Pediatric Chemotherapy Infusions in Outpatient Examination Rooms: A Novel Patient Care Approach.

Background: Many health care organizations offer pediatric infusions in outpatient infusion centers or, as in our organization, in a hospital-based outpatient Pediatric Infusion Therapy Center (PITC). When restrictions related to the COVID-19 pandemic decreased our PITC appointment capacity by 40%, other patient and family satisfaction issues were exacerbated. We implemented a new approach to pediatric infusions with the aim of improving patient and family satisfaction and reducing the amount of time in an appointment itinerary without negatively affecting patient safety. Methods: Our team used a phased approach to pilot the administration of short chemotherapy infusions in the same outpatient clinic examination rooms where consultation and routine office visits were conducted. Patients saw their specialist for an examination and, if clinically indicated, their infusion was administered in the same room. Appointment itineraries were then completed. The team tracked efficiency, satisfaction, and safety metrics related to the new process. Results: All efficiency metrics improved. No harm came to the 49 unique patients who received a total of 184 infusions. Patient appointment itineraries were shortened by an average of 1.03 hr. Satisfaction survey responses indicated a clear preference (93%) for the new process. Discussion: The novel approach of offering short infusions in outpatient clinic examination rooms provides an opportunity to ease capacity constraints and further increase patient and family satisfaction. This method may be especially helpful for health care organizations when external influences (e.g., lack of physical space, challenging patient volumes, and pandemics) necessitate a change.

Introducing Essential Oils into Pediatric and Other Practices at an Academic Medical Center.

Aromatherapy is an integrative intervention that uses essential oils to address symptom management, potentially as a first-line intervention or as a complement to other medical treatments. Aromatherapy is gaining widespread acceptance and increased scientific evidence of efficacy. Integrative and holistic nursing care uses integrative therapies such as aromatherapy and the principle of moving from a less invasive intervention to a more invasive intervention according to patient needs, symptoms, and preferences. Aromatherapy is often provided as a minimally invasive, independent, and integrative nursing intervention. This article describes the process used to introduce essential oils into practices at a large Midwestern academic medical center.

Pressure Ulcer Prevention: Where Practice and Education Meet.

This article describes the processes used to implement a pressure ulcer management program in a Midwest academic medical center, which led to a decrease in reportable pressure ulcers. A learning needs assessment was completed, and a workgroup was formed to address the learning needs. Methods, materials, and processes included lectures, technology-enhanced learning, and interactive stations with mannequins and pressure ulcer moulages. The processes and outcome measures used to measure effectiveness of the program are discussed.

Identifying hospitalized pediatric patients for early discharge planning: a feasibility study.

A screening tool utilized by nurses at a critical point in the discharge planning process has the potential to improve caregiver decisions and enhance communication. The Early Screen for Discharge Planning-Child version (ESDP-C) identifies pediatric patients early in their hospital stay who will benefit from early engagement of a discharge planner. This study used a quasi-experimental, non-equivalent comparison group design to evaluate the impact of the ESDP-C on important outcomes related to discharge planning. Findings from the study provide preliminary evidence that the integration of the ESDP-C into the pediatric discharge planning process may be clinically useful.

Developing and testing a discharge planning decision support tool for hospitalized pediatric patients.

PURPOSE: To develop and test a decision support tool that identifies patients who would benefit from early consult with discharge planners. DESIGN AND METHODS: A predictive, correlational design was used with parents/guardians of children (1 month to 18 years; N = 197). Data were collected by interviews and record reviews. Expert consensus determined referral to discharge planning. RESULTS: Mean age was 8.7 years; mean length of stay was 7.5 days. Forty percent (n = 79) were identified for early referral. The variable "substantial post-acute care needs" had the strongest association with expert consensus (internally validated AUC = 0.79). PRACTICE IMPLICATIONS: Findings from this study provide preliminary evidence for a decision support tool to improve the discharge planning process by reducing individual decision-making variability through systematic matching of patient needs to service delivery.

Discordance between urine pH measured by dipstick and pH meter: implications for methotrexate administration protocols.

OBJECTIVES: To minimize toxicity of high-dose methotrexate (MTX) therapy, urinary alkalinization with frequent monitoring of urine pH is required. Urine pH is usually assessed by fast and convenient dipstick methods. When urine color interferes with dipstick measurement, as occurs in patients receiving MTX, alternative methods such as pH meters are used. Nursing staff caring for patients on high-dose MTX reported that urine pH results from dipstick and pH analyzers were often clinically discordant. As a result urine pH by dipstick and pH meter were compared in patients on high-dose MTX therapy and patients with normal-colored urine samples. DESIGN AND METHODS: We measured urine pH by dipstick and pH meter in 116 urine samples from 4 patients receiving high-dose MTX therapy, and in 50 normal-colored urine samples from 50 patients not on MTX therapy. RESULTS: In patients on MTX therapy the mean (±standard deviation) bias between dipstick and pH meter urine pH was 0.7±0.4, compared to 0.4±0.3 in patients not on MTX. For patients on MTX clinical concordance between dipstick and pH meter urine results was poor around a clinical cut-off of pH 8.0. Of the 92 samples with a meter urine pH≤8.0, 72 had a discordant value by dipstick (pH>8). CONCLUSIONS: Urine pH readings by dipstick and pH meter are not equivalent, and the bias between them is exacerbated in patients on MTX. Institutions with high-dose MTX therapy protocols should not alternate between dipstick and pH meter urine pH monitoring.