":"Background: We developed a multidisciplinary antimicrobial stewardship team to optimize antimicrobial use within the Pediatric Cardiac Intensive Care Unit. A quality improvement initiative was conducted to decrease unnecessary broad-spectrum antibiotic use by 20%, with sustained change over 12 months.Methods: We conducted this quality improvement initiative within a quaternary care center. PDSA cycles focused on antibiotic overuse, provider education, and practice standardization. The primary outcome measure was days of therapy (DOT)/1000 patient days. Process measures included electronic medical record order-set use. Balancing measures focused on alternative antibiotic use, overall mortality, and sepsis-related mortality. Data were analyzed using statistical process control charts.Results: A significant and sustained decrease in DOT was observed for vancomycin and meropenem. Vancomycin use decreased from a baseline of 198 DOT to 137 DOT, a 31% reduction. Meropenem use decreased from 103 DOT to 34 DOT, a 67% reduction. These changes were sustained over 24 months. The collective use of gram-negative antibiotics, including meropenem, cefepime, and piperacillin-tazobactam, decreased from a baseline of 323 DOT to 239 DOT, a reduction of 26%. There was no reciprocal increase in cefepime or piperacillin-tazobactam use. Key interventions involved electronic medical record changes, including automatic stop times and empiric antibiotic standardization. All-cause mortality remained unchanged.Conclusions: The initiation of a dedicated antimicrobial stewardship initiative resulted in a sustained reduction in meropenem and vancomycin usage. Interventions did not lead to increased utilization of alternative broad-spectrum antimicrobials or increased mortality. Future interventions will target additional broad-spectrum antimicrobials.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 1","pages":"e710"},"PeriodicalIF":1.2,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10843537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699096","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}

引用次数: 0

Promoting a Sleep-friendly Environment by Minimizing Overnight Room Entries. 尽量减少过夜人员进入房间，营造有利于睡眠的环境。

Pediatric quality & safety Pub Date : 2023-12-12 eCollection Date: 2023-11-01 DOI: 10.1097/pq9.0000000000000668

Lauren M McDaniel, Nilesh Seshadri, Elizabeth A Harkins, Megan Keydash, Alice Pan, Laura M Sterni, Shawn L Ralston

{"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":"Introduction: 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.Methods: 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.Results: 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.Conclusions: 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.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 6","pages":"e668"},"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}

引用次数: 0

Sustainability Standards in Pediatric Anesthesia: Quality Initiative to Reduce Costly Environmentally Harmful Volatile Anesthetics. 儿科麻醉的可持续性标准：减少对环境有害的高成本挥发性麻醉剂的质量倡议。

Pediatric quality & safety Pub Date : 2023-12-12 eCollection Date: 2023-11-01 DOI: 10.1097/pq9.0000000000000708

Andrew T Waberski, Sophie R Pestieau, Caroll Vazquez-Colon, Jessica Cronin, Barbara H Braffett

{"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":"Background: 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.Methods: 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.Results: 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%.Conclusions: 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.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 6","pages":"e708"},"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}

引用次数: 0

Establishing a Quality Improvement Program for Pediatric In-hospital Cardiac Arrest. 建立儿科院内心脏骤停质量改进计划。

Pediatric quality & safety Pub Date : 2023-12-12 eCollection Date: 2023-11-01 DOI: 10.1097/pq9.0000000000000706

Anya J Freedman, Erik C Madsen, Lia Lowrie

{"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":"Background: 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.Methods: 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.Results: 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 (P < 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.Conclusions: 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.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 6","pages":"e706"},"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}

引用次数: 0

Reducing the Time to Action on Bilirubin Results Overnight in a Newborn Nursery. 缩短新生儿保育室隔夜胆红素结果的处理时间。

Pediatric quality & safety Pub Date : 2023-12-12 eCollection Date: 2023-11-01 DOI: 10.1097/pq9.0000000000000707

Andrew M Beverstock, Lily Rubin, Meredith Akerman, Estela Noyola

{"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":"Introduction: 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.Methods: 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.Results: 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.Conclusions: Combining resident education, electronic medical record result alerts, and policy standardization allowed us to achieve our stated aim and improved care for our neonates.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 6","pages":"e707"},"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}

引用次数: 0

Multidisciplinary Initiative to Increase Guideline-concordant Antibiotic Prescription at Discharge for Hospitalized Children with Uncomplicated Community-acquired Pneumonia. 多学科倡议：提高住院儿童非并发社区获得性肺炎患者出院时抗生素处方的指南一致性。

Pediatric quality & safety Pub Date : 2023-12-12 eCollection Date: 2023-11-01 DOI: 10.1097/pq9.0000000000000711

Alexandra B Yonts, Laura B O'Neill, Matthew A Magyar, Michael J Bozzella

{"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":"Background: 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.Methods: 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.Results: 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.Conclusions: 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.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 6","pages":"e711"},"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}

引用次数: 0

A Quality Improvement Project to Improve the Utilization of an Intraoperative Rapid Response System. 提高术中快速反应系统使用率的质量改进项目。

Pediatric quality & safety Pub Date : 2023-12-12 eCollection Date: 2023-11-01 DOI: 10.1097/pq9.0000000000000686

Asheen Rama, Daniel Qian, Ty Forbes, Ellen Wang, Lynda Knight, Marc Berg, Thomas J Caruso

{"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":"Introduction: 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.Methods: 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.Results: 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 (P = 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.Conclusion: 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.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 6","pages":"e686"},"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}

引用次数: 0