Publications by authors named "Andrea B Smith"

Patient falls are considered a significant safety risk, but little evidence regarding the significance of falls in children is available. A multisite, observational study of fall events occurring in pediatric inpatients (younger than 18 years of age) from Child Health Corporation of America member hospitals was conducted to determine the prevalence and significance of falls. Fall prevalence was 0.84 per 1,000 patient days with 48% classified as preventable. Injuries occurred in 32%, but only two falls resulted in an increased length of stay; none resulted in permanent disability or death. Only 47% of the children who fell were identified to be at risk for fall. Alert mechanisms were used in 60% and preventive measures in 23%. These findings suggest that while inpatient pediatric fall rates are lower than those of adults, greater diligence in identification and risk reduction may further reduce the prevalence of falls and the proportion of fall-related injuries.

Hypothesis: Health care failure mode and effect analysis identifies critical processes prone to information transfer and communication failures and suggests interventions to improve these failures.

Design: Failure mode and effect analysis.

Setting: Academic research.

Participants: A multidisciplinary team consisting of surgeons, anesthetists, nurses, and a psychologist involved in various phases of surgical care was assembled.

Main Outcome Measures: A flowchart of the whole process was developed. Potential failure modes were identified and evaluated using a hazard matrix score. Recommendations were determined for certain critical failure modes using a decision tree.

Results: The process of surgical care was divided into the following 4 main phases: preoperative assessment and optimization, preprocedural teamwork, postoperative handover, and daily ward care. Most failure modes were identified in the preoperative assessment and optimization phase. Forty-one of 132 failures were classified as critical, 26 of which were sufficiently covered by current protocols. Recommendations were made for the remaining 15 failure modes.

Conclusions: Modified health care failure mode and effect analysis proved to be a practical approach and has been well received by clinicians. Systematic analysis by a multidisciplinary team is a useful method for detecting failure modes.

The purpose of this comparative descriptive study was to identify the impact of providing a parent bed space in the PICU, allowing for continual parental presence, on stress of the parents of critically ill children. Data were collected from parents (n = 86) at two children's hospitals 3 months prior to the opening of new PICUs with parent bed spaces. Following a transition period, data were collected from a sample of parents (n = 92) who had used the parent bed to stay overnight with their child. Parental stress was measured with the Parental Stressor Scale: Pediatric Intensive Care (PSS: PICU). Stress scores were significantly lower (p = .02) for parents who utilized the parent beds in the new PICUs. New PICU environments that facilitate continual parental presence may reduce parental stress related to a child's hospitalization.

More than 70% of children/adolescents diagnosed with cancer are long-term survivors. Little is known about the health perceptions and practices of this population, and limited previous studies have come exclusively from a risk reduction/health protection model rather than a health promotion model. This study was conducted to describe the perceived health status and health-promoting behaviors of adolescent/young adult cancer survivors. This study used Pender's revised health promotion model; perceived health status and health-promoting behaviors were measured using the General Health Index (GHRI) and the Health Promoting Lifestyle Profile II (HPLP-II). The sample consisted of 60 cancer survivors 2 years after completion of cancer treatment and attending a survivorship clinic. Mean baseline scores for the GHRI (76.66; SD, 10.41) indicate perceived health status is positive and similar to normative (noncancer survivor) adolescent/young adult samples. Surprisingly, there was no correlation between scores on the GHRI and the HPLP-II in this sample (r = 0.03).