Delays to Antibiotics in the Emergency Department and Risk of Mortality in Children With Sepsis.

Importance: Pediatric consensus guidelines recommend antibiotic administration within 1 hour for septic shock and within 3 hours for sepsis without shock. Limited studies exist identifying a specific time past which delays in antibiotic administration are associated with worse outcomes.

Objective: To determine a time point for antibiotic administration that is associated with increased risk of mortality among pediatric patients with sepsis.

Reducing (Behavioral) Restraint Use Through Simulation at the Bedside.

Hospitals are experiencing an influx of patients in active behavioral crises, leading to restraints as a behavior management strategy. Over 100 staff participated in simulation training designed to manage escalating patient behavior. The training had a direct impact on the reduction of restraint use and increased preparedness and confidence of participants managing escalating patient behavior.

Quality Improvement Incorporating a Feedback Loop for Accurate Medication Reconciliation.

Objectives: Medication reconciliation errors on hospital admission can lead to significant patient harm. A pediatric intermediate care unit initiated a quality improvement project and aimed to reduce errors in admission medication reconciliation by 50% in 12 months.

Methods: From August 2017 to December 2018, a multidisciplinary team conducted a quality improvement project with plan-do-study-act methodology.

Dornase alpha and exhaled NO in cystic fibrosis.

Nitric oxide (NO) that is produced within the airways can be measured in the exhaled air. Concentrations of exhaled NO (FENO) are decreased in cystic fibrosis (CF) and, in cross sectional studies, have been shown to be even lower in patients with more advanced pulmonary disease. This may result from retention and metabolisation of NO within viscous airway secretions.