A Coproduced Family Reporting Intervention to Improve Safety Surveillance and Reduce Disparities.

Objectives: Examine family safety-reporting after implementing a parent-nurse-physician-leader coproduced, health literacy-informed, family safety-reporting intervention for hospitalized families of children with medical complexity.

Methods: We implemented an English and Spanish mobile family-safety-reporting tool, staff and family education, and process for sharing comments with unit leaders on a dedicated inpatient complex care service at a pediatric hospital. Families shared safety concerns via predischarge surveys (baseline and intervention) and mobile tool (intervention).

Reduced Postdischarge Incidents After Implementation of a Hospital-to-Home Transition Intervention for Children With Medical Complexity.

Objectives: Prior research suggests that errors occur frequently for patients with medical complexity during the hospital-to-home transition. Less is known about effective postdischarge communication strategies for this population. We aimed to assess rates of 30-day (1) postdischarge incidents and (2) readmissions and emergency department (ED) visits before and after implementing a hospital-to-home intervention.

Developing a Responsive Transferable Model for Delivering Large-Scale Simulation Education to Inpatient Nursing Staff.

Implementing large-scale nursing continuing development programs for bedside staff can be operationally challenging. The aim of this project was to establish a sustainable simulation education program that is incorporated into staff nurses' work schedules and provides provisions to accommodate patient assignment coverage. This article describes the planning, implementation, and evaluation of a simulation program that was successfully delivered to 89% of nurses employed on four inpatient units at an academic medical center.

In their own words: Safety and quality perspectives from families of hospitalized children with medical complexity.

Background: Children with medical complexity (CMC) experience adverse events due to multiorgan impairment, frequent hospitalizations, subspecialty care, and dependence on multiple medications/equipment. Their families are well-versed in care and can help identify safety/quality gaps to inform improvements. Although previous studies have shown families identify important safety/quality gaps in hospitals, studies of inpatient safety/quality experience of CMC and their families are limited.

Family Safety Reporting in Hospitalized Children With Medical Complexity.

Background And Objectives: Hospitalized children with medical complexity (CMC) are at high risk of medical errors. Their families are an underutilized source of hospital safety data. We evaluated safety concerns from families of hospitalized CMC and patient/parent characteristics associated with family safety concerns.

Children with medical complexity: A concept analysis.

Aim: The aim of this paper is to conduct a concept analysis on the term, "children with medical complexity."

Background: Children with medical complexity (CMC) describes pediatric patients with chronic, sustained acuity; however, there is a lack of consensus in the literature regarding its exact meaning, characteristics, and implications.

Design: This analysis relied upon the framework described by Walker and Avant.

Medication Order Errors at Hospital Admission Among Children With Medical Complexity.

Objectives: We sought to characterize the nature and prevalence of medication order errors (MOEs) occurring at hospital admission for children with medical complexity (CMC), as well as identify the demographic and clinical risk factors for CMC experiencing MOEs.

Methods: Prospective cohort study of 1233 hospitalizations for CMC from November 1, 2015, to October 31, 2016, at 2 children's hospitals. Medication order errors at admission were identified prospectively by nurse practitioners and a pharmacist through direct patient care.

Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study.

Objective: To determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds.

Design: Prospective, multicenter before and after intervention study.

Setting: Pediatric inpatient units in seven North American hospitals, 17 December 2014 to 3 January 2017.

Issues Identified by Postdischarge Contact after Pediatric Hospitalization: A Multisite Study.

Background: Many hospitals are considering contacting hospitalized patients soon after discharge to help with issues that arise.

Objective: To (1) describe the prevalence of contactidentified postdischarge issues (PDI) and (2) assess characteristics of children with the highest likelihood of having a PDI.

Design, Setting, Patients: A retrospective analysis of hospital-initiated follow-up contact for 12,986 children discharged from January 2012 to July 2015 from 4 US children's hospitals.

Clinician Perceptions of the Importance of Hospital Discharge Components for Children.

Background: Discharging hospitalized children involves several different components, but their relative value is unknown. We assessed which discharge components are perceived as most and least important by clinicians.

Methods: March and June of 2014, we conducted an online discrete choice experiment (DCE) among national societies representing 704 nursing, physician, case management, and social work professionals from 46 states.

Nurse Practitioner Lead Pediatric Baclofen Pump Program: Impact on Safety and Quality of Care.

Children with cerebral palsy experience spasticity that can be debilitating and cause significant pain and contractures. Intrathecal baclofen (ITB) therapy can help relieve this spasticity and improve the quality of life for these patients, but it comes with risk. Withdrawal from the medication in case of abrupt discontinuation of delivery can be life-threatening.

Parent-Provider Miscommunications in Hospitalized Children.

Background: Miscommunications lead to medical errors and suboptimal hospital experience. Parent-provider miscommunications are understudied.

Objectives: (1) Examine characteristics of parent-provider miscommunications about hospitalized children, (2) describe associations among parent-provider miscommunications, parent-reported errors, and hospital experience, and (3) compare parent and attending physician reports of parent-provider miscommunications.

Nursing-led Home Visits Post-hospitalization for Children with Medical Complexity.

Purpose: Hospital discharge for children with medical complexity (CMC) can be challenging for families. Home visits could potentially benefit CMC and their families after leaving the hospital. We assessed the utility of post-discharge home visits to identify and address health problems for recently hospitalized CMC.

Families as Partners in Hospital Error and Adverse Event Surveillance.

Importance: Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism would improve incident detection.

Parent and Provider Experience and Shared Understanding After a Family-Centered Nighttime Communication Intervention.

Objective: To assess parent and provider experience and shared understanding after a family-centered, multidisciplinary nighttime communication intervention (nurse-physician brief, family huddle, family update sheet).

Methods: We performed a prospective intervention study at a children's hospital from May 2013 to October 2013 (preintervention period) and May 2014 to October 2014 (postintervention period). Participants included 464 parents, 176 nurses, and 52 resident physicians of 582 hospitalized 0- to 17-year-old patients.

From development to implementation-A smartphone and email-based discharge follow-up program for pediatric patients after hospital discharge.

The purpose of this case study was to investigate opportunities to electronically enhance the transitions of care for both patients and providers and to describe the process of development and implementation of such tools. We describe the current challenges and fragmentation of care for pediatric patients and families being discharged from inpatient stays, and review barriers to change in practice. Care transitions vary in the complexity of the clinical and social scenarios and no one-size-fits-all approach works for every patient, provider or hospital system.

Communication and Shared Understanding Between Parents and Resident-Physicians at Night.

Background And Objective: Communication breakdowns between members of the health care team compromise patient safety and experience. Communication breakdowns with parents, an important but often overlooked part of the health care team, are understudied. Parents may play a particularly important role in nighttime care given decreased staffing and inadequate transitions of care at night.

Parent-Reported Errors and Adverse Events in Hospitalized Children.

Importance: Limited data exist regarding the incidence and nature of patient- and family-reported medical errors, particularly in pediatrics.

Objective: To determine the frequency with which parents experience patient safety incidents and the proportion of reported incidents that meet standard definitions of medical errors and preventable adverse events (AEs).

Design, Setting, And Participants: We conducted a prospective cohort study from May 2013 to October 2014 within 2 general pediatric units at a children's hospital.

Discharge Facilitation: An Innovative PNP Role.

Efficient and safe transition from the hospital to the community setting remains a priority in health care. Providers face mounting pressure of both timely discharges and minimizing readmissions, because these factor have an impact on provider reimbursement. Traditionally in academic medical centers, rotating teams of resident physicians have been responsible for discharging inpatients.

Physician and Nurse Nighttime Communication and Parents' Hospital Experience.

Background And Objective: Night teams of hospital providers have become more common in the wake of resident physician duty hour changes. We sought to examine relationships between nighttime communication and parents' inpatient experience.

Methods: We conducted a prospective cohort study of parents (n = 471) of pediatric inpatients (0-17 years) from May 2013 to October 2014.

A framework of pediatric hospital discharge care informed by legislation, research, and practice.

To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10 000 pediatric discharges per day in the United States. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality-improvement efforts, and adversely affects the health and well-being of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge; a variety of toolkits that aim to improve discharge care; and the research evidence that supports the discharge process.

Engaging in secondhand smoke reduction discussions with parents of hospitalized pediatric patients: a national survey of pediatric nurses in the United States.

Objective: To identify individual- and system-level predictors and barriers associated with US pediatric nurses' routine counseling about child secondhand smoke exposure for parents of hospitalized children.

Methods: In 2008, members of the Society of Pediatric Nurses completed a questionnaire assessing demographic, hospital systems, and work attitudes related to the following outcomes: asking about child secondhand smoke exposure, informing about sources of secondhand smoke exposure, counseling about the dangers of secondhand smoke exposure, and advising a smoke-free home policy.

Results: Of 1475 eligible nurses, 888 completed the survey.

The teachable moment captured: a framework for nurse-led smoking cessation interventions for parents of hospitalized children.

This article explores the topic of smoking cessation counseling for parents in the context of pediatric hospitalization. Teachable moments, a widely used concept in the literature, uses three key concepts including perception of risk, emotional response, and self-concept to precipitate change (McBride, Health Education Research, 18 [McBride, 2003], 156-170). The interweaving of these concepts with institutional systems; clinically trained personnel; parental smoking considerations; parent presence; and external supports, or collectively the novel idea of the "capturable moment", may allow for an increased rate of parental smoking cessation.

Inpatient asthma education program.

Asthma is the second leading admitting diagnosis at Children's Hospital Boston (CHB), having an impact on many patients and families annually. To improve education for parents of patients hospitalized with asthma and increase health care providers' completion of individualized asthma action plans (AAPs), nurse experts established a comprehensive inpatient asthma education program based on the 2007 National Heart, Lung and Blood Institute/National Asthma Education and Prevention Program (NHLBI/NAEPP) guidelines. These guidelines recommend that caregivers teach and reinforce asthma education at every opportunity across the health care continuum.