• Conference/Meeting
  • March 4-9, 2018

2018 Quality and Safety in Children's Health Conference

  • Antimicrobial Stewardship: Making Data Relevant and Measuring Success

    Tracking and reporting antimicrobial prescribing is a core element of antimicrobial stewardship for hospitals. The purpose of this project was to develop a method to measure and display antibiotic use applying days of therapy for all antimicrobials to monitor the impact of the hospital’s antimicrobial stewardship program.

  • BEE MINDFUL™: A Sweet Approach for Children with Special Needs

    The purpose was to redefine care delivery for children with special needs. The BEE MINDFUL™ program uses an original Pediatric Neurobehavioral Assessment Tool, branded symbol and desensitization kit to improve outcome measures. Implementation of this unique program created a shared mental model transforming care for vulnerable pediatric population.

  • Behavioral and Mental Health in the Emergency Department

    Among adults, suicide is the 10th leading cause of death; it’s second in pediatrics. Annually, this results in 500,000 mental health visits to emergency departments nationally. Of those visits, 11.9 percent require subsequent inpatient admissions. At Seattle Children's Hospital’s emergency department, mental health visits account for 7.5 percent of all visits—three times the national average.

  • Building A Focus on Pediatric Care within Adult Health System

    Health systems demonstrating a focus on pediatric population health is necessary as national measures surrounding pediatric patients are less advanced. Mercy Children’s Hospital – St. Louis coordinated a new approach to develop a pediatric quality measures program for children within an adult hospital system. This results in identifying measures which act as a catalyst to safer and more effective models of care.

  • Can You Hear Me Now? Child and Parent Voices at Discharge

    This educational session will feature the single-site, successful implementation of an initiative to include children as young as 7 years of age and their parents in offering their ratings to previously validated items regarding satisfaction with care and readiness for discharge across five inpatient units, including intensive care.

  • CLABSI: Journey to Zero and Beyond

    Gillette Children's Specialty Healthcare has had zero central line-associated bloodstream infections (CLABSI) for over two years. The hospital reached this milestone for several reasons: sustained leadership longevity within the CLABSI team, increasing and sustained bundle reliability to greater than 90 percent, top leader support, and interdisciplinary collaboration.

  • Continuous Infusion Medication Safety in a Pediatric Intensive Care Unit

    The Pediatric Intensive Care Unit improved the percentage of infusing continuous medications with a matching provider order from 74 percent to 92 percent, leading to improved provider and staff efficiency, and increased medication safety for patients. Progress was made by using quality improvement methodologies including Failure Modes Effects Analysis, Key Driver Diagrams, PDSA cycles and statistical process control.

  • Electronically-Augmented “Sepsis Huddle” Decreased Time to Antibiotics in the PICU

    Delayed antimicrobial therapy is an independent risk factor for mortality and prolonged organ dysfunction in pediatric sepsis. Targeted electronic provider alert technology combined with a multidisciplinary bedside huddle can increase situational awareness about patient-level challenges to timely antibiotic administration, and facilitate proactive strategies to address them.

  • Implementation of the CHA Improving Pediatric Sepsis Outcomes Collaborative at a Pediatric Hospital

    Sepsis is a leading cause of death among pediatric patient population. Appropriate and timely diagnosis of sepsis can reduce hospital onset of severe sepsis and mortality. This abstract summarizes the intervention roll-out plan and potential outcomes of CHA‘s Improving Pediatric Sepsis Outcome collaborative implementation at Boston Children’s Hospital.

  • Implementing a Universal Food Insecurity Screen

    Nationwide Children’s Hospital piloted the implementation of a universal food insecurity screen, referral, and follow-up process in 12 clinics at a large, urban children’s hospital. The poster discusses steps taken to implement the project, leadership and staff engagement strategies, screening and follow-up protocol, data and results, and lessons learned.

  • Improving Employee and Patient Safety with De-escalation Training

    The number of pediatric psychiatric and behaviorally challenging patients is a growing problem nationally. De-escalation training is a critical skill necessary to care for this patient population. This initiative aimed to improve competency, skills and techniques for recognition, and de-escalation to prevent and mitigate harm to patients and staff.

  • Increasing the Number of Children Seen for Well-child Visits

    The journey to value involves healthy patients through all stages of life. Children account for 23.3 percent of the U.S. population and until recently, there have been limited national standards surrounding the unique care needs for the pediatric patient. Mercy Clinic – St. Louis serves nearly 300,000 children, and hospital teams worked with providers to communicate information about missing well-child visits.

  • Is this Sepsis? Implementing Sepsis Improvement by Adapting Existing Processes

    In collaboration with CHA’s Improving Pediatric Sepsis Outcomes Collaborative, phase one of Children's Hospital Colorado’s inpatient sepsis improvement project focuses on treatment. Staff implemented rapid cycle process improvement initiatives on general care floors aimed at early identification and intervention when sepsis is suspected to halt the progression to septic shock.

  • Playing it S.A.F.E.: Accommodating Pediatric Phlebotomy Patients with Challenging Behaviors

    Blood collections often make kids anxious, especially children with histories of challenging behavior. Nationwide Children’s Hospital’s S.A.F.E. (Safe Area for Everyone) program identifies patients requiring accommodations for blood collection. The hospital provides training and tools for laboratory staff to help alleviate anxieties, making the process safer for everyone and improving outcomes.

  • Power of Kaizen: A Leaner Approach to Faster Specimen Processing

    Timely and accurate lab results are critical to ensure that providers make the appropriate clinical decisions for patients. Front line staff from the lab participated in a rapid improvement event, also known as a Kaizen event, to improve their workflow and reduce specimen processing turnaround time.

  • Proactive Safety Culture Improves Event Reporting and Decreases Harm Events

    An enhanced reporting culture is imperative on the journey to eliminate preventable harm. A requirement for this is to ensure a consistent just culture and an organizational preoccupation with failure. In this session, learn about strategies at Steven and Alexandra Cohen Children's Medical Center of New York that were successful in enhancing their proactive safety culture.

  • Reduction of False-Positive Blood Cultures Utilizing Lean Methodologies

    False positive blood cultures in the pediatric population have harmful outcomes, leading to unnecessary therapies, unnecessary hospitalizations, and increased lengths of stay. They also add substantial unnecessary costs, resulting in suboptimal patient and family experiences. The team at Children's Hospital of The King's Daughters objective was to decrease the number of false positive blood cultures collected within their health system.

  • SHARPI Rounds (Stomping Harm and Reducing Preventable Infections)

    SHARPI (Stomping Harm and Reducing Preventable Infections) Rounds is a scripted process for intra-professional rounds on all neonatal patients with IV access in the Intensive Care Unit. By identifying barriers to bundle compliance and patient-specific risk-factors for harm, the team proactively implements interventions which reduce the risks for harm and harm indicators.

  • Surgical Subspecialty Team: An Innovative Approach to Surgical Care

    A co-management model was created to allow a subset of surgical subspecialty patients to be cared for on the surgical floor rather than in the Pediatric Intensive Care Unit. An interdisciplinary team addresses both surgical and medical needs, providing 24-hour front line coverage for these patients.

  • Take My IV Out! Partnering to Reduce PIV Extravasation Harm

    Through the implementation of an IV question on GetWellNetwork, the goal at Ann & Robert H. Lurie Children's Hospital of Chicago was three-fold: increase patient and family engagement, increase compliance with nurses providing Touch, Look, Compare education with patients with a peripheral intravenous line (PIV), and decrease the number of moderate or severe PIV extravasations.

  • The Implementation of Patient Reported Outcomes in Multidisciplinary Outpatient Clinics

    Patient Reported Outcomes is now recognized as a critical component of patient-centered medical care and serves as a key indicator of intervention success. The purpose of this session is to provide a thorough description of the development and successful implementation of Patient Reported Outcomes Measurement Information System in multi-disciplinary outpatient clinics.

  • Using Human Factors to Increase the Prominence of Actionable Alarms

    The Alarm Management Project that took place in a neonatal intensive care unit focused on implementing a system that increases the prominence of actionable alarms while reducing the noise of non-actionable monitor alarms. The secondary focus of the project was mitigating alarm fatigue while maintaining high levels of patient safety.

  • Using the NSRAS for Better Skin Care: A Pressure Injury Project

    Neonatal Intensive Care Unit nurses undertook a project to decrease rates of pressure injuries. The team chose the Neonatal Skin Risk Assessment Scale (NSRAS) as the tool to help identify risk for skin injuries. Data analysis revealed the need to develop specific interventions aimed at identifying high risk patients and decreasing the incidence of pressure injuries.

  • Zero is Possible - CLABSI Reduction in a Pediatric Cardiovascular ICU

    In 2015, the Cardiovascular Intensive Care Unit’s (CVICU) central line-associated blood stream infection (CLABSI) rate was above the national benchmark. A multidisciplinary team focused on improving the culture of patient safety, promoting team accountability, and standardizing clinical practice. As a result of these process improvements, the CVICU at Riley Hospital for Children at Indiana University Health experienced a period of 502 consecutive days CLABSI free.