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Aims and objectives To describe shared governance in action through the example of one paediatric institution's decision to institute daily chlorhexidine bathing. Background Shared governance processes are discussed extensively in the literature; however, implementation of the processes can be challenging. Recently nurses at one paediatric hospital were involved in a hospital-wide practice change where the theoretical approach of shared governance was actualised. Several questions arose from direct care nurses about unwarranted variations in bathing practices across settings and whether bathing standardisation could address the recent increase in central line-associated bloodstream infections. Shared governance council members identified daily chlorhexidine bathing as a potential intervention to standardise bathing across the hospital and to decrease infection rates. At this time, chlorhexidine bathing had been widely adopted in adult hospitals but was less commonly practiced in paediatric institutions. Design This is a position paper describing the use of shared governance to make a house-wide practice decision and positively impact patient outcomes. Method Inquiry Council members conducted a systematic evidence search on best practices around chlorhexidine bathing. This evidence was used in Practice Council discussions to standardise house-wide practice. Once consensus was achieved, council members collaborated with Education Council to ensure understanding, competency, and the adoption and sustainment of the practice change. Conclusions Patients with central lines are at decreased risk for acquiring a central line-associated blood stream infection due, in part, to the change in nursing practice to include daily chlorhexidine bathing. The shared governance structure was the vehicle through which this practice was vetted and instituted. Relevance to clinical practice This paper provides a real-life example of leveraging shared governance structures and the direct care nurse leaders within the councils when an organisation faces critical needs in patient care. [ABSTRACT FROM AUTHOR]

The article explains how Cincinnati Children's Hospital Medical Center redefined the expectations for conference attendees. The Center enhanced the experience and the outcomes for practice and the organization. It sent a total of almost two hundred clinical workers and managers to the annual Magnet conference.

Purpose. This pilot study assessed the feasibility, acceptability, and utility of a text messaging system that allowed teenagers with asthma to generate and control medical reminders sent to their mobile phones. Methods. The 12 teens in the study group were able to create their own reminder text messages, add or change reminders, and determine when and how often the messages were sent to their cell phone. Results. In total, 18 of the 21 unique messages created were reminders to take medication. No teen made changes to their original text messages or delivery schedule on their own. They gave high ratings on the usefulness, acceptability, and ease of use of the text messaging system. Self-reported asthma control at baseline was similar for both the study and comparison groups and did not change significantly. Conclusions. Allowing teens to control the timing and content of reminder text messages may support self-management of chronic disease. [ABSTRACT FROM PUBLISHER]

The article presents a study that investigates the perceptions of providers of pediatric emergency care in the implementation of universal screening for sexually transmitted infections (STIs) of the pediatric emergency department (PED) of hospitals in the U.S. Researchers interviewed PED doctors and nurses working on large pediatric teaching hospital of the Midwest of the U.S. They found that barriers, attitudes and solutions are the three themes that describe the perceptions of PED providers.

Background and Objective: Inadequate follow-up of positive sexually transmitted infection (STI) test results is a gap in health care quality that contributes to the epidemic of STIs in adolescent women. The goal of this study was to improve our ability to contact adolescent women with positive STI test results after an emergency department visit., Methods: We conducted an interventional quality improvement project at a pediatric emergency department. Phase 1 included plan-do-study-act cycles to test interventions such as provider education and system changes. Phase 2 was a planned experiment studying 2 interventions (study cell phone and patient activation card), using a 2 × 2 factorial design with 1 background variable and 2 replications. Outcomes were: (1) the proportion of women aged 14 to 21 years with STI testing whose confidential telephone number was documented in the electronic medical record; (2) the proportion of STI positive women successfully contacted within 7 days., Results: Phase 1 interventions increased the proportion of records with a confidential number from 24% to 58% and the proportion contacted from 45% to 65%, and decreased loss to follow-up from 40% to 24%. In phase 2, the proportion contacted decreased after the electronic medical record system changed and recording of the confidential number decreased. Study interventions (patient activation card and study cell phone) had a synergistic effect on successful contact, especially when confidential numbers were less reliably documented., Conclusions: Feasible and sustainable interventions such as improved documentation of a confidential number worked synergistically to increase our ability to successfully contact adolescent women with their STI test results.

Objective: Patient portals may improve pediatric chronic disease outcomes, but few have been rigorously evaluated for usability by parents. Using scenario-based testing with think-aloud protocols, we evaluated the usability of portals for parents of children with cystic fibrosis, diabetes or arthritis. DESIGN Sixteen parents used a prototype and test data to complete 14 tasks followed by a validated satisfaction questionnaire. Three iterations of the prototype were used., Measurements: During the usability testing, we measured the time it took participants to complete or give up on each task. Sessions were videotaped and content-analyzed for common themes. Following testing, participants completed the Computer Usability Satisfaction Questionnaire which measured their opinions on the efficiency of the system, its ease of use, and the likeability of the system interface. A 7-point Likert scale was used, with seven indicating the highest possible satisfaction., Results: Mean task completion times ranged from 73 (+/- 61) seconds to locate a document to 431 (+/- 286) seconds to graph laboratory results. Tasks such as graphing, location of data, requesting access, and data interpretation were challenging. Satisfaction was greatest for interface pleasantness (5.9 +/- 0.7) and likeability (5.8 +/- 0.6) and lowest for error messages (2.3 +/- 1.2) and clarity of information (4.2 +/- 1.4). Overall mean satisfaction scores improved between iteration one and three., Conclusions: Despite parental involvement and prior heuristic testing, scenario-based testing demonstrated difficulties in navigation, medical language complexity, error recovery, and provider-based organizational schema. While such usability testing can be expensive, the current study demonstrates that it can assist in making healthcare system interfaces for laypersons more user-friendly and potentially more functional for patients and their families.