Liberation from respiratory technology is a complex, multi-step process that can be accomplished in medically complex children with varying underlying disease processes at relatively young ages. Five major steps (tracheotomy, initiation of HMV, initiation of TC trials, HMV independence, and decannulation) performed in conjunction with clinic visits, procedures, and home nursing support were integral in the successful decannulation process. Pediatr Pulmonol. 2016;51:838-849. © 2016 Wiley Periodicals, Inc.
BACKGROUND AND OBJECTIVE: Many pediatric rheumatology patients are at increased risk of pneumococcal disease secondary to a deficient immune system and/or immunosuppressive medications. The goal of this study was to improve pneumococcal vaccination rates in this high-risk population.METHODS: Eligible patients included children at least 2 years old and adults with systemic lupus erythematosus and/or currently on immunosuppressive medication. Interventions included a presentation to rheumatology providers, creation of immunization algorithm, previsit planning, placing reminders on clinic forms, and sending reminder e-mails to providers. Chart reviews were performed, and control charts were established to portray change in immunization rates. RESULTS:The preintervention immunization rates for 90 patient visits compared with the immunization rates for the 53-week postintervention period with 1033 patient visits and 299 separate patients were all statistically significant. The 13-valent pneumococcal conjugate vaccine rate increased from 6.7% to 48.4% (x 2 = 58.3, P , .001), 23-valent pneumococcal polysaccharide vaccine rate increased from 8.9% to 28.4% (x 2 = 16.0, P , .001), and combined rate increased from 0% to 23.2% (x 2 = 25.2, P , .001). The improvement was sustained with shifts in the data for each vaccine and combined immunizations for final average rates of 60.9% for 13-valent pneumococcal conjugate vaccine, 39.2% for 23-valent pneumococcal polysaccharide vaccine, and 33.7% for combined.
KEY WORDS POTENTIAL CONFLICT OF INTEREST:The authors have indicated they have no potential confl icts of interest to disclose.A Quality Improvement Initiative to Achieve High Nursing Presence During Patient-and Family-Centered Rounds abstract OBJECTIVES: The objectives of this study were to: (1) identify local barriers to nursing presence on patient-and family-centered rounds (PFCR); and (2) increase nursing attendance during PFCR. METHODS:An electronic survey needs assessment was administered to nursing staff on a single acute medical care unit to identify local barriers to nursing presence on PFCR. Daily tracking of nursing presence on rounds was then performed over a 7-month period. During this time period, 2 Plan-DoStudy Act cycles were conducted. The fi rst intervention was a workshop for nurses about PFCR. The second intervention was the development of a strategy to contact nurses by using a hands-free communication device so that nurses were notifi ed when rounds were starting on their patients. To evaluate the impact of our interventions, a p-chart was generated for the outcome of average daily nursing attendance (%) on PFCR per week over the 7-month period. RESULTS:Two barriers identifi ed on the survey were: (1) nurses were uncertain if physicians valued their input during PFCR; and (2) nurses were unsure when the physician team would be conducting rounds on their patients. On the p-chart, the average percentage of nursing attendance before interventions was 47%. After the nursing workshop, no change in the mean nursing attendance on PFCR was noted. After initiation of the hands-free contact strategy, nursing attendance on PFCR rose to 80%. CONCLUSIONS:A nursing contact strategy using a hands-free device led to a sustained increase in nursing attendance during PFCR.Patient-and family-centered rounds (PFCR) have been identifi ed as an effective model for high-quality patient care. Research has shown that families are more satisfi ed when they are included on rounds and that patient care is optimal when both the patient and family are included in medical decision-making.
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Background/Purpose: This quality improvement project was conducted to increase pneumococcal vaccination rates in eligible Pediatric Rheumatology Clinic patients. Streptococcus pneumoniae is a leading cause of bacteremia, meningitis, pneumonia, sinusitis, and acute otitis media. Many patients in the Pediatric Rheumatology Clinic are at increased risk of pneumococcal disease secondary to a deficient immune system and/or immunosuppressive medications. Infections remain one of the leading causes of hospitalization and death in patients with certain rheumatic diseases. The Centers for Disease Control and Prevention recommends both the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for this high-risk population.Methods: Baseline immunization rates were assessed for eligible clinic patients over a four week period. Eligible patients include children at least two years old and adults with systemic lupus erythematosus and patients currently on or starting an immunosuppressive medication. Interventions included a presentation to rheumatology providers and nurses, creation of clinic document with immunization algorithm, previsit planning, placing reminders on patient clinic forms, and sending letters to out-of-state patients. Chart reviews of eligible patients occurred throughout the study period. Control charts were established to portray change in immunization rate.Results: The pre-intervention immunization rate for 90 eligible Pediatric Rheumatology Clinic patients was 6.7% for PCV13, 8.9% for PPSV23, and 0% for both vaccines. Data from 53 weeks were analyzed following the interventions for a total of 1123 eligible patient visits
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