Standardizing and optimizing nutrition evaluation frequency of enterally fed patients in an ambulatory pediatric gastroenterology practice: A single-center study.

BACKGROUND: Nutrition monitoring is essential in feeding tube-dependent patients receiving home enteral nutrition (HEN). We identified lack of consistency in dietitian evaluations for our pediatric patients receiving HEN. Consequently, after establishing an institutional standard for nutrition reassessment intervals, we underwent a quality improvement (QI) initiative to improve rates of adherence to standard frequency of dietitian consults and referrals among patients receiving HEN. METHODS: A prospective QI initiative from April 2021 to December 2021 was performed using multiple plan-do-study-act (PDSA) cycles. Interventions included (1) a reminder placard, (2) the display of feeding tube status and date of the last dietitian note in the electronic health record (EHR) clinic schedule dashboard, and (3) an autotext smart element to the EHR default clinic note template. The goal was to enable clinicians to quickly identify the need for nutrition evaluation with either a same-day dietitian consult or a referral to nutrition clinic. RESULTS: Among 111 HEN patients with >6 months since last nutrition encounter, the dietitian referral/consult rate prior to any interventions was 58%. The placard (PDSA 1) was abandoned before obtaining reportable data because of sampling bias and clinic workflow inefficiencies. The clinic schedule dashboard modification (PDSA 2) improved the dietitian referral/consult rate to 66%. Subsequently, the clinic note smart element (PDSA 3) increased the rate to 77%. An 8-week postintervention check revealed a compliance rate of 78%. CONCLUSION: Implementation of minimally interruptive EHR enhancements showed a sustained increase in dietitian referrals and consults for patients receiving HEN, which may improve nutrition outcomes.

The expanding role of school nurses: an ozone awareness flag program.

Children with asthma are at risk of experiencing the effects of ozone on the respiratory system at a lower concentration than normal or with a greater morbidity. The North Texas Asthma Consortium partnered with the U.S. Environmental Protection Agency, the Department of Health and Human Services, and the Asthma Coalition of Texas to implement an ozone awareness program in schools in North Texas. The goal of the ozone awareness program was to introduce and support a process for schools to raise ozone awareness in the school and community. Schools participating in the program fly a green, yellow, orange, or redflag each day alerting students, school staff parents, and community members about the ozone. Activities for an active indoor curriculum on high ozone days, education about asthma and the effect of ozone, tools for implementing the program, and flags were provided. The program has been presented to almost 250 schools with 85 schools participating.

Examining the validity, reliability, and preference of three pediatric pain measurement tools in African-American children.

PURPOSE: To compare the validity, reliability, and preference of pain intensity measurement tools--the African-American Oucher Scale, the Wong-Baker FACES Scale, and the Visual Analog Scale (VAS)--in 100 African-American children between 3 and 18 years of age. METHODS: During a visit to the sickle cell anemia clinic, the children were asked to describe two painful procedures/treatments they had experienced and to choose which one hurt the most. They rated the pain intensity of each procedure/treatment on the three scales that were presented in a preselected order. After using all the scales, the children then chose their favorite scale. The same procedure was repeated at the end of the visit, with a minimum of 15 minutes between the test and retest. RESULTS: Concurrent validity was determined by comparing the rank order of the two identified painful items with the pain scores on the three scales. Chi square analysis indicated a statistically significant difference among the scales for preference (chi2 = 24.08, df = 2, p < 0.0001) and reliability (chi2 = 6.12, df = 2, p < 0.05), but not validity (chi2 = 0.81, df = 2, NS) for the entire sample. Most children preferred using the FACES Scale (56%) versus the Oucher (26%) and VAS (18%). When the data were analyzed for three cognitive stages (ages 3-7, 8-12, and 13-18 years), the following were found: For the school-age period, chi square for reliability did not reach significance (chi2 = 4.35, df = 2, NS); for the preschool-age period, chi square for validity did reach significance (chi2 = 6.49, df = 2, p < 0.05) and was strongest for the FACES scale, followed by the Oucher. CONCLUSIONS: The study findings indicated that the FACES and African-American Oucher Scales are valid and reliable tools for measuring pain in children. Among the entire sample and each age group, the FACES scale was the most preferred scale.