Navigating COVID-19 Educational Challenges: Transitioning an In-Person Mentoring Program to a Virtual Learning Environment.

Nursing professional development practitioners and leadership staff implemented a second Transitional Mentor Education Program. The pilot program was classroom based; however, with pandemic restrictions, a shift to deliver a hybrid mentoring program was needed. Learning needs, clinician well-being, and professional development were addressed. Regardless of the method of educational delivery, the nurses in Phase 2 achieved the same outcomes as the pilot program, including increased clinical confidence, communication, integration of stress reduction strategies, and reflective practice.

Transitional Mentor Education Program Pilot: Preparing Nurses to Adapt to Changing Acute Care Settings.

Nursing professional development practitioners and nursing leadership identified a need for a transitional mentoring program to assist staff nurses' transition beyond orientation. Mentoring was identified as an effective strategy to promote professional development. The benefits of this year-long transitional mentoring program include an increase in clinical confidence, integration of stress reduction strategies, and reflective practice into daily practice. The transitional mentoring program is a beneficial strategy for enhancing professional development of both mentors and mentees.

Standardized Tracheostomy Education Across the Enterprise.

PURPOSE: The purpose of this quality improvement project was to create a Tracheostomy Subject Matter Expert (Trach SME) Committee to standardize tracheostomy care, education, and the discharge process across Boston Children's Hospital. DESIGN AND METHODS: Boston Children's Hospital (BCH) is a free-standing urban tertiary pediatric hospital with 15 inpatient units. The newly formed Trach SME Committee evaluated the discharge process across the enterprise including hospital satellites and intra-hospital practice. Education materials were centralized, and policies were reviewed, revised and standardized to reflect current best practice. The Trach SME provided education to Trach Champions from each area that became resources for their respective units. The Trach SME also developed measurement outcomes to assess the effectiveness of the education process. RESULTS: In the implementation year of 2104, our 7-day unplanned readmission rate for tracheostomy patients was 18.18%. This rate decreased to 6.67% in 2015 and to 0% in 2016. In 2015, we began to monitor 30-day unplanned readmissions and the rate was 6.67% in 2015 and decreased to 0% in 2016. CONCLUSIONS AND PRACTICE IMPLICATIONS: Standardization of policies, procedures and caregiver educational materials for the management of patients with a tracheostomy tube improved tracheostomy care across the enterprise and reduced tracheostomy readmission rates.

Reducing Readmissions Post-tonsillectomy: A Quality Improvement Study on Intravenous Hydration.

INTRODUCTION: Dehydration is a potentially preventable complication post-tonsillectomy and can result in an Emergency Department visit and/or readmission. Our objectives were to identify risk factors for dehydration readmissions and develop interventions to prevent them. METHODS: We used retrospective chart reviews to determine if increased intravenous (IV) hydration post-tonsillectomy prevented hospital readmissions for dehydration. All children aged 1-18 years who underwent tonsillectomy between July 1, 2007 and September 30, 2015 were included in this quality improvement study. Using the Pediatric Health Information System database, patients who experienced a readmission for dehydration within 72 hours of surgery were identified and validated with internal data. We analyzed the pre-implementation and post-implementation readmission rates after standardization of increased IV fluids (1.5 times maintenance). An interrupted time series analysis was used to estimate the effects of our hydration initiative. RESULTS: Of 11,157 patients who underwent tonsillectomy during the study period, 96 (0.9%) met the criteria for readmissions for dehydration. The pre-implementation readmission rate was 1% compared to 0.2% post-implementation, a reduction of 82%. CONCLUSIONS: The hydration initiative was associated with a significant decrease in hospital readmissions. This safe, low-cost, easy-to-implement approach to preventing dehydration post-tonsillectomy could be explored at other institutions.

Enhanced central venous catheter bundle for pediatric parenteral-dependent intestinal failure.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) cause substantial morbidity and increase antimicrobial use and length of stay among hospitalized children in the United States. CLABSI occurs more frequently among high-risk pediatric patients, such as those with intestinal failure (IF) who are parenteral nutrition (PN) dependent. Following an increase in CLABSI rates, a quality improvement (QI) initiative was implemented. METHODS: Using QI methodology, an enhanced central venous catheter (CVC) maintenance bundle was developed and implemented on 2 units for pediatric PN-dependent patients with IF. CLABSI rates were prospectively monitored pre- and postimplementation, and bundle element adherence was monitored. Enhanced bundle elements included chlorhexidine-impregnated patch, daily bathing, ethanol locks, 2 nurses for CVC care in a distraction-free zone, peripheral laboratory draws, bundling routine laboratory tests, and PN administration set changes every 24 hours. RESULTS: Adherence to enhanced bundle elements increased to >90% over 3 months. CLABSI rates averaged 1.41 per 1,000 central line days preimplementation compared with 0.40 per 1,000 device days postimplementation (P = .003), an 85% absolute reduction in CLABSI rates over 12 months. CONCLUSIONS: Patients with IF are at an increased risk for CLABSI. Enhanced CVC maintenance bundles that specifically target prevention practices in this population may be beneficial.

Reducing Pediatric Readmissions: Using a Discharge Bundle Combined With Teach-back Methodology.

The authors describe a quality improvement initiative aimed at decreasing unplanned 7- and 30-day readmission rates in an urban, pediatric, tertiary care hospital. A stepwise approach was used to disseminate the pilot initiative across 16 inpatient units. Use of a teach-back methodology combined with a discharge bundle resulted in an 8% reduction in 7-day readmission and 10% reduction in 30-day readmission over 16 months.

Charting the Course for a Nursing Online Journal Club: Part II.

In a pediatric inpatient setting, an interdisciplinary team designed and implemented an online journal club to discuss current nursing trends and research, as well as to foster evidence-based practice. This article is Part II of a two-part series in which the implementation process is described.

Charting the Course for a Nursing Online Journal Club: Part I.

In a pediatric inpatient setting, an interdisciplinary team designed and implemented an online journal club to discuss current nursing trends and research and to foster evidence-based practice. This article is Part I of a two-part series in which the process will be described.

An Inpatient Child Passenger Safety program.

Background. Our institution implemented an Inpatient Child Passenger Safety (CPS) program for hospitalized children to improve knowledge and compliance with the Massachusetts CPS law, requiring children less than 8 years old or 57 inches tall to be secured in a car seat when in a motor vehicle. Methods. After the Inpatient CPS Program was piloted on 3 units in 2009, the program was expanded to all inpatient units in 2010. A computerized nursing assessment tool identifies children in need of a CPS consult for education and/or car seat. Results. With the expanded Inpatient CPS Program, 3650 children have been assessed, 598 consults initiated, and 325 families have received CPS education. Car seats were distributed to 419 children; specialty car seats were loaned to 134 families. Conclusions. With a multidisciplinary approach, we implemented an Inpatient CPS Program for hospitalized children providing CPS education and car seats to families in need.

Spica cast care: a collaborative staff-led education initiative for improved patient care.

One of the most challenging aspects for nurses caring for incontinent children in spica casts is maintaining healthy skin integrity. Noting an increase in the number of phone calls from parents of discharged children in spica casts concerning diaper rash and skin breakdown, inpatient orthopedics staff nurses lead an interdisciplinary quality improvement and educational initiative. They standardized pediatric spica cast care and education by creating an intranet narrated PowerPoint presentation for staff and parents of children with spica casts. A take-home DVD of this education module is now produced and given to parents, reinforcing nursing discharge teaching and giving parents the opportunity to review these new skills at home as needed. The purpose of this article is to share this experience of improving patient outcomes and empowering other orthopedics nurses to develop creative educational solutions.

Peer teaching: using patient-directed information sessions as an active learning strategy.

Patient-directed information sessions were implemented on three inpatient surgical units as a method for education delivery. Patient-directed information sessions are brief education sessions that are influenced and planned based on current patient diagnosis, procedures, and treatments. The success of patient-directed information sessions has been shown by the more than 300 sessions offered, 2,500 participants, 200 topics, and an average of 8 participants per session over a 1-year period. A patient-directed information session facilitator class was then developed to train bedside nurses to facilitate the sessions during their own shifts. The training of facilitators has provided opportunities for professional development of the staff and increased education offerings on all nursing shifts.

Career mapping: developing nurse leaders, reinvigorating careers.

Nurse leaders must ensure the continued development and learning of all nurses, including those who postpone participation in existing professional development activities. In this article, the authors describe a career mapping program for nurses who have demonstrated reluctance in establishing and pursuing career advancement goals. The program incorporates a 2-tiered mentoring strategy and guides nurses in assessing their strengths and interests, developing career goals, and mapping out and implementing a career plan to meet personal and professional needs. The 18-month program resulted in career advancement for most participants and offers a model for leadership development.

The impact of culture change on nurse retention.

Given the nursing shortage, retaining qualified nurses is of primary importance to nurse executives. In this article, the authors discuss problems they experienced in retaining newly hired nurses on 3 surgical nursing units and describe how efforts to change the culture of the units resulted in dramatic improvements in nurse satisfaction and the retention of new hires.