O'Connor Tamara
1University of California San Francisco (UCSF) Medical Center and UCSF Benioff Children's Hospital, San Francisco, United States 2UCSF Centre for Evidence Synthesis and Implementation: a Joanna Briggs Institute Centre of Excellence.
JBI Database System Rev Implement Rep. 2017 Nov;15(11):2799-2814. doi: 10.11124/JBISRIR-2017-003359.
A progressive decline in acute psychiatric facility beds has led to a steadily increasing number of pediatric psychiatric patients hospitalized on acute care medical-surgical units. Clinical nurses in this environment feel ill-equipped to provide quality behavioral health care.
AIMS/OBJECTIVES: This project aimed to improve continuity of care as well as staff and patient safety in pediatric acute and transitional care units. The specific objectives related to implementation of a resource allocation algorithm for staffing behavioral health admissions and consistent use of an interdisciplinary psychiatric huddle.
This project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit tool for promoting health practice change. A baseline medical record audit was conducted which was followed by charge nurse education on the resource allocation algorithm and huddle initiation. Three follow-up audits measured compliance with best practice criteria for assessing and managing care of behavioral pediatric patients.
Compliance with comprehensively assessing children with challenging behaviors who were hospitalized in acute care units achieved 100% for the first three months following algorithm implementation. Nurses reached 100% compliance with initiating psychiatric huddles. All audits for individualized care plans, which included family or carer involvement, were fully compliant.
Use of a resource allocation algorithm for individualizing care of pediatric behavioral patients enhanced quality of care through a standardized process which enabled acute care nurses to better meet the safety needs of this patient population. Early signs of sustaining improvements were promising for hard-wiring workflows. Future plans include adoption of the algorithm and huddle by all in-patient areas in the children's hospital.
急性精神病治疗床位的逐渐减少导致在急性护理内科-外科病房住院的儿科精神病患者数量稳步增加。在这种环境下的临床护士感到没有足够的能力提供高质量的行为健康护理。
本项目旨在改善儿科急性和过渡性护理病房的护理连续性以及工作人员和患者的安全。具体目标涉及实施用于安排行为健康入院患者人员配备的资源分配算法，以及持续使用跨学科精神病学碰头会。
本项目使用乔安娜·布里格斯研究所的临床证据系统实际应用（PACES）和将研究应用于实践（GRiP）审核工具来促进健康实践变革。进行了基线病历审核，随后对护士长进行了资源分配算法和启动碰头会的培训。三次后续审核衡量了在评估和管理行为儿科患者护理方面符合最佳实践标准的情况。
在实施算法后的前三个月，对在急性护理病房住院的有挑战性行为儿童进行全面评估的合规率达到了100%。护士在启动精神病学碰头会方面达到了100%的合规率。所有包括家庭或照顾者参与的个性化护理计划审核均完全合规。
使用资源分配算法对儿科行为患者进行个性化护理，通过标准化流程提高了护理质量，使急性护理护士能够更好地满足这一患者群体的安全需求。持续改进工作流程的早期迹象令人鼓舞。未来计划包括儿童医院所有住院区域采用该算法和碰头会。
