Strategies for Success in Regulatory Readiness.

This article describes the formation of a Regulatory Advisory Council to address regulatory preparedness. The council used quality improvement methods to address data and findings from previous mock surveys and created 2 categories of work, an environment of care and clinical standards group, with checklists and work streams to improve organizational success with regulatory readiness.

New knowledge, innovations, and improvement in a Magnet® Children's Hospital Cardiac Center.

Bedside nurses involved in research and evidence-based practice (EBP) have the ability to change policies, patient care, and outcomes. This article describes the journey of a research committee using the Magnet® component of new knowledge, innovation, and improvements. Using several tools, the unit-based committee developed skills in meeting management, nursing research methods, and EBP. Focusing to improve family and nurse communication about the plan of care, the committee recommended changes in the existing Plan of Care tool, including family input and recommendations for families to view and add to the sheet and participate in daily rounds, which was not the standard practice. Since this intervention was implemented, patient satisfaction has increased, as well as nurse engagement and intent to stay. This project exemplifies how nurse-driven innovations and family partnership led to new knowledge, innovations in learning about research, applying it to practice, and improving practice.

Groundwater heat pump feasibility in shallow urban aquifers: Experience from Cardiff, UK.

Ground source heat pumps have the potential to decarbonise heating and cooling in many urban areas. The impact of using shallow groundwater from unconsolidated sedimentary aquifers for heating in urban areas is often modelled, but rarely validated from field measurements. This study presents findings from the 'Cardiff Urban Geo-Observatory' project. This study focuses on an experimental open loop ground source heat pump scheme retrofitted to a school building. Field monitoring for three years between 2015 and 2018 provided data on the environmental impact of the scheme on aquifer conditions. Average aquifer thermal degradation in the first three years was kept below 2 °C, with a maximum change of 4 °C measured during the heating season. The numerically modelled predictions of thermal degradation around the production and injection wells are compared with long-term field monitoring data, providing new insights into both aquifer, and user, behaviour. The Seasonal Performance Factor (SPFH4) of the pilot installation was 4.5 (W13/W50) in the monitoring period. An initial thermal resource estimation of the wider aquifer volume suggests that lowering the temperature of the aquifer by 8 °C could generate equivalent to 26% of the city's 2020 heating demand, but achievable heat extraction would in reality, be less. The study concludes that large parts of the aquifer can sustain shallow open loop ground source heat pump systems, as long as the local ground conditions support the required groundwater abstraction and re-injection rates. Future schemes can be de-risked and better managed by introduction of a registration of all GSHP schemes, with open sharing of investigation, design and performance monitoring data, and by managing thermal interference between systems using spatial planning tools.

Threatened efficiency not autonomy: Prescriber perceptions of an established pediatric antimicrobial stewardship program.

BACKGROUND: Implementing antimicrobial stewardship programs (ASPs) can be challenging due to prescriber resistance. Although barriers to implementing new ASPs have been identified, little is known about how prescribers perceive established programs. This information is critical to promoting the sustainability of ASPs. OBJECTIVE: To identify how prescribers perceive an established pediatric inpatient ASP that primarily utilizes prior authorization. METHODS: We conducted a cross-sectional survey administered from February through June 2017 in a large children's hospital. The survey contained closed- and open-ended questions. Descriptive statistics and thematic content analysis approaches were used to analyze responses. RESULTS: Of 394 prescribers invited, 160 (41%) responded. Prescribers had an overall favorable impression of the ASP, believing that it improves the quality of care (92.4% agree) and takes their judgment seriously (73.8%). The most common criticism of the ASP was that it threatened efficiency (26.0% agreed). In addition, 68.7% of respondents reported occasionally engaging in workarounds. Analysis of 133 free-text responses revealed that prescribers perceived that interacting with the ASP involved too many phone calls, caused communication breakdowns with the dispensing pharmacy, and led to gaps between approval and dispensing of antibiotics. Reasons given for workarounds included not wanting to change therapy that appears to be working, consultant disagreement with ASP recommendations, and the desire to do everything possible for patients. CONCLUSIONS: Prescribers had a generally favorable opinion of an established ASP but found aspects to be inefficient. They reported engaging in workarounds occasionally for social and emotional reasons. Established ASPs should elicit feedback from frontline prescribers to optimize program impact.

Home Is Where the HeartWare Is: Preparing Pediatric Patients and Caregivers for Discharge to Home and Integration Into the Community.

The Cardiac Center at The Children's Hospital of Philadelphia has cared for patients with implanted ventricular assist device (VAD) technology since 1998. Historically, patients requiring VAD support were managed exclusively in the Cardiac Intensive Care Unit with the first medically stable transition to the Cardiac Care Unit (step-down) taking place in 2001. Patient management was confined to the inpatient setting, as the primary device used at the time was paracorporeal and not suitable for home use. Continuous-flow devices, such as the HeartWare HVAD, have gained popularity because of miniaturized size and lower profiles of side effects and adverse events, making them more suitable for home use. This article describes a single-center experience with transitioning the VAD-supported pediatric patient to the outpatient setting, highlighting outcomes, strategies, and lessons learned in order to support VAD patients and their caregivers in the hospital and community setting.