Pilot testing of 10 quality measures

The 10 quality measures that met criteria for pilot testing across freestanding children’s hospitals were implemented in 9 C4-MNP collaborating centers over the course of a six-month pilot testing phase that began in January 2016. Sites were selected based on their available resources to support data collection, and their ongoing participation in the Children’s Hospital Association Pediatric Health Information System (PHIS).

Pilot testing concluded in September 2016. Dissemination of the pilot testing data is underway. Variation in nursing workforce characteristics were reported across pilot sites, including the proportion of registered nurses (RNs) with 0-2 years of experience, the proportion of RNs with a Bachelor of Science in Nursing, and the proportion of RNs with certification. For detailed results, please review the C4-MNP Phase III Aggregate Result Report.

Quality measure feasibility and usability were also assessed at the conclusion of pilot testing. With the exception of pain score reduction, all pilot measures were deemed feasible to implement. Eight of the ten measures received a score of ≥75% for their ability to be used for internal quality improvement; confirming, changing, or standardizing practice; increasing efficiency; and improving patient outcomes. For detailed results, please review the C4-MNP Phase III Measure Feasibility and Usability Aggregate Result Report.

Results from this work will support initial development of benchmarks and evaluation of the association of the quality measures with patient outcomes.

For a list of the quality measures tested and detailed measurement plans, navigate to Quality Measures.

Benchmarking nursing structure measures

C4-MNP centers have endorsed annual data collection and benchmarking for the five nursing workforce structure measures. Development of the annual measurement and benchmarking process is underway, and will launch in 2019.

Pediatric Critical Care Nurses Use of an Evidence-Based Pressure Injury Prevention Clinical Practice Guideline

The purpose of this dissertation research project is to describe pediatric critical care nurses’ knowledge of, value for, and implementation of evidence-based practice and the use of an evidence-based pressure injury prevention clinical practice guideline. Data collection concluded in December 2018 and data analysis is underway.

Measuring the Acuity of Pediatric Critical Care Nursing using the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) – A Multi-site Experience

The aim of this multisite prospective cohort study is to utilize the internally validated CAMEO© acuity tool to describe the cognitive workload complexity of pediatric critical care nursing across eight children’s hospitals. The CAMEO defines acuity in terms of nursing cognitive workload complexity, the intellectual processing of information about patients that drives critical thinking, decision-making and the resulting level of surveillance necessary to meet patient needs. For more information about the CAMEO tool, please review our CAMEO publication. This study will seek to enroll 800 (100 patients per site) pediatric patients admitted to intensive care units across participating sites to externally validate the tool.

Cardiovascular Operating Room (CVOR) Health of the Work Environment (HWE) Benchmarking

The aims of this improvement science project were to (1) assess the health of the work environment in CVORs across free-standing children’s hospitals in the U.S. by engaging CVOR leadership to disseminate the American Association of Critical Care Nurses (AACN) HWE survey, and (2) use the results to establish targets for benchmarking. For detailed results, please review the C4-MNP CVOR HWE Assessment Aggregate Report.

Simulation for Cardiac Nursing Orientation State of Nursing Practice Assessment

The aims of this project were to (1) develop and disseminate a survey to assess whether simulation is utilized as a teaching tool for nurses in CICU’s across free-standing children’s hospitals in the U.S., and (2) work with the Pediatric Cardiac Intensive Care Society (PCICS) to propose a standardized CICU Nurse Orientation Curriculum. For detailed results, please review the C4-MNP Simulation for Nursing Orientation Aggregate Result Report.

Hydrocortisone for Adrenal Insufficiency State of Nursing Practice Assessment

The aims of this project were to (1) develop and disseminate a survey to assess the state of nursing practice around the use of hydrocortisone in the post-operative period and (2) identify variation in current practice in order to inform advancement of standardization. For detailed results, please review the C4-MNP Hydrocortisone Use State of Practice Aggregate Report.

Use of Chlorhexidine Gluconate (CHG) State of Nursing Practice Assessment

The aims of this project were to (1) develop and disseminate a survey to assess the state of nursing practice around the use of CHG in patients less than two months of age and (2) identify variation in current practice in order to inform advancement of standardization. Data collection and analysis are complete, and development of the aggregate result report is underway.

Pediatric Critical Care Cardiac Education State of Nursing Practice Assessment

The aims of this project are to (1) develop and disseminate a survey to assess the current state of practice around pediatric cardiac critical care nursing education in dedicated CICUs and mixed pediatric ICUs, and (2) identify variation in current practice in order to inform advancement of standardization. Data collection and analysis are complete, and development of the aggregate result report is underway.

Neurodevelopmental Care of Infants with Congenital Heart Disease in the Critical Care Setting State of Nursing Practice Assessment

The aims of this project are to (1) develop and disseminate a survey to assess the state of practice of individualized family-centered developmental care (IFDC) for infants < 6 months old in daily nursing assessment and care in ICU settings and (2) identify variation in current practice in order to inform advancement of standardization.