Steering the Titanic: One tertiary care children's hospital's experience navigating safe sleep for hospitalized infants.

BACKGROUND: Sudden Unexpected Infant Death (SUID) is the leading cause of death in infants 1 month to 1 year of age in the United States. Despite extensive efforts in research and public education, rates of sleep-related infant death have plateaued since the late-1990s, largely due to unsafe sleep practices and environments. LOCAL PROBLEM: A multidisciplinary team assessed our institution's compliance with its own infant safe sleep policy. Data was collected on infant sleep practices, nurses' knowledge and training on the hospital policy, and teaching practices for parents and caregivers of hospitalized infants. Zero crib environments from our baseline observation met all the American Academy of Pediatrics recommendations for infant safe sleep. METHODS: A comprehensive safe sleep program was implemented in a large pediatric hospital system. The purpose of this quality improvement project was to improve compliance with safe sleep practice from 0% to 80%, documentation of infant sleep position and environment every shift from 0% to 90%, and documentation of caregiver education from 12% to 90% within 24 months. INTERVENTIONS: Interventions included revision of hospital policy, staff education, family education, environmental modifications, creation of a safe sleep taskforce, and electronic health record modifications. RESULTS: Documented compliance with infant safe sleep interventions at the bedside improved from 0% to 88%, while documentation of family safe sleep education improved from 12% to 97% during the study period. CONCLUSIONS: A multifaceted, multidisciplinary approach can lead to significant improvements in infant safe sleep practices and education in a large tertiary care children's hospital system.

Incorporating a Civility Program Into a Healthcare System: Journey or Expedition?

PURPOSE/OBJECTIVES: Incivility contributes to employee dissatisfaction, turnover, patient errors, and a disrespectful culture. Turnover rates and employee exit interviews alerted hospital leaders to uncivil behaviors exhibited by staff. A clinical nurse specialist (CNS) team captured this as an opportunity to create a civility program to develop team cohesiveness and improve patient safety. The purpose of this process improvement project was to identify uncivil behaviors in a pediatric hospital. DESCRIPTION OF THE PROJECT/PROGRAM: Using the Plan-Do-Study-Act model, an interprofessional team led by CNSs collaborated on a program to assess, intervene, and evaluate a program to improve civility. A preprogram survey, the Negative Acts Questionnaire-Revised, was used to assess staff perceptions of their work environment. Staff attended an education program on ways to recognize and intervene in situations involving less than standard civil behavior. Classes included communication application in uncivil situations using scenarios paired with evidence-based practice articles. Unit leaders reset behavioral expectations learned from a leader-specific class on managing unproductive behaviors. OUTCOME: Staff completed a postprogram Negative Acts Questionnaire-Revised survey 6 months after conclusion of classes. Survey results indicated the civility program effected a reduction in frequency of negative behaviors indicating an overall positive shift in workplace civility. CONCLUSION: The program provided staff with tools to recognize and intervene for improving civility, which impacted the overall work environment and patient safety.

Purposeful Hourly Rounding to Decrease Peripheral Intravenous Infiltrations and Extravasations in Pediatrics.

PURPOSE: Pediatric patients are at high risk for peripheral intravenous infiltrations and extravasations (PIVIE) resulting in patient harm. Structured hourly rounding has demonstrated to improve quality outcomes. The purpose of this quality improvement project was to implement structured hourly rounding to decrease the median rate of moderate PIVIE rates from 3.13 to 2.58 per thousand patient days over a 6-month time period in pediatric patients with infusing continuous IV fluids. DESIGN AND METHODS: A pilot was conducted to hardwire hourly assessments for peripheral intravenous lines (PIV) in pediatric patients with continuous fluids utilizing a structured hourly rounding process. Bedside nurses utilized the P.A.T.H. model to assess pain management (P), assess PIVs for early PIVIE recognition (A), address things patient and family may need (T), and reduce the occurrence in hospital acquired conditions (H). Data was collected on unit nurse sensitive indicators and compliance to hourly rounding. RESULTS: Structured hourly rounding using the P.A.T.H. model successfully hardwired hourly PIV assessments. The unit reduced their median moderate PIVIE rate to 1.83 per thousand patient days, an 41% improvement. The pilot also had positive unintended consequences of improved pain reassessment from 67% to 100%, increased patient satisfaction scores of 67% to 97% and reduced patient falls by 29%. CONCLUSIONS: Structured hourly rounding using the P.A.T.H. model can positively hardwire hourly PIV assessments in pediatric patients. PRACTICE IMPLICATIONS: Sustainability of hourly rounding requires leadership support and nursing commitment to impact quality metrics. Organizations should consider implementing focused hourly rounding to address PIVIEs.

Adolescents' decision to pursue bariatric surgery: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this qualitative review is to identify what motivates an adolescent to pursue bariatric surgery.

Orienting and Onboarding Clinical Nurse Specialists: A Process Improvement Project.

PURPOSE: Clinical nurse specialists (CNSs) have a unique advanced practice role. This article describes a process useful in establishing a comprehensive orientation and onboarding program for a newly hired CNS. DESCRIPTION: The project team used the National Association of Clinical Nurse Specialists core competencies as a guide to construct a process for effectively onboarding and orienting newly hired CNSs. Standardized documents were created for the orientation process including a competency checklist, needs assessment template, and professional evaluation goals. In addition, other documents were revised to streamline the orientation process. OUTCOME: Standardizing the onboarding and orientation process has demonstrated favorable results. As of 2016, 3 CNSs have successfully been oriented and onboarded using the new process. CONCLUSION: Unique healthcare roles require special focus when onboarding and orienting into a healthcare system. The use of the National Association of Clinical Nurse Specialists core competencies guided the project in establishing a successful orientation and onboarding process for newly hired CNSs.