Mallory Rittel, Markeyta Brown, Ron Chenoweth, Marcy Page, Chelsi Peterzalek, and Amanda Woldruff
6 Hall will increase NDNQI RN-RN interaction scores from 5.06 to 5.45 to meet the 2019 National Magnet Facilities benchmark b August 1, 2019.
6 Hall Team Norms
- We strive for excellence: our work is complex, mistakes will happen.
- We provide timely (<1>week) feedback, which includes positive, learning and interpersonal feedback.
- We celebrate as a team and our environment feels like every individual matters.
- When trust is broken, we ask ourselves: how did I contribute? What can I do to make it better? We are careful in not making assumptions.
- Our behaviors are supportive and display respect.
- We create a work environment that feels consistently awesome.
Paula Capel, Jessica Banks, Micaela McKenna, Ashley Andrews, and Christopher M. Oermann
Standard quality improvement methodology was used to improve quarterly visit rates among cystic fibrosis patients at Children's Mercy Kansas City Cystic Fibrosis Center.
- A family-centered, team-based approach was adopted
- A change in culture led to sustained improvement
Improved quarterly visit rates should drive improvement in outcomes including pulmonary function and nutritional status.
CLABSI Prevention through Prevention Huddles and CLABSI Risk Assessment and Prevention Form in Electronic Medical Record
Tara Benton, Barb Haney, Lacey Bergerhofer, Yolanda Ballam, and Kaitlyn Hoch
Our aim is to increase the awareness of high risks for central line associated bloodstream infection (CLABSI) and decrease the CLABSI rate with the implementation of CLABSI prevention huddles and an electronic medical record (EMR) "CLABSI Risk Assessment and Prevention" form.
Jennifer Wooster, Aimy Patel, Brian R. Lee, and Amanda Nedved
Time spent waiting in the urgent care clinic is dissatisfying for patient and staff. This "wasted time" accounted for more than 52% of the urgent care visit at our urgent care.
The aim of our project is to decrease length of stay by 10 minutes by April 30, 2019 for all patients discharged from Blue Valley Urgent Care by offering patients a paperless depart process. To be eligible for discharge without paper families must be enrolled in the online patient portal.
Electronic discharge instructions significantly decrease length of stay and is associated with improved patient experience scores. Patients who received hardcopy discharge instructions also had short median LOS, likely due to overall improved urgent care workflow with the use of the portal.
Examining Nurse Resiliency & a Mindfulness-Based Stress Reduction Intervention to Prevent Nurse Burnout
Nurses continually give of themselves at work, as well as outside of work. This results in extensive stress, physiological distress, and ultimately burnout for individuals in the nursing profession. Nurses that work in high-stress environments, such as critical care, pediatrics, and oncology, are at a significantly increased risk of manifesting physical and psychological symptoms of burnout syndrome, compassion fatigue, and post-traumatic stress disorder (PTSD). Many of these factors are leading to nurses leaving the profession prematurely, resulting in significantly high turnover rates. High burnout and turnover rates of nurses result in the lack of adequate nursing staff in hospitals, which in turn results in the inadequate ability to provide safe and effective care to patients. Resilience is a topic that has gained much discussion in recent years surrounding the significant burdens nurses are experiencing. Nurses with resilience exhibit a heightened awareness, internal stability, and flexibility that allow them to navigate high-stress situations. The goal of resilience training and education is to enable nurses to respond to clinically challenging situations in ways that will protect them against detrimental consequences. Mindfulness based stress reduction (MBSR) has gained significant headway in recent years as a valuable, evidence based intervention to increase resiliency in nurses, improve job satisfaction, and reduce burnout. The purpose of this quality improvement project was to implement a MBSR course for nursing staff to improve nurse resiliency in a mid-western freestanding Children’s hospital. This project examined nurse resiliency pre-intervention, and post-intervention utilizing the Connor-Davidson Resilience Scale, as well as compassion fatigue, compassion satisfaction, burnout, and secondary traumatic stress pre-intervention, and post-intervention using the Professional Quality of Life scale. Results of the project indicate that resilience scores improved, at a statistically significant level, from pre-intervention to post-intervention.
Identifying Structural Factors Associated with Central Line-Associated Bloodstream Infections (CLABSI) Risk in a Single-Center Pediatric Academic Hospital
Elizabeth Monsees, Paul N. Bauer, Yolanda Ballam, and Brian R. Lee
Objective: compare unit structure and process-related factors against unit-specific CLABSI rate.
Conclusion: CLABSI mitigation requires more than individual competence with task-related practices; the unique work ecology of each clinical area may broadly influence CLABSI as an outcome; extending analyses to consider organizational structure can inform resource allocation and recalibrate traditional prevention strategies.
Julia G. Harris, Jamie Holland, Emily Fox, Leslie Favier, and Ashley M. Cooper
Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory disease seen in pediatric rheumatology. Despite advances in biologic therapy, many children with JIA will experience morbidity. Treat to Target is a treatment paradigm that involves setting a target of disease activity, using shared decision making, and incorporating clinical decision support. Our clinic aimed to set a treatment target on 50% of eligible JIA patients by December 31, 2019.
Beckie Palmer, Sarah Carboneau, Ashley Domsch, Barb Haney, Brandy Huitt, Ashley Lewis, Ashley Mirabile, Allison Ronco, and Dianne Wilderson
- Improve nursing engagement in QI as evidenced by increasing nurse involvement to 40% of overall staff by December 2018, with a continual increase to >50% by June 2019.
- Decrease the % of nurses who express "my opinion doesn't matter" as a reason they do not participate in QI by 30% by June 2019.
Beckie Palmer, Abdebayo Oshodi, Brandy Huitt, Kaylee Hurt, Pamela Kliethermes, Trudy Koons, Patricia Lanzer, Ashley Mirabile, Allyson Owen, Christian Anthony Schneider, Betsi Anderson, and Steven Olsen
Hierarchy of Aims:
- Global Aim: Create a Small Baby Unit for infants admitted to our NICU that arebirth, in which 90% of our patients are admitted to F pod on day of admission, by March 2019
- Interim Aim: Staff 80% of our micropremie patients with a Small Baby Team nurse from admission until >32 weeks by May 2019.
- Sub Aim: Increase rates of developmentally appropriate care (2 person cares, kangaroo care compliance) by 50% by August 2019.
Dianne Wilderson; Barb Haney; Ashley Mirabile; Beckie Palmer; Jenny Heltzer; Erin Keith-Chancy BSN,CCRN; Brooke Smith; Christian Anthony Schneider; and Abdebayo Oshodi
Project Aim: Increase the percent of eligible patients receiving kangaroo care from 19% to 30% by September 2019.
113 staff completed education
OT consults completed on all SBU patients
20 kangaroo wraps purchased
Kangaroo care rate in NICU increased from 19% (prior to SBU) to 36% (Post SBU opening).
Conclusion: Due to increased multidisciplinary awareness of importance of kangaroo care in the SBU more parents are completing kangaroo care.
Increasing Rates of Breastmilk Use at Time of Neonatal Intensive Care Unit (NICU) Discharge: An Improvement Project in a Midwest Level IV NICU
Kathleen Hortenstine, Teresa Fulk, Stephanie Callis, Kyla Galate, and Beckie Palmer
- Breast milk is the preferred food for all infants.
- The rate of breast milk use at time of discharge was below the goal of the institution.
- A gap was identified in bedside nursing education, limiting their ability to provide resources and education to mothers. Nursing involvement ensures skilled, comprehensive, and accessible breastfeeding support.
- The aim of this project is to increase breast milk rates at time of NICU discharge to 95% of eligible patients by December of 2019.
Barb Haney, Ashley Mirabile, Dianne Wilderson, Beckie Palmer, Ashley Lewis, Cris Mills, and Eugenia K. Pallotto
All aspects of discharge (education, screenings, appointments, plans and home services" must be completed and appropriately communicated prior to discharge to ensure safe transition to home.
Goal: Standardize all aspects of discharge in a large, busy 84-bed Level IV NICU with >1000 admissions/year and >300 nurses, >60 NNPs, and >25 neonatologists.
- 95% of patients with lengths of stay >3 days have all discharge planning completed prior to discharge/Parent Care Unit overnight stay
Cassandra Newell, Donna Wyly, Tanis Stewart, Alaina N. Burns, Brian R. Lee, and Rana El Feghaly
To improve Watchful Waiting or Safety Net Antibiotic Prescription (WW/SNAP) in children >6 months old diagnosed with acute otitis media by Advanced Practice Nurses in the Emergency Department by May 2020.
Ashley Mirabile, Barb Haney, Dianne Wilderson, Beckie Palmer, Ashley Domsch, and Eugenia K. Pallotto
Goal: To evaluate a staff education program on approach to improve in the rate of eligible NICU infants in safe sleep in a busy 84-bed level IV NICU.
Outcome Measures; Improve safe sleep compliance for eligible patients to 90% or greater by December 2019.
Process Measures: Audits from bedside RNs showing compliance with safe sleep.
Planned Intervention: In December of 2018 a multidisciplinary work group brainstormed and implemented best practice safe sleep education for staff and parents. September 2019 a Safe Sleep Educational Toolkit was made available for staff.
Results: Safe Sleep compliance has gone from 53% to 90% in September of 2019 after the initiation of a safe sleep toolkit.
Megan Kelly, Alexandra (Lexi) Van Noy, Molly Kruse, Megan English, Hannah Culbertson, Brianne Truitt, Ziryan Salihparkhy, Jenny McKee, and Brecklyn Findley
The CDC states that 1,545 infants passed away from SIDS in 2014. Safe sleep includes supine, in a crib, head of bed flat, firm sleep surface, tightly fitted sheet, no loose blankets, no toys or supplies in crib with infant. It is important for nurses to model safe sleep practices in the hospital setting. Current compliance with safe sleep in the Intensive Care Nursery is 50%.
By August 1, 2019 we want to increase the compliance of modeling safe sleep behaviors for patients who qualify for safe sleep from 50% to 90% in the Intensive Care Nursery.
Rylee Ainge, Mackenzie Flaws, Natalie Heim, Emily Herndon, Hayley Norris, and Amy L. Scott
Brett Butler, Jacob Burden, Carly Creekmore, Blair Griffin, Taylor Godemann, Taylor Hagen, Theresa Koelling, Mary Anne Kucera, Halle Magid, Makenna Miller, Monica Page, Mary Riffel, Madison Stebbins, Sarah Stokes, and Skylar Suppes
Kangaroo Care (skin to skin care) is a parent-led, evidence-based intervention which improves outcomes in neonatal patients including: decreased apnea, increased weight gain, increased parent satisfaction and decreased length of stay.
Nurse resident team interventions to support parent engagement and remove barriers to Kangaroo Care (KC) through iterative PDSA cycles from January 2018 to July 2019 yielded positive results within a subset of ICN patients.
Kara Humphreys, Katherine Karstens, Kortney Neiderhauser, Briana Pina, Payton Tallent, Stephanie Assad, and Madison Dexter
Six Henson staff reported feeings of burnout and compassion fatigue.
Decrease percentage of 6 Henson staff feeling sometimes or often "worn out because of [their] work as a helper" from 86% to 50% by August 1, 2019.
Increase the number of KUDOS cards submitted by 6 Henson staff from 2-3 per week to 10 per week by August 3, 2019.
Both aim statements were met and exceeded.
Who Codes in the NICU: An Analysis of Demographics and Factors that Place Neonates at Higher/Lower Risk of a Serious Code Event and Prognosis Post-Code
Danielle N. Gonzales, Ashley K. Sherman, Jennifer Dremann, Staci Elliott, Amelia Gute, Amber Bellinghausen, Jessica Brunkhorst, and Danielle Reed
This study analyzed resuscitation events in a level IV neonatal intensive care unit from 2012-2017 to determine whether there are identifiable differences between those who have a rapid response event and those with a short or long code and determine factors post-event that may impact survival to discharge.
Kristina Foster, Michele Fix, and Lacey Bergerhofer
Metrics for hospital acquired pressure ulcers over time, by stage, by device, and compared to other pediatric hospitals.
Kathlyn Baharaeen, Kimberly Palmer, Jamie Leroy, Julia Crouch, Bryan Limer, Gianna Swift, and Kate Gibbs
Jeremy Affolter, Kathlyn Baharaeen, Mari Hanson, Lisa Laddish, Amy Bohm, Lindsey Bradbury, Megan McGhee, Anne Leroy, Hannah Cunningham, Michelle Waddell, Tiffany Mullen, Kimberly Lucas, William Douglas, Angel Pope, Marita Thompson, Paul N. Bauer, Erica Molitor-Kirsch, Tara Benton, and Laura Miller-Smith
Kristi Gordon, Elizabeth Simpson, Sarah Forge, and Eileen Almon
•In 2012, our hospital expanded obstetrical services resulting in the delivery over 3700 infants per year.
•Approximately 35% of these infants had no relationship to a primary care physician with privileges at our hospital.
•These infants were either uninsured, Medicaid insured or privately insured but whose primary care physician did not have hospital privileges.
•Private Pediatricians “on call” were given these unassigned infants and were attempting to evaluate infants in the mornings, prior to seeing their scheduled office patients
•This resulted in an unmanageable daily census for them.
•This led to Pediatrician dissatisfaction, delayed medical evaluations of some infants, discharge planning dilemmas and financial burdens to both the hospital and the Pediatricians on staff.
•The existing affiliation with an Academic Children’s Hospital for Neonatology Professional and Neonatal Intensive Care Directorship services was expanded to include an Advanced Practice Registered Nurse (APRN) Newborn Hospitalist service to care for unassigned, routine newborns. Oversight was provided by physicians within the Division of Neonatology dedicated to coverage for this service.
Newborn Hospitalist Role
•Provide care to infants born at the delivery center whose primary care providers are not on staff.
•Dedicate 100% professional effort on newborns outside of intensive care setting. •Recent QI projects:
•Improving testing for drugs of abuse.
•Implementation of transcutaneous monitoring of bilirubin.
•Refining car seat testing guidelines.
•The team is currently preparing the first edition of a newsletter, Newborn Connections.
•Consistent, timely medical evaluation of all infants without consideration of insurance/Physician availability or limitations.
•Safe, comprehensive, quality care for all infants without need for Private Pediatrician oversight.
•High family satisfaction ratings on patient satisfaction survey. •Small number of dedicated APRN Providers led to standardized education and care for families. •Consistent availability of services improved communication with nursing staff and hospital administrative staff.
•Improved discharge coordination with scheduled PCP follow-up appointments prior to hospital discharge.
•Affiliation with local Academic Center/Neonatology, improved credibility with families and seamless transition between NICU and routine newborn services. •APRN job satisfaction/career growth opportunities with autonomy building hospitalist service and coordination with supervisory physicians
•In our state, development and growth of an APRN -led Newborn Hospitalist Service has permitted a population of infants to receive consistent, safe, quality care.
•This program could be duplicated at institutions with similar circumstances
Erin Fecske, Paul Glasier, Lines Vargas Collado, and Elizabeth Rende
Describes the use of the Neurological Disorders Depression Inventory-Epilepsy-Youth (NDDI-E-Y) in adolescent patients in a comprehensive epilepsy center to identify patients who need referral for mental health care.
Haley Borchers, Kelly Fehlhafer, Barbara Mueller, Jessica Nichols, Sarah Talken, Mary Hunter, and Kenneth Sam