2008 Annual Meeting Poster Presentations

Poster Presentations An Airway Registry to Improve Patient Safety Children's Medical Center Dallas, Dallas, TX Children with high-risk airways require expert care for airway management in an emergency. This poster will describe how to create and maintain a patient registry in the electronic health record that automatically fires an alert for the current care team. An airway stat team was put in place to assure rapid access to airway experts when the patient requires intubation outside the operating room. A letter is sent to the family in their own language and in English along with instructions for a medical alert bracelet. Airway alert wrist bands are placed at the time of admission. Medication Drip Double Check: Paving a Path to Safety Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN Medication errors impact patient quality of care, patient safety, and cost to organizations. The medication drip double check prevents errors, provides for earlier interventions when errors occur, and increases staffs awareness of drip errors. With the implementation process outlined, staff holds each other accountable in implementation. Long term plans to maintain change will be identified. Cultural Change in the Security Department Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, NY Patients, families and other visitors often form their first impression of our large, urban hospital based on their interactions with security personnel who greet them as they enter our doors. Previously, the responsibilities of our Security Department mainly involved handing out passes and, of course, maintaining a safe environment. But in 2003, the hospital determined that security staff members should be trained to become, in essence, ambassadors - graciously interacting with patients and families to create a more friendly, welcoming experience. To reflect this expanded role, the Security Department developed programs to effect a cultural change among its staff. Comfort Care St. Joseph's Children's Hospital, Paterson, NJ Collaborative project to provide palliative care to children with chronic illnesses. Maximizing Service Response Opportunities Through Family Involvement Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, NY When a food tray is delivered late or a room is not properly cleaned, parents and families can feel anxious and helpless and, in frustration, often turn to the nursing staff for help in resolving these support service problems. Recently, our hospital introduced an interactive bedside program that allows patients and families to communicate concerns or requests directly to our Food and Nutrition or Housekeeping Services. This empowers them to easily and rapidly resolve these issues without taking nurses away from patient care responsiblities. The innovative system also enables the hospital to track and resolve recurring food and housekeeping problems. Parents As Partners: A Picture Is Worth a Thousand Words St. Joseph's Children's Hospital, Paterson, NJ In January of 2004, St. Joseph's Children's Hospital developed our "Parents as Partners" Safety Team modeled after The Safety Program at Johns Hopkins Children's Center by Dr. Marlene Miller. To date we have instituted 54 safety initiatives. This poster presentaiton will showcase 3 of those initiatives. 1. Hand Washing Campaign; 2. Individualized pre-printed Code Sheets, a computer demonstration; 3. Photos of child's healthcare team with name, title and phone number posted in child's room. Empowering our patients and parents to actively participate has assured enforcement of many of our Safety Initiatives. Complex Needs Discharge Planning Process: From Burn ICU to Residential Outpatient Care Shriners Hospitals for Children, Galveston, TX This poster will describe a process to discharge complex needs patients from ICU to residential outpatient care. Improving ED to Bed Times with SPEED Children's National Medical Center, Washington, DC In order to deliver quality, safe care, patients must be cared for in the setting best suited to meet their needs. Once the Emergency Department's licensed independent practitioner determines that the Emergency Department (ED) patient requires inpatient care it is critical that the patient be transferred to the inpatient unit as expeditiously as possible. This poster will review the efforts taken by Children's National Medical Center (CNMC) to successfully achieve and sustain a 37 percent decrease in our average ED to Bed time. An Algorithm for Nursing Research to Address Workforce Issues Children's Mercy Hospitals and Clinics, Kansas City, MO A team including a doctorally prepared Director of Nursing Research Workforce & Systems, two PhD nurse researchers (1.2 FTE), advanced clinical research coordinator, PhD nurse faculty, Director of Quality Improvement, Director of Nurse Informatics, Physician/nurse for Evidence-based practice and other personnel with expertise in research design and disseminating results addresses workforce issues for bedside nurses. This unique infrastructure at a Children's Hospital for creating, implementing and disseminating research used Donabedian's (2006) structure-process-outcome to develop an algorhythm for workforce issues. A well-developed structure increases the likelihood of favorable processes resulting in improved patient outcomes that leads to enhanced nurse satisfaction and retention. Educating Tomorrow's Nurses Using Facility Based Clinical Instructors Cincinnati Children's Hospital Medical Center, Cincinnati, OH Cincinnati Children's Hospital Medical Center in an effort to address the nursing and faculty shortage implemented the Adjunct Clinical Faculty program. The program is offered to five out of eleven local colleges in varied degree programs. The hospital offers the service of a clinical instructor to the college/university for a clinical rotation. The Ohio Board of Nursing no longer requires pediatric nursing clinical experiences to graduate from a nursing program. This change in state policy will impact future recruitment for the organization. The Adjunct Clinical Faculty program is the first step to address the impending nursing and faculty shortages. Promoting Excellence in Caring for Kids: Increasing RN Certification Rate Schneider Children's Hospital North Shore - LIJ Health System, New Hyde Park, NY Increased RN certification rates have been linked to improved patient outcomes by requiring certified nurses to remain up to date on current knowledge and practices leading to improved critical thinking skills, better patient assessments and earlier interventions. To enhance the development of nurses and care of the pediatric patients of Schneider Childrens' Hospital, an initiative was put in place to increase the RN certification rate in 2007. This poster presentation depicts the multifaceted approach used by the institution to promote and increase RN certification. Stimulating Positive Change Through APN Collaboration Inova Fairfax Hospital for Children, Falls Church, VA Participants who view this poster will have a better understanding of how Advance Practice Nurses can have a positive impact and be best utilized in the outpatient setting. Developing a Safety Coach Program Cincinnati Children's Medical Center, Cincinnati, OH We delineate the process by which we designed a safety coach program. This encompassed a thorough needs assessment, partnership across disciplines for uniform definitions, goals and expectations of roles, and standardization of curriculum. Impact of a Dedicated Inpatient Medication Reconciliation Team Riley Hospital for Children, Clarian Health Partners, Indianapolis, IN This project reviews the importance of medication reconciliation (MR) and how to achieve Joint Commission compliance with MR. A dedicated MR day shift position was created, which improved completion of the required elements outlined by Joint Commission on admission MR. Later, a second FTE was hired to work the evening shift. The impact included improved compliance with MR on admission, on discharge, and on providing the information to the next provider of care. An unintended but beneficial effect was to catch potential medication variances, which were sent to hospital patient safety leadership. Moving Order Entry Off the Units to Improve Safety Kosair Children's Hospital, Norton Healthcare, Inc., Louisville, KY The med/surg Unit Secretary position had become increasingly complex with multiple high-priority demands and numerous interruptions. Time studies revealed as many as 280 interruptions per hour, making accurate order entry impossible. To remedy this problem, nursing leadership decided to separate the order entry functions from the unit coordination tasks so that both sets of skills could be mastered and executed well. In just three months, the order entry error rate dropped to only 2%, and the response to call lights, monitors and alarms on the units greatly improved. Embracing Change to Achieve Transparency of Outcomes Children's Hospital of Wisconsin, Milwaukee, WI Most children's hospitals are attempting to achieve the goal of transparency in outcomes. However, there is generally a push-back from within the organization to achieve this goal. This poster session provides the stories and lessons learned from a children's hospital that has successfully overcome this push-back. This has been accomplished by embracing change by both hospital administrators and physicians. This session will provide attendees with insights from experiences at this children's hospital to allow the attendees to transfer knowledge to their organizations to successfully lead change to achieve transparency. A Custom Tailored Bundle to Reduce the Incidence of VAP in Mechanically Ventilated Neonatal and Pediatric Patients The Children's Hospital Medical University of South Carolina, Charleston, SC Ventilator-associated pneumonia (VAP) is the second most common healthcare associated infection among hospital inpatients. VAP prolongs hospitalization, length of stay, and incresases cost. The focus of this project is completion of an entire neonatal and pediatric bundle as a single intervention in our ICUs rather than completion of individual interventions. Building a Research Program Through Multisite Collaborative Groups Dell Children's Medical Center of Central Texas, Austin, TX Critical illness has a life-changing impact on children and their families. The need for research to validate and provide knowledge for the care of these children is crucial to this area of practice, yet the ability to conduct this research is limited due to challenges with population, funding and time constraints. Collaborative research groups provide an important means to develop and support pediatric critical care research through shared resources. Through collaborative multisite groups, our hospital has established participation in pediatric critical care research and successfully contributed to clinical, nursing and quality improvement research. Reaching for Zero: Spreading Central Line Care Practices to Eliminate Catheter-associated Blood Stream Infections Dell Children's Medical Center of Central Texas, Austin, TX Focus on preventing harm associated with hospitilization has increased dramatically in the last 5 years. One area of attention in almost all hospitals is Catheter-Associated Blood Stream Infections (CA-BSI). Efforts to identify and implement best practices around insertion and maintenance of central venous catheters to eliminate CA-BSI in pediatric patients have resulted in reductions in this complication. This presentation describes one hospital's experience with implementing practice changes first in the intensive care setting and then spreading those practice changes to other areas in the hospital and the resulting impact on CA-BSI rates. Hospital Care for Children with Chronic Complex Medical Illness: Do Parents Feel Care Is Family-centered? Primary Children's Medical Center, Salt Lake City, UT Family centered care has been shown to improve quality of care and customer satisfaction for hospitalized children. Children with chronic complex medical illnesses (CCMI) are frequently hospitalized, and have unique challenges as recipients of health care. Some of these children are cared for in diagnosis-specific structured clinical programs (SCP), others experience less coordinated care. We studied the perception parents of these 2 groups have regarding receipt of family centered care using a validated tool, the Medical Processes of Care survey. We found a significant difference in reporting positive ratings (6 or 7) between the groups, favoring the SCP group. An Adventure in Bronchiolitis: Outpatient Treatment Clinic Project Plan and Implementation Primary Children's Medical Center, Salt Lake City, UT and Dixie Regional Medical Center, St. George, UT Bronchiolitis is the leading cause for hospitilization of children under the age of 1 year. These children are admitted primarily for the treatement of low oxygen saturations, poor PO intake and/or nasopharyngeal secretions. In 2005 Dixie Regional Medical Center introduced a nasopharyngeal outpatient suctioning clinic. They were able to significantly decrease the number of Bronchiolitis admissions and shorten hospital length of stay. Primary Children's Medical Center, in an attempt to share best practice across the Intermountain system, proposed a pilot of an outpatient Bronchiolitis treatment clinic. Providing Continuity of Care Through a Multi-disciplinary Approach University of Iowa Children's Hospital, Iowa City, IA The University of Iowa Children's Hospital, in collaboration with Child Health Specialty Clinics (CHSC), Iowa's Title V Program for Children with Special Health Care Needs, developed a program called "Continuity of Care" in August 2001. This program is for children birth to 21 years who require health and related services that involve a significant amount of coordination both within the hospital and as they reenter the community. This program was formed in response to an identified need for a greater coordination of care for certain children with significant illness expected to last over one year in duration. Creation of a Virtual Psychiatric Crisis Intervention Unit to Reduce Emergency Department Overcrowding Yale-New Haven Children's Hospital, New Haven, CT Many hospitals struggle with crowded emergency rooms. Children who present with behavioral and emotional illnesses have difficult presentations to manage and utilize valuable space, time, and medical-surgical beds. Attendees will learn how such patients are managed by our institution. We show that children who require psychiatric admission can be safely managed on pediatric medical floors, when needed. We outline what we do, the personnel we use, and the procedures and protocols we have implemented. We outline the collaboration required among the stakeholders in a large system to make the approach successful. No Longer an Afterthought: Optimizing Patient Flow and Safety Through Timely Discharge Cincinnati Children's Hospital Medical Center, Cincinnati, OH In the hustle and bustle of a busy unit, discharge planning and processes can find their way to the bottom of the priority list. The seemingly more important needs of new admissions and more acutely ill patients tend to rise to the top, keeping patients in beds longer than they need to be and new patients waiting for critical beds and services. Through the systematic application of improvement science, we are predicting discharges and managing barriers to their timely execution, thus optimizing two of the great challenges we face - patient flow and patient safety. Kids First Konnection Brings NICU Babies and Families Together Kosair Children's Hospital, Norton Healthcare, Inc., Louisville, KY Supporting maternal-child bonding in the NICU is a challenge because of the restrictive environment of the setting and life-sustaining medical procedures taking priority over this bonding experience. The most frequently cited perceived needs of NICU parents include information, comfort and assurance that their infant is being well cared for. The Kid's First Konnection (KFK) is an internet-based telehealth system which allows parents and nurse and physician to provide information about the child's condition, as well as give visual confirmation of the child's status. See-through Process: Improving Effectiveness, Efficiency and Patient Safety Related to Chest and Abdominal X-rays in a PICU Children's Hospital, Omaha, NE Ordering the right test for the right reason(s) at the right time is critical to patient safety and to effectiveness and efficiency of care; we are the participating pediatric teaching facility for two medical schools with 370 resident rotations and over 300 medical students caring for and ordering tests for our patients annually; using CPOE and a "drop-down", multiple choice format for chest and abdominal x-ray ordering was a good opportunity to teach and reinforce appropriate ordering of these diagnostic radiology tests. Pulling Together: Implementing an Asthma Disease Management Team to Improve Outcomes Children's National Medical Center, Washington, DC Progress often depends on the ability to unify diverse stake-holders for a common purpose. Quality Improvement (QI) Committees can facilitate this progress by empowering disease specific teams while holding them accountable to outcomes. This poster highlights the process of creating an Asthma Disease Management Team at Children's National Medical Center (CNMC) and reports on outcomes in their care of patients across the health spectrum. Learn about the success of this team and how their experience can translate to other diesases and initiatives. Can We Predict When a Patient Is Ready to Transfer Out of the CICU? Cincinnati Children's Hospital Medical Center, Cincinnati, OH We recognized the need to predictably influence the safe timing of transfer out of the CICU, and to take some of the guesswork out of deciding when a patient is ready to transfer. One of our outcomes was to decrease the number of "bounce backs" to the CICU. A microsytems interdisciplinary task force was created and the PCITS (Pediatric Cardiac Internal Transfer Score) tool was developed to improve safety, efficiency, and to objectively indicate transfer readiness. The organization was very supportive of this work and resources were provided to develop and implement this project. One Stone, Two Birds: Achieving Handoff Education Through Data Collection Seattle Children's, Seattle, WA This poster illustrates how quantitative data on attending physician perception of physician hand-off was obtained through by a periodic email survey that simultaneously collects data, reinforces expectations and modifies physician behavior. Physician-to-Physician Handoff Communication at Time of ICU Transfer Seattle Children's, Seattle, WA This project describes an effort to improve attending/fellow physician to physician communication at the time of patient transfer form the ICU. Utilization Lan principles we understood a 4 day rapid process improvement workshop that resulted in the development of a standard reliable process to ensure that physician communication occurred following patient transfer from the ICU. Implementing the Acuity Adaptable Care Model In a Pediatric Pulmonary Unit Children's Memorial Hospital, Chicago, IL Children's Memorial Hospital (CMH) is a 250 bed, free standing, pediatric academic medical center located in Chicago, IL. In preparation for the deisgn and construction of a new hospital an alternative care delivery model was tested to evaluate the opportunity to improve the patient care experience and enhanced bed flexibility. A three month pilot on the pulmonary unit demonstrated significant reductions in patient transfers/hand offs and averted medication errors as well as improvement in patient and employee satisfaction. Innovating Asthma Severity Documentation in the ED Connecticut Children's Medical Center, Hartford, CT Documentation of asthma severity is important in determining appropriate therapy, response to therapy, and transfer of care to other providers. The Modified Pulmonary Index Score (MPIS) is a validated measure of asthma severity used throughout our institution. A specific MPIS template was developed for insertion into the emergency department (ED) electronic medical record. It was added to the nursing/respiratory care areas first and 6 months later to the physician area. Adding the template significantly improved MD documentation of MPIS in our ED. Transforming Ideas Into Action: An Inpatient Asthma Assessment and Improvement Project The Children's Hospital Medical University of South Carolina, Charleston, SC Asthma is one of the most common conditions in pediatrics with a strong evidence base to support treatment decisions. A need was identified to standardize and improve Asthma management in the MUSC Children's Hospital including emergent care, inpatient care, and outpatient care. This presentation discusses how a multi-disciplinary team worked together to standardize pratice and developed interventions and tools to improve care of the pediatric Asthma population. Collaboration Within the CA-BSI Collaborative Kosair Children's Hospital, Norton Healthcare, Inc., Louisville, KY Collaboration with successful strategies is possible across unit borders. Our poster describes how a PICU and a NICU can achieve good outcomes utilizing the same processes and can learn from other's roadblocks that are encountered. Making a Difference: A Team Approach to Eliminate CA-BSI in the PICU Children's Hospital of Wisconsin, Milwaukee, WI We would like to share our experience in implementing change to improve patient care in the PICU. We hope to inspire others by describing our team approach to implement practice changes within the PICU to achieve our goal of eliminating catheter associated blood stream infections (CA-BSI). Practice changes were designed using best available evidence. Rapid Cycle Improvement (PDSA) was utilized to evaluate the effectiveness of the change processes. The team included Physician Champions, PICU APN and RN, RN's from Infection Control, CVL Access Team, Interventional Radiology and Outcomes Department. Reducing the Bugs Among Us by Adapting Central Line Bundled Practices for Intestinal Failure Patients Children's Medical Center Dallas, Dallas, TX This is a performance improvement project designed to reduce rates of nosocomial and community acquired central line associated bloodstream infections (CLABSIs) in TPN dependent infants and children with intestinal failure. Unique features included the focus on high risk patients outside the ICU, leadership and ownership by the G.I. primary nursing staff, collaboration and infection control and outpatient G.I. clinic staff, and use of data to drive the progression of the project. Effective education, empowerment of the primary nursing staff to effect change based on their observations and provision of human and fiscal resources were the most important success factors. Toward Elimination of Central Line Associated Blood Stream Infections: Scrub the Hub and Reducing Line Entries Mayo Eugenio Litta Children's Hospital, Mayo Clinic, Rochester, MN Central line associated blood stream infections (CLA-BSI) are the most common hospital acquired infections in PICUs. A CLA-BSI increases patient mortality, length of stay and hospital costs. The PICU at Mayo clinic participated in the NACHRI Eradicating CLA-BSI Learning Collaborative. Two key elements included the insertion and maintenance bundles. Although other PICUs in the collaborative demonstrated a decrease in CLA-BSI rates, the Mayo CLA-BSI workgroup did not observe a similar decrease. In an effort to further improve the CLA-BSI rate at Mayo a Scrub the Hub campaign was implemented and strategies to reduce the frequency of line entries were initiatied. An Innovative Model for Improving Communications Between Referring Partners and a Children's Hospital Sainte-Justine Mother and Child University Hospital Center, Montreal, Quebec, Canada Close collaboration between referring partners and specialized centers is needed to improve clinical effectiveness and health system performance. Effective communication and collaboration between centers are key elements in patient safety and healthcare delivery as patients are stabilized and transitioned through the hospital system. In a health network approach there are multiple care transitions that can expose the patients to fragmented services and increase the risk of communication breakdown. We describe an innovative network service model. Diabetes Education Across the Continuum of Care Legacy Emanuel Children's Hospital, Portland, OR This poster presentation describes one Children's Hospital's experience with regard to how it provides diabetes education across the continuum of care. This was achieved through collaboration between the outpatient Diabetes and Endocrine Center and the inpatient pediatric units. This collaboration provides improved continuity of patient education, improved documentation and communication tools, and the latest diabetes self-management tools presented at the onset of the education. One significant result of providing diabetes education across the continuum has been the decreased length of stay in the inpatient units. We have also experienced increased patient/family, physician and staff satisfaction with the services provided. Expanding Patient Care Delivery and Community Access Through Remote Tele-echocardiography Cincinnati Children's Hospital Medical Center, Cincinnati, OH Many communities do not have immediate access to pediatric cardiologists to interpret echocardiograms in a timely manner. The objective of the remote tele-echocardiography program at Cincinnati Children's Hospital Medical Center is to enable a hospital/clinic to transmit, at a low cost, live echocardiographic images from external facilities using high-speed phone line or the Internet, thus enabling remote sites to access world class care close to home. The program ultimately provided immediate and actionable information that improved outcomes and yielded positive clinical, patient, and community benefits. The program pilot was initiated in July 2006 with Cabell Huntington Hospital in Huntington, WV. Building Support for Ongoing Parental Participation in Diabetes Self-management Cincinnati Children's Hospital Medical Center, Cincinnati, OH Regardless of the child's age, continued parental participation in diabetes care results in better glycemic outcomes and self-management skills. But there are many barriers to parental participation in care. Parents and children/teens with diabetes negotiate "who does what" on a daily basis. Often children become responsible for diabetes tasks and self-management far before they are ready to assume this responsiblity. The Cincinnati Children's Diabetes Team has developed creative strategies to increase and maintain parental participation in care. Attendees will learn about these strategies and the process used to affect parental participation and diabetes outcomes.