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025–Four-Limb Blood Pressure: Is It a Valid Screening Method for Coarctation?
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CLINICAL PRACTICE
Conclusion: The literature review provides best practice guidelines for managing a child with fever. The lack of consistency of nursing interventions directly affects patient outcomes, parental knowledge, anxiety, and lack of appropriate interventions. The primary focus is to provide interventions to increase the child’s comfort while decreasing the fever. Education is focused on the decision to treat a fever, sponging, advice aimed at parents, as well as the appropriate use and dosage of antipyretics in managing a child with fever.
022 – The Role of the Nurse in the Interdisciplinary Care of the Child Undergoing the Nuss Procedure. Tracy Patrick-Panchelli, BSN, RN, CPN, Susan Weaver, RN, CPN, Alfred I. duPont Hospital for Children of the Nemours Foundation, Wilmington, DE Pectus excavatum is an abnormal growth of bone and cartilage of the chest wall, which results in a concave appearance of the chest, or a bsunken chest.Q The Nuss procedure is an innovative, minimally invasive procedure for the repair of pectus excavatum involving placement of a titanium bar into the chest wall. Children undergoing this procedure require specialized care to prevent displacement of the bar and to facilitate lung reexpansion. This procedure was new for our hospital as of 2005, and it was imperative to prepare nurses to understand the unique aspects of this procedure and specialized postoperative care. Nurses caring for these children are an integral part of a multidisciplinary team, which includes surgeons, physician assistants, anesthesia and pain management advanced practice nurses, respiratory therapists, perioperative nurses, child life therapists, physical and occupational therapists, and pharmacists. This poster displays examples of multiple initiatives put into place to educate nurses and ancillary staff to care for these patients, including various inpatient services, development of a reference binder, drafting a standard of care, and placing signs above patients’ beds, which alert caregivers of important activity restrictions. We have also provided hands-on demonstrations of proper handling and turning of these patients. This poster demonstrates that multidisciplinary teamwork in implementing the Nuss procedure in our hospital has resulted in a much shorter length of stay and low complication rate as compared to traditional surgical repair of this deformity. 023 – Pediatric-Nurse-Placed PICCs in an Interventional Radiology Setting Improves Patient Experience and Outcomes. Beverly Paul, RN Objectives: ! Become familiar with the innovative concepts in clinical practice: Ultrasoundguided peripherally inserted central catheter (PICC) lines placed in interventional radiology ! Evaluate patient outcomes from the integration of interventional radiology and vascular access nursing Content: Patient population ! ! ! ! !
Oncology patients Neonates Patients requiring long-term therapy Patients with poor venous access requiring frequent peripheral IV access All pediatric PICC lines are placed in interventional radiology either by the vascular access nurse or by the interventional radiologist except for those placed in the PICU and NICU
Competency criteria/Training ! All vascular access nurses who place PICC lines complete a PICC certification program offered by Perivascular Nurse Consultants ! All vascular access nurses who place PICC lines complete a Pediatric IV Program Skills checklist ! All vascular access nurses who place PICC lines must complete the Ultrasound Vascular Access Assessment and Placement of PICC Competency prior to inserting PICC lines with ultrasound guidance Team members ! ! ! ! ! !
Radiology/Sedation nurse practitioner Interventional radiology nurse scheduler Vascular access nurse Interventional radiology nurse/Sedation nurse Interventional radiology technologist Interventional radiology attending physician
Process for scheduling PICC lines ! Physician enters order for PICC line placement. ! Vascular access nurse accesses patient for nurse placed PICC line versus interventional radiologist placement.
! Patient is scheduled accordingly (Vascular Access Team has two morning slots daily in Interventional Radiology). ! Patient is evaluated for sedation by the interventional radiology/sedation nurse practitioner who completes the presedation assessment, and sedation orders are written Advantages for placing PICC lines in interventional radiology ! Availability of PALS-certified nurses to administer sedation and recover patients postprocedure ! Use of Maximum Sterile Barrier Techniques for PICC insertion ! Availability to assist the vascular access nurse with use of ultrasound and fluoroscopy equipment ! Availability of the interventional radiology physician to assist the vascular access nurse with placement of PICC line if difficulty occurs, which alleviates the need of the patient requiring a second sedation and attempt at access ! Immediate verification of PICC placement ! Allows for immediate use of PICC line ! Optimizes utilization of interventional radiology and the interventional radiology team Future plans ! Implementation of a vascular access database ! Increase the number of vascular access nurses who are competent in ultrasound-guided placement PICC lines ! Increase the number of PICC lines placed with ultrasound guidance by vascular access nurses
024 – A New Era in Pediatric Nursing: The Implementation of a Nursing Professional Practice Model. Cara Rakow, MSN, RN, CPN, Allyson Daniels, BSN, RN, Susan DiTaranto, MHA, RN In May 2005, a large tertiary care children’s hospital instituted a nursing professional practice model (PPM) across the department of nursing. PPM is a shared governance philosophy that provides a structure through which all nurses can contribute to nursing practice and improve patient care. PPM positions nursing by providing an environment where nurses can learn together, strategize to create change, and voice opinions to influence nursing practice. This PPM is composed of four councils representing a staff of more than 2,500 registered nurses. Each nurse participates in one of four councils that are located within each unit and are mirrored at the department level. The Coordinating Council oversees the Quality Practice/Patient Safety Council, the Advancing Practice/ Education Council, and the Supporting Practice/Management Council. The council structure creates a synergy of endeavors at the unit and department level and aligns the nursing staff with the departmental goals. Nursing staff who participate in the PPM are able to organize, frame, and communicate recommendations to the department’s administration for endorsement. The design of this PPM is unique in that nursing staff chair the councils at both the unit and department levels. This PPM evokes a stimulating atmosphere that is truly a model of staff empowerment and accountability. This model has resulted in professional growth and job satisfaction. A description of the model’s development and implementation process will be shared. In addition, the preliminary outcomes reflecting improvements in nursing staff professional growth, participation, and methods of communication will be provided.
025 – Four-Limb Blood Pressure: Is It a Valid Screening Method for Coarctation? Ivy Razmus, MSN, RN, Lynette Lewis, BSN, RN-BC, Saint Francis Health System, Children’s Hospital at Saint Francis, Tulsa, OK Purpose: The purpose of this study is to determine if four-limb blood pressures are an effective way to screen for coarctation of the aorta for every normal newborn prior to discharge from the hospital. Research questions addressed are the following: Why are we doing four-limb blood pressures? Do they reliably identify the infant with coarctation of the aorta? Is there a better method of assessing this heart defect? Methods: Our Unit-Based Council asked the questions and reviewed the literature, obtained expert opinions, contacted peers on best practices and community standards, considered scientific principals, and recognized theory. Results: Obtaining four-limb blood pressures to screen for coarctation of the aorta is not supported by evidence in the literature, expert opinions, community standards, or best practices from our peers. Conclusions: Unit-Based Councils provided a framework to address practice issues at the bedside. Using palpation of lower extremity pulses appears to be a more effective method of screening for coarctation of the aorta especially when one considers nursing resources and reliability of the methods.
CLINICAL PRACTICE
Conclusion: The literature review provides best practice guidelines for managing a child with fever. The lack of consistency of nursing interventions directly affects patient outcomes, parental knowledge, anxiety, and lack of appropriate interventions. The primary focus is to provide interventions to increase the child’s comfort while decreasing the fever. Education is focused on the decision to treat a fever, sponging, advice aimed at parents, as well as the appropriate use and dosage of antipyretics in managing a child with fever.
022 – The Role of the Nurse in the Interdisciplinary Care of the Child Undergoing the Nuss Procedure. Tracy Patrick-Panchelli, BSN, RN, CPN, Susan Weaver, RN, CPN, Alfred I. duPont Hospital for Children of the Nemours Foundation, Wilmington, DE Pectus excavatum is an abnormal growth of bone and cartilage of the chest wall, which results in a concave appearance of the chest, or a bsunken chest.Q The Nuss procedure is an innovative, minimally invasive procedure for the repair of pectus excavatum involving placement of a titanium bar into the chest wall. Children undergoing this procedure require specialized care to prevent displacement of the bar and to facilitate lung reexpansion. This procedure was new for our hospital as of 2005, and it was imperative to prepare nurses to understand the unique aspects of this procedure and specialized postoperative care. Nurses caring for these children are an integral part of a multidisciplinary team, which includes surgeons, physician assistants, anesthesia and pain management advanced practice nurses, respiratory therapists, perioperative nurses, child life therapists, physical and occupational therapists, and pharmacists. This poster displays examples of multiple initiatives put into place to educate nurses and ancillary staff to care for these patients, including various inpatient services, development of a reference binder, drafting a standard of care, and placing signs above patients’ beds, which alert caregivers of important activity restrictions. We have also provided hands-on demonstrations of proper handling and turning of these patients. This poster demonstrates that multidisciplinary teamwork in implementing the Nuss procedure in our hospital has resulted in a much shorter length of stay and low complication rate as compared to traditional surgical repair of this deformity. 023 – Pediatric-Nurse-Placed PICCs in an Interventional Radiology Setting Improves Patient Experience and Outcomes. Beverly Paul, RN Objectives: ! Become familiar with the innovative concepts in clinical practice: Ultrasoundguided peripherally inserted central catheter (PICC) lines placed in interventional radiology ! Evaluate patient outcomes from the integration of interventional radiology and vascular access nursing Content: Patient population ! ! ! ! !
Oncology patients Neonates Patients requiring long-term therapy Patients with poor venous access requiring frequent peripheral IV access All pediatric PICC lines are placed in interventional radiology either by the vascular access nurse or by the interventional radiologist except for those placed in the PICU and NICU
Competency criteria/Training ! All vascular access nurses who place PICC lines complete a PICC certification program offered by Perivascular Nurse Consultants ! All vascular access nurses who place PICC lines complete a Pediatric IV Program Skills checklist ! All vascular access nurses who place PICC lines must complete the Ultrasound Vascular Access Assessment and Placement of PICC Competency prior to inserting PICC lines with ultrasound guidance Team members ! ! ! ! ! !
Radiology/Sedation nurse practitioner Interventional radiology nurse scheduler Vascular access nurse Interventional radiology nurse/Sedation nurse Interventional radiology technologist Interventional radiology attending physician
Process for scheduling PICC lines ! Physician enters order for PICC line placement. ! Vascular access nurse accesses patient for nurse placed PICC line versus interventional radiologist placement.
! Patient is scheduled accordingly (Vascular Access Team has two morning slots daily in Interventional Radiology). ! Patient is evaluated for sedation by the interventional radiology/sedation nurse practitioner who completes the presedation assessment, and sedation orders are written Advantages for placing PICC lines in interventional radiology ! Availability of PALS-certified nurses to administer sedation and recover patients postprocedure ! Use of Maximum Sterile Barrier Techniques for PICC insertion ! Availability to assist the vascular access nurse with use of ultrasound and fluoroscopy equipment ! Availability of the interventional radiology physician to assist the vascular access nurse with placement of PICC line if difficulty occurs, which alleviates the need of the patient requiring a second sedation and attempt at access ! Immediate verification of PICC placement ! Allows for immediate use of PICC line ! Optimizes utilization of interventional radiology and the interventional radiology team Future plans ! Implementation of a vascular access database ! Increase the number of vascular access nurses who are competent in ultrasound-guided placement PICC lines ! Increase the number of PICC lines placed with ultrasound guidance by vascular access nurses
024 – A New Era in Pediatric Nursing: The Implementation of a Nursing Professional Practice Model. Cara Rakow, MSN, RN, CPN, Allyson Daniels, BSN, RN, Susan DiTaranto, MHA, RN In May 2005, a large tertiary care children’s hospital instituted a nursing professional practice model (PPM) across the department of nursing. PPM is a shared governance philosophy that provides a structure through which all nurses can contribute to nursing practice and improve patient care. PPM positions nursing by providing an environment where nurses can learn together, strategize to create change, and voice opinions to influence nursing practice. This PPM is composed of four councils representing a staff of more than 2,500 registered nurses. Each nurse participates in one of four councils that are located within each unit and are mirrored at the department level. The Coordinating Council oversees the Quality Practice/Patient Safety Council, the Advancing Practice/ Education Council, and the Supporting Practice/Management Council. The council structure creates a synergy of endeavors at the unit and department level and aligns the nursing staff with the departmental goals. Nursing staff who participate in the PPM are able to organize, frame, and communicate recommendations to the department’s administration for endorsement. The design of this PPM is unique in that nursing staff chair the councils at both the unit and department levels. This PPM evokes a stimulating atmosphere that is truly a model of staff empowerment and accountability. This model has resulted in professional growth and job satisfaction. A description of the model’s development and implementation process will be shared. In addition, the preliminary outcomes reflecting improvements in nursing staff professional growth, participation, and methods of communication will be provided.
025 – Four-Limb Blood Pressure: Is It a Valid Screening Method for Coarctation? Ivy Razmus, MSN, RN, Lynette Lewis, BSN, RN-BC, Saint Francis Health System, Children’s Hospital at Saint Francis, Tulsa, OK Purpose: The purpose of this study is to determine if four-limb blood pressures are an effective way to screen for coarctation of the aorta for every normal newborn prior to discharge from the hospital. Research questions addressed are the following: Why are we doing four-limb blood pressures? Do they reliably identify the infant with coarctation of the aorta? Is there a better method of assessing this heart defect? Methods: Our Unit-Based Council asked the questions and reviewed the literature, obtained expert opinions, contacted peers on best practices and community standards, considered scientific principals, and recognized theory. Results: Obtaining four-limb blood pressures to screen for coarctation of the aorta is not supported by evidence in the literature, expert opinions, community standards, or best practices from our peers. Conclusions: Unit-Based Councils provided a framework to address practice issues at the bedside. Using palpation of lower extremity pulses appears to be a more effective method of screening for coarctation of the aorta especially when one considers nursing resources and reliability of the methods.