Seize the day: A quality improvement approach to support transition of care and decrease 30-day readmissions for pediatric patients with epilepsy.

PURPOSE: Elevated rates of 30-day readmission for children with epilepsy were noted at a stand-alone pediatric acute care facility. To address this issue, a standardized pathway was created and implemented in 2017. The main objective was to ensure that patients with epilepsy and their families were adequately prepared for discharge and the transition to home. DESIGN AND METHODS: Using a quality improvement (QI) approach, a standardized education pathway was developed and implemented to decrease unplanned 30-day readmissions of patients with a diagnosis of epilepsy from a specialized neurology unit. An interprofessional care team received training to ensure standardized communication around the pathway approach and components. All patients with a diagnosis of epilepsy and their families were educated using the pathway and guided through additional simulation and teach-back exercises. RESULTS: Analysis demonstrated a 27.6 % decrease in unplanned 30-day readmissions in the 6 years following implementation. An estimated $950,000 in cost savings was achieved secondary to program implementation. CONCLUSIONS: Utilizing the pathway standardizes epilepsy management education and decreases unplanned 30-day readmissions for pediatric patients diagnosed with epilepsy. A standardized educational plan is an essential component of patient discharge teaching and proper home management of epilepsy. PRACTICE IMPLICATIONS: For sustainability, education needs to be continuously refreshed and included in onboarding new nurses. To ensure health equity, translation of the pathway into multiple languages is needed.

A telehealth nursing intervention to improve the transition from the neonatal intensive care unit to home for infants & caregivers: Preliminary evaluation.

PURPOSE: The purpose of this nurse-led telehealth intervention was to support caregivers and infants during the difficult period of transition from the neonatal intensive care unit (NICU) to home. METHODS: The Baby Steps project was designed using quality improvement methodology, and was implemented in April 2020 at a stand-alone pediatric institution in South Florida. Using a nurse-led telehealth model, follow-up nursing care was provided in the home setting for two weeks after discharge. Any infant cared for in the NICU and discharged to a home setting in the state of Florida was eligible for services. Encounters included assessment, anticipatory guidance, connection with community resources, and general support. Caregiver satisfaction, unplanned emergency care use, and 30-day readmissions were assessed. RESULTS: Within the first 18 months of the program, a total of 378 infants were enrolled, and 74.6% received follow-up services in the home setting (n = 282). Caregivers reported high satisfaction with the program (100% strongly agree or agree). There was a 46% decrease in 30-day readmissions from baseline rates, and a substantial decrease in use of emergency care services within a month of discharge as compared to infants discharged during the same time period who did not receive services (30.9% vs.13.8%). DISCUSSION: This nurse-led intervention was found to be a feasible and highly satisfactory approach to improve NICU patient outcomes and support caregivers during transition from hospital to home. PRACTICE IMPLICATIONS: Nurses can provide post-discharge telehealth support, which not only improves caregiver satisfaction but also decreases readmissions and emergency care use among NICU patients.

The revised Humpty Dumpty Fall Scale: An update to improve tool performance and predictive validity.

PURPOSE: The purpose of this study was to identify potential modifications to the Humpty Dumpty Fall Scale (HDFS) in order to enhance the accuracy of fall prediction in the pediatric population, thus contributing to the safest possible environment for the hospitalized child. DESIGN AND METHODS: A secondary analysis of data collected by Gonzalez et al. (2020), including a total of 2428 patients, was conducted for this study. Multiple logistic regression was used to examine the relationship between each parameter of the HDFS (e.g., age, gender, diagnosis, cognitive impairments, environmental factors, response to surgery/sedation/anesthesia, and medication usage) and the outcome of fall status. RESULTS: After reviewing associations between HDFS parameters and fall risk, neither gender nor medication use were found to be associated with fall risk. These two parameters were removed from the scoring algorithms, and the HDFS was modified to a minimum score of 5 and maximum score of 20, with a score of 12 or above indicative of high risk of fall. The modified scale demonstrated a sensitivity of 84% and specificity of 57%. CONCLUSIONS: These revisions are anticipated to help support clinical practice and improve fall prevention, thus supporting a safer pediatric environment for the hospitalized child.

Evaluating the Humpty Dumpty Fall Scale: An International, Multisite Study.

BACKGROUND: The Humpty Dumpty Falls Prevention Program was developed to address an unmet need to identify pediatric patients at risk of a fall event. PURPOSE: The aim of this study was to evaluate the performance of the Humpty Dumpty Fall Scale-Inpatient (HDFS) across a diverse, international pediatric population. In addition, the characteristics of patients who experienced a fall were analyzed. METHODS: A retrospective, cross-sectional design was used to assess fall risk across 16 hospitals and 2238 pediatric patients. Multiple and simple logistic regressions were performed to evaluate association of individual scale items and total score with falls during hospitalization. Reliability, sensitivity, and specificity of the HDFS were also assessed. RESULTS: Several of the HDFS items were significantly associated with the risk of falls in the pediatric population, but specificity of the tool is a concern to consider for future tool enhancement. CONCLUSIONS: Characteristics for further refinement of the HDFS were identified.

Federal Polices Influence Access to Primary Care and Nurse Practitioner Workforce.

Although most nurse practitioners (NPs) are aware of state-level regulations that influence practice, many are unaware of the ways that federal policies affect NP workforce supply and the delivery of primary care. In this investigation we provide an overview of federal initiatives enacted through the Patient Protection and Affordable Care Act that impact the NP workforce. We explore how the law supports NP workforce supply and settings in which NPs provide care. We then describe challenges that may prevent full utilization of the NP workforce. Examining both federal policies and state-level regulations is essential to achieving an increased NP workforce supply and improved access to care.

Perspectives on Telehealth Use with the Neonatal Population: Policy, Practice, and Implementation Considerations.

Telehealth has proven to be a valuable approach to providing care to the neonatal population, including supporting families during the transition to home, facilitating remote monitoring of fragile neonates, and connecting neonatal experts with infants and caregivers in underserved or remote communities. Clinicians engaging in telehealth need to be aware of policies and regulations that govern practice as well as the potential health equity issues that may present themselves.

Best Practices to Support Maternal Mental Health During the Transition from Neonatal Intensive Care Unit to Home: A Scoping Review.

Mothers with an infant hospitalized in the neonatal intensive care unit (NICU) are at an increased risk of mental health concerns, including depression and anxiety. Successful mental health support during the critical time of transition from hospital to home requires careful consideration of the mothers' mental health beginning during the NICU stay. Major themes from a scoping review to identify best practices to support maternal mental health include (1) comprehensive evaluation of needs and continuity of care, (2) key role of in-person support, and (3) the potential to use technology-based support to increase mental health support.

Psychological and Socioeconomic Burdens Faced by Family Caregivers of Children With Asthma: An Integrative Review.

INTRODUCTION: Asthma affects nearly 1 in every 12 children in the United States. Caring for a child with asthma poses significant challenges for the parent or caregiver. The purpose of this integrative review was to identify the psychological and socioeconomic burdens faced by family caregivers of children with asthma. METHOD: An integrative review was conducted to review and appraise 80 studies. RESULTS: Psychosocial burdens included decreased mental health, quality of life, sleep, family stress, educational deficits, cultural and health disparities, and health care communication challenges. Socioeconomic burdens included poor access to care, as well as work and financial challenges. Studies demonstrated a link between family caregiver health and child health outcomes. Facilitators included education and empowerment, social support, and use of technology. DISCUSSION: As the family caregiver's health directly affects the asthmatic child's health, addressing the burdens of family caregivers should be a key consideration in pediatric asthma care.

Development of an Interprofessional Pharmacist-Nurse Navigation Pediatric Discharge Program.

OBJECTIVES: Numerous challenges face clinically complex patients as they transition from hospital to home. The purpose of this project was to add pharmacy discharge services to an existing nurse-led discharge service (patient navigation program) to facilitate the transition of care process for clinically complex pediatric patients. METHODS: For select patients referred to the service, a pharmacist resolved medication discrepancies, provided discharge counseling, and conducted follow-up telephone encounters on days 1, 7, and 14 post discharge. Patient demographics, admitting diagnosis, and number of discharge medications were recorded. The impact on patient outcomes was measured by the number and type of pharmacist interventions identified. Program utilization was measured by the number of referrals received, percentage of patients seen by a pharmacist, follow-up phone call completion rate, and pharmacist time required. Financial benefit gained from the program was estimated by translating each pharmaceutical intervention into potential cost savings. RESULTS: There were 321 patient navigation referrals during the 5 months of pharmacist service. A pharmacist was able to provide discharge counseling for 56 discharges (17%). Patients who were provided pharmacy services had a median of 8 comorbidities, 10-day length of stay, and 4 discharge medications. Pharmacists identified 168 interventions, of which 93.5% were accepted or informational in nature. The most frequently identified interventions included clarification of drug order, assistance obtaining medication, and dose rounding. This program resulted in an estimated cost savings of $22,308 in the first 5 months. CONCLUSIONS: A unique partnership between nurses and pharmacists facilitated the discharge process for clinically complex children.