Using four-phased unit-based patient safety walkrounds to uncover correctable system flaws.

Background: A unit-based Patient Safety Leadership Walkrounds (PSWR) model was deployed in six medical/surgical units at The Children's Hospital of Philadelphia to identify patient safety issues in the clinical microsystem. Specific objectives of PSWR were to (1) provide a forum for frontline staff to freely report and discuss patient safety problems with unit local leaders, (2) improve teamwork and communication within and across units, and (3) develop a supportive environment in which staff and leaders brainstorm on potential solutions.

Methods: Baseline data collection and discussion with leaders and staff from the pilot units were used to create a standard set of safety tools and questions.

Screening for psychosocial risk in pediatric cancer.

Major professional organizations have called for psychosocial risk screening to identify specific psychosocial needs of children with cancer and their families and facilitate the delivery of appropriate evidence-based care to address these concerns. However, systematic screening of risk factors at diagnosis is rare in pediatric oncology practice. Subsequent to a brief summary of psychosocial risks in pediatric cancer and the rationale for screening, this review identified three screening models and two screening approaches [Distress Thermometer (DT), Psychosocial Assessment Tool (PAT)], among many more articles calling for screening.

Screening for psychosocial risk at pediatric cancer diagnosis: the psychosocial assessment tool.

Background: To investigate the feasibility of integrating an evidence-based screening tool of psychosocial risk in pediatric cancer care at diagnosis.

Methods: Parents of children newly diagnosed with cancer received either the Psychosocial Assessment Tool (PAT; n=52) or psychosocial care as usual (n=47; PAU), based on their date of diagnosis and an alternating monthly schedule. Time to completion of the PAT, time to communication of PAT results to clinical care teams, distribution of PAT risk scores, and identification of psychosocial risks in the medical record were examined.

Association of psychosocial risk screening in pediatric cancer with psychosocial services provided.

Objective: How screening for psychosocial risk in pediatric oncology may relate to the number and type of psychosocial services provided is a critical step in linking screening with treatment. We predicted that screening at diagnosis would be associated with the delivery of more psychosocial services over 8 weeks and that these services would be consistent with Universal, Targeted, or Clinical psychosocial risk level based on the Pediatric Psychosocial Preventative Health Model (PPPHM).

Methods: Parents of children newly diagnosed with cancer received either the Psychosocial Assessment Tool (PAT; n = 49) or psychosocial care as usual (PAU; n = 47), based on their date of diagnosis and an alternating monthly schedule.

Family psychosocial risk, distress, and service utilization in pediatric cancer: predictive validity of the Psychosocial Assessment Tool.

Background: The way families negotiate diagnosis and early treatment for pediatric cancer sets the stage for their adaptation throughout treatment and survivorship. The Psychosocial Assessment Tool (PAT) is a brief parent-report screener capable of systematically identifying families at risk for problems of adaptation. The current study evaluated stability and predictive validity of PAT psychosocial risk classification with regard to distress, family functioning, and the use of psychosocial services over the first 4 months of treatment.

Evolution of a Rapid Hydration Protocol.

The Oncology Division of the Children's Hospital of Philadelphia (CHOP) embarked on a comprehensive project to reduce chemotherapy errors. Careful review of all systems revealed many areas for improvement. Using a unique systems improvement approach, the interdisciplinary team carried out many concurrent change projects.

Multidisciplinary systems approach to chemotherapy safety: rebuilding processes and holding the gains.

Purpose: The problem of medication safety came to public attention largely through a chemotherapy error, and the high toxicity and low therapeutic index of anticancer medications make safety in their prescription and administration critical. We have undertaken a thorough revision of our systems for inpatient chemotherapy.

Methods: We participated in a multi-institutional collaborative effort of the Institute for Healthcare Improvement, and used their rapid cycle change method.