ABSTRACT
OBJECTIVES: Intravenous methylprednisolone (IVMP) infusions have been associated with adverse cardiovascular effects. Inconsistent monitoring practices in a pediatric hospital led to questions about patient safety and allocation of nursing resources. This study describes vital sign changes in children and monitoring practices related to IVMP. METHODS: This retrospective chart review received Institutional Review Board approval. Children aged 5 to 17 years receiving IVMP from January 2006 to January 2009 were included. Seventy-four patients with 94 hospital admissions were evaluated. Data collected included systolic blood pressure, diastolic blood pressure, and heart rate, as well as the time and dosage of IVMP. Frequency of vital sign monitoring as ordered and as performed was described. Interrater reliability was calculated, and descriptive statistics were used in the data analysis. RESULTS: At baseline, about half of the patients had vital signs out of normal range for age. After the first dose, vital signs fluctuated, with a majority having greater than 10% changes from baseline as increases, decreases, or both. Time of initial 10% change in vital signs ranged from immediately after the dose to 135.5 hours later. Increased vital sign changes were seen in the older patients and in patients receiving higher doses. Monitoring of vital signs occurred more frequently than was ordered. Only 1 patient had a specific order for monitoring with IVMP. CONCLUSIONS: The patients included in this study experienced documented fluctuations in vital signs. A prospective study to evaluate the relationship of IVMP and patient safety will assist in standardizing vital sign monitoring guidelines.
ABSTRACT
A safety event response team at Cincinnati Children's Hospital Medical Center developed and tested improvement strategies to reduce peripheral intravenous (PIV) infiltration and extravasation injuries. Improvement activities included development of the touch-look-compare method for hourly PIV site assessment, staff education and mandatory demonstration of PIV site assessment, and performance monitoring and sharing of compliance results. We observed a significant reduction in the injury rate immediately following implementation of the interventions that corresponded with monitoring compliance in performing hourly assessments on patients with a PIV, but this was not sustained. The team is currently examining other strategies to reduce PIV injuries.
Subject(s)
Catheterization, Peripheral/adverse effects , Clinical Competence , Extravasation of Diagnostic and Therapeutic Materials/prevention & control , Patient Care Team/organization & administration , Academic Medical Centers , Adolescent , Catheterization, Peripheral/methods , Child , Child, Preschool , Education, Professional/methods , Female , Health Care Surveys , Hospitals, Pediatric , Humans , Infant , Infusions, Intravenous/adverse effects , Male , Monitoring, Physiologic/methods , Monitoring, Physiologic/nursing , Nursing Staff, Hospital/education , Patient Safety , Physical Examination/methods , Quality Improvement , Risk Assessment , United States , Wounds and Injuries/etiology , Wounds and Injuries/prevention & controlABSTRACT
This clinical paper presents the evolution of a Point of Care Scholars (POCS) program, which embodies three components of the Magnet model: exemplary professional practice, new knowledge, innovations, and improvements, and empirical outcomes. The drive to achieve Magnet designation and redesignation provides a focused approach on innovation. The innovative POCS program is structured to introduce new knowledge to point-of-care staff with improvements that will lead to quality outcomes. Empirical outcomes of the POCS program include practice and policy changes, improved safety, program cost, dissemination, professional advancement, and program satisfaction.
Subject(s)
Evidence-Based Nursing/education , Pediatric Nursing/education , Quality Improvement , Staff Development/methods , Child , Curriculum , Health Plan Implementation , Hospitals, Pediatric , Humans , Mentors , Ohio , Program EvaluationABSTRACT
This article describes the process of incorporating evidence into policies and procedures, resulting in the establishment of evidence as a basis for safe practice. The process described includes use of the Rosswurm and Larrabee model for change to evidence-based practice. The model guided the work of evidence-based practice mentors in developing a template, system, and educational plan for dissemination of evidence-based policies and procedures into patient care.
