Aligning Organizational Culture and Infrastructure to Support Evidence-Based Practice.

Standardized nursing practice based on the foundations of evidence-based practice leads to high-quality patient care and optimal outcomes. Despite knowing the benefits of evidence-based practice, health care organizations do not consistently make it the standard of care; thus, implementation of evidence-based practice at the system level continues to be challenging. This article describes the process adopted by a facility in the Southwest that took on the challenge of changing the organizational culture to incorporate evidence-based practice. The organization met the challenges by identifying perceived and actual barriers to successful implementation of evidence-based practice. The lack of standardized practice was addressed by developing a group of stakeholders including organizational leaders, clinical experts, and bedside providers. Changing the culture required a comprehensive process of document selection and development, education, and outcome evaluation. The ultimate aim was to implement an integrated system to develop practices and documents based on the best evidence to support patient outcomes.

Using Valid and Reliable Tools for Pain and Sedation Assessment in Pediatric Patients.

Pain management and sedation strategies have become more complex in recent years, with accompanying documented increases in morbidity and mortality. Consequently, various government agencies and professional associations have issued requirements or recommendations designed to ensure optimal and safe pain management in different populations. The pediatric nurse must understand the rationale behind these guidelines, which pain and sedation assessment tools are valid and reliable, how and when to use these tools, and the purpose and limitations of each tool. This article summarizes the recent recommendations, identifies valid and reliable pediatric pain and sedation assessment tools, and describes the appropriate use of these tools to provide safe and high-quality patient care.

A Standard Push-Pull Protocol for Waste-Free Sampling in the Pediatric Intensive Care Unit.

Blood sampling is a major source of blood loss in the pediatric intensive care unit (PICU). Blood-sparing sampling techniques such as the push-pull method can significantly reduce sampling-related blood loss and protect patients from anemia and blood transfusions. The push-pull method is supported by research evidence for central venous catheter (CVC) sampling, but research protocols differ and not all CVCs and laboratory tests have been studied. A standard push-pull protocol for the PICU was developed, implemented, and evaluated in this evidence-based practice project. Results show that the protocol can be used safely and reliably as a standard waste-free sampling method in the PICU.

Pediatric central line: bundle implementation and outcomes.

Central vascular catheters are an integral part of caring for a pediatric intensive care patient, providing hemodynamic monitoring capabilities, reliable vascular access for hydration, medication administration, and blood sampling. However, central vascular catheters put the patient at risk for central line-associated bloodstream infections (CLABSIs). In 2010, the Centers for Medicare & Medicaid Services added CLABSI to the list of "never events." This article discusses the measures one hospital implemented to reduce the CLABSI rate, and the research that supports this evidence-based practice.

Research evidence review and appraisal: pediatric central venous catheter care bundling.

Central venous catheters are integral to the care of acutely ill children, providing reliable vascular access for infusions, hemodynamic monitoring, and blood sampling. However, there are risks associated with their use, the most common of which is central line-associated blood stream infections. These infections result in increased lengths of stay, increased costs, and high mortality rates. A thorough review of research evidence has been completed to fully appreciate the state of the evidence regarding the effects of bundling together the care for central venous catheters, and practice recommendations have been provided. Published studies have been appraised and evaluated for clinical and statistical significance. This appraisal has resulted in clear and specific recommendations for evidence-based practice applications, and potential policy implications are outlined in this article.

Juvenile idiopathic arthritis: why do I have to hurt so much?

In the current world of high-tech medicine, some individuals nevertheless experience immeasurable chronic pain daily. Among these are 60,000 to 70,000 children in the United States who have juvenile idiopathic arthritis. The children affected by this disease experience a decreased quality of life and sometimes blindness. Outcome severity in these cases is related directly to the amount of injury to bones, joints, soft tissue, and eyes at the time of diagnosis. There are not enough specialists to ensure timely diagnosis and medications, and although the symptoms of juvenile idiopathic arthritis are treatable, there is no cure. Until timely diagnosis and treatment can be ensured, pain and blindness will continue to be the daily experience of these children.

Pediatric and neonatal cardiovascular pharmacology.

Advances in cardiology, surgical techniques, postoperative care, and medications have improved the chances of long-term survival of the neonatal and pediatric patient with complex congenital cardiac anomalies. Rather than undergoing palliative repair, these children are now frequently taken to the operating room for complete repair. As complete repair becomes the norm, collaborative management and a thorough understanding of the pre and postoperative medications used become essential to the care of these patients. The nurse's ability to understand preop, postop, and management medications is enhanced by an understanding of the principles of cardiac anatomy and physiology, as well as developmental changes in cardiac function. All of these are reviewed. In addition, since the safe and effective administration of these drugs depends on the pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU) nurse's thorough knowledge of these medications and their effects on the cardiovascular system, a brief review of these medications is presented. While new technology and techniques are improving survival rates for children with congenital heart anomalies, it is the postoperative care that these children receive that enhances the patient's survival even more.