A Cell-Phone Medication Error eHealth App for Managing Safety in Chronically Ill Young Patients at Home: A Prospective Study.

Introduction: Whereas ample information describes medication errors (MEs) in children or in mixed pediatric and adult populations discharged with acute or chronic diseases from hospital to community settings, little is known about MEs in children and adolescents with chronic diseases discharged home, a major concern. To promote home medication safety, we trained parents of children discharged with chronic diseases to record ME with a tailored cell-phone eHealth app. Methods: In a 1-year prospective study, we used the app to monitor ME in patients with chronic diseases discharged home from a tertiary hospital in Rome, Italy. Univariate and multivariate analyses detected the ME incidence rate ratio (IRR). Results: Of the 310 parents enrolled, 194 used the app. The 41 MEs involved all drug management phases. The ME IRR was 0.46 errors per child. Children <1 year had the highest ME risk (1.69 vs. 0.35, p = 0.002). Children discharged from the cardiology unit had a statistically higher ME IRR than others (3.66, 95% confidence interval: 1.01-13.23%). Conclusions: The highest ME risk at home involves children with chronic diseases <1 year old. A significant ME IRR at home concerns children with heart diseases of any age. Parents find a tailored eHealth app for monitoring and reporting ME at home easy to use. At discharge, clinical teams need to identify age-related and disease-residual risks to target additional actions for monitoring ME, thus increasing medication safety at home.

Pediatric nurses in pediatricians' offices: a survey for primary care pediatricians.

BACKGROUND: The role played by nurses in caring for children in pediatricians' officies in the community is crucial to ensure integrated care. In Italy, pediatricians are responsible for the health of children aged 0-14 years living in the community. This study aimed to describe Italian primary care pediatricians' opinions about the usefulness of several nursing activities that pediatric nurses could perform in pediatricians' offices. METHODS: An online survey with pediatricians working in primary care in Italy was conducted between April-December 2018. A 40-item questionnaire was used to assess four types of nursing activities: clinical care, healthcare education, disease prevention, and organizational activities. The answers ranged from 1 (not useful at all) to 6 (very useful). Moreover, three open-ended questions completed the questionnaire. RESULTS: Overall, 707 pediatricians completed the online survey. Participants were mainly female (63%), with a mean age of 57.74 (SD = 6.42). The presence of a pediatric nurse within the pediatrician's office was considered very useful, especially for healthcare education (Mean 4.90; SD 1.12) and disease prevention (Mean 4.82; SD 1.11). Multivariate analysis confirmed that pediatricians 'with less working experience', 'having their office in a small town', and 'collaborating with a secretary and other workers in the office' rated the nurse's activities significantly more useful. CONCLUSIONS: A pediatric nurse in the pediatrician's office can significantly contribute to many activities for children and their families in the community. These activities include clinical care, healthcare education, disease prevention, and the organizational processes of the office. Synergic professional activity between pediatricians and pediatric nurses could ensure higher health care standards in the primary care setting.

Deep dissecting haematoma in patients with dermatoporosis: implications for home nursing.

Dermatoporosis is a chronic cutaneous insufficiency/fragility syndrome with a high prevalence in older adults. Dermatoporotic skin becomes thin and fragile and tends to tear. It may lead to deep dissecting haematomas (DDHs) as a final stage of dermatoporosis, which is a clinical emergency. Management can be challenging, as patients with lower-limb haematomas are frequently older and affected by multiple comorbidities, or are probably on medications that negatively influence wound healing. This article describes the essential role of nurses in prevention, early recognition and wound management of DDHs in patients with dermatoporosis.

Five Years of Journal Clubs With Pediatric Nurses and Allied Health Professionals: A Retrospective Study and Satisfaction Survey.

PURPOSE: Journal Clubs (JCs) for nurses and allied health professionals have been held in an Italian pediatric hospital since April 2008. This study aimed to: examine what type of articles have been used during JCs across 5years; investigate the potential implications for clinical and organizational practice; assess the participants' satisfaction about JCs and their contribution to professional development. DESIGN AND METHODS: Using a retrospective design, all articles proposed in the JCs were examined. Specific criteria were used to evaluate the implications for practice within the hospital, which were classified as direct or indirect. Using a cross-sectional design, 63 JCs participants were asked to express their opinion and satisfaction about the JC sessions attended. RESULTS: Overall, 132 articles were analyzed: most of them focused on pediatric care (64.4%) and nursing (96.2%). Almost half of the articles (n=60, 45.6%) were appraised as having brought implications for clinical practice, both direct (58.3%) and indirect (41.7%). Forty-one participants (12 attendees; 29 active participants) completed a questionnaire about their opinion about JCs. Most of participants (80.5%) reported that the topics selected for the JCs were interesting and relevant to their everyday practice. CONCLUSIONS: Multidisciplinary JCs were considered useful for clinical practice, improvement of the quality of care, and professional development. However, lack of pragmatism and the difficulty to bridge the gap between research and practice were reported as weaknesses. PRACTICE IMPLICATIONS: JCs can represent a quality improvement strategy for promoting research utilization among health professionals and thereby improving the quality of care.

Skin Injuries and Chlorhexidine Gluconate-Based Antisepsis in Early Premature Infants: A Case Report and Review of the Literature.

Early premature infants are subjected to many invasive procedures in neonatal intensive care units, and effective skin antisepsis is an essential step in caring for these vulnerable patients. Nevertheless, preterm infants have an anatomically and physiologically immature skin and preserving their skin integrity is essential to avoid the risk of local and systemic complications. Skin particularities of newborns reduce the list of available antiseptics in neonatology. Chlorhexidine gluconate (CHG) has excellent antiseptic properties and its antimicrobial efficacy cannot be understated, but there is great concern about its use for premature infants, referring to the risk of development skin injuries, such as skin erythema, burns, and blisters. Current guidelines do not recommend the use of CHG as antiseptic in the neonatal population, but despite the lack of safety data in premature infants, CHG is commonly used worldwide for off-label indications in neonatal intensive care units. A clinical case of an infant born at 26 weeks of gestation who sustained a CHG-related chemical burn after skin antisepsis was reported. A review of the literature was undertaken to evaluate the skin safety of CHG in infants born less than 32 weeks of gestation, to summarize clinical practice' recommendations, and to discuss the wound treatment options available.

Recognising and managing age-related dermatoporosis and skin tears.

Dermatoporosis is a chronic skin fragility syndrome, caused by age and environmental factors. People with dermatoporosis have skin whose protective mechanical function is reduced and which has a decreased tolerance for friction and shearing forces. Skin tears are another clinical consequence of age-associated skin vulnerability and people with dermatoporosis are at increased risk of skin tears. Dermatoporosis may also delay the healing of skin tears, making it vital that healthcare professionals are aware of this condition. Skin tears have profound effects on the health and well-being of older people, and these kinds of injuries are being seen more frequently in clinical practice as the average age of the population increases. The treatment of skin tears in three older people with dermatoporosis is discussed and the clinical decisions made in each case.

How to prevent and avoid common mistakes in skin tear management in the home setting.

Skin tears are acute wounds, often mismanaged and misdiagnosed that can convert to chronic wounds, representing a common but relevant burden to both the individual and the health care system. The implementation of prevention protocols and training programs is essential to manage these wounds in the community. Managing a skin tear-related problem at home represents a challenge, due to some critical issues and specific conditions. A multifaceted prevention programme should consider the involvement of relatives, caregivers and personal care aides in order to promote patients' safety, to minimise the risk of trauma and to improve patients' outcomes following a skin injury.

Thirdhand Smoke Knowledge, Beliefs and Behaviors among Parents and Families: A Systematic Review.

Families play a primary role in protecting children. Thirdhand smoke (THS) is an underestimated public health issue, and health effects correlated to its exposition are emerging. The aim of this systematic review was to analyze papers focusing on knowledge, beliefs, and behaviors regarding THS among parents, families, and caregivers, published until May 2022 on MEDLINE, CINAHL, EMBASE, and the Cochrane Library. Critical appraisal of the included studies was conducted by two independent reviewers using the Joanna Briggs Institute Critical Appraisal tool. Out of the 97 articles, 8 were included in this review (two from the USA, one from Europe, and five from Asia). Although there were no restrictions on the date of publication, all the articles were published in the last 10 years, underlining that THS is an emerging concept. They were characterized by relevant heterogeneity in the study design and assessment tools. The results showed that percentages of parents who believed that THS is harmful ranged from 42.4% to 91%, but parental awareness was not always associated with the adoption of a home- and car-smoking ban or healthy behaviors. Further research is needed to understand the resistance and problems faced by parents who are aware of THS risks but unable to improve good practices.

Self-Care in Pediatric Patients with Chronic Conditions: A Systematic Review of Theoretical Models.

BACKGROUND: To improve outcomes in children and young adults (CYAs) with chronic conditions, it is important to promote self-care through education and support. AIMS: (1) to retrieve the literature describing theories or conceptual models of self-care in CYAs with chronic conditions and (2) to develop a comprehensive framework. METHODS: A systematic literature search was conducted on nine databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All peer-reviewed papers describing a theory or a conceptual model of self-care in CYAs (0-24 years) with chronic conditions were included. RESULTS: Of 2674 records, 17 met the inclusion criteria. Six papers included a theory or a model of self-care, self-management, or a similar concept. Six papers developed or revised pre-existing models or theories, while five papers did not directly focus on a specific model or a theory. Patients were CYAs, mainly with type 1 diabetes mellitus and asthma. Some relevant findings about self-care in CYAs with neurocognitive impairment and in those living with cancer may have been missed. CONCLUSIONS: By aggregating the key elements of the 13 self-care conceptual models identified in the review, we developed a new overarching model emphasizing the shift of self-care agency from family to patients as main actors of their self-management process. The model describes influencing factors, self-care behaviors, and outcomes; the more patients engaged in self-care behaviors, the more the outcomes were favorable.