- Email: [email protected]
Central Venous Catheter Injection Cap Disinfection: Chlorhexidine Versus 70% Alcohol
e6 outcomes thus far. We have identified potential barriers to successful outcomes and have full support of management. Interviewing select patients/families for additional feedback is also being considered. Conclusion and Implications: Ongoing evaluation of the following continues to determine the success of outcomes for this project: (a) staff opinion and interpretation of project success/changes needed, (b) patient/family satisfaction scores, (c) event reports related to errors in patient care, including medication/laboratory/order errors. doi:10.1016/j.pedn.2010.12.029 The Psychometric Properties of the Pediatric Early Warning Score System in the Pediatric Medical Surgical Units Nicole Ryan BSN, RN, CPN Children's Hospital Orange County, Orange, CA
Objectives: 1. Describe our institution's Pediatric Early Warning Score (PEWS) tool. 2. Discuss the preliminary results of the research project including reliability, validity, specificity, and sensitivity. Description: Identifying and treating clinical deterioration in a pediatric patient is crucial to improving outcomes. Response teams in the pediatric setting have been proven effective, but the use of an early warning scoring tool to improve recognition has mostly been studied in the adult population. In 2008, 60% of our patients displayed signs of deterioration 8 hours prior to the Rapid Response Team (RRT) call. Many pediatric hospitals across the nation have begun to institute a scoring tool to begin to recognize deterioration earlier. The purpose of this study is to determine if the PEWS at our institution is a reliable, valid, specific, and sensitive measure of deterioration in medical–surgical patients. A retrospective study will be conducted to examine the PEWS of patients who had an event (RRT, pediatric intensive care unit transfer, and/or code white) and those who did not have an event. PEWS captures the patient's current respiratory, cardiovascular, and neurobehavioral status into one single score that is displayed in the Cerner system and on the electronic patient assignment board on the units. We anticipate 114 patients will have an event and 114 control patients. We project a high interrater reliability correlation, a significant difference in PEWS for the sample and control groups, and an increase in the patient's PEWS number as the patient's status deteriorates. The use of the PEWS empowers the nurse to present the patient to the health care team in a shared terminology that is clear, intuitive, and easy to visualize. doi:10.1016/j.pedn.2010.12.030 Central Venous Catheter Injection Cap Disinfection: Chlorhexidine Versus 70% Alcohol Kimberly Peterson MSN, APRN-PCNS-BC, CPN Children's Hospital & Medical Center, Omaha, NE
Purpose: The hospital practice for central venous catheter (CVC) injection cap disinfection consisted of a 15-second 70% alcohol wipe scrub followed by a 15-second dry time. As part of the initiative to reduce central line-associated blood stream infections
Abstract (CLA-BSI), the organization wanted to determine the best practice for injection cap disinfection. PICO Question: For hospitalized pediatric patients with a CVC, does the use of chlorhexidine to scrub CVC injection caps reduce the incidence of CLA-BSI rates when compared with the use of 70% alcohol? Methods: A literature search was performed that yielded two randomized clinical trials in the past 16 years. The evidence was rated and classified based on the Oncology Nursing Society's Putting Evidence into Practice weight of evidence classification schema. Additional sources of evidence obtained from benchmark data, listserv queries, and manufacturer recommendations were evaluated. Findings: The body of evidence was classified as “effectiveness not established” because there was insufficient data and inadequate data quality. No research studies were found that strongly supported the use of chlorhexidine for injection cap disinfection to reduce CLABSI rates, although the literature and benchmark data demonstrated a shift toward the use of chlorhexidine for injection cap disinfection. Conclusions: Our current hospital practice of using 70% alcohol was determined to be within the national practice standards. Further research is needed to better determine the most effective CVC injection cap cleanser for prevention of CLA-BSI. doi:10.1016/j.pedn.2010.12.031 Stamping Out Stress in the Pediatric Intensive Care Unit Angie Allen RN, Karin Ragudo RN, Patricia Ridgell RN Arkansas Children's Hospital, Little Rock, AR
Purpose: Nurses in pediatric intensive care units (PICUs) frequently provide care to children at the end of life. Evidencebased interventions, such as peer-based support programs, are needed to help nurses cope with end-of-life events and overwhelming case experiences. The purpose of this project was to develop and evaluate a peer support intervention to help PICU staff cope with end-of-life and other stressful events. Method/Research Question: PICU nurses at a large children's hospital completed a needs assessment. Data were analyzed using descriptive statistics to inform the development and implementation of a grief support intervention for PICU staff. Postimplementation surveys are planned to evaluate the program. Administrative review by the institutional review board indicated that the project did not meet criteria for human subjects research. Findings: The needs assessment demonstrated that patient deaths affected job satisfaction at least moderately for 16%. In addition, 32% of respondents were dissatisfied with support currently provided during escalation of care or patient death. Seventy-four percent of respondents indicated a need for a nurse-driven grief support system in the PICU. The most frequent recommendations were a grief box with comfort items such as chocolate or coffee (87%), a peer support nurse (66%), and peer debriefing (33%). Based upon the findings, grief boxes were implemented, and bimonthly peer debriefing or “stamp out stress” sessions were implemented. Evaluation data are pending. Conclusion/Discussion: Preliminary results indicate a need for additional support during patient death or escalation of care. The PICU staff can benefit from a peer-driven support intervention. doi:10.1016/j.pedn.2010.12.032
Objectives: 1. Describe our institution's Pediatric Early Warning Score (PEWS) tool. 2. Discuss the preliminary results of the research project including reliability, validity, specificity, and sensitivity. Description: Identifying and treating clinical deterioration in a pediatric patient is crucial to improving outcomes. Response teams in the pediatric setting have been proven effective, but the use of an early warning scoring tool to improve recognition has mostly been studied in the adult population. In 2008, 60% of our patients displayed signs of deterioration 8 hours prior to the Rapid Response Team (RRT) call. Many pediatric hospitals across the nation have begun to institute a scoring tool to begin to recognize deterioration earlier. The purpose of this study is to determine if the PEWS at our institution is a reliable, valid, specific, and sensitive measure of deterioration in medical–surgical patients. A retrospective study will be conducted to examine the PEWS of patients who had an event (RRT, pediatric intensive care unit transfer, and/or code white) and those who did not have an event. PEWS captures the patient's current respiratory, cardiovascular, and neurobehavioral status into one single score that is displayed in the Cerner system and on the electronic patient assignment board on the units. We anticipate 114 patients will have an event and 114 control patients. We project a high interrater reliability correlation, a significant difference in PEWS for the sample and control groups, and an increase in the patient's PEWS number as the patient's status deteriorates. The use of the PEWS empowers the nurse to present the patient to the health care team in a shared terminology that is clear, intuitive, and easy to visualize. doi:10.1016/j.pedn.2010.12.030 Central Venous Catheter Injection Cap Disinfection: Chlorhexidine Versus 70% Alcohol Kimberly Peterson MSN, APRN-PCNS-BC, CPN Children's Hospital & Medical Center, Omaha, NE
Purpose: The hospital practice for central venous catheter (CVC) injection cap disinfection consisted of a 15-second 70% alcohol wipe scrub followed by a 15-second dry time. As part of the initiative to reduce central line-associated blood stream infections
Abstract (CLA-BSI), the organization wanted to determine the best practice for injection cap disinfection. PICO Question: For hospitalized pediatric patients with a CVC, does the use of chlorhexidine to scrub CVC injection caps reduce the incidence of CLA-BSI rates when compared with the use of 70% alcohol? Methods: A literature search was performed that yielded two randomized clinical trials in the past 16 years. The evidence was rated and classified based on the Oncology Nursing Society's Putting Evidence into Practice weight of evidence classification schema. Additional sources of evidence obtained from benchmark data, listserv queries, and manufacturer recommendations were evaluated. Findings: The body of evidence was classified as “effectiveness not established” because there was insufficient data and inadequate data quality. No research studies were found that strongly supported the use of chlorhexidine for injection cap disinfection to reduce CLABSI rates, although the literature and benchmark data demonstrated a shift toward the use of chlorhexidine for injection cap disinfection. Conclusions: Our current hospital practice of using 70% alcohol was determined to be within the national practice standards. Further research is needed to better determine the most effective CVC injection cap cleanser for prevention of CLA-BSI. doi:10.1016/j.pedn.2010.12.031 Stamping Out Stress in the Pediatric Intensive Care Unit Angie Allen RN, Karin Ragudo RN, Patricia Ridgell RN Arkansas Children's Hospital, Little Rock, AR
Purpose: Nurses in pediatric intensive care units (PICUs) frequently provide care to children at the end of life. Evidencebased interventions, such as peer-based support programs, are needed to help nurses cope with end-of-life events and overwhelming case experiences. The purpose of this project was to develop and evaluate a peer support intervention to help PICU staff cope with end-of-life and other stressful events. Method/Research Question: PICU nurses at a large children's hospital completed a needs assessment. Data were analyzed using descriptive statistics to inform the development and implementation of a grief support intervention for PICU staff. Postimplementation surveys are planned to evaluate the program. Administrative review by the institutional review board indicated that the project did not meet criteria for human subjects research. Findings: The needs assessment demonstrated that patient deaths affected job satisfaction at least moderately for 16%. In addition, 32% of respondents were dissatisfied with support currently provided during escalation of care or patient death. Seventy-four percent of respondents indicated a need for a nurse-driven grief support system in the PICU. The most frequent recommendations were a grief box with comfort items such as chocolate or coffee (87%), a peer support nurse (66%), and peer debriefing (33%). Based upon the findings, grief boxes were implemented, and bimonthly peer debriefing or “stamp out stress” sessions were implemented. Evaluation data are pending. Conclusion/Discussion: Preliminary results indicate a need for additional support during patient death or escalation of care. The PICU staff can benefit from a peer-driven support intervention. doi:10.1016/j.pedn.2010.12.032