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.

An Integrative Review of Pediatric Early Warning System Scores.

Increasingly, early warning system scores are being introduced into pediatric clinical practice to support the early recognition of and intervention for clinical deterioration in hospitalized children at risk. This integrative review explored what is known about early warning system scores with pediatric patients. Twenty-eight publications, including research, clinical practice articles, and conference abstracts, were identified. Five major concepts emerged from analysis of retrieved documents: overview of pediatric early warning system scores, supplementary benefits, facilitators to successful implementation, barriers to successful implementation, and needed research. Greater psychometric testing of tools is needed before any recommendations can be made regarding extensive implementation with the pediatric population.

Review of outcomes in pediatric patients undergoing anterior cruciate ligament repairs with regional nerve blocks.

PURPOSE: This article compared the outcomes of pediatric patients undergoing ACL repairs receiving intravenous opioids versus regional nerve blocks for pain management. It was hypothesized that compared to intravenous opioids the use of regional nerve blocks would decrease pain, opioid consumption, and opioid-related side effects. METHOD: A random retrospective chart review was conducted on a total of 93 pediatric patients who underwent ACL repairs either in 2004 prior to the implementation of regional nerve blocks for pain management [pre-protocol cohort, (n=44)] or in 2009/2010, after the implementation of regional nerve block use [post-protocol cohort, (n=49)]. FINDINGS: The two cohorts were comparable in age, weight and gender. The post-protocol cohort had a significantly lower total opioid consumption (p<0.001). A sensitivity analysis excluding patients who received patient controlled analgesia (PCA) further validated the findings of significantly lower total opioid consumption adjusted for body weight [mg/kg] (p=0.02) and reduction in the highest numerical rating score (NRS) reported on post-operative day (POD) 1 (p=0.01). The cohorts were not significantly different in incidence of common opioid-related side effects or median length of stay (LOS). CONCLUSIONS: There was evidence that regional nerve blocks reduced opioid consumption and also impacted pain reduction on POD 1 but demonstrated no significant change on opioid-related side effects or readiness for discharge. In view of the retrospective nature of the study the potential benefits of regional nerve blocks suggested a clinical equipoise to conduct a controlled trial in children.

Reducing (Behavioral) Restraint Use Through Simulation at the Bedside.

Hospitals are experiencing an influx of patients in active behavioral crises, leading to restraints as a behavior management strategy. Over 100 staff participated in simulation training designed to manage escalating patient behavior. The training had a direct impact on the reduction of restraint use and increased preparedness and confidence of participants managing escalating patient behavior. Results suggest simulation can be an effective strategy to train medical staff to manage challenging behavior and reduce restraint use.

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.

A Multimodal Project to Assess Preceptor Burnout: Implications for Professional Development Practitioners.

This article describes the assessment of contributing factors to preceptor burnout and strategies to address them. A review of the literature, surveys, and focus groups were conducted, and no single solution to address burnout was found. Findings did not show significant differences related to the number of preceptors, the experience of preceptors, or the experience of new hires. Preceptors expressed the need for ongoing professional development, formalized feedback, resource materials, operational policies, and meaningful recognition.

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.

The Impact of Critical Reflective Inquiry Education on Experienced Nurses' Insights Into Practice.

Successful succession planning necessitates use of innovative strategies to encourage and support knowledge recovery and transfer. This quality improvement project evaluated the impact of a critical reflective inquiry workshop on experienced nurses' insights into practice. Nurses assessed written clinical narratives using the Critical Reflective Inquiry Assessment Tool before and after the workshop. Guided reflection led by nursing professional development practitioners fostered insight into practice, which is an essential step in supporting knowledge transfer to novice nurses.

Use of portable simulation manikins to increase the frequency of mock code training on four inpatient surgical units.

Educators within Children's Hospital Boston created a mock code facilitation curriculum and expectations for nurses to become Surgical Programs' mock code facilitators. Since implementation, the number of mock codes and the number of mock code participants have tripled.

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.