Presentations

These slides have been presented at a meetings in Children's Mercy and around the world. They represent research that was done at the time they were created, and may not represent medical knowledge or practice as it exists at the time viewers access these slide presentations.

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Screening Pediatric Patients for Readmission Risk

Sarah Bradshaw and Blair Buenning

Kansas City Nurse Research Consortium Forum: Presentation on HARRPS Research Project
Screening Pediatric Patients for Readmission Risk

Sarah Bradshaw, Blair Buenning, and Anita Powell

Overview of the HARRPS Research Project
Save the Pharmacy Piggy Bank: Managing Mega High-Cost Drugs

Richard K. Ogden Jr., Jerame Hill, and Sam Abdelghany
Intractable Diarrhea and Steatorrhea after Initiation of Ivacaftor/Lumacaftor in a Child with Cystic Fibrosis and a History of Meconium Ileus and Small Bowel Resection

Christopher M. Oermann

Background.LB is a 6 year old with pancreatic insufficient CF> Delivered at 35 week EGA and diagnosed with meconium ileus. Segmental resection of 7 cm of the distal ileum and ileostomy. Ileostomy take-down at 8 weeks of age. Intermittent gastrointestinal issue and poor growth early in life.
Congenital Abnormalities of the Lower Airway and Lungs

Christopher M. Oermann

Goals and Objectives. Participants will be able to: Describe the 5 stages of fetal lung development. Summarize the prenatal identification and management of congenital abnormalities of the lower airways and lung (CALA). Explain the classification of CALAL. Compare the clinical characteristic, pathology and management of common CALAL. Discuss the long term prognosis of CALAL.
Patterns of use of non-ambulatory care services in patients with attention-deficit/hyperactivity disorder

July K. Jean Cuevas, Hongying Dai, and Suman Sahil

Background:

ADHD affects 1 out of 11 children (ages 4-17)

Cost of psychiatric disorders: – Limited investigation in children and adolescents. – Limited studies on economic burden of ADHD in the US

A recent study showed increased cost of healthcare in $USD for patients with ADHD in United States.

Hypothesis: – Costly non-ambulatory services contribute to this discrepancy

Objective: To compare non-ambulatory health care utilization patterns of patients with and without ADHD in a large socioeconomically, racially and geographically diverse population.

Methods:

Retrospective review of data from Cerner Health Facts ®.

A total of 190,365 patients with ADHD and 131,473 patients without ADHD who received non-ambulatory care across the United States.

– Ages 3-19 years

– Three year period (2014-2016)

4,000 patients on each group

Looking at the most expensive aspects of care

Statistical analysis

: – Two-sided independent t-tests for continuous variables.

– Chi-square or Fisher's exact test for categorical variables.

Conclusion: Non-ambulatory care use by children with ADHD is likely to be the high cost services; patients are likely to be admitted and stay longer in the hospital
Problematic Child Mealtime Behavior and Caregiver Mobile Phone Use

Libby Milkovich, Meredith Dreyer, Brooke Sweeney, Sarah Nyp, and Benjamin Black

TITLE: Problematic Child Mealtime Behavior and Caregiver Mobile Phone Use

BACKGROUND Problematic mealtime behaviors (PMB) (externalizing behavior at mealtime) have been seen anthropologically when adult caregivers are absorbed in their mobile phones. Parents with mobile phone problematic use (MPPU) are more likely to be absorbed in a mobile device. Use of mobile devices interrupts personal interactions which may cause children to engage in more externalizing behavior to gain attention of the caregiver. MPPU may also be seen among parents attempting to be distracted from a child’s problematic behaviors. Neither the correlation of MPPU to PMB, nor the frequency of PMB to perceived impairment of problem behavior have been quantitatively studied.

OBJECTIVE Evaluate correlation of caregiver MPPU and child PMB to improve understanding of the possible implications of caregiver MPPU

METHODS Participants included caregivers of children ages 2-8 years being seen in a pediatric hospital clinic. Participants completed a survey on an iPad via REDCAP. The survey included demographics (caregiver/child age, gender, race/ethnicity; child BMI; caregiver level of education, a validated measure for caregiver MPPU (Mobile Phone Problematic Use Scale; MMPUS) and a validated measure for perception of child PMB (Meals in our Household; MIOH). MIOH includes frequency of PMB and perceived impairment from PMB. Measures are continuous variables. Spearman correlation was used for the studied variables and possible confounding variables. Significant confounding variables were evaluated in a regression model.

RESULTS 100 caregivers (mean age 32.9 years, 65% white, 20% ≤ high school completion) participated. Correlation of MIOH problematic behavior total with MMPUS was significant (p=.004, r=0.289). MIOH perceived impairment from PMB had stronger correlation with MMPU (p=<.001, r=.333). Significantly correlated caregiver variables with MPPU include younger age (p=.017, r=-0.241) and gender F>M (p=.005). No significant caregiver variables noted for PMB. Younger child age was significantly correlated with PMB (p=.007, r=-.274). No significant differences in child variables for MPPU. Significant variables were evaluated in regression a model, and MPPU and PMB remained significant.

CONCLUSION Correlation was found between MPPU and PMB. Correlation was stronger when measure of perceived impairment was evaluated. This suggests that caregivers with increased MPPU perceive behavior as more problematic. Improving the understanding of the negative correlation of caregiver MPPU with PMB necessitates pediatricians facilitating conversations with caregivers about this relationship and strategies to ameliorate MPPU during mealtime.
Implementation of a Guideline-based Non-tuberculous Mycobacteria Management Algorithm

Christopher M. Oermann

NTM in CF. NTM are ubiquitous environmental organisms that can cause chronic pulmonary infection. Prevalence among CF patients is increasing. 1-3% in the earliest study reported in 1984. CF Registry with average of 12% but significant range (0-28%). 32.7% reported among patients less than or equal to 40 years in Colorado. Generally categorized as “slow growers” and “rapid growers”.
ABCs of Safe Sleep

Alyson Hill RN, Jennifer Markey RN, Bailey Ritter RN, Ashley Smith RN, and Aaron Smithson RN

PICO Question

Does education and teaching to parents and family regarding safe sleep practices increase the compliance of safe sleep for infants 0-12 months on 4 Sutherland compared to the current practice?

Aim Statement

The objective of the evidence based practice project is to increase Safe Sleep compliance by improving education given to parents and family from 20% to 90% by February 2018
Baby Got BAC

Tina Histand BSN, RN; Heidi Mustapich BSN, RN; Brittany Parks RN; Mallory Potter BSN, RN; and Melanie Traynham RN

PICO Statement

• Population: 6 Henson patients who qualify for Safe Sleep Practices according to the Safe Sleep Policy.
• Intervention: Signs will placed in high patient care areas to provide awareness and reminders to 6 Henson patient caregivers of correct safe sleep practices.
• Comparison: Current standard of care
• Outcomes: Increased compliance with safe to sleep practices

Aim Statement

The objective of this evidence based practice project is to increase Safe Sleep compliance on the 6 Henson unit by 10% by March of 2018
Chasing Never: Unplanned Extubation

LeeAnna Gaspers BSN,RN; Brittney Gerber BSN,RN; Madison Hersma BSN,RN; Erin Keith-Chancy BSN,CCRN; Audrey Knodell BSN,RN; Jordan Miller BSN,RN; Liz Morrow BSN,RN; Tara Otterson BSN,RNC; Chantal Rogers BSN,RN; and Abby Slaven BSN,RN

PICO Question

• P:In the Intubated neonate
• I: can the bundling of potentially best practice recommendations (tube location documentation, 2-person handling, and management of positioning and secretions) and standardized hourly assessment with documentation of compliance
• C: current standard of practice
• O: decreased unplanned extubations

Aim Statement

Decrease the rate of unplanned extubations in the ICN from 1.38/100 ventilator days in 2016 to 1 event/100 ventilator days in 2017.
ED Staff Morale

Madison Wilkins RN, Tonya Cross RN, Brittany Schmalzbach RN, Noah Olla RN, Fred Richards RN, and Emily Pendleton RN

PICO Question

PICO Question & Aim Statement

• (Population, Intervention, Comparison, Outcomes Measures)

• P: ED Nurses and Support Staff

• I: Huddle Recognition and prizes

• C: No recognition

• O: Improved nursing morale

 To increase the median morale of nursing and support staff from 74% to 80% as measured by Daily Pulse by March of 2018
ICN Flu Vaccine Cocooning

Allison Bauer BSN, RN; Brittany Wolter BSN, RN; Jonathan Rind BSN, RN; Maggie Butaud BSN, RN; Sarah Dumovich BSN,RN; Tori Weishaar BSN, RN; and Karli Wittenbach BSN, RN

PICO Question

P (Population): Registered nurses in the CMH Intensive Care Nursery providing patient care.

I (Intervention): Electronic documentation of parent flu vaccine status. Include vaccine status reminder in pod huddle.

C (Comparison): Current practice

O (Outcome): Increase the percentage of families receiving the flu-vac

Aim Statement

The objective of this evidence based practice project is to increase the percentage of families receiving the flu vaccine from 83% to 85% by March of 2018
PICU Patient Satisfaction

Kaitlyn Enochs BSN, RN; Jonathan Foley BSN, RN; Tara Goodman BSN, RN; Abby Haupt BSN, RN; Chelsea Koerkenmeier BSN, RN; Allison Mills BSN, RN; Kara Mishler BSN, RN; Madison Myers BSN, RN; Michelle Noykhovich BSN, RN; Sophia Poplin BSN,RN; Austin Reyes BSN, RN; Kylie Stottlemyre BSN, RN; Sarah Swift BSN, RN; Danielle Warner BSN, RN; Emily Zimmerman BSN, RN; Brooke English MSN, RN, CCRN; and Katherine Hoffman BSN, RN

PICO

PICU secretaries and parents will be able to increase the number of completed parent satisfaction surveys compared to current actions and supports.

Aim Statement
- To increase rate of completed parent survey by 5%, as measured by the number of surveys submitted each quarter by January 2018
- To have 10% response rate to surveys for patients that have been in the PICU for 30 days or greater.
Safe Baby

Hannah Burger BSN, RN; Samantha Cockrell BSN, RN; Shauni Lawrence BSN, RN; Shae McGinnis BSN, RN; Christina Montgomery RN; and Elizabeth Taylor RN

PICO Question

P: 4 Henson and 5 Sutherland patients who qualify for Safe Sleep Practices according to the Safe Sleep Policy.
I: Creating a useable checklist to be completed with each infant and each shift change
C: Current standard of care
O: Increased compliance with safe to sleep practices

Aim Statement

The objective of this evidence based practice project is to increase Safe Sleep compliance from 50% to 65% on 4 Henson and 5 Sutherland by February 1, 2018.
Same Day Discharge for Non-Perforated Appendicitis in Children: An Updated Institutional Protocol

Tolulope A. Oyetunji MD MPH
Evaluating the Consistency and Quality of Search Strategies and Methodology in Cochrane Urology Group Systematic Reviews

Jennifer A. Lyon, Carrie Price, Jamie Saragossi, and Clara Y. Tran

OBJECTIVES

The Cochrane Urology Working Group has undergone multiple administrative and personnel changes over its history. Presently, there are nearly a dozen Information Specialists volunteering from several institutions and two countries. To identify areas for quality and consistency improvement, we evaluated the search methodologies in 64 Urology Group Reviews/Protocols.

METHODS

64 published Urology Group Cochrane Systematic Reviews (CSR) and Protocols (CSP) were downloaded from the Cochrane Library on September 15, 2016. A data form was created using Qualtrics consisting of several sections including expanded PRESS (Peer-Review of Electronic Search Strategies) elements, database selection, search methodology reporting, & consistency. Four librarians, including two Cochrane Urology Assistant Information Specialists, evaluated 20 CSR/Ps each, allowing overlap to verify data extraction reliability.

RESULTS

Librarian reviewers noted high variability in CSR/P search methods including selection of databases searched, full search strategies reporting, and use of publication filters, clinical trial registries, conference proceedings, and journal TOCs. Within search strategies, common errors included wrong line numbers, misspellings, inappropriate syntax, and duplicated lines.

CONCLUSIONS

Cochrane Reviews are frequently viewed as the "gold standard" of systematic reviews, therefore the CSR/Ps should have high quality search methodology. This retrospective analysis represents a historical overview of search method reporting in CSR/Ps from the Cochrane Urology Group. Our results demonstrate a need for improved standardization including complete documentation of all strategies, more consistent database selection, less variation in strategy construction, increased use of peer-review and inclusion of the PRISMA Flow Diagram, and tighter adherence to the Cochrane Handbook/MECIR Standards.
Congenital Abnormalities of the Lower Airways and Lungs

Christopher M. Oermann

Goals and Objectives. Participants will be able to: Describe the 5 stages of fetal lung development. Summarize the prenatal identification and management of congenital abnormalities of the lower airway and lung (CALAL). Explain the classification of CALAL. Compare the clinical characteristics, pathology and management of common CALAL. Discuss the long term prognosis of CALAL.
High Acuity Readmission Risk Pediatric Screen Tool (HARRPS)

Sarah Bradshaw and Anita Powell

Podium Presentation on Quality Improvement Project: Implementing Use of HARRPS Tool

Objectives:
- Describe the development of an evidence-based pediatric risk screen tool for inpatient admissions
- Articulate how formal Continuous Quality Process Improvement (CQPI) methods were utilized during implementation
- Discuss lessons learned and next steps
Pulmonary Complications of Cystic Fibrosis

Christopher M. Oermann

Goals and Objectives. Participants will be able to: Explain the pathophysiology leading to the pulmonary complications of cystic fibrosis. Recognize the clinical presentation of the pulmonary complications of cystic fibrosis. Formulate a treatment plan for the pulmonary complications of cystic fibrosis.