Saturday, June 23, 2012

Quality and Safety Mini Grant Program Update

The MassGeneral Hospital for Children Quality and Safety Team has continued its Mini Grant Program for a second year. This year, the team was able to support four projects whose focus ranged from interventions in the Neonatal Intensive Care Unit (NICU) to a handoff checklist for postoperative patients admitted to the Pediatric Intensive Care Unit (PICU).

At the midpoint of project completion, each project has progressed as follows:

Time to Antibiotics in Seriously Ill Children at MGHfC

Team Leader: Brian Cummings, MD

The collaborative effort between the pediatric emergency department and the PICU aims to improve the time of antibiotic administration for patients admitted to the PICU from the emergency department. Through a multidisciplinary approach between these two departments, in addition to the pharmacy, the team is working to increase the percentage of septic patients receiving antibiotics prior to leaving the emergency department for the PICU by 50 percent. They are currently working on stocking SureMed in the emergency department with select antibiotics.

The Safe Patient Handoff Checklist for Postoperative Patients

Team Leaders: Chetan Bhupali, MD, and Brian Cummings, MD

Dr. Bhupali, Dr. Cummings and their team aim to improve the cohesiveness and timeliness of postoperative patient handoff. Postoperative patients often arrive in the PICU accompanied by Anesthesia and Nursing staff, but a surgical representative is not always present. The team has designed a handoff checklist, which will be used for all postoperative patients coming to the PICU. Use of the checklist and improved communication between the surgical services and the medical service during the handoff is expected to improve the transfer of care as well as the family perception of teamwork in the PICU.

Optimizing Nutrition and Growth in the Neonatal Intensive Care Unit

Team Leader: Joe Chou, MD

A review of weight percentile changes of premature infants in the NICU demonstrated impaired growth between birth and discharge. The team plans to improve nutrition and growth outcomes for infants during their NICU hospitalization by reducing the average weight loss percentile from birth to discharge. Thus far, electronic growth charts and web-based calculators have been developed to evaluate growth (, in addition to observed improvements in growth outcomes that exceeded initial expectations. Upon completion of the project, the team plans to develop templates in POE to optimize nutrition delivery.

Initiate Non-Invasive Ventilator Strategy in the Delivery Room to Reduce Chronic Lung Disease in Premature Infants

Team Leader: Ting-Yi Lin, MD

In an effort to reduce injuries from the use of mechanical ventilation in premature infants, this team has initiated continuous positive airway pressure (CPAP) use in the delivery room. This initiative aims to reduce the incidence of chronic lung disease and improve quality of life for premature infants. With the implementation of early CPAP, the goal is to reduce the rate of bronchopulmonary dysplasia in < 34 week gestational age infants by 20 percent. The team has developed a standardized guideline for applying early CPAP and designed three portable CPAP apparatus for the delivery room that can be transported with the infant to the NICU.

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