Evaluating an urban pediatric hospital's scald burn prevention program.

BACKGROUND: Over 450,000 individuals are hospitalized with burns annually and roughly 35% are scald burns. Children younger than 5 years of age are at the greatest risk of scald burn injury. Caregiver burn prevention programs have been found to reduce the prevalence of injuries in young children; however, low-income and underserved populations seldomly have access to these programs. The impact of scald burn prevention programs in underserved populations remains unexplored. The objective of the current study was to evaluate the efficacy of a scald burn prevention program at a Level One Pediatric Trauma Center in a low-income, underserved community. METHODS: Our hospital developed a one-hour scald burn prevention program for caregivers with children 5 years of age or younger. The program educated caregivers on ways to prevent scald burns and create safeguards in their home. Caregivers completed a pre-post survey to measure their ability to identify hot or cold objects, as well as respond to items about their perceptions of the program's utility, their willingness to share it with others, and the likelihood that they would use the information in the future. Data was analyzed using a paired t-test. RESULTS: Two-hundred and sixty-nine (N = 269) caregivers participated in the program. Before the program, caregivers could identify potentially hot objects 83.17% of the time, and after the program, they were able to identify these items 92.31% of the time: t (268) = 12.46, p < .001, d = 1.07. Additionally, 95% of caregivers indicated that the program was helpful, 99% stated that they were likely to share this information with others, and 100% indicated that they would use the information from the program. CONCLUSIONS: Education is a critical component to prevent scald burns. Results indicate that a hospital-led scald burn prevention program can positively impact a caregiver's ability to identify possible scald-burn risks. Providing education to caregivers who typically do not receive this information could lower the prevalence of scald burns not only institutionally, but in communities that are disproportionately impacted by this mechanism of injury.

Measuring the effectiveness of a car seat program in an urban, level one pediatric trauma center.

BACKGROUND: Motor vehicle collisions (MVCs) are a significant safety issue in the United States. Young children are disproportionally impacted by car accidents and suffer high rates of injuries and mortality. When used properly, car seats have been found to reduce the severity of injuries. However, individuals from low-income areas often do not have access to education or car seats compared to those in suburban or higher income areas. Therefore, the goal of the present study was to measure the effectiveness of a car seat program in an urban, Level I Pediatric Trauma Center on caregiver car seat knowledge. METHODS: Caregivers (N = 200) attended a single, one-hour car seat educational program with a Child Passenger Safety Technician (CPST). The sessions included educational and hands-on components, where caregivers were asked to complete a seven-item pre-post knowledge assessment. For completion of the course, caregivers received a car seat for their child. RESULTS: A paired t-test revealed that the workshop significantly increased caregiver knowledge from pre-post: t (199) = - 12.56, p < .001; d = 1.27. McNemar's Chi-Square analyses displayed that caregivers increased in all knowledge categories (p < .001). CONCLUSIONS: While caregivers in urban areas or in low-income areas may have less access to resources, hospital-led car seat courses can increase knowledge of proper car seat usage in these communities. These findings should be used to establish programs in hospitals in areas where these resources are not readily available to caregivers.

Implementation of an Abusive Head Trauma Prevention Program Through Interdisciplinary Collaboration: A Pilot Study.

BACKGROUND: Shaken baby syndrome/abusive head trauma (SBS/AHT) is the leading cause of child abuse death. Our institution piloted an evidence-based educational program to increase nurse and caregiver knowledge about SBS/AHT. METHODS: Nurses participated in a pretest survey, completed online implementation training, and then were given a posttest survey to determine the change in SBS/AHT knowledge. Once trained, nurses disseminated information to caregivers with children younger than 6 months. Caregivers (N = 87) watched an educational video, reviewed information in a booklet with a nurse, and participated in teach-back related to key points of the intervention in both a hospital and the community setting. RESULTS: Prior to the education, nurses (n = 115) scored 8.03 out of 10.00 on the SBS/AHT assessment. Following the intervention, nurses (n = 120) scored 9.00 out of 10.00 on the assessment, t(233) = -6.61, p < .001. During education, caregivers (n = 69) were able to recall 8.55 out of 12 key educational components. In the community setting, caregivers (n = 18) worked together to recall 12 out of the 12 key components. Caregivers were most likely to recall ways to comfort their crying baby (94%) and why shaking a baby is dangerous (93%). CONCLUSION: This pilot study significantly increased nurses' knowledge of SBS/AHT and provided education to caregivers about SBS/AHT.

The Use of an Autologous Cell Harvesting and Processing Device to Decrease Surgical Procedures and Expedite Healing in Two Pediatric Burn Patients.

INTRODUCTION: Autologous cell harvesting and processing devices are designed to facilitate the harvesting of cells using enzymatic and physical disruption techniques to immediately apply non-cultured autologous cell suspension (ACS) to the wound area. OBJECTIVE: This case report evaluates clinical outcomes following application of cellular suspension with split-thickness skin grafts (STSGs) as an adjunct for definitive closure of burn injuries and donor sites in 2 pediatric patients. MATERIALS AND METHODS: The cases were performed under a humanitarian use protocol following institutional review board approval at St. Christopher's Hospital for Children (Philadelphia, PA). RESULTS: The first patient was a 4-year-old girl with partial- and full-thickness (32% total body surface area) burn injuries of her head, trunk, flank, arms, thighs, and feet. The patient was discharged 19 days following ACS treatment. The second patient was an 18-month-old girl with partial- and full-thickness (21% total body surface area) burns involving the bilateral lower extremities. She was discharged 22 days after ACS treatment with widely meshed autograft. Neither patient required additional surgical interventions. All treatment and donor areas for both patients remained uninfected and neither patient experienced any unexpected treatment-related adverse events. CONCLUSIONS: These cases are the first of their kind reported in the pediatric population and suggest ACS in conjunction with STSGs can help decrease surgical procedures and expedite healing in pediatric patients with large surface burns.

Stop the Bleed Training Improves Knowledge, Skills, and Confidence Among School Nurses.

BACKGROUND: School nurses play an integral part in prehospital care for life-threatening bleeding in educational environments. This study evaluated the efficacy of Stop the Bleed training for improving school nurses' knowledge, hands-on skill, self-confidence, and belief in school preparedness for responding to a life-threatening bleeding emergency. METHOD: Sixteen northeastern U.S. public school nurses completed a 1-hour seminar on appropriate life-threatening bleeding intervention with written and hands-on pre- and postassessments. Written assessments measured bleeding control knowledge, self-confidence, and perceptions of school preparedness. Hands-on assessments measured tourniquet application and wound-packing skills. RESULTS: After training, participants scored significantly higher on the written assessment measuring basic bleeding control knowledge. The written postassessment showed significantly higher levels of self-confidence and belief in school preparedness (p ≤ .05, n = 16). Hands-on skill for tourniquet application and wound packing also significantly increased following training (p ≤ .05, n = 16). CONCLUSION: The Stop the Bleed training was effective in improving school nurses' basic knowledge about life-threatening bleeding control and improved tourniquet application and wound-packing skills. [J Contin Educ Nurs. 2019;50(11):501-507.].

Practice makes perfect: The impact of Stop the Bleed training on hemorrhage control knowledge, wound packing, and tourniquet application in the workplace.

INTRODUCTION: The national Stop the Bleed (STB) campaign was implemented in 2015 to provide hemorrhage control education to non-medical providers to reduce the number of deaths due to uncontrolled hemorrhage. Hands on training limits the availability of this program, and its importance is not known amongst lay providers. This study aimed to evaluate the efficacy of STB training for laypersons on knowledge and skill-based abilities in the workplace setting. We hypothesized such hands on and in-person training would improve performance. METHODS: Non-medical potential first responders (PFR; N = 298) participated in STB training comprised of a lecture and hands-on component. PFRs completed a bleeding control knowledge-based pre-and post-assessment. Following the lecture, participants were divided into experimental and control groups during which hands-on practice was manipulated to determine the impact of guided practice on wound packing and tourniquet application. Wound packing and tourniquet application assessments were performed and scores compared between the experimental and control groups. RESULTS: PFRs scored higher on the bleeding control bleeding control knowledge-based post-test (M = 4.63, SD = 1.32) than on the pre-test (M = 3.21, SD = 1.14). Employees in the experimental group (M = 2.93, SD = .26) also scored significantly higher than the control group (M = 1.97, SD = .77) that attempted wound packing without any hands-on training. PFRs in the experimental group scored significantly higher (M = 7.41, SD = .91) than PFRs in the control group (M = 5.99, SD = 1.81) for tourniquet application. CONCLUSION: Knowledge related to hemorrhage control increased following the STB course. Participants who engaged in hands-on practice for tourniquet and wound packing were more proficient than those who only saw the lecture. We confirm that in person, hands on training is key to the success of lay STB training.

Cohorting Trauma Patients in a Medical/Surgical Unit at a Level I Pediatric Trauma Center to Enhance Interdisciplinary Collaboration and Documentation.

Medical errors are a significant issue in health care that may be avoided through enhanced communication and documentation. This study examines interdisciplinary communication and compliance with trauma standards of care demonstrated through following the implementation of cohorting trauma patients to one medical/surgical unit and instituting daily interdisciplinary trauma patient rounds. Potential benefits include enhanced communication, improved nursing satisfaction, and increased compliance with trauma standards of care demonstrated through documentation, which the literature suggests improves quality of care. Pre- and postcohorting surveys related to safety attitudes, comfort with caring for trauma patients, and the efficacy of cohorting were administered to the nursing staff. As a marker for increased compliance with trauma standards of care, medical records were reviewed for completion of substance abuse screening upon admission and Functional Independence Measure screening at discharge. The results were compared after the cohorting initiative with 2 years prior. The rate of compliance with substance abuse screening increased from an average of 62.5% in 2015 and 2016 to 84% in 2017. Functional Independence Measure compliance increased from an average of 72.5% in 2015 and 2016 to 94% in 2017 following the cohorting intervention. Nursing perceptions of teamwork, safety climate, and staff support significantly improved (p < .05) from pre- to postcohorting surveys. Improvements were noted in comfort with performing tasks associated with caring for trauma patients but were not statistically significant. Cohorting trauma patients to one medical/surgical unit resulted in positive perceptions of professional relationships, improved communication, and compliance with trauma standards of care for documentation.