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Pain Free Times Three
e6
SPN 2010 Convention Poster Abstracts • guide to successful action planning • a nursing quality outcomes newsletter.
doi:10.1016/j.pedn.2009.12.017 “Wash Your Paws” Handwashing Campaign Joanne Kaye RN, CPN, Jessica Parent RN, Linda Allred RN, Heather Carney BSN, RN, Beth Scotter BSN, RN, Stephanie Benning RN Arkansas Children's Hospital, Little Rock, AR
Background: Handwashing has been shown to be the single most effective barrier to reducing the transmission of infections to patients and others in any setting. CDC guidelines for hand hygiene in health care settings (2002) state that based on extensive evidence, improved adherence to hand hygiene (i.e., handwashing or the use of alcohol-based hand rubs) has been shown to terminate infectious disease outbreaks in health care facilities, reduce transmission of antimicrobial resistant organisms, and reduce overall infection rates. Method: The hand hygiene campaign was designed to heighten the awareness of proper handwashing and hand hygiene techniques using multiple methods: 1. Glitter Bug Handwashing system allowed participants to determine impact of hand hygiene by viewing hands under a black light after washing off the glow lotion. 2. Laminated handwashing signs were placed by the sink in every patient's room. 3. A poster highlighted culture plates from common surfaces within the unit to show where bacterial colonies exist that we are not always aware of. A game to guess which culture plate matched which surface was used to encourage learning and participation. 4. A handwashing education video was created for patients and families to encourage them to wash their hands and to remind staff if they see them forget to wash or sanitize hands. 5. Additional hand sanitizing foams and gels were mounted in hallways and patients' rooms for greater convenience. Results: Hand hygiene compliance improved on both units. Graph shows baseline data of 49% compliance. After the initial interventions, hand hygiene increased by 25%. After additional interventions, hand hygiene had increased by 42%. Conclusions: Hand hygiene campaigns are not new. We can look back to Florence Nightingale who was a pioneer in showing improved outcomes with better hygiene practices. Developing a culture that focuses on the importance of the basic principles of hygiene and determining what barriers exist that prevent 100% hand hygiene compliance becomes essential. While we have concluded that a handwashing campaign can improve hand hygiene compliance, we are still monitoring to see that the improvements are maintained over time and if further interventions will be required to maintain compliance equal to or greater than 90%. doi:10.1016/j.pedn.2009.12.018 Aiming for 90%: An Interdisciplinary Project Improving Immunization Record Keeping Karalyn Kerby BSN, RN, CPN, Lisa Spikes BSN, RN, CPN, Lissa Symancyk BSN, RN Arkansas Children's Hospital, Little Rock, AR
Background: Children often receive vaccines in multiple places: clinic visits, inpatient, health department, or “open vaccine” events. This may result in lost or scattered immunization records. As a result, using records from a single site may underestimate immunization rates. Purpose: This presentation describes the first steps of an interdisciplinary project aimed at improving immunization rates: identifying incomplete immunization records and integrating records from multiple sites. Process: A Vaccines for Children site visit to a large pediatric clinic determined an immunization rate of 57%. An interdisciplinary team of nurses, physicians, and information technology specialists convened in response. Discrepancies were found in immunization records, and multiple areas of concern were identified. The first to be addressed was obtaining an accurate immunization record. Outcomes: The team developed a program that combines documentation of vaccines in electronic records with those in the state immunization registry. In addition, the group determined a need to improve the facility-wide system that identifies patients deficient in immunizations. The patient dashboard, which flags patients who are delinquent, is now more reliable. An icon on the dashboard allows access to an accurate combined report of the immunization record. Having this accurate record may reduce missed opportunities to vaccinate. Through this process, errors in the state registry were also identified. That information was shared with technologists. Improvements are being made to the state's immunization registry system. Implications: Accurate and up-to-date vaccination records will result in improved immunization rates, bringing us closer to the goal of 90%. doi:10.1016/j.pedn.2009.12.019 Pain Free Times Three Kerry Kovar RN, Jennifer Hudnall BSN, RN, Becky Wolfe BSN, RN Texas Children's Hospital, Houston, TX
Background: Results from a hospital wide pain prevalence study indicated that patients were experiencing moderate to severe pain without adequate intervention. This motivated a group of nurses to develop a program to improve staff performance and compliance with pain management. Purpose: The aim of this study is to alleviate or reduce the patients' experience with pain in the moderate to severe range by improving bedside assessment on the general medicine/ transplant unit. Methods: A subcommittee from the Unit Practice was assembled to devise a plan to improve pain control practices for every patient. Our improvement strategy is to increase pain assessment frequency to three times a shift in order to become proactive in the management of the patients' pain. Using a PowerPoint presentation, we presented our campaign, “Pain Free Times Three,” along with current scores related to pain management to the staff. Flyers were designed and posted on the unit with the slogan to remind staff. To encourage staff's participation, those who were observed implementing this new practice were rewarded. Results: We are awaiting the next hospital-wide pain prevalence study and patient satisfaction scores to evaluate the effectiveness of this program.
SPN 2010 Convention Poster Abstracts Conclusion: Currently, members of the Unit Practice Council are performing random chart audits on a weekly basis to assess RN compliance. We hope our 3-month data collection reveals a 90% or higher compliance with every 4-hour pain assessment. doi:10.1016/j.pedn.2009.12.020 Reviving Resuscitation in the Pediatric ICU and Pediatric Inpatient Units Yvette Laboy RN, CCRN, CPN Sinai Hospital, Baltimore, MD
Description: In small pediatric inpatient units and PICUs, despite high acuity, there is often a lack of frequency of patients experiencing deterioration. Concerns from PICU and pediatric nursing staff include a lack of experience in participation in patient codes and in their confidence levels in responding when patients are doing poorly. A review of the literature on both simulation and resuscitation reveals that the opportunity to practice in rapidly changing situations has been shown to improve performance at the “real” patient's bedside. In many institutions, code teams are already assembled, and staff participate in an identified position at each and every resuscitation. Based on this evidence and the formal code team experience, a description of roles during resuscitation was developed. Multidisciplinary educational sessions were presented within the PICU and pediatric units. Quick reference pocket cards were also completed with information regarding drugs and dosing on one side and staff roles on the other. Surprise mock resuscitation drills are being implemented on a regular basis and will be followed by debriefing. Evaluation/Outcome: Defining roles during resuscitation, implementing monthly mock codes, and providing staff members with quick reference pocket cards has begun to prepare staff for the real thing. During debriefings, staff have voiced increased comfort in managing rapidly changing pediatric patient conditions and additional confidence in their assigned resuscitation roles. doi:10.1016/j.pedn.2009.12.021 Mentoring Health Care Providers Through the Maze of EBP Lisa English Long MSN, RN, CNS, Barbara Giambra MS, RN, CNP, Susan McGee MSN, RN, CNP, Mary Meier MSN, RN Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Practice Problem/Background: In a unique role developed at a large pediatric hospital, Evidence-Based Practice Mentors guide staff in implementation of the evidence-based practice (EBP) process. Mentors use a systems-wide approach to integrating evidence into practice. Development of processes, resources, and tools was essential to complete this work. Mentors work closely with staff engaged in EBP to disseminate findings through the development of evidence summaries, poster and podium presentations, and publications. In working with staff, mentors identify strengths and areas for growth as a way to advance staff personally and professionally. A formal program for immersing staff in EBP has also been developed. PICO Question: Among staff at a large tertiary pediatric institution, does mentoring by EBP Mentors, compared to no mentoring, increase the number of policies, procedures, and projects that are evidence based?
e7 EBP Model: PARIHS framework (Rycroft-Malone, 2004) Summary of Literature: Mentorship is a powerful relationship between professionals that can foster best practices, productivity, leadership, retention, and satisfaction for both the mentor and mentee (Melnyk, 2007; Wagner, 2007). Many training programs in health care use mentors as a necessary supplement to more formal educational experiences. Mentoring has been a cornerstone of many EBP programs (Larabee et al., 2007; Melynk & Fineout-Overholt, 2002; Promising Practices, 2008; Stetler, 1998). Outcomes: Direct outcomes of EBP mentoring include consistency of evidence use, professional development, publications, presentations, and a formal program for educating point of care staff. Outcomes of mentored EBP projects include patient and staff safety and satisfaction and evidence-based policies and procedures. doi:10.1016/j.pedn.2009.12.022 Drug Endangered Children and Methamphetamine: A Provider Tool for Identification Janice Mahaffey MSN, RN, ARNP, CPN, Elizabeth A. Cull BSN, RN, Deysi Aguilera BSN, RN, Tameron Mouser BSN, RN, Lenora Poynter BSN, RN, Ann Lyons DSN, RN Spalding University, Louisville, KY
Problem: Rising methamphetamine use in the United States contributes substantially to the dangers faced every day by drug endangered children (DEC). Methamphetamine exposure is associated with clusters of documented physical and behavioral cues. Symptom clusters may mimic other illnesses. Health care provider pattern recognition of symptom clusters is lacking. Purpose of Project: To promote attention and pattern recognition of DEC exposed to methamphetamine use in the home environment through the development of a poster assessment tool for use by the health care provider. Methods: • When: Literature review conducted in 2008–2009— CINAHL, Medline, PubMed, Ovid, Embase, National Guidelines Clearinghouse, and Agency for Healthcare Research and Quality 2006–2009. • What: Poster/Tool development Spring of 2009 with expertise from ○ Louisville Metro Police Department (Narcotics Division) ○ National Alliance for Drug Endangered Children ○ Kosair Children's Hospital Child Abuse Committee ○ Holly Hopper, Director of Kentucky Alliance of DEC • Where: Pilot Tool Development Site—A tertiary care facility for children located in southeastern United States with eventual regional distribution through the state by National Alliance for Drug Endangered Children. • How: Signs and symptoms on poster arranged in ROS format by age and developmental status based on prevalence of terms in reviewed literature. Physical and behavioral findings were identified for children and their caretakers. ○ Pictures were included for visual demonstration. ○ Partners were chosen for degree of respect in community, knowledge base, interest in topic, and willingness to provide assistance and resources.
SPN 2010 Convention Poster Abstracts • guide to successful action planning • a nursing quality outcomes newsletter.
doi:10.1016/j.pedn.2009.12.017 “Wash Your Paws” Handwashing Campaign Joanne Kaye RN, CPN, Jessica Parent RN, Linda Allred RN, Heather Carney BSN, RN, Beth Scotter BSN, RN, Stephanie Benning RN Arkansas Children's Hospital, Little Rock, AR
Background: Handwashing has been shown to be the single most effective barrier to reducing the transmission of infections to patients and others in any setting. CDC guidelines for hand hygiene in health care settings (2002) state that based on extensive evidence, improved adherence to hand hygiene (i.e., handwashing or the use of alcohol-based hand rubs) has been shown to terminate infectious disease outbreaks in health care facilities, reduce transmission of antimicrobial resistant organisms, and reduce overall infection rates. Method: The hand hygiene campaign was designed to heighten the awareness of proper handwashing and hand hygiene techniques using multiple methods: 1. Glitter Bug Handwashing system allowed participants to determine impact of hand hygiene by viewing hands under a black light after washing off the glow lotion. 2. Laminated handwashing signs were placed by the sink in every patient's room. 3. A poster highlighted culture plates from common surfaces within the unit to show where bacterial colonies exist that we are not always aware of. A game to guess which culture plate matched which surface was used to encourage learning and participation. 4. A handwashing education video was created for patients and families to encourage them to wash their hands and to remind staff if they see them forget to wash or sanitize hands. 5. Additional hand sanitizing foams and gels were mounted in hallways and patients' rooms for greater convenience. Results: Hand hygiene compliance improved on both units. Graph shows baseline data of 49% compliance. After the initial interventions, hand hygiene increased by 25%. After additional interventions, hand hygiene had increased by 42%. Conclusions: Hand hygiene campaigns are not new. We can look back to Florence Nightingale who was a pioneer in showing improved outcomes with better hygiene practices. Developing a culture that focuses on the importance of the basic principles of hygiene and determining what barriers exist that prevent 100% hand hygiene compliance becomes essential. While we have concluded that a handwashing campaign can improve hand hygiene compliance, we are still monitoring to see that the improvements are maintained over time and if further interventions will be required to maintain compliance equal to or greater than 90%. doi:10.1016/j.pedn.2009.12.018 Aiming for 90%: An Interdisciplinary Project Improving Immunization Record Keeping Karalyn Kerby BSN, RN, CPN, Lisa Spikes BSN, RN, CPN, Lissa Symancyk BSN, RN Arkansas Children's Hospital, Little Rock, AR
Background: Children often receive vaccines in multiple places: clinic visits, inpatient, health department, or “open vaccine” events. This may result in lost or scattered immunization records. As a result, using records from a single site may underestimate immunization rates. Purpose: This presentation describes the first steps of an interdisciplinary project aimed at improving immunization rates: identifying incomplete immunization records and integrating records from multiple sites. Process: A Vaccines for Children site visit to a large pediatric clinic determined an immunization rate of 57%. An interdisciplinary team of nurses, physicians, and information technology specialists convened in response. Discrepancies were found in immunization records, and multiple areas of concern were identified. The first to be addressed was obtaining an accurate immunization record. Outcomes: The team developed a program that combines documentation of vaccines in electronic records with those in the state immunization registry. In addition, the group determined a need to improve the facility-wide system that identifies patients deficient in immunizations. The patient dashboard, which flags patients who are delinquent, is now more reliable. An icon on the dashboard allows access to an accurate combined report of the immunization record. Having this accurate record may reduce missed opportunities to vaccinate. Through this process, errors in the state registry were also identified. That information was shared with technologists. Improvements are being made to the state's immunization registry system. Implications: Accurate and up-to-date vaccination records will result in improved immunization rates, bringing us closer to the goal of 90%. doi:10.1016/j.pedn.2009.12.019 Pain Free Times Three Kerry Kovar RN, Jennifer Hudnall BSN, RN, Becky Wolfe BSN, RN Texas Children's Hospital, Houston, TX
Background: Results from a hospital wide pain prevalence study indicated that patients were experiencing moderate to severe pain without adequate intervention. This motivated a group of nurses to develop a program to improve staff performance and compliance with pain management. Purpose: The aim of this study is to alleviate or reduce the patients' experience with pain in the moderate to severe range by improving bedside assessment on the general medicine/ transplant unit. Methods: A subcommittee from the Unit Practice was assembled to devise a plan to improve pain control practices for every patient. Our improvement strategy is to increase pain assessment frequency to three times a shift in order to become proactive in the management of the patients' pain. Using a PowerPoint presentation, we presented our campaign, “Pain Free Times Three,” along with current scores related to pain management to the staff. Flyers were designed and posted on the unit with the slogan to remind staff. To encourage staff's participation, those who were observed implementing this new practice were rewarded. Results: We are awaiting the next hospital-wide pain prevalence study and patient satisfaction scores to evaluate the effectiveness of this program.
SPN 2010 Convention Poster Abstracts Conclusion: Currently, members of the Unit Practice Council are performing random chart audits on a weekly basis to assess RN compliance. We hope our 3-month data collection reveals a 90% or higher compliance with every 4-hour pain assessment. doi:10.1016/j.pedn.2009.12.020 Reviving Resuscitation in the Pediatric ICU and Pediatric Inpatient Units Yvette Laboy RN, CCRN, CPN Sinai Hospital, Baltimore, MD
Description: In small pediatric inpatient units and PICUs, despite high acuity, there is often a lack of frequency of patients experiencing deterioration. Concerns from PICU and pediatric nursing staff include a lack of experience in participation in patient codes and in their confidence levels in responding when patients are doing poorly. A review of the literature on both simulation and resuscitation reveals that the opportunity to practice in rapidly changing situations has been shown to improve performance at the “real” patient's bedside. In many institutions, code teams are already assembled, and staff participate in an identified position at each and every resuscitation. Based on this evidence and the formal code team experience, a description of roles during resuscitation was developed. Multidisciplinary educational sessions were presented within the PICU and pediatric units. Quick reference pocket cards were also completed with information regarding drugs and dosing on one side and staff roles on the other. Surprise mock resuscitation drills are being implemented on a regular basis and will be followed by debriefing. Evaluation/Outcome: Defining roles during resuscitation, implementing monthly mock codes, and providing staff members with quick reference pocket cards has begun to prepare staff for the real thing. During debriefings, staff have voiced increased comfort in managing rapidly changing pediatric patient conditions and additional confidence in their assigned resuscitation roles. doi:10.1016/j.pedn.2009.12.021 Mentoring Health Care Providers Through the Maze of EBP Lisa English Long MSN, RN, CNS, Barbara Giambra MS, RN, CNP, Susan McGee MSN, RN, CNP, Mary Meier MSN, RN Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Practice Problem/Background: In a unique role developed at a large pediatric hospital, Evidence-Based Practice Mentors guide staff in implementation of the evidence-based practice (EBP) process. Mentors use a systems-wide approach to integrating evidence into practice. Development of processes, resources, and tools was essential to complete this work. Mentors work closely with staff engaged in EBP to disseminate findings through the development of evidence summaries, poster and podium presentations, and publications. In working with staff, mentors identify strengths and areas for growth as a way to advance staff personally and professionally. A formal program for immersing staff in EBP has also been developed. PICO Question: Among staff at a large tertiary pediatric institution, does mentoring by EBP Mentors, compared to no mentoring, increase the number of policies, procedures, and projects that are evidence based?
e7 EBP Model: PARIHS framework (Rycroft-Malone, 2004) Summary of Literature: Mentorship is a powerful relationship between professionals that can foster best practices, productivity, leadership, retention, and satisfaction for both the mentor and mentee (Melnyk, 2007; Wagner, 2007). Many training programs in health care use mentors as a necessary supplement to more formal educational experiences. Mentoring has been a cornerstone of many EBP programs (Larabee et al., 2007; Melynk & Fineout-Overholt, 2002; Promising Practices, 2008; Stetler, 1998). Outcomes: Direct outcomes of EBP mentoring include consistency of evidence use, professional development, publications, presentations, and a formal program for educating point of care staff. Outcomes of mentored EBP projects include patient and staff safety and satisfaction and evidence-based policies and procedures. doi:10.1016/j.pedn.2009.12.022 Drug Endangered Children and Methamphetamine: A Provider Tool for Identification Janice Mahaffey MSN, RN, ARNP, CPN, Elizabeth A. Cull BSN, RN, Deysi Aguilera BSN, RN, Tameron Mouser BSN, RN, Lenora Poynter BSN, RN, Ann Lyons DSN, RN Spalding University, Louisville, KY
Problem: Rising methamphetamine use in the United States contributes substantially to the dangers faced every day by drug endangered children (DEC). Methamphetamine exposure is associated with clusters of documented physical and behavioral cues. Symptom clusters may mimic other illnesses. Health care provider pattern recognition of symptom clusters is lacking. Purpose of Project: To promote attention and pattern recognition of DEC exposed to methamphetamine use in the home environment through the development of a poster assessment tool for use by the health care provider. Methods: • When: Literature review conducted in 2008–2009— CINAHL, Medline, PubMed, Ovid, Embase, National Guidelines Clearinghouse, and Agency for Healthcare Research and Quality 2006–2009. • What: Poster/Tool development Spring of 2009 with expertise from ○ Louisville Metro Police Department (Narcotics Division) ○ National Alliance for Drug Endangered Children ○ Kosair Children's Hospital Child Abuse Committee ○ Holly Hopper, Director of Kentucky Alliance of DEC • Where: Pilot Tool Development Site—A tertiary care facility for children located in southeastern United States with eventual regional distribution through the state by National Alliance for Drug Endangered Children. • How: Signs and symptoms on poster arranged in ROS format by age and developmental status based on prevalence of terms in reviewed literature. Physical and behavioral findings were identified for children and their caretakers. ○ Pictures were included for visual demonstration. ○ Partners were chosen for degree of respect in community, knowledge base, interest in topic, and willingness to provide assistance and resources.