Tracy Ann Pasek

A foundation for patient safety: phase I implementation of interdisciplinary bedside rounds in the pediatric intensive care unit.

in the department of critical care medicine and pediatrics and the medical director for the pediatric intensive care unit, Chris Kyper is a nurse practitioner, Todd Spencer is a staff nurse, Marcie Tharp is a clinical leader, Michael Scott is a staff nurse, Melinda Fiedor Hamilton is an assistant professor of critical care medicine and pediatrics and director of pediatric simulation, Peter M. Winter Institute for Simulation, Education, and Research (WISER), and Tracy A. Pasek is a clinical nurse specialist. All authors are from the pediatric intensive care unit at Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Predicting Pressure Injury Risk in Pediatric Patients: The Braden QD Scale

Objective To describe the development and initial testing of the Braden QD Scale to predict both immobility‐related and medical device–related pressure injury risk in pediatric patients. Study design This was a multicenter, prospective cohort study enrolling hospitalized patients, preterm to 21 years of age, on bedrest for at least 24 hours with a medical device in place. Receiver operating characteristic curves using scores from the first observation day were used to characterize Braden QD Scale performance, including areas under the curve (AUC) with 95% CIs. Results Eight centers enrolled 625 patients. A total of 86 hospital‐acquired pressure injures were observed in 49 (8%) patients: 22 immobility‐related pressure injuries in 14 (2%) patients and 64 medical device–related pressure injuries in 42 (7%) patients. The Braden QD Scale performed well in predicting immobility‐related and medical device–related pressure injuries in the overall sample, with an AUC of 0.78 (95% CI 0.73‐0.84). At a cutoff score of 13, the AUC was 0.72 (95% CI 0.67‐0.78), providing a sensitivity of 0.86 (95% CI 0.76‐0.92), specificity of 0.59 (95% CI 0.55‐0.63), positive predictive value of 0.15 (95% CI 0.11‐0.19), negative predictive value of 0.98 (95% CI 0.97‐0.99), and a positive likelihood ratio of 2.09 (95% CI 0.95‐4.58). Conclusions The Braden QD Scale reliably predicts both immobility‐related and device‐related pressure injuries in the pediatric acute care environment and will be helpful in monitoring care and in guiding resource use in the prevention of hospital‐acquired pressure injuries.

Case Study of High-Dose Ketamine for Treatment of Complex Regional Pain Syndrome in the Pediatric Intensive Care Unit

Complex regional pain syndrome (CRPS) is a life-altering and debilitating chronic pain condition. The authors are presenting a case study of a female who received high-dose ketamine for the management of her CRPS. The innovative treatment lies not only within the pharmacologic management of her pain, but also in the fact that she was the first patient to be admitted to our pediatric intensive care unit solely for pain control. The primary component of the pharmacotherapy treatment strategy plan was escalating-dose ketamine infusion via patient-controlled-analgesia approved by the pharmacy and therapeutics committee guided therapy for this patient. The expertise of advanced practice nurses blended exquisitely to ensure patient and family-centered care and the coordination of care across the illness trajectory. The patient experienced positive outcomes.

Skin Care Oktoberfest: A Creative Approach to Pressure Ulcer Prevention Education in a Pediatric Intensive Care Unit

Michael Scott, Allison Lancas, and Ashley Duke are staff nurses, Tracy Ann Pasek is an advanced practice nurse, and Carol Vetterly is a clinical pharmacist in the pediatric intensive care unit at Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pennsylvania. festival. Attendees included PICU nurses, critical care physicians, respiratory therapists, pharmacists, and nursing school faculty and students. Learner objectives targeted (1) pressure ulcer prevention, (2) patient safety, and (3) patient and familycentered care (Table 1). Objectives 1 through 5 were the primary catalysts for the education. Nurses observed during weekly skin care rounds that an increased number of acute care support surfaces were being procured for PICU patients. Additionally, Pressure ulcer prevention is an important and challenging focus of care for pediatric critical care nurses. A unit-based skin care team in the pediatric intensive care unit (PICU) at Children’s Hospital of Pittsburgh provided skin care education through a collaborative and interactive venue—a Skin Care Oktoberfest. Root “beer” and ginger “ale” provided a light-hearted backdrop for the sharing of essential knowledge pertaining to support surfaces and a patient and family-centered turning tool (“Time 2 Turn”; Figure 1). Because of the role that moisture plays with compromising skin integrity and increasing pressure ulcer risk, topical pharmaceutical preparations to manage incontinenceassociated dermatitis (IAD) were included in the seasonal curriculum. Attendees were provided with the opportunity to stage, measure, and document pressure ulcers in fresh “critically ill” pumpkins (Figure 2). Pumpkins were used to simulate a patient’s skin surface and to align with the theme of the educational