RESUMO
Background: Diabetes is an immunocompromising condition, and diabetic children should receive the 23-valent pneumococcal polysaccharide (PPSV23) vaccine as part of their preventive care because of their increased risk for invasive pneumococcal disease. This recommendation is often not followed, however, and at our institution, we discovered that a factor limiting vaccine administration was lack of knowledge about the recommendation among residents. Methods: Our objective with this quality improvement initiative was to improve pneumococcal vaccination rates among the inpatient pediatric diabetic population to 70% in 6 months. Three education and awareness initiatives were conducted during the postintervention period of March 2021 to August 2021 at St. Mary Medical Center in Shreveport, Louisiana. All pediatric diabetic patients from age 2 to 18 years who were admitted to the inpatient general pediatrics or critical care services were included. The primary outcome was vaccination with PPSV23. Results: We studied 63 pediatric patients with a mean age of 12.7 years. The vaccination ordering rate during the 6 months prior to the implementation of the quality improvement initiatives was 41%. In the 6 months postintervention, the overall vaccination ordering rate improved to 81%. During data collection, however, we discovered that even though the residents were assessing for vaccine eligibility and ordering the vaccines, not all vaccines were administered prior to discharge. In the preintervention period, the overall vaccine administration rate was 27%, improving to 42% in the postintervention period. Conclusion: Simple interventions that included resident education, development of a smart phrase in the electronic medical record, and liaison with pharmacy led to an increase in the pneumococcal vaccination ordering rate for pediatric patients with diabetes. However, we did not anticipate that the vaccination ordering and administration rates would be different when we initiated the project and had therefore focused our interventions on resident education only. Our discovery of the difference between vaccination ordering and vaccination administration helped identify 2 other areas for improvement: nursing education and additional improvement of the electronic medical record.
RESUMO
Background: Respiratory distress is a clinical finding often seen in neonates. Common causes of respiratory distress in this population include respiratory distress syndrome, transient tachypnea of the newborn, infection, aspiration, and cardiac etiologies. We present the case of a neonate who presented with respiratory distress with no identifiable cause on initial workup. The patient was eventually found to have a variant of a genetic mutation that predisposed the infant to this presentation. Case Report: A term male infant born via spontaneous vaginal delivery was admitted to the pediatric service at 3 weeks of age because of tachypnea. Chest x-ray showed perihilar infiltrates. Septic screen, thyroid function test, sweat test, echocardiogram, intracranial ultrasound, and modified barium swallow were normal. Computed tomography scan of the chest showed ground glass opacities in the upper and lower lobes. Airway evaluation showed no evidence of obstruction or anatomic abnormalities. Bronchoscopy showed no masses or tracheomalacia. Bronchoalveolar lavage was negative for infection. The infant was treated with intravenous antibiotics, steroids, and furosemide but continued to be tachypneic and required supplemental oxygen. Genetic studies were obtained to assess for surfactant deficiencies, and the patient was transferred to another center for a higher level of care. Genetic evaluation was positive for NKX2.1 variance mutation C.190C. The patient's symptoms improved, and he was weaned to room air by 3 months of age. Conclusion: When evaluating a child with unexplained pulmonary disease, clinicians should have a high index of suspicion for interstitial lung disease including surfactant protein mutations.
