Mapping in a Pediatric Emergency
Mapping in a Pediatric Emergency
CLC EBP Research Table
CLC: EBP Research Table
Citation
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Abstract/Purpose
Craft a 100-150 word summary of the research.
Research/Study
Describe the design of the relevant research or study in the article.
Methods
Describe the methods used, including tools, systems, etc.
Setting/Subject
Identify the population and the setting in which the study was conducted.
Findings/Results
Identify the relevant findings, including any specific data points that may be of interest to your EBP project.
Variables
Describe the independent and dependent variables in the research/study.
Implication for Practice
Articulate the value of the research to the EBP project your group has chosen.
Independent Variable
Dependent Variable
Black, M., Singh, V., Belostotsky, V., Roy, M., Yamamura, D., Gambarotto, K., & … Kam, A. J. (2016). Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections. International Journal Of Pediatric , 1-4. doi:10.1155/2016/2625870
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A quality improvement initiative was undertaken to reduce CAUTIs in tertiary pediatric ER. A retrospective study was done on children less than 3 years old with positive urinary cultures. In 12% of the children presented with a UTI there was not treatment of follow up. A process map was implemented to determine how many UTI where missed. After the implementation of the PM, it was noted that only 1% of those patients had a missed UTI.
A QI study was put together from a retrospective study was used to collect data and to review current practices used to identify and manage current UTI’s in the pediatric ER. Patients that where seen by a subspecialist where removed from the study. The ER used paper charts that where scanned electronically. These charts where then review by two researchers. The main focus was to evaluate if the wrong antibiotic was used or if a follow up was performed using a PM (process mapping) tool.
A follow up chart review was performed to evaluate the impact of mapping process (MP) as an analytical tool. This MP tool can be used to effectively reduce missed UTI diagnosis and reduce future UTIs in pediatric ER patients.
All children less than 3 years old coming to the ER with a UTI where considered.
In the initial chart review, identified 159 patients under 3 years of age. Of the 159 cases, 82 charts where eligible for the study. 46 percent of the cases, or 38 cases received antibiotics. In 17 percent of the cases, 14 cases, antibiotics where given but no follow up was conducted. In 18 percent of the cases, or 15 cases no antibiotics where given, but a follow up was arranged with a pediatrician. Of the 15 cases, 5 did not have a UTI, 4 had a possible, and 6 had a UTI.
In the subsequent chart review, of the 80 qualified charts it was revealed that 76 cases had a follow up and 4 cases did not have a follow up.
Identifying Patient coming into the ER, with urinary tract infections.
Pediatric patient coming into the ER.
ER with high pediatric volume are at risk for inefficiency. Improving the process in reporting the inefficiency of missed laboratory diagnosis in the ER can lead to a major decrease of UTIs in pediatric patients.
Davis, K. F., Colebaugh, A. M., Eithun, B. L., Klieger, S., B., Meredith, D. J., Plachter, N., … & Coffin, S. E. (2014). Reducing catheter-associated urinary tract infections: a quality-improvement initiative. Pediatrics, peds-2013. Retrieved from http://pediatrics.aappublications.org/content/pediatrics/early/2014/08/06/peds.2013-3470.full.pdf
This article discusses Catheter Associated Blood Stream Infections (CAUTIs) and interventions to prevent this occurrence in hospitalized children over the course of three years. The study about CAUTIs was conducted by an observational study with a retrospective analysis. The researchers implemented a CAUTI prevention bundle to see if this would help reduce the CAUTI rates on the pediatric unit studied. The prevention bundle includes primary interventions or “drivers,” such as, “minimize exposure to devices, evidence-based practices of catheter insertion, communication and transparency, infrastructure support, compliance with basic standards of urinary catheter care, and education/training” (Davis, 2014, p. 859). The result of the prevention bundle was favorable and showed a decrease of 50% of CAUTI rates in the chosen population.
Observational study: “assess changes in infection rates before and after a multidisciplinary QI project was initiated (July 2010) to reduce the rate of pediatric CAUTI throughout the institution, a 500-bed tertiary care children’s hospital where ∼40% of beds are in ICUs” (Davis, 2014, p. 858). Data collection was done by “CHOP Department of Infection Prevention and Control to identify all CAUTIs and capture hospital-wide urinary catheter device days” (Davis, 2014, p. 860)
Retrospective analysis: “For our analysis of epidemiologic characteristics of CAUTI, we performed univariate analyses to summarize patient-level demographic, clinical, and microbiologic characteristics. We summarized results as frequencies and percentages. Comparisons were made by using Fisher’s exact test or Wilcoxon rank-sum (Mann-Whitney) test” (Davis, 2014, p. 861).
“An observational study was conducted to assess the impact of a CAUTI quality improvement prevention bundle that included institution-wide standardization of and training on urinary catheter insertion and maintenance practices, daily review of catheter necessity, and rapid review of all CAUTIs” (Davis, et. al, 2014, p. 857).
Pediatric patients of a tertiary care children’s hospital from June 2009- June 2012
“50% reduction in the mean monthly CAUTI rate (95% confidence interval:
21.28 to 20.12;
P= .02) from 5.41 to 2.49 per 1000
catheter-days. The median monthly catheter utilization ratio remained
unchanged;
∼90% of patients had an indication for urinary
catheterization. Forty-four patients experienced 57 CAUTIs over the
study period. Most patients with CAUTIs were female (75%),
received care in the pediatric or cardiac ICUs (70%), and had at
least 1 complex chronic condition (98%). Nearly 90% of patients
who developed a CAUTI had a recognized indication for initial
catheter placement” (Davis, 2014, p. 857).
CAUTI prevention bundle
Reduced CAUTI rates in hospitalized children
The value this EBP practice has on nursing practice is substantial. With reduction in CAUTI rates, children can have improved outcomes and experienced decreased lengths of stay in the hospital compared to not implementing the EBP practices described in the bundle.
(Quantitative article)
Marra, A. R., Camargo, T. Z., Goncalves, P., Sogayar, A. M., Moura Jr, D. F., Guastelli, L. R., . . . Edmond, M. B. (2011). Preventing catheter-associated urinary. American Journal of Infection Control, 1-6.
The article identifies CAUTIs one of the major illnesses that affect patients in the critical care setting. Research undertakes a quasi-experimental study with several interferences that lessen the occurrence of CAUTI in an intensive care unit (ICU). The study also analyzes the differences in causative microorganisms and CAUTI rates. The conclusions of the survey were that there was a statistically meaningful decline in the cases of CAUTI in the ICU. The other results of the investigation are that lessening the rates of CAUTI in the ICU context is a complicated process that requires the health professionals to make multiple performance measures and interventions.
The study utilized the quasi-experimental design. This design is applied in the study because the study involves a group of the patients in the ICU and SDU but do not use any random pre-selection processes.
The investigation was conducted in two phases. In the first stage, the nurses and physicians in the ICU implanted urinary catheters (UCs) using the aseptic procedure. The insertion and maintenance of the catheters were done according to the CDC requirements. UCs were replaced regularly with the patient’s physician having the sole responsibility of making the decision to remove the UC. The catheters maintained up to the point where the occurrence of an adverse effect requires its removal. The nurses working in these two units were assigned to directly observe UC insertion in a convenience representation of subjects and provide feedback on how the ICU team implemented the practices. The second phase of the process involved continuing the processes started in step 1 but included undertaking monthly audits of the processes in a small sample of subjects using the UC. The phase also included the implementation of a bladder bundle. The collected data include the quantity of CAUTI incidents before and after the interventions and interventions.
The population was the patients in a 38-bed ICU and two 20-bed SDUs with a similar that had similar features in a private hospital that offers tertiary care. The investigation was conducted at the hospital in the two units.
The results of the survey are that most of the CAUTIs cases that occurred in the SDUs and the ICU in both stages of the investigations were in the form of monomicrobial infections, but the implementation of the interventions led to a statistically notable decline in the CAUTI rate in both hospital settings used for the investigation.
The independent variable is the periods before and after the interventions.
The dependent variable was the quantity of CAUTI instances
The value if this research to the EBP project is that it provides evidence that implementation of evidence-based practices can make significant contributions to the reduction of CAUTIs in the inpatient acute care setting for pediatric patients in the ICU.
(Qualitative Article)
Safdar, N., Codispoti, N., Purvis, S., & Knobloch, M. J. (2015). Patient perspectives on indwelling urinary catheter use in the hospital. American Journal of Infection Control, 1-2.
The article starts by stating that UTIs are one of the most common infections acquired in a hospital with most of them resulting from the CAUTIs. The purpose of this research was to find out the perspectives of patients on the indwelling urinary catheters. The investigations figured out that there was the need to improve the awareness and patient engagement concerning the use of indwelling urinary catheters. The findings of this research were that the health care sector requires implementing educational programs for both patients and health care workers. The implementation has the potential to increase the involvement of patients in making decisions about the use of catheters and may lead to a decline in the occurrence of CAUTIs in the hospitals and the ICU.
The study uses the grounded theory qualitative research design. The study uses this model because it derives its interpretations from raw data collected using qualitative methods.
The methods of the study involved the use of a semi-structured interview guide that the investigators used for interviewing patients in their rooms one at a time where there were no visitors in the rooms but after getting the treating team’s approval. Each patient gave a written consent before the participation in the study. The interviews were recorded and transcribed. After data collection, a systematic textual inquiry was used to code the qualitative data to detect trends.
The population was twenty adults. The relevant findings that may be of interest to my EBP project were that most of the participants had got been informed about any risks they faced for the use of the catheter and were not notified of any alternative ways of excretion. The study also found out improving patient awareness and engagement on the use of catheters has the potential to reduce the occurrence of CAUTIs in patients hospitalized with indwelling urinary catheters. The study was conducted in a hospital setting in the p
