Decreasing Variation to Enhance Accurate Identification of Hypothermic Infants in Pediatric Primary Care.

Hypothermia can be the first and only sign of sepsis in young infants, yet there is a paucity of standard recommendations for pediatric primary-care office management of those infants identified. The SMART aim of this study was to standardize the identification and care of infants age 0 to 49 days at risk of hypothermia in pediatric primary care by decreasing the percent of infants with temperatures ≤36.5°C from 24% to 10% within 2 years. Over the course of this project, variation in documented temperatures ≤36.5°C decreased from 24% to 7% of encounters. Temperatures ≤36.5°C were documented for 951 infants or 13.4% (1078 of 8020 encounters). Of the 951 infants with temperatures ≤36.5°C, 96.1% were rewarmed in the office. Thirty-one patients ultimately required hospitalization. Application of quality improvement in a primary-care office decreased low temperatures by standardizing care, empowering staff, and triaging at-risk infants to the most appropriate level of care.

Effective Implementation of Culturally Appropriate Tools in Addressing Overweight and Obesity in an Urban Underserved Early Childhood Population in Pediatric Primary Care.

Overweight and obese children are at an increased risk of remaining obese. The American Academy of Pediatrics recommends addressing healthy habits at well-child checks, but this poses challenges, especially in low-income populations. A clinical innovation project was designed to adapt recommendations in a busy urban clinic and consisted of motivational interviewing, culturally tailored tools, and standardizing documentation. A quasi-experimental design examined innovation outcomes. Of 137 overweight and obese children aged 24 to 66 months, providers' documentation of weight during well-child check visits improved post-innovation ( P < .01), as did development of healthy habits goals ( P < .001). Families were more likely to return for visits post-innovation ( P = .01). A logistic regression analysis showed that adding body mass index to the problem list and establishing a specific follow-up timeframe most predicted follow-up visits to assess progress ( P < .001). Comprehensive innovations consisting of motivational interviewing, implementation of culturally tailored tools, and standardized documentation can enhance engagement in an urban clinic setting.

Nurse-Led Telephone Follow-Up to Improve Parent Promotion of Healthy Behaviors in Young Children With Motivational Interviewing Techniques.

INTRODUCTION: The American Academy of Pediatrics (AAP) recommends primary care-based health promotion for obesity prevention at all visits, focusing on nutrition and activity. METHODS: In this quality improvement project, a primary care innovation was developed to support parents in promoting healthy habits in their children ages 2 to 5 years old. Nurse-led telephone support using motivational interviewing was implemented during two follow-up phone calls aimed at helping parent-child dyads reach self-created activity or nutrition goals. RESULTS: Parent-rated confidence and motivation related to meeting these goals showed significant increases. During the second call, 80% self-reported goal completion and high satisfaction with the visits. Registered nurses reported a significant increase in their self-efficacy of communication with parents. DISCUSSION: This project showed the feasibility of using nurse telephone visits in an urban low-income primary care setting to improve parental recognition and understanding of healthy habits that align with American Academy of Pediatrics recommendations for obesity prevention.