Asunto(s)
Linfoma de Burkitt/etiología , Colitis Ulcerosa/tratamiento farmacológico , Diarrea/etiología , Hemorragia Gastrointestinal/etiología , Infliximab/efectos adversos , Inhibidores del Factor de Necrosis Tumoral/efectos adversos , Pérdida de Peso , Linfoma de Burkitt/diagnóstico , Linfoma de Burkitt/tratamiento farmacológico , Linfoma de Burkitt/inmunología , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/inmunología , Colitis Ulcerosa/cirugía , Diarrea/inmunología , Hemorragia Gastrointestinal/inmunología , Humanos , Huésped Inmunocomprometido , Masculino , Recto , Inducción de Remisión , Factores de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Faced with a lack of evidence, institutions often develop local protocols for use of heparin to flush-lock venous access ports. Our objective was to evaluate catheter-related complications in patients after introduction of a lower-concentration heparin flush protocol. PROCEDURE: Patients with implanted vascular access devices followed by a Pediatric Oncology service were exposed to a practice change in which heparin dose for flush-lock was decreased from 5 ml of 100 units/ml to 5 ml of 10 units/ml. Outcome measures included port malfunctions leading to use of intra-port tissue plasminogen activator (tPA), and positive blood cultures. RESULTS: Rates of tPA usage were statistically similar before and after the practice change (0.82 compared to 0.59 per 100 line days absolute change -0.23, 95% CI -0.66, 0.20). Positive blood culture rates were also statistically similar before and after the practice change. CONCLUSIONS: Children with implanted ports had similar complication rates and care safety measures whether their ports were flushed with 10 units/ml of heparin or 100 units/ml. Standardizing flush-locks to lower doses of heparin may be a promising approach to maintaining port patency without compromising patient safety.
Asunto(s)
Anticoagulantes/administración & dosificación , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Catéteres de Permanencia/efectos adversos , Heparina/administración & dosificación , Neoplasias/tratamiento farmacológico , Complicaciones Posoperatorias , Adolescente , Adulto , Niño , Preescolar , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Neoplasias/cirugía , Pronóstico , Activador de Tejido Plasminógeno/uso terapéutico , Adulto JovenRESUMEN
Central line-associated bloodstream infections (CLABSIs) cause major patient harm, preventable through attention to line care best practice standards. The objective was to determine if a digital self-assessment application (CLABSI App), bundling line care best practices with social gamification and in-context microlearning, could engage nurses in CLABSI prevention. Nurses caring for children with indwelling central venous catheters in 3 high-risk units were eligible to participate. All other units served as controls. The intervention was a 12-month nonrandomized quality improvement study of CLABSI App implementation with interunit competitions. Compared to the preceding year, the intervention group (9886 line days) CLABSI rate decreased by 48% ( P = .03). Controls (7879 line days) did not change significantly. In all, 105 unique intervention group nurses completed 673 self-assessments. Competitions were associated with increased engagement as measured by self-assessments and unique participants. This model could be extended to other health care-associated infections, and more broadly to process improvement within and across health care systems.
Asunto(s)
Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Capacitación en Servicio/métodos , Aplicaciones Móviles , Personal de Enfermería en Hospital/educación , Mejoramiento de la Calidad/organización & administración , Catéteres Venosos Centrales , Hospitales Pediátricos/organización & administración , Humanos , Paquetes de Atención al Paciente , Estudios Prospectivos , Autoevaluación (Psicología) , Compromiso LaboralRESUMEN
Pediatricians and other child care providers manage a large number of children with constipation, a recurrent medical problem that is frustrating to patients, their care givers, and the health care providers themselves. Most often the constipation in children is functional in nature, and only a very small percentage of patients have an organic cause for it. In this review, we discuss the epidemiology, causes, evaluation, and management of children with functional constipation. [Pediatr Ann. 2016;45(5):e189-e196.].
Asunto(s)
Estreñimiento/etiología , Niño , Estreñimiento/terapia , Manejo de la Enfermedad , Humanos , PediatríaRESUMEN
INTRODUCTION: Simulation-based interprofessional team training is important to ensure high-quality, safe patient care, but several barriers exist, including diverging learning needs and schedules as well as limited available resources. METHODS: The authors developed an in situ, simulation-based interprofessional team training program around pediatric emergencies for physicians, nurses, respiratory therapists, and pharmacists at their institution and performed an analysis of the program's impact on self-efficacy in resuscitation skills among pediatric residents and nurses. RESULTS: The results showed that with a design based in best principles of team training and simulation education, interprofessional team training is feasible and sustainable. The program had a beneficial effect on self-efficacy in resuscitation skills among both residents and nurses at the authors' institution and received widespread acceptance. CONCLUSIONS: A collaborative approach to design and implementation of interprofessional team training can lead to a sustainable program that serves both patient safety and training requirements set forth by professional organizations.