• Food Insecurity Screening and Referral in a Pediatric Emergency Department

      Shock, Chelsea N.; Satyshur, Rosemarie D. (2022-05)
      Problem: Many neighborhoods surrounding a 20-bed pediatric emergency department in an urban medical center are considered food deserts. This suggests patients receiving care are at high risk of experiencing food insecurity. Previous patient care practices in this pediatric emergency department did not screen for food insecurity. Evidence recommends pediatric patients receiving medical care be screened for food insecurity and connected with the necessary resources to limit associated consequences, such as poor health, developmental risks, and mental health issues. Purpose: The purpose of this project was to implement the Hunger Vital Sign, a 2- item food insecurity screening tool, over 15 weeks in a pediatric emergency department located in an urban medical center. This quality improvement project aimed to identify patients with food insecurity concerns and subsequently refer positive screens to social work for resources. Methods: A quality improvement project was designed to implement the Hunger Vital Sign into a pediatric emergency department’s triage process. Using a standardized nursing note in the electronic health record, the triage nurse screened all patients except those arriving by ambulance or requiring immediate medical attention. Positive screens prompted a social work referral to provide the patient and family resources. Weekly chart audits were completed to track the number and percentage of patients screened in triage, positive screens, positive screens with social work referrals, social work consults before patient discharge, and patients who accepted resources. Results: Run charts were used to analyze data variations of the process and project outcome measures. Results collected during the 15 weeks of project implementation determined triage nurses screened 56% of the 3,607 eligible patients and identified 7% as food insecure. Of the 94% referrals, social work consulted 60% of patients with positive screens, with 89% of patients accepting resources. Conclusions: Following project completion, results were analyzed to evaluate the screening process, efficiency, barriers, facilitators, and sustainability. Conclusions indicate the Hunger Vital Sign effectively identifies food insecurity, and there is a need for food insecurity screening in this pediatric emergency department.
    • Improving Safety in the Pediatric Emergency Department through Early Violence/Aggression Assessment

      Mancl, Margo E.; Rawlett, Kristen (2020-05)
      Problem & Purpose: The Pediatric Emergency Department (PED) setting is not exempt from workplace violence (WPV). Frontline staff in the PED have identified concerns around a rise in WPV incidents over the last few years. From January 1, 2018 through March 5, 2019, this PED saw 2,058 mental/behavioral health visits. Of mental/behavioral health focused visits, 79 visits (3.8%) resulted in coercion in the form of intramuscular antipsychotic or anxiolytic medication administration related to aggressive or violent behavior. The purpose of this project was to implement and evaluate the effectiveness of a violence risk assessment tool in a PED setting. Methods: This quality improvement (QI) project involved training PED Psychiatric RNs in an urban, academic PED on the use of the Pediatric Violence/Aggression Assessment Tool (PVAAT) to screen patients aged 8 years-17 years presenting with a chief complaint related to acute mental/behavioral health concerns. The P-VAAT score assisted the RNs to determine preventive or early intervention measures to implement in the interest of patient and staff safety. Results: Of 297 eligible patients, 152 were screened resulting in a 51.1% tool completion rate. One hundred twenty eight patients scored as ‘Low’ risk, 12 scored as ‘High’ risk, and 12 as ‘Moderate’ risk. Of those that scored ‘High,’ five exhibited violent/aggressive behavior during their encounter. Of these five, four required a short-term physical hold with intramuscular anxiolytic/antipsychotic medication administration and one was placed in seclusion. Another patient in the ‘High’ group was de-escalated and cooperative taking oral anxiolytic/antipsychotic medication. Conclusion: Observed and reported feedback through personal interactions with RNs support the ease of use and effectiveness of the Pediatric Violence/Aggression Assessment Tool (PVAAT). RNs report early identification of risk for violence allows for better preparation and safety in potential outbursts. Opportunity exists to expand this QI project with a focus on the use of this tool to include medical patient as well as building the P-VAAT into the electronic medical record system.