scholarly journals Correction to: Prevention of spinal fusion post-operative wound infections in pediatric patients with scoliosis: a quality improvement initiative

2021 ◽  
Author(s):  
Elizabeth Partridge ◽  
Dean Blumberg ◽  
Rolando F. Roberto
Keyword(s):  
Quality Improvement ◽  
Spinal Fusion ◽  
Pediatric Patients ◽  
Original Version ◽  
Quality Improvement Initiative ◽  
Wound Infections ◽  
Operative Wound

The original version of this article unfortunately contained a mistake.

scholarly journals Prevention of spinal fusion post-operative wound infections in pediatric patients with scoliosis: a quality improvement initiative

2021 ◽  
Author(s):  
Elizabeth Partridge ◽  
Dean Blumberg ◽  
Rolando F. Roberto
Keyword(s):  
Quality Improvement ◽  
Spinal Fusion ◽  
Infection Rate ◽  
Neuromuscular Scoliosis ◽  
Quality Improvement Intervention ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Wound Infections ◽  
Deep Wound ◽  
Operative Wound

Abstract Purpose Post-operative wound infections increase patient morbidity and mortality as well as the length of hospital stay, with a profound personal and institutional cost. The aim of this study was to decrease post-operative infections through development of a surgical antibiotic prophylaxis policy based on institution-specific risk factors and microbiology data. Methods We conducted a retrospective review of deep wound infections at our institution over a 5-year period (2014–2018). 399 spinal fusion procedures were performed with a 2.5% post-operative infection rate. Patients with neuromuscular scoliosis were six times more likely to develop deep wound infections (7.6%) compared to patients with congenital and idiopathic scoliosis (combined rate of 1.25%). The microbiology data revealed that polymicrobial, extended spectrum beta-lactamase (ESBL) gram negative organisms predominated in patients with neuromuscular scoliosis. Based on these findings, we implemented an evidence-based quality improvement intervention: all patients with neuromuscular scoliosis undergoing spinal fusion were given a single 15 mg/kg dose of amikacin, in addition to our standard practice of perioperative cefazolin plus vancomycin with intra-operative betadine wash and vancomycin powder application. This intervention was put into practice in January 2019. Results Since the implementation of our quality improvement initiative, the overall post-operative infection rate decreased to 1.1% (2 infections in 176 cases). Ninety-eight percent of the 43 neuromuscular scoliosis patients who underwent spinal fusion in the post-intervention time frame have remained infection free. Conclusion Examination of post-operative infection and microbiology data at the institution level can guide the development of institution specific, evidence-based quality improvement initiatives that reduce post-operative wound infections.

A Multidisciplinary Quality Improvement Initiative to Facilitate Penicillin Allergy Delabeling Among Hospitalized Pediatric Patients

2021 ◽  
Vol 11 (5) ◽  
pp. 427-434
Author(s):  
Maureen Egan Bauer ◽  
Christine MacBrayne ◽  
Amy Stein ◽  
Justin Searns ◽  
Allison Hicks ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pediatric Patients ◽  
Penicillin Allergy ◽  
Quality Improvement Initiative

A Retrospective Quality Improvement Study of Ketorolac Use Following Spinal Fusion in Pediatric Patients

2010 ◽  
Vol 29 (5) ◽  
pp. 342-343 ◽  
Author(s):  
Pamela L. Horn ◽  
Sharon Wrona ◽  
Allan C. Beebe ◽  
Jan E. Klamar
Keyword(s):  
Quality Improvement ◽  
Spinal Fusion ◽  
Pediatric Patients

scholarly journals Neurosurgical Post‐Operative Wound Infections: A retrospective study on surgical site infections for quality improvement

2020 ◽  
Vol 17 (4) ◽  
pp. 1039-1046
Author(s):  
Brian Fiani ◽  
Alessandra Cathel ◽  
Kasra J. Sarhadi ◽  
Jordan Cohen ◽  
Javed Siddiqi
Keyword(s):  
Quality Improvement ◽  
Retrospective Study ◽  
Surgical Site Infections ◽  
Wound Infections ◽  
Operative Wound

scholarly journals A standardized protocol to reduce preoperative hypothermia in pediatric spinal fusion surgery: a quality improvement initiative

2021 ◽  
pp. 1-4
Author(s):  
Katrina Ducis ◽  
R. Dianne Seibold ◽  
Tylyn Bremer ◽  
Andrew Jea
Keyword(s):  
Quality Improvement ◽  
Spine Surgery ◽  
Surgical Procedure ◽  
Pediatric Patients ◽  
Subcutaneous Fat ◽  
Surgical Patients ◽  
Quality Improvement Initiative ◽  
Spinal Fusion Surgery ◽  
Increased Risk ◽  
Spinal Deformity Surgery

OBJECTIVEHypothermia in adult surgical patients has been correlated with an increase in the occurrence of surgical site wound infections, increased bleeding, slower recovery from anesthetics, prolonged hospitalization, and increased healthcare costs. Pediatric surgical patients are at potentially increased risk for hypothermia because of their smaller body size, limited stores of subcutaneous fat, and less effective regulatory capacity. This risk is exacerbated during pediatric spinal surgery by lower preoperative temperature, increased surface exposure to cold during induction and positioning, and prolonged surgical procedure times. The purpose of this quality improvement initiative was to reduce the duration of hypothermia for pediatric patients undergoing spine surgery.METHODSDemographic and clinical data were collected on 162 patients who underwent spinal deformity surgery between October 1, 2017, and July 31, 2019. Data points included patient age, gender, diagnosis, surgical procedure, and temperature readings throughout different phases of perioperative care. Temperatures were obtained upon arrival to the day of surgery, upon presentation to the operating room, during prone positioning, at incision, and at the end of the procedure. Twelve patients were analyzed prior to implementation of a protocol, while 150 patients composed the post-protocol group.RESULTSUsing descriptive statistics, the authors found that the average body temperature at the time of incision was 34.0°C prior to the adoption of a preoperative warming protocol, and 35.3°C following a preoperative warming protocol (p = 0.001). There were no complications, such as burns, hyperthermia, or arrhythmias, related to preoperative warming of patients.CONCLUSIONSThe placement of a warming blanket on the bed prior to patient arrival and actively targeting normothermia reduced the incidence and duration of hypothermia in pediatric patients undergoing spine surgery with no adverse events.

scholarly journals Optimizing Pediatric Esmolol Dosing Using Computerized Practitioner Order Entry

2014 ◽  
Vol 19 (4) ◽  
pp. 302-309
Author(s):  
Tihua Chao ◽  
James C. Perry ◽  
Gale L. Romanowski ◽  
Adriana H. Tremoulet ◽  
Edmund V. Capparelli
Keyword(s):  
Intensive Care ◽  
Quality Improvement ◽  
Pediatric Patients ◽  
Vital Signs ◽  
Therapeutic Targets ◽  
Systemic Hypertension ◽  
Quality Improvement Initiative ◽  
Concurrent Administration ◽  
Protocol Adherence ◽  
Target Effect

OBJECTIVES: The aims of this study were to 1) describe the cardiovascular dose-response of esmolol and dose-limiting adverse effects in pediatric patients; 2) assess an institutional guideline for protocol adherence, efficacy, and achievement of therapeutic targets for pediatric patients with tachyarrhythmias or systemic hypertension; and 3) revise the protocol accordingly. METHODS: In this prospective study, pediatric/neonatal subjects were identified using a medication utilization report in the electronic medical record and treated with esmolol for blood pressure or rhythm control at Rady Children's Hospital San Diego between November 1, 2012, and February 28, 2013. Inclusion criteria required subjects to be under intensive care and have bedside telemetry monitoring. Data collection consisted of patient demographic information, administration history of esmolol, concurrent administration of other cardiovascular medications, patient cardiovascular goals, and vital signs. RESULTS: A total of 8 subjects representing 10 administrations of esmolol were included in the study. Whereas esmolol was found to be safe and effective overall for control of hypertension and tachyarrhythmia, protocol adherence was poor, leading to subtherapeutic dosing schemes, dose changes prior to achievement of presumed steady-state pharmacokinetics, and erratic dosing to target effect. CONCLUSIONS: After the review, the data were revealed at a program-wide conference and consensus was reached on a new, data-driven protocol. As a result of this quality improvement initiative, the new protocol provides more precise dosing and clearly delineated therapeutic targets and is designed to reflect specific esmolol pharmacokinetics. The effort emphasizes the need to construct foundations for follow-up quality improvement efforts in intensive care pharmacology.

scholarly journals Ultrasound guidance for pediatric vein cannulation: an emergency nurse quality improvement initiative and registry

2020 ◽  
Vol 43 (2) ◽  
pp. 8-9
Author(s):  
Domhnall O Dochartaigh ◽  
Christopher Picard ◽  
Warren Ma ◽  
Richard Drew ◽  
Tahira Daya ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pediatric Patients ◽  
Linear Increase ◽  
Lessons Learned ◽  
Quality Improvement Initiative ◽  
Independent Practice ◽  
Ultrasound Guided ◽  
University Of Alberta ◽  
First Pass ◽  
Trained Staff

Background Between 10 and 25 percent of pediatric patients present to the emergency department (ED) with difficult to cannulate veins. Recent RCT evidence suggests that in pediatric patients assessed at being a predicted difficult IV start (by DIVA score of 3 or more), ultrasound guided catheter placement decreased the number of IV attempts, decreased time to successful IV placement, and improved first pass success, patient satisfaction, and catheter dwell time. Our QI project examines the specific learnings around ultrasound guided peripheral IV in pediatric patients and suggests opportunity for non-pediatric specialist hospitals to consider with the overall aim of minimizing IV attempts on all pediatric patients within our EDs. Building on a RCT led by Dr Curtis in pediatrics patients conducted at the Stollery from 2012-2014, a standardized ultrasound guided nurse performed procedure was implemented in 2016 at the University of Alberta and Stollery EDs, and expanded to the Royal Alexandra ED in 2017 and the Misericordia ED in 2019. Using the same education package and QI study methodology as previously reported in adult patients this study focused specifically on pediatric patients. Methods A quality improvement (QI) registry was utilized to track complications and success of pediatric patients at all sites. The aim was to assess for program success, and improve education, training, and procedural success as required. Staff who had achieved independent practice voluntarily completed a tracking form whenever an ultrasound procedure occurred. Completed forms were assessed on a continual basis for any opportunities for improvement. Qualitative feedback was also obtained from informal interviews, a focus group, and a survey of the trained nurses. Feedback was thematically analyzed and grouped into themes for reporting. Results There were no reported pediatric UGIV placed at the MCH and RAH during the study period. At the Stollery 126 cases were reported. Immediate insertion complications were noted in three cases as ‘pain or swelling at site’, and ‘unable to advance catheter’. In the first and second years of data collection the average number of traditional IV attempts prior to UGIV attempt decreased from 3.9 to 2.8; first ultrasound pass success increased from 65% to 86%; overall ultrasound success improved from 85% to 97.6% respectively. Increasing nurse skill was significant with a linear increase of first pass and overall success seen with increasing number of ultrasound starts: From 6-20 starts (54% first pass 64% overall success) through to >150 starts (97% first pass and 100% overall). QI staff feedback included ensure adequate pediatric specific supplies such as longer length small gauge catheters, and a procedural focus of patient, provider, and assistant set up. Location of IV placement was noted to change in a number of cases from hand and A/C to forearm. Advice and Lessons Learned The key for staff to transition to procedural competance was to ensure initial and ongoing oportunities to place many ultrasound guided IVs (i.e. when time allows in all patients with non-optimal IV placement locations or with non-easy predicted tradititional IV starts) Further work is required at non specilaist hospitals with trained staff to increase ultrasound guided use in pedatric patients At all particapting sites work continues on unit level QI to minimize the number of IV attempts on all pedatric patients as well as work towards a cohort of available staff that are comforable and competent with ultrasound that can provide 24/7 unit coverage. (with limited numbers of trained staff there is increase burden on these staff to assist others while also completing their own nursing assignment.

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