The Online Newsletter for Children's Nurses
e-Edition, Issue 11
A culture of clinical inquiry which drives nursing research and
results in evidence-based practice and sharing of new knowledge.
By Mary E. Müller, PhD, RN, WHNP-BC
Improving our Practice through Research and Performance Improvement
In the midst of busy schedules providing care, consultation and education, nurses are conducting research that will provide professional insight, improve practice and contribute to the care of pediatric patients in many settings. This past year there are many research and performance improvement projects in process at Children’s Hospital Central California. In addition, a few projects have recently closed and are being evaluated and their results submitted for publication. Children’s nurses are contributing to nursing science as well as improving performance. This article will identify those projects that are ongoing or recently closed. We invite you to take a few minutes to talk with the researchers and performance “improvers” about their experiences. Talking leads to learning, and perhaps will encourage you to begin your own research or performance improvement journey.
Institutional Review Board (IRB) Approved Research Protocols and Publications
Sutters, Kimberly, PhD, RN, CNS, VA-BC
HSC 388 Home Care Management of Pediatric Pain. The Primary Investigator for this study is Kimberly Sutters. PhD, RN, CNS, VA-BC. With members of her team, Kim has published three documents that share the information with other nurses about the dosing of pain medicine at home.
- Sutters, K. A. (2011). Commentary on Letter to the Editor for article titled – “A randomized clinical trial of the efficacy of scheduled dosing of acetaminophen and hydrocodone for the management of postoperative pain in children after tonsillectomy.” The Clinical Journal of Pain, 27(1), 90-91.
- Sutters, K. A., Savedra, M. C., & Miaskowski, C. (2011). “The pediatric PRO-SELF©: Pain control program: An effective educational program for parents caring for children at home following tonsillectomy.” Journal for Specialists in Pediatric Nursing, 16, 208-294.n_9 1
- Sutters K. A., Miaskowski C., Holdridge-Zeuner D. Waite, S., Paul, S., Savedra, M., Lanier, B., & Mahoney, K. (2010). “A randomized clinical trial of the efficacy of scheduled dosing of acetaminophen and hydrocodone for the management of postoperative pain in children after tonsillectomy.” Clinical Journal of Pain, 26, 95-103.
- HSC 658 Home Care Management of Pediatric Pain in Young Children Following Tonsillectomy. The Primary Investigator is Kimberly Sutters, PhD, RN, CNS, VA-BC. There is a publication from this study as well.
- Sutters, K. A., Holdridge-Zeuner, D., Waite, S., Paul, S., Savedra, M., Lanier, B., & Mahoney, K., & Miaskowski, C. (in press). “A descriptive feasibility study to evaluate scheduled oral analgesic dosing at home for the management of postoperative pain in preschool children following tonsillectomy.” Pain Medicine.
HSC 833 National Data Base of Nursing Quality Indicators (NDNQI). The current PI for this project is Mary E. (Betsy) Müller, PhD, RN, WHNP-C. For the first five years of the study, Carole Cooper, MHA, BSN, RN, CPN, was the Primary Investigator. This study is multi-centered and conducted in hundreds of hospitals across the country. The purpose is to gather data about conditions that indicate the contribution of nursing care to patient quality outcomes. Each month research assistants (staff nurses from all the inpatient units) fan out across the Hospital to gather data on peripheral and central intravenous catheters (IV) integrity, patient pain assessment and treatment, and pressure ulcer occurrence. The data is analyzed at the University of Kansas National Database of Nursing Quality Indicators (NDNQI) Central site, and the results enable Children’s to benchmark our results against national and pediatric results.
HSC 861 Nurses Perceived Knowledge, Beliefs, Skills and Needs Regarding Evidence Based Practice Survey (Closed). The Primary Investigator for this study was Carole Cooper, MHA, BSN, RN, CPN. Many of you may remember participating in the survey which provided the Nursing Research Council and Hospital Administration with information about evidence based practice attitudes at Children’s.
HSC 882 NICQ 2009 (Vermont Oxford Network-Performance Improvement Collaborative) (Closed). The PI for this project was Jennifer Norgaard, MSN, RN-NIC, CNS. Jennifer’s work with the Collaborative was aimed at identifying best practices for incorporation into the care of babies in the Neonatal Intensive Care Unit (NICU).
HSC 922 Retrospective case matched study to identify variables associated with hospitalized children at risk for falling at Children’s. (Closed). The Primary Investigator for this study was Carole Cooper, MHA, BSN, RN, CPN. Carole’s program of research has focused on falls in children. She is one of the first nurse researchers to examine falls strictly in the pediatric population.
HSC 923 Common Components of Current Nursing Professional Practice Models in the Hospital Setting in the United States of America—A Qualitative Study. The Primary Investigator for this study is Denise Vermeltfoort, MSN, RN, NE-BC. Sub-investigators are Keitha Mountcastle, PhD, RN, CNNP and Margarita Dragomanovich, BSN, RN, NE-BC. With her team, Denise researched the literature and interacted with numerous nurses to identify those elements that comprise professional models for nursing practice.
HSC 939 Pediatric Early Warning Tool Study. The Primary Investigator is Mary-Ann Robson. Sub-investigators are Carole Cooper, MHA, BSN, RN, CPN; Lori Medicus, MN, RN, CNS, CPNP and Mary Jo Quintero, RN, CCRN, CPN, MICN. This is a follow up to the original study retrospectively testing the ability of the Pediatric Early Warning Score (PEWS) to detect children at risk for codes. It is a validation study of the PEWS as a warning sign of potential deterioration and the need for Rapid Response Team (RRT), Code Blue and transfer to the Pediatric Intensive Care Unit (PICU).
HSC 963 Development and testing of an instrument to measure Nursing Perception of Components of Professional Practice. The Primary Investigator is Denise Vermeltfoort, MSN, RN, NE-BC. Sub-investigators are Keitha Mountcastle, PhD, RN, CNNP and Margarita Dragomanovich, BSN, RN, NE-BC. This study is a follow up to HSC 923. Using the information gained in a qualitative study, the team developed an easy to answer questionnaire that nurses could use to describe their personal perceptions of the elements critical to professional practice.
HSC 972 Epidemiology and evaluation of referrals for abnormal coagulation screening tests to pediatric Hematology service at Children’s. The Primary Investigator is Terea Giannetta, MSN, RN, CPNP. The purpose of this study is to determine if the incidence of bleeding disorders is increasing in the Central Valley.
HSC 973 HEADS UP Program Questionnaire. The Primary Investigator of this study is Mary Jo Quintero, RN, MICN, CPN. This is phase one of a study. The goal is to determine how the electronic documentation system affects the use of the PEWS.
Nursing and Interdisciplinary Performance
By Donna Wesenberg, BSN, RN, CPN
Performance improvement is core to the excellence exhibited at Children’s Hospital. The performance improvement projects highlighted below provide a window into the efforts of nurses in performance improvement activities to enhance patient care outcomes.
Children’s Asthma Care (CAC) - Measure One monitors the use of relievers for inpatient asthma, Measure Two monitors the use of systemic corticosteroids for inpatient asthma, and Measure Three monitors the Home Management Plan of Care; i.e., asthma discharge instructions. Several nurses are part of the CAC Task Force that oversees performance improvement for the compliance of Measure Three. The most recent CAC Task Force efforts include enhancing communication with the family by providing a follow-up appointment phone number on the discharge instructions.
Central Line-Associated Blood Stream Infection (CLABSI) – Nurses are members of the interdisciplinary committees and task forces that have been formed house-wide; i.e., pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), Craycroft (hematology/oncology unit) and Total Parental Nutrition (TPN)-dependent gastroenterology (GI) patients, to oversee performance improvement to prevent CLABSI in both the inpatient and home care settings.
Ventilator Associated Pneumonia (VAP) – Nurses are part of the house-wide committee as well as the NICU, PICU and acute care subcommittees that oversee performance improvement activities for preventing VAP.
The Emergency Medical Response Team (EMRT) responds to codes and rapid response calls. All responses are reviewed by a team of physicians and nurses for opportunities for improvement. Their findings and recommendations then become part of clinical and medical staff education; e.g., Morbidity and Mortality (M&M) reviews, mock-code scenarios, simulator scenarios, crash cart revisions, system improvements, etc. The EMRT leadership, in collaboration with the HEADS UP Task Force, evaluates current practices and makes recommendations to decrease critical codes in the acute care setting. A recent improvement included the implementation of the Pediatric Early Warning System Score (PEWSS) in acute care areas.
Surgical Care Improvement Project (SCIP) – Nurses are involved in the collection, review and reporting of the data for giving approved prophylactic antibiotics an hour or less before incision and discontinuing within 24 hours post-surgery (or 48 hours post-closure of cardiac incision).
Hand Hygiene Performance Improvement Program – Hand hygiene coordinator Lisa Roden, BSN, RN, manages this interdisciplinary best practice project. Many nurses are part of the Hand Hygiene Committee ensuring audit compliance and/or providing education to staff, patients and visitors regarding gelling in and out and washing hands before patient care is initiated.
Prevention of Pressure Ulcers and Catheter-Associated Urinary Tract Infections - PICU Clinical Nurse Specialist, Carole Cooper, MSN, MHA, RN, CNS, CPN, CRRN, has recruited nurses to help with performance improvement activities for the prevention of skin breakdown and prevention of catheter-associated urinary tract infections (CAUTI). PICU nurses have been recruited to participate in an interdisciplinary Skin Care Task Force to promote skin assessment, skin care, appropriate use of the Braden Q score and pressure ulcer prevention. Children’s also joined CHCA’s Pressure Ulcer Prevention Zipline program this past year in which children’s hospitals across the nation share performance improvement successes.
Catheter-Associated Urinary Tract Infections (CAUTI) prevention has been a focus for the PICU since 2009. An interdisciplinary committee has worked to implement best practice to include aseptic insertion of catheters, peri-care and assessment of need for indwelling urinary catheters. The implementation of a portable bedside Bladder scanner as a nursing assessment has been a recent improvement to help decrease the utilization of urinary catheters.
Magnet nurses at Children’s Hospital have continued the journey of nursing excellence through developing clinical expertise, integrating evidence-based practice in innovative ways and conducting nursing research to enhance our understanding of nursing care and practice. The results of these endeavors have been shared with healthcare professionals and the community throughout the state and nation through publication in professional journals and presentations.
DeFendis, Denise, BSN, RN, CAPA
DeFendis, D (Summer, 2011) “And the leadership award goes to.....”. PANAC, Pulseline, Volume 31, #2, pg 3. PeriAnesthesia Nurses Association of California PANAC
Edwardsen, Beverly, BS, RN, CPN
Edwardsen, B (Summer 2011) “Governmental Affairs Rep Reports on RN Lobby Days.” PANAC, Pulseline, Volume 31, Number 2; pg 6.
Edwardsen, B (Spring 2011) “Governmental Affairs 101.” PANAC, Pulseline, Volume 31, Number 1; pg 5.
Giannetta, Terea, MSN, RN, CPNP
Giannetta, T.A. (2011) “Approach to the Pediatric Patient and Family,” Reuter-Rice, K., & Bolick, B.N. Pediatric Acute Care: A Guide for Interprofessional Practice. Chapter 8
Kitt, Garrett, BSN, RN, CCRN
Xu, C., Kitt, G., & Dimand, R. (2010) “Highly Successful Bedside Transpyloric Feeding Tube Placement by Nursing Staff in Pediatric Intensive Care Patients. “ Peds Crit Care Med 11, 674
Cooper, Carole, MSN(c), MHA, BSN, RN, CPN
“Making an Impact...The Power of One” 25th Annual Nursing Research Conference Implementing Evidence-Based Practice, Saint Agnes Medical Center, Fresno, CA April 29, 2011
Eggleston, Rupinder, RN, CPEN
“Oral Maxillo Facial Injuries & Abdominal Trauma” Fresno County Emergency Nurses, Fresno, CA October 20-21, 2011
“Initial Triage & Assessment and Psychiatric Emergencies” Fresno County Emergency Nurses, Fresno, CA December 17-18, 2011
Flores, Sally, BSN, RN, FCN, MAPM
"Uniting our Sufferings with Christ" Roman Catholic Diocese of Fresno, Parishioners and Clergy, Diocesan Congress, Convention Center, Visalia, CA October 2011
Garner, Deborah, BSN, RN, IBCLC, RLC
"Nursing Interventions to Maintain Normothermia in the Very Low Birth Weight and the Extremely Low Birth Weight Neonate Undergoing Surgery" U S-Russian Nursing Conference Cruise, St. Petersburg to Moscow, Russia August 2011
Giannetta, Terea, MSN, RN, CPNP
"Blood Dyscrasias in School-age Children" Fresno County Child Health and Disability Prevention (CHDP) Providers, Fresno, CA May 2011
“Health Assessment and Blood Problems in Children" Teacher Credential Program, University of California at San Diego (UCSD), San Diego, CA May 2011
Hull, Jennifer, RN
"Neurogenic Bladder/Catherizations" 61st Annual California School Nurse Organization (CSNO) Conference, Fresno, CA March 4, 2011
Kitt, Garrett, RN, BSN, CCRN & Cathy Xu, MD
"Successful Bedside Placement of Transpyloric Feeding Tubes" Co-presented with Cathy Xu, MD, American Association of Pediatrics Experience, San Francisco, CA October 2011
Lally, Jeffrey, MSN, RN, PHN
"High Fidelity Mannequin Simulation Demonstration" Grand Opening Knorr Simulation Laboratory, California State University, Fresno, Fresno, CA 2011
"Pediatric Aspiration Simulation Scenario" California State University, Fresno, Fresno, CA 2011
Lingenfelter, Deborah, ASD, RNC-NIC
“Amazing People, Incredible Care” Network of Children's Outreach, Gateway Church Auditorium, First 5 of Merced County, Merced, CA March 2011
Loo, Kamela, MSN, RNC-NIC, CFNP, CNNP
"Subcapsular Hemorrhage, A Resuscitation Nightmare" Central California Association of Neonatal Nurses (CCANN), Children’s Hospital Central California, Madera, CA October 26, 2011
Mountcastle, Keitha, PhD, RN, CNNP
Co-Presenter with Denise Vermeltfoort, MSN, RN, NE-BC, “Common Components of Current Nursing Professional Practice Models in the Hospital Setting in the United States of America - A Qualitative Study”, 25th Annual Nursing Research Conference Implementing Evidence-Based Practice, Saint Agnes Medical Center, Fresno, CA April 29, 2011
Netzley-Morales, Christine, BSB, RN, CPAN
"Data Mining Through Manage Case Records" Perioperative Reporting Roundtable, Picis Exchange, Global Customer Conference, San Diego, CA June 7, 2011
Norgaard, Jennifer, MSN, RNC-NIC, CNS
Co-presented with Stacie Venkatesan, MSN, RN, CNS
“Neonatal Safety” The International Nursing Conference, Guadalajara, Mexico September 5 and 6, 2011
Norgaard, Jennifer, MSN, RNC-NIC, CNS
“Safety-Quality Neonatal Care, International Goals,” The International Nursing Conference, Guadalajara, Mexico September 9, 2011
Quintero, Mary Jo, RN, CCRN, CPN, MICN
"The Pediatric Septic Shock Continuum" and “Rescue Me” Emergency Medical Systems (EMS) Conference, Boise, Idaho October 2010
"Children Deserve It!" Children First Conference, Detroit, Michigan July 2011
"Children Deserve It!" Pediatric Gems Conference, Detroit, Michigan July 2011
Robson, Mary-Ann, BSN, RN, CCRN
”Identification and Implementation of a Pediatric Early Warning (PEW) Tool in a Tertiary Pediatric Hospital” 25th Annual Nursing Research Conference Implementing Evidence-Based Practice, Saint Agnes Medical Center, Fresno, CA April 29, 2011
Sturrock, Anne, RN, CPN
"Gastrostomy Tubes (GT)" 61st Annual California School Nurse Organization (CSNO) Conference, Fresno, CA March 4, 2011
Trujillo, Melanie, BSN, RN
"Volunteering on a Hospital Mercy Ship in West Africa" PeriAnesthesia Nurses Association of California (PANAC) Nursing Conference, Clovis Community Hospital, Clovis, CA May 2011
Venkatesan, Stacie, MSN, RNC-NIC, CNS
Co-presented with Jennifer Norgaard, MSN, RN, CNS
“Neonatal Safety” The International Nursing Conference, Guadalajara, Mexico September 5 and 6, 2011
Vermeltfoort, Denise, MSN, RN, NE-BC
Co-Presenter with Keitha Mountcastle, PhD, RN, CNNP
“Common Components of Current Nursing Professional Practice Models in the Hospital Setting in the United States of America - A Qualitative Study,” 25th Annual Nursing Research Conference Implementing Evidence-Based Practice, Saint Agnes Medical Center, Fresno, CA April 29, 2011
In This Issue
Research / Evidence-Based Practice
Reward and Recognition