Evaluating Effectiveness of the Use of an Extremity Stabilization Device for Vascular Access Procedures in Pediatrics.

The purpose of this study is to evaluate the effectiveness of SafeBoard, a Food and Drug Administration-approved extremity stabilization device, as an assistive method in performing peripherally inserted central catheter procedures on children 0 to 3 years of age. This is a retrospective chart review ( n = 59) of vascular access procedures where SafeBoard was utilized ( n = 32 ) in comparison to those procedures which utilized a traditional approach to placement ( n = 27). Statistical analysis demonstrated significant effect on length of procedure time, number of personnel needed for procedure, and success of placement when SafeBoard was utilized. Obtaining vascular access in pediatrics can be a challenging endeavor. Most young pediatric patients require procedural sedation and/or assistive personnel as a "holder" for successful vascular access placement to occur. An alternative option for extremity stabilization may provide improved workflow and improved placement success, which in turn may positively affect workflow.

A Quality Improvement Project to Reduce Antibiotic Utilization and Ancillary Laboratory Tests in the Appraisal of Early-Onset Sepsis in the NICU.

BACKGROUND: Diagnosis and treatment of early-onset sepsis (EOS) of the newborn remains a controversial issue among providers due to the non-infectious symptomology which exists in the newborn period. METHODS: Pre/post interventional quality improvement project in a level III NICU to reduce antibiotic utilization and ancillary laboratory tests with the introduction of an evidence-based guideline for the evaluation of EOS in the NICU. RESULTS: Primary outcome measures include mean number of empiric antibiotic treatment days and utilization rate (AUR), number of laboratory tests ordered, and incidence of unwarranted antibiotic therapy beyond the 48-h rule out period. Mean empiric antibiotic treatment days decreased from 2.94 to 1.58 days and overall antibiotic use decreased from 73.7% to 57.1%. Likewise, the mean AUR decreased from 212.5 to 147.6 days of therapy per 1000 patient days. There was an 86% decline in the number of ancillary tests and unwarranted antibiotic use beyond 48- h was reduced by 74%. DISCUSSION: Guidelines for EOS of the newborn should include a thorough baseline evaluation of the drivers of antibiotic use to create an evidence-based foundation. Reducing unnecessary antibiotic use and EOS evaluations in a safe and effective manner have the potential to lower consumer and healthcare expenditures while improving the long-term health of the newborn in the NICU. CONCLUSIONS: These findings emphasize the importance of implementing an evidence-based protocol for antibiotic stewardship in the NICU. With further research there is the potential to improve the healthcare of newborns while reducing expenditures in a safe, effective evaluation of EOS in the newborn population.

Effects of Implementing a Simulation-Learning Based Training Using a Train-The-Trainer Model on the Acquisition and Retention of Knowledge about Infant Safe Sleep Practices Among Licensed Nurses.

PURPOSE: The purpose of this study was to evaluate the effectiveness of the implementation of a simulation-learning based training using a train-the-trainer model on the acquisition and retention of knowledge about infant safe sleep practices among nursing staff employed at a women's and children's hospital. DESIGN AND METHODS: This was a two-phase, quasi-experimental study with repeated measure in a women's and children's hospital in Southwest XXXX. A total of 120 nurses completed phase I of the study, while 74 completed phase II. Kolb's Experiential Learning Theory and Observational Experiential Theory were used to guide the development of the methods and research question. RESULTS: Overall, there was statistically significant (p < .001) increases between pre-test and post-test scores immediately and at three months. The post-partum, well-baby nursery, and pediatric department had statistically significant (p < .001) increases between pre-test and post-test scores immediately and at three months. The pediatric intensive care unit did not have statistically significant increases between pre-test and post-test scores immediately and at three months (p = .086). CONCLUSIONS: A train-the-trainer program in simulation and infant safe sleep can positively affect nurses' knowledge about safe sleep and SUID. Future research should include longer follow-up assessments to better determine long-term impact.

Understanding the Risks Sitting and Carrying Devices Pose to Safe Infant Sleep.

There have been various campaigns and recommendations to decrease the incidence of sudden unexpected infant death. Despite this, caregivers continue to place infants in unsafe sleeping environments. These environments, such as sitting devices, slings, carriers, and car seats, pose a significant risk to an infant's safety because of the risk from suffocation and cardiorespiratory instability. It is important for health care providers to understand the appropriate use of car seats, slings, and other sitting devices, to model appropriate behaviors, and to educate parents and caregivers. All parents, hospital staff, and other caregivers should understand the potential dangers associated with the inappropriate use of sitting devices for routine sleep.

Assessment, Treatment, and Prevention Strategies for Hair-Thread Tourniquet Syndrome in Infants.

Hair-thread tourniquets are a rare occurrence but result in significant injury as a hair or thread wraps around a digit, resulting in tissue swelling, pain, or possible tissue ischemia. This condition is often overlooked in the differential diagnosis for a fussy infant. Awareness of this condition will help nurses and other clinicians identify and treat the condition. Some simple prevention strategies can help parents and other caregivers mitigate risk.