• Implementation of a Pediatric Oncology Nutritional Algorithm on an Inpatient Unit

      Weisbrot, Ricki D.; Simone, Shari (2021-05)
      Problem: The rate of malnutrition in pediatric oncology patients receiving chemotherapy is as high as 50% without nutritional support. The consequences of malnutrition are severe and can include reduced survival rates. The Children’s Oncology Group recommends these children receive nutrition screening at diagnosis and throughout treatment. Nutritional management and support for oncology patients in an academic, tertiary care pediatric unit was inconsistent and lacked a standardized policy. Purpose: The purpose of this quality improvement project was to implement a nutritional management algorithm for pediatric oncology patients admitted to an inpatient unit to improve early recognition of malnutrition and early nutritional interventions. Methods: The Mobilize Assess Plan Implementation Track framework was used to develop and implement a novel nutritional management algorithm over a 14-week period. Multifaceted education strategies were used and project leader attended multidisciplinary rounds. Patients were assessed daily for changes in weight/BMI or weight for length. Patients experiencing a loss of 1 z-score in BMI/weight for length or ≥5% weight loss from diagnosis, prompted referencing an algorithm for nutritional interventions. Chart audits were conducted to track outcome measures. Run charts were used to track compliance. Baseline comparison data were patients admitted 14-weeks prior to implementation. Results: Twenty-one patients with over 50 admissions met eligibility criteria. Compliance in daily weights improved from 72% to 88%. 96% of patients received a nutrition consult compared to 32% pre-implementation. 100% of patients had a nutrition consult during their diagnosis admission vs. 56% pre-implementation. 100% of patients had weight/BMI/weight for length tracked during every admission. Conclusion: Implementation of a nutrition management algorithm can improve early recognitionof malnutrition and early nutritional interventions in hospitalized pediatric oncology patients. Standardizing the nutrition assessment with electronic prompts for calculation and evaluation of anthropometric indices improved overall staff compliance. This project may have future application to the outpatient nutritional management of pediatric oncology patients undergoing chemotherapy treatment.
    • Screening, Brief Intervention, and Treatment in a Latina Immigrant Prenatal Clinic

      Kennedy, Jules Q.; Hoffman, Ann G. (2020-05)
      Problem & Purpose: Babies born in Maryland found with drugs in their systems has increased 57.6 percent in the last 9 years. The American College of Obstetricians and Gynecologists recommends universal screening for substance use disorders at first prenatal visit. Substance use disorders are usually interrelated with other behavioral health issues requiring more comprehensive screening at primary care sites for better screening and treatment success. The use of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol combined with motivational interviewing (MI) has shown success in earlier identification and more successful referrals of behavioral health issues. The aim of this MAP-IT guided (Mobilize, Assess, Plan, Implement, Track) quality improvement project is to educate, better detect, and successfully refer out a Latinx immigrant prenatal patient population with suspected behavioral health issues to specialty behavioral health treatment centers to decrease negative long term behavioral health issues occurring in the community. Methods: Implement an SBIRT protocol for behavioral health. Train and use MI techniques when interacting with patients; support patients throughout the specialty referral process by being present and using same-day appointments; increase education about of behavioral health issues and their treatment; and track behavioral health issues from the clinic to the specialty referral site. Results: During the 12-week implementation period, four patients were identified with behavioral health issues with one patient being successfully referred to county behavioral health. Conclusions: The Latinx immigrant culture stigmatizes behavioral health. Increasing education and trust for behavioral health treatment must be a focus. Prenatal clinic employees should be trained in MI techniques and cultural engagement to successfully engage in patient collaboration for behavioral health issues. Repeated behavioral interventions are needed to increase the motivation needed to accept treatment. Behavioral health experts embedded in prenatal clinics would help make referrals and treatment more successful.
    • 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.