• The effect of a computerized physician order entry system on managing continuous infusion medications at a pediatric intensive care unit

      Sowan, Azizeh Khaled; Mills, Mary Etta C. (2006)
      Background. Errors of continuous infusion medications are very common in pediatrics and can be life threatening. The "rule of 6" manual equation introduces a major risk for calculation errors as a result of formulating individualized concentrations. The JCAHO has mandated transition from the rule of 6 to standardized concentrations. This transition was achieved through the creation of a CPOE system specific to pediatric patients. The effect of CPOE on medication errors, efficiency, and user satisfaction as critical factors for system success has been insufficiently addressed in the literature. Objectives. To examine the effect of CPOE on efficiency, medication errors, user satisfaction, and the check-methods used to verify pump settings accuracy. Methods. A repeated measures design within a simulation environment was utilized. Data were collected from a convenience sample of 26 residents, 10 pharmacists, and 36 nurses in a pediatric intensive care unit with the order of treatment conditions (CPOE and handwritten system) randomly assigned. Data collection tools included: time to measure efficiency; medication order sheets, drip labels, and a checklist to verify pump settings accuracy for medication errors; a checklist for identifying and ranking of check-methods used; and a questionnaire for user satisfaction. Results. CPOE required less time across the stages of the medication management process (p < .05). CPOE eliminated all types of prescribing errors except for missing signature and resulted in 80% to 86% reduction of dispensing errors (p < .05); however, the system did not decrease medication administration errors. Users were more satisfied with CPOE as compared to the handwritten system (p < .05). The number of check-methods used by nurses was comparable in both systems. Inconsistent use of computerized order sheets was found among nurses and pharmacists. Conclusions. CPOE is an effective and efficient solution to satisfy the JCAHO mandate. However, CPOE is not a panacea. Appropriate use of the technology and careful integration of CPOE into the pharmacy system is critical to maintain patient safety. Future studies should focus on the transferability of the system to other units and on the use of computerized order sheets and infusion pumps by nurses.
    • Evaluation of an Early Mobilization Program in a Pediatric Intensive Care Unit

      Wieczorek, Beth (2015)
      Introduction: The focus of care in a pediatric intensive care unit (PICU) is on resuscitation, stabilization, management of critical disease processes, and reversal of organ failure. As a result, the child is often sedated, restrained and confined to bed for prolonged periods of time for perceived needs of safety, comfort and hemodynamic stability. Multi-system anatomic and physiologic alterations are known to occur in response to critical illness and may be compounded by immobility. These sequelae may have long- term implications for the patient and the patient’s family. A robust body of literature has showed that early mobilization in the intensive care unit can decrease these sequelae and reduce length of stay for the critically ill adult, but little has been published in regards to the pediatric population. Objective: To determine the safety and feasibility of an early rehabilitation and progressive mobilization program in a pediatric intensive care unit. Method: A before/after retrospective design was used for this QI project that focused on evaluating an early mobility program as it became routine care for the children hospitalized in this PICU. Data was collected and analyzed from July to August 2014 (pre-implementation phase) and July to August 2015 (post-implementation). Program implementation was completed in April to May 2015. Setting: Pediatric intensive care unit (PICU) in a tertiary academic hospital in the US. Results: Analysis of 200 children aged 1 day through 17 years admitted to a Pediatric Intensive Care Unit with a length of stay of at least three days demonstrated a significant increase in occupational and physical therapy consultations after implementation of the early mobility program (p <0.05) . In addition the number of mobilization activities increased post-implementation (p <0.05). No adverse events, such as unplanned extubations, occurred as a result of early mobilization. Conclusions: Implementation of a structured and stratified early mobilization program in a pediatric intensive care unit resulted in an increase in occupational and physical therapy consultations, increased patient activity, without adverse events.
    • Post-traumatic Stress Disorder Screening in Parents of Trauma Patients

      Miller, Mariah; Simone, Shari (2022-05)
      Problem: Post-traumatic stress disorder (PTSD) is a disorder that can occur after experiencing a stressful event and long-term stress can affect one’s physical health including the cardiovascular, immune, and digestive systems. Parents of children following a severe traumatic injury are at high risk for PTSD. Approximately 120 pediatric trauma patients are seen annually at a large university hospital system’s pediatric intensive care unit (PICU). However, there is no screening process or structured information given to families to cope with their personal stress. Purpose: The purpose of this quality improvement project was to screen for early signs of PTSD, educate, and provide resources for parents of PICU trauma patients. Methods: Parents of trauma patients were screened for PTSD using the Posttraumatic Adjustment Scale within 48 hours of admission over a 24-week period. The PICU fellow was notified of all positive screens and a social worker consult initiated. A resource folder was given to all families who volunteered to be screened or expressed interest. This folder included information on post-traumatic stress, local family referral programs, and information on how to help the child and parents cope with trauma. A post-discharge survey was sent to all participating families via Qualtrics to assess quality of resources provided. Results: There was a total of 10 patients admitted to the PICU as trauma patients. Of those ten, one family was not able to be screened due to child protective service restrictions and one due to patient death on arrival. Four of eight parents had a positive screen for early warning signs of PTSD and depression. All who screened positive were successfully referred to social work. Four parents responded positively to the survey stating the resources were helpful. Conclusions: This quality improvement project demonstrated that screening parents of trauma patients for PTSD early in the PICU can be of benefit to provide prompt resources for those with positive symptoms. Next steps are to screen all pediatric trauma families admitted to inpatient units.
    • Simulation to Improve Confidence among Newly Licensed Nurses in the Pediatric Intensive Care Setting

      Hamilton, Hannah; Franquiz, Renee (2020-05)
      Introduction: Communication and critical thinking are essential practice competencies for every registered nurse. However, newly licensed registered nurses (NLRN) often lack these skills on entry into practice contributing to low levels of clinical confidence. Aims: The purpose of this Quality Improvement (QI) project was to implement and evaluate the effectiveness of simulation on clinical confidence among NLRNs. Methods: This QI project was guided by the MAP-IT model and involves NLRNs in a Pediatric Intensive Care Unit within an urban academic teaching hospital. NLRNs participated in three clinical simulations reflecting common PICU clinical practice, utilizing the Simulation Module for Assessment of Resident’s Targeted Event Responses (SMARTER) and the Behavior Assessment Tool (BAT). NLRN confidence data were collected immediately pre-simulation and post-simulation, as well as one-month post-simulation using the self-report C-Scale Instrument of Clinical Confidence. Qualitative data was collected via observation by the NLRN preceptor using the C-Scale Instrument of Clinical Confidence. Paired sample t-tests were used to determine a significant change in confidence, and content analysis was performed by two evaluators on the qualitative data derived from the C-Scale observations to identify confidence themes and patterns. Results: Paired sample t-tests revealed a significant increase in clinical confidence between baseline and sustained one-month post simulation. Qualitative data collection of preceptor observations revealed improved clinical confidence and communication abilities. Conclusions and Implications: Data indicates that simulation is an effective strategy to increase clinical confidence as perceived by the NLRNs. Incorporation of simulation into transition-to-practice programs such as Nurse Residency or facility orientation is an evidence-based recommendation to improve development of clinical confidence and communication abilities in this population.