Levofloxacin prophylaxis in pediatric oncology and hematopoietic stem cell transplantation: a literature review.

Bloodstream infections (BSI) are one of the leading causes of morbidity and mortality in children and young adults receiving chemotherapy for malignancy or undergoing hematopoietic stem cell transplantation (HSCT). Antibiotic prophylaxis is commonly used to decrease the risk of BSI; however, antibiotics carry an inherent risk of complications. The aim of this manuscript is to review levofloxacin prophylaxis in pediatric oncology patients and HSCT recipients. We reviewed published literature on levofloxacin prophylaxis to prevent BSI in pediatric oncology patients and HSCT recipients. Nine manuscripts were identified. The use of levofloxacin is indicated in neutropenic children and young adults receiving intensive chemotherapy for leukemia or undergoing HSCT. These results support the efficacy of levofloxacin in pediatric patients with leukemia receiving intensive chemotherapy and should be considered in pediatric patients undergoing HSCT prior to engraftment.

Creating safe and healing environments: Innovative curriculum to support team members during patient and family escalations in a quaternary care pediatric hospital.

Workplace violence in healthcare settings is at a crisis point. Healthcare organization have almost as many serious injuries from violence then all other industries combined (OSHA, 2013; Phillips, 2016). The costs of workplace violence have reached a crescendo provoking a response from several leading healthcare organizations including the Center for Disease Control, Occupational Safety and Health Administration, American Organization of Nurse Executives, American Nurse Association, and the Joint Commission who have all prioritized workplace violence initiatives. To address the issues of workplace violence our hospital embarked on a systematic change to improve the physical and psychological safety of faculty and team members. A multidisciplinary curriculum team developed the Creating Safe and Healing Environment course that introduces concepts to honor the unique demand on team members as they manage the intricacies of caring for others in a hospital setting. The team revisited the complex nature of the relationships and partnerships that are formed in healthcare between the team member, patients and families. The focus of this paper is to discuss the complex issue of workplace violence and review the development of curriculum that focuses the complexities of caring for pediatric patients, introduce the concepts of healing environments and teaches the skills and knowledge needed to co-create safe and healing environments for both care providers and their patients. This paper will also highlight the how a curriculum of this type is informed by the expertise of nursing theories including revisiting Nightengale ideals and incorporating Jean Watson's "Philosophy and Science of Human Caring".

Using Patient Whiteboards to Engage Families in Harm Prevention and Care Planning: A Quality Improvement Study.

OBJECTIVES: Whiteboards are a valuable tool used to facilitate communication between families and the care team, but they were underused in our institution. Our aim was to increase families' knowledge of their child's plan of care, safety plan, and medical care team names by increasing the use of patient whiteboards with inpatient populations at a freestanding quaternary care children's hospital. METHODS: With this quality improvement study, we redesigned the whiteboard template to address the following 4 main barriers to use: (1) not having enough space to explain concepts to families, (2) having too much information to complete, (3) unclear roles of who completes the whiteboard, and (4) forgetting to update the whiteboard. We focused the content of the new template on critical information the family needed to know, assigned roles to make it easy to know who filled out which section, and used plain language. RESULTS: The use of each whiteboard section on the old templates (n = 92) versus new templates (n = 424) were compared. Use increased for all sections (plan of care [48.9% to 71.6%; P = .008], safety plan [4.3% to 22.8%; P ≤ .001], medical team [85.8% to 87.6%; P = .068], nurse's name [94.5% to 98.8%; P = .031]). After the template redesign, 85.8% of families knew the plan of care, 32.3% knew the safety plan, 61.5% knew the medical team's name, and 92.8% knew the nurse's name. CONCLUSIONS: After the implementation of a new whiteboard template, we significantly increased the use of patient whiteboards and demonstrated improvement in families' knowledge of the plan of care with inpatient populations at a freestanding quaternary care children's hospital.