Nurse Research Rounds: In the Spirit of Inquiry.

Nurses deliver a point-of-care service to patients. The nursing staff work extensive schedules and do not have time to research a clinical question to help support patient care. This article describes the implementation of the first research service that supports evidence-based practice at Georgia's second largest hospital. Inspired by a similar service at a children's hospital in 2014, the first year of nurse research rounds provides clinicians a new research service in their clinical setting.

Intravenous immunoglobulin utilization in the Canadian Atlantic provinces: a report of the Atlantic Collaborative Intravenous Immune Globulin Utilization Working Group.

BACKGROUND: Intravenous immunoglobulin (IVIG) use for labeled and unlabeled indications is growing steadily. By use of a collaborative regional strategy, baseline IVIG usage and appropriateness of utilization were determined for Atlantic Canada. The effectiveness of strategies designed to optimize utilization was also studied. STUDY DESIGN AND METHODS: A regional working group was created to monitor IVIG utilization for a 2-year period in the four Canadian Atlantic Provinces. A registry of IVIG was created. Assessment of indication appropriateness was determined with national and provincial guidelines along with expert clinical opinion. To optimize IVIG use, IVIG guidelines and feedback reports were distributed to stakeholders. Appropriateness of IVIG use was compared over the course of the study. RESULTS: The leading indications for IVIG use were idiopathic thrombocytopenic purpura (17.3%), primary immune deficiency conditions (14.9%), and chronic idiopathic demyelinating polyneuropathy (11.8%). The leading prescribing specialists were neurologists (32.2%) and hematologists (26.1%). A total of 37.1 percent of IVIG usage was in accordance with labeled indications. After optimization strategies were implemented, there was little change in labeled use. There was a 4.2 percent decrease in unlabeled use not supported by evidence (p<0.001). CONCLUSIONS: A regional collaborative strategy for monitoring IVIG use was established. Most of the IVIG use was for labeled or appropriate indications. The majority of unlabeled use was supported by the medical literature. Strategies to optimize IVIG utilization were associated with a decrease in inappropriate IVIG use and a plateau in IVIG utilization compared to the rest of the country.

Optimizing the delivery and use of a new monoclonal antibody in children with congenital heart disease: a successful provincial respiratory syncytial virus prophylaxis program.

OBJECTIVES: To describe a program for passive immunization against respiratory syncytial virus infection in infants with hemodynamically significant congenital heart disease (CHD) in accordance with the Canadian Paediatric Society recommendations. METHODS: A provincial coordinating committee composed of specialists in pediatrics, cardiology, infectious diseases, neonatology and public health collaborated to develop and implement a program to identify children with hemodynamically significant heart disease and offer respiratory syncytial virus prophylaxis. Database records for all children younger than two years of age who were seen by the provincial pediatric cardiology referral service were reviewed. Children with hemodynamically significant heart disease, as determined by a clinical assessment and echocardiography, were considered to be eligible for monthly palivizumab prophylaxis for five winter months. All physicians in the province were notified that approval of the provincial cardiology service was required for prophylaxis to be administered. Immunization rates were compared with projected rates based on the expected population-based immunization rates in infants with CHD in other provinces. RESULTS: 401 children with any cardiac diagnoses were identified, representing 545 potential patient-seasons of prophylaxis over two years in a birth cohort of 20,173 and 19,227 children, in each respective season (13.8 patient-seasons per 1000 births). Of these, 21 children were eligible for palivizumab prophylaxis according to the Canadian Paediatric Society criteria. All eligible children were immunized, and no ineligible children received the immunization. A review of palivizumab use in other provinces revealed highly variable rates of prophylaxis. CONCLUSIONS: The use of palivizumab for children with CHD can be optimized through a provincial model, in which children requiring prophylaxis are prospectively identified and reviewed by pediatric cardiologists -- and to whom evidence-based guidelines developed by a multidisciplinary team -- are applied. Such a model ensures that all patients requiring prophylaxis receive the appropriate immunization and avoids the immunization of low-risk children with CHD, in whom the benefits of palivizumab have not been proven.