Reducing Serious Safety Events and Priority Hospital-Acquired Conditions in a Pediatric Hospital with the Implementation of a Patient Safety Program.

BACKGROUND: A freestanding children's hospital evaluated the impact of a patient safety program on serious safety events (SSEs) and hospital-acquired conditions (HACs). METHODS: The No Harm Patient Safety Program was developed throughout the organization using a multifaceted approach that included safety moments, leadership rounding, cause analysis changes, event reporting enhancements, error prevention training, leadership training, identifying priority HACs, Eye on Safety Campaign, and safety coaches. The organization set strategic goals for improvement of SSEs and priority HACs. RESULTS: The rate of SSEs decreased from 0.19 in 2014 to 0.09 in 2015. The rate significantly declined from 2015 to 2016 to a rate of 0.00, for a rate difference of -0.00009 (95% confidence interval [CI]: -0.00016, -0.00002; p = 0.012). The organization reached two years without an SSE in July 2017. The central line-associated bloodstream infection rate significantly declined from 2.8 per 1,000 line-days in 2015 to 1.6 in 2016, for a difference of -0.00118 (95% CI: -0.002270, -0.00008; p = 0.036). Surgical site infection rates declined from a 2015 rate of 3.8 infections per 100 procedures to a 2016 rate of 2.6 (p = 0.2962), and catheter-associated urinary tract infection rates declined from a 2015 rate of 2.7 per 1,000 catheter-days to a 2016 rate of 1.4 (p = 0.2770). CONCLUSION: The No Harm Patient Safety Program was interwoven into the organization's strategic mission and values, and key messaging was used to purposefully tie the many interventions being implemented back to it. These interventions were associated with improvements in patient safety outcomes.

From "What the Hell Is Going on?" to the "Mushy Middle Ground" to "Getting Used to a New Normal": Young People's Biographical Narratives Around Navigating Parental Dementia.

The number of young people who have a parent with dementia is rising as a result of improvements in diagnosis of young onset variants and demographic shifts. There has, however, been very little research focusing on this group. Accounts elicited as part of the Perceptions and Experiences of Young People With a Parent With Dementia described the period, usually some years, leading up to a diagnosis of a dementia and then the progress of the condition post diagnosis. These narratives were characterized by confusion, uncertainty, trauma, and distress as the young people struggled to make sense of the significant and often extreme, behavioral and attitudinal changes that were symptoms of the illness. This article describes and discusses how the young people experienced and navigated the temporal messiness and consequent biographical disruption arising from parental dementia.

"It Would Be Easier If She'd Died": Young People With Parents With Dementia Articulating Inadmissible Stories.

In the U.K. context where the emphasis is (quite rightly) on living well with dementia, on positivity and enabling approaches, it can be difficult for researchers to investigate and report negative experiences. Failing to re-present perceptions and experiences as they are lived, however, does a serious disservice to the research endeavor and can prevent policy and service development and positive change. In this article, we present some stories told by participants in an Alzheimer's Society (United Kingdom) Funded project uniquely investigating the perceptions and experiences of children and young people who have a parent with dementia. Sometimes the stories were not easy to hear, especially when they challenged dominant master narratives around dementia. We discuss our view that when the young people we spoke with told us how things were for them, we were ethically bound to respect and disseminate their accounts.

Does the British Orthodontic Society orthognathic DVD aid a prospective patient's decision making? A qualitative study.

OBJECTIVES: To explore the views of potential orthognathic patients regarding the influence of the BOS Orthognathic DVD in their decision making process. DESIGN: Qualitative, cross-sectional study. SETTING: A UK dental teaching hospital. PARTICIPANTS: Patients considering orthognathic treatment. METHODS: New patients were recruited from orthognathic clinics following an initial consultation. After an appropriate time to view the DVD, in-depth interviews were conducted with 10 patients (aged 16-48 years) in their homes. Interviews explored the attitudes and perceptions that influenced decisions about surgery, with a focus on the role of the DVD in this process. The interviews were transcribed and a framework analysis was undertaken. RESULTS: The main themes identified were participant perceptions on the patient stories, use of images, the nature of the DVD itself and its usefulness in the decision making process. Participants reported they were heavily influenced by the patient stories. Virtual animations of surgery were seen as useful; whereas the before and after images of surgery were found to be disorientating. The design of the menu resulted in confusion or information being missed. The DVD was seen as a trusted resource, whereas the Internet was seen as biased, general and sensationalistic. CONCLUSIONS: The DVD gives trusted information that patients cannot obtain or process from professional sources or the Internet. If used properly it can have a role in the decision making process, but should be seen within the context of other influences on the patient. This research has highlighted some aspects of the DVD that could be improved upon.

Engaging older people to explore the age-friendliness of a rural community in Northern England: A photo-elicitation study.

An ageing society brings with it increased health costs due to the prevalence of long term conditions increasing with age. It is therefore vital to support good health in older people, both to improve their quality of life and to reduce the financial implications of an ageing society. Isolation and loneliness can put people at risk of dying early, and increasing opportunities for social interaction and engagement could mitigate some of the health effects of ageing. However, this requires society to create the conditions that enable older people to participate fully. The World Health Organization's Age-Friendly Cities programme has identified factors that make urban areas Age-Friendly, but research shows that older rural dwellers have unique unmet needs preventing full engagement in their communities. This article describes a pilot project which adapted photo-elicitation to explore the age-friendliness of a rural area in Calderdale, Northern England. It shows that photo-elicitation is a successful method for identifying what older people think is important in making their community age-friendly and it reveals differences between ageing in a city and in a rural setting. This rich data can be used to inform the development of policy in rural areas which is more closely aligned to the needs, preferences and interests of the growing population of older residents. The project also demonstrates the engagement potential of this methodology. Participants continued as co-researchers, learning new skills and taking responsibility for a variety of dissemination activities such as photographic exhibitions, a public report and presentations. This suggests that adapted photo-elicitation is a useful tool for engaging older people in research.

Antibiotic use in cirrhotic children with acute upper gastrointestinal bleeding: A retrospective study using the pediatric health information system (PHIS) database.

Prior studies have demonstrated positive impacts of antibiotic use on reducing mortality, rebleeding events, and length of hospitalization in adult cirrhotic patients with acute upper gastrointestinal bleeding (UGIB). We aimed to investigate the use of antibiotics in cirrhotic children with acute UGIB and its impact on patient outcomes.This was a retrospective study using the Pediatric Health Information System database. Cirrhotic patients aged 0 to 18 years with acute UGIB, admitted between October 2005 and September 2015, were identified based on ICD-9 codes. Patients with no documented endoscopy during admission were excluded.Forty-four (23 females) cirrhotic children were eligible for data analysis. The median patient age was 6 years. Etiology of acute UGIB included esophageal varices (n = 37), non-variceal bleeding (n = 4), and both (n = 3). A significant proportion of cirrhotic children with acute UGIB (n = 30, 68%) were given intravenous antibiotics within 48 hours of admission. Among children who did not develop bacteremia, 68% received antibiotics vs. 32% who did not (P = .6). The rate of readmission within 30 days of discharge was 7% in patients with antibiotics vs. 21% in those without antibiotics (P = .3).This study suggested that antibiotic use within 48 hours of admission in cirrhotic children with acute UGIB might have a positive impact on the percentage of children free of bacteremia and the readmission rate. A prospective study should investigate whether prophylactic antibiotics should be targeted only to a subgroup of cirrhotic children with acute UGIB who are particularly at high risk for bacterial infection.

"It was then that I thought 'whaat? This is not my Dad": The implications of the 'still the same person' narrative for children and young people who have a parent with dementia.

This research used auto/biographical interviews to explore the experiences of 19, 8 to 31 year olds who had a parent with dementia. Thematic analysis revealed challenges occasioned by the master narrative that people with dementia are 'still' the same person they were prior to the onset of their condition. While this notion is - rightly - at the heart of person-centered care in dementia services, the 'still' discourse conflicts with the experiences of young people. Their accounts suggest that the construction of their parent as the same person is not helpful and that, furthermore, expectations that they will behave and feel towards that parent as they did before are a source of distress in what is already a challenging situation. This paper highlights the need to equip young people with support that acknowledges that their parent may well be drastically different to the Mum or Dad they previously 'knew'.

A modified "cover your cough" campaign prevents exposures of employees to pertussis at a children's hospital.

BACKGROUND: In the 4th quarter of 2004, there was an increase in patients seeking medical care for pertussis symptoms at the Children's Hospital, Omaha, NE. The Hospital Epidemiology service noted a sharp rise in exposures of Children's Hospital employees to these patients, requiring employee testing, prophylactic antibiotic prescriptions, and relief from duty. METHODS: Initial efforts at employee education failed to prevent the exposures. An exposure-control plan was then initiated by placing "Cover Your Cough" posters (in English and Spanish) describing appropriate cough etiquette at entrances to the emergency room, outpatient clinics, and hospital lobby. In addition, personal protective equipment (PPE) including child- and adult-sized masks, hand sanitizers, and tissues were provided at these stations for patients and their attendants. RESULTS: Prior to the initiation of the above exposure control measures, there were 166 reports of employee exposure to patients and other employees with pertussis symptoms during a 4-week period. Of these, 140 were given prophylactic antibiotics, and 31 underwent diagnostic testing for pertussis and required paid time off from work. The cost of antibiotics and diagnostic testing was $17,407.00. After the introduction of the modified "Cover Your Cough" campaign, the number of employee exposures declined significantly to 37 in the next 4-week period. Notably, the number of patients tested for pertussis during the second 4-week period was 290 compared to 162 in the first 4-week period, indicating continuation of the epidemic. CONCLUSIONS: Availability of PPE along with posters regarding cough etiquette at entry points of the hospital interrupted employee exposure to patients/personnel with pertussis symptoms significantly, when an employee educational initiative alone was unable to achieve this outcome.

Costs Associated with Ebola Preparedness at a Freestanding Pediatric Assessment Center.

The 2014-2016 West Africa Ebola outbreak led US hospitals to prepare to treat Ebola patients, with significant attributable costs. A nationwide preparedness transition to a tiered approach allowed regional allocation of preparedness resources for Ebola frontline, assessment, and treatment hospitals. Preparedness costs for assessment centers were significant and largely uncompensated. Infect Control Hosp Epidemiol 2017;38:1367-1369.