Publications by authors named "Sandra L Staveski"

16 Publications

  • Page 1 of 1

Prevalence of ICU Delirium in Postoperative Pediatric Cardiac Surgery Patients.

Pediatr Crit Care Med 2021 Jan;22(1):68-78

University of California San Francisco, School of Nursing, San Francisco, CA.

Objectives: The objective of this study was to determine the prevalence of ICU delirium in children less than 18 years old that underwent cardiac surgery within the last 30 days. The secondary aim of the study was to identify risk factors associated with ICU delirium in postoperative pediatric cardiac surgical patients.

Design: A 1-day, multicenter point-prevalence study of delirium in pediatric postoperative cardiac surgery patients.

Setting: Twenty-seven pediatric cardiac and general critical care units caring for postoperative pediatric cardiac surgery patients in North America.

Patients: All children less than 18 years old hospitalized in the cardiac critical care units at 06:00 on a randomly selected, study day.

Interventions: Eligible children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the study team in collaboration with the bedside nurse.

Measurement And Main Results: Overall, 181 patients were enrolled and 40% (n = 73) screened positive for delirium. There were no statistically significant differences in patient demographic information, severity of defect or surgical procedure, past medical history, or postoperative day between patients screening positive or negative for delirium. Our bivariate analysis found those patients screening positive had a longer duration of mechanical ventilation (12.8 vs 5.1 d; p = 0.02); required more vasoactive support (55% vs 26%; p = 0.0009); and had a higher number of invasive catheters (4 vs 3 catheters; p = 0.001). Delirium-positive patients received more total opioid exposure (1.80 vs 0.36 mg/kg/d of morphine equivalents; p < 0.001), did not have an ambulation or physical therapy schedule (p = 0.02), had not been out of bed in the previous 24 hours (p < 0.0002), and parents were not at the bedside at time of data collection (p = 0.008). In the mixed-effects logistic regression analysis of modifiable risk factors, the following variables were associated with a positive delirium screen: 1) pain score, per point increase (odds ratio, 1.3; 1.06-1.60); 2) total opioid exposure, per mg/kg/d increase (odds ratio, 1.35; 1.06-1.73); 3) SBS less than 0 (odds ratio, 4.01; 1.21-13.27); 4) pain medication or sedative administered in the previous 4 hours (odds ratio, 3.49; 1.32-9.28); 5) no progressive physical therapy or ambulation schedule in their medical record (odds ratio, 4.40; 1.41-13.68); and 6) parents not at bedside at time of data collection (odds ratio, 2.31; 1.01-5.31).

Conclusions: We found delirium to be a common problem after cardiac surgery with several important modifiable risk factors.
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http://dx.doi.org/10.1097/PCC.0000000000002591DOI Listing
January 2021

Is adequate sleep enough, or is it time to add lipid-lowering medication to prenatal vitamin recommendations to improve infant outcomes?

Sleep Med 2021 Jan 17;77:374-375. Epub 2020 Jan 17.

Department of Family Health Care Nursing, School of Nursing, Box 0606, University of California, San Francisco, San Francisco, CA, 94143, USA. Electronic address:

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http://dx.doi.org/10.1016/j.sleep.2020.01.006DOI Listing
January 2021

Development of a clinician-parent home care education intervention.

Cardiol Young 2019 Oct 30;29(10):1230-1235. Epub 2019 Aug 30.

Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA.

Objectives: To examine the strengths and opportunities for improvement of current home care education practices to inform the development of the Home Care for Heart Health intervention, and to develop a web-based intervention for parents and clinicians with complimentary print materials that could provide the right education at the right time to foster a safer transition from hospital to home.

Methods: An inter-professional focus group of parents, clinicians, and designers was formed to co-create a home care education intervention for parents of children with congenital heart disease (CHD) and their care team. We used the Integrated New Product Development process model created by Jonathon Cagan and Craig Vogel at Carnegie Mellon University to develop the intervention. This process model is a way of thinking that combines horizontal and inter-disciplinary teams, stakeholder-centric focus, and a system of qualitative discovery and development evolving towards quantitative methods of refinement.

Results: Our team developed the Home Care for Heart Health intervention. The evidenced-based intervention includes a quick reference guide for parents of children with CHD, an accompanying app, family-friendly pathways, and clinician education.

Conclusion: Using an inter-professional approach, our team of clinicians, parents, and design experts were able to co-create a clinician-parent home care education intervention with broad application and lifelong relevance to the Congenital Heart Disease Community.

Practice Implications: Our intervention has the potential to be used as a model for other home care education interventions for parents of children with chronic illnesses.
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http://dx.doi.org/10.1017/S1047951119001318DOI Listing
October 2019

The Impact of Massage and Reading on Children's Pain and Anxiety After Cardiovascular Surgery: A Pilot Study.

Pediatr Crit Care Med 2018 08;19(8):725-732

Department of Pediatrics, Stanford University, School of Medicine, Palo Alto, CA.

Objectives: The purpose of this pilot study was three-fold: 1) to evaluate the safety and feasibility of instituting massage therapy in the immediate postoperative period after congenital heart surgery, 2) to examine the preliminary results on effects of massage therapy versus standard of care plus three reading visits on postoperative pain and anxiety, and 3) to evaluate preliminary effects of opioid and benzodiazepine exposure in patients receiving massage therapy compared with reading controls.

Design: Prospective, randomized controlled trial.

Setting: An academic children's hospital.

Subjects: Sixty pediatric heart surgery patients between ages 6 and 18 years.

Interventions: Massage therapy and reading.

Measurement And Main Results: There were no adverse events related to massage or reading interventions in either group. Our investigation found no statistically significant difference in Pain or State-Trait Anxiety scores in the initial 24 hours after heart surgery (T1) and within 48 hours of transfer to the acute care unit (T2) after controlling for age, gender, and Risk Adjustment for Congenital Heart Surgery 1 score. However, children receiving massage therapy had significantly lower State-Trait Anxiety scores after receiving massage therapy at time of discharge (T3; p = 0.0075) than children receiving standard of care plus three reading visits. We found no difference in total opioid exposure during the first 3 postoperative days between groups (median [interquartile range], 0.80 mg/kg morphine equivalents [0.29-10.60] vs 1.13 mg/kg morphine equivalents [0.72-6.14]). In contrast, children receiving massage therapy had significantly lower total benzodiazepine exposure in the immediate 3 days following heart surgery (median [interquartile range], 0.002 mg/kg lorazepam equivalents [0-0.03] vs 0.03 mg/kg lorazepam equivalents [0.02-0.09], p = 0.0253, Wilcoxon rank-sum) and number of benzodiazepine PRN doses (0.5 [0-2.5] PRN vs 2 PRNs (1-4); p = 0.00346, Wilcoxon rank-sum).

Conclusions: Our pilot study demonstrated the safety and feasibility of implementing massage therapy in the immediate postoperative period in pediatric heart surgery patients. We found decreased State-Trait Anxiety scores at discharge and lower total exposure to benzodiazepines. Preventing postoperative complications such as delirium through nonpharmacologic interventions warrants further evaluation.
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http://dx.doi.org/10.1097/PCC.0000000000001615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086725PMC
August 2018

Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices.

Pediatr Crit Care Med 2018 06;19(6):538-543

Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.

Objectives: The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery.

Design: Descriptive self-report survey.

Setting: A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society.

Patient Or Subjects: Pediatric cardiac intensive care clinicians (physicians and nurses).

Interventions: None.

Measurement And Main Results: One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia.

Conclusions: Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.
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http://dx.doi.org/10.1097/PCC.0000000000001558DOI Listing
June 2018

Partnership models for the establishment of sustainable paediatric cardiac surgical and cardiac intensive care programmes in low- and middle-income countries.

Cardiol Young 2017 Dec;27(S6):S55-S60

8Cardiac Surgery Department,The Royal Children's Hospital Melbourne,Parkville,Victoria,Australia.

The care of patients with CHD remains a challenge in low- and middle-income countries. Their health systems have not been able to achieve consistently high performance in this field. The large volume of patients, manpower constraints, inconsistencies in the level and type of background training of the teams caring for this patient population, and the inadequate quality control systems are some of the barriers to achieving excellence of care. We describe three different international projects supporting the paediatric cardiac surgical and paediatric cardiac intensive care programmes in Latin America, Asia, and the Caribbean.
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http://dx.doi.org/10.1017/S1047951117002621DOI Listing
December 2017

The global burden of paediatric heart disease.

Cardiol Young 2017 Dec;27(S6):S3-S8

7Cincinnati Children's Hospital Medical Center,Research in Patient Services,Cincinnati,Ohio,United States of America.

An estimated 15 million children die or are crippled annually by treatable or preventable heart disease in low- and middle-income countries. Global efforts to reduce under-5 mortality have focused on reducing death from communicable diseases in low- and middle-income countries with little to no attention focusing on paediatric CHD and acquired heart disease. Lack of awareness of CHD and acquired heart disease, access to care, poor healthcare infrastructure, competing health priorities, and a critical shortage of specialists are important reasons why paediatric heart disease has not been addressed in low resourced settings. Non-governmental organisations have taken the lead to address these challenges. This review describes the global burden of paediatric heart disease and strategies to improve the quality of care for paediatric heart disease. These strategies would improve outcomes for children with heart disease.
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http://dx.doi.org/10.1017/S1047951117002530DOI Listing
December 2017

Interprofessional Team's Perception of Care Delivery After Implementation of a Pediatric Pain and Sedation Protocol.

Crit Care Nurse 2017 Jun;37(3):66-76

Sandra L. Staveski is an assistant professor at Cincinnati Children's Hospital Medical Center, Department of Research in Patient Services, and the Heart Institute, Cincinnati, Ohio.

Background: Pain and agitation are common experiences of patients in pediatric cardiac intensive care units. Variability in assessments by health care providers, communication, and treatment of pain and agitation creates challenges in management of pain and sedation.

Objectives: To develop guidelines for assessment and treatment of pain, agitation, and delirium in the pediatric cardiac intensive unit in an academic children's hospital and to document the effects of implementation of the guidelines on the interprofessional team's perception of care delivery and team function.

Methods: Before and after implementation of the guidelines, interprofessional team members were surveyed about the members' perception of analgesia, sedation, and delirium management RESULTS: Members of the interprofessional team felt more comfortable with pain and sedation management after implementation of the guidelines. Team members reported improvements in team communication on patients' comfort. Members thought that important information was less likely to be lost during transfer of care. They also noted that the team carried out comfort management plans and used pharmacological and nonpharmacological therapies better after implementation of the guidelines than they did before implementation.

Conclusions: Guidelines for pain and sedation management were associated with perceived improvements in team function and patient care by members of the interprofessional team.
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http://dx.doi.org/10.4037/ccn2017538DOI Listing
June 2017

Parent education discharge instruction program for care of children at home after cardiac surgery in Southern India.

Cardiol Young 2016 Aug 17;26(6):1213-20. Epub 2015 Nov 17.

4University of California San Francisco School of Nursing,San Francisco,California,United States of America.

Unlabelled: Introduction In many developing countries, children with CHD are now receiving surgical repair or palliation for their complex medical condition. Consequently, parents require more in-depth discharge education programmes to enable them to recognise complications and manage their children's care after hospital discharge. This investigation evaluated the effectiveness of a structured nurse-led parent discharge teaching programme on nurse, parent, and child outcomes in India. Materials and methods A quasi-experimental investigation compared nurse and parent home care knowledge before and at two time points after the parent education discharge instruction program's implementation. Child surgical-site infections and hospital costs were compared for 6 months before and after the discharge programme's implementation.

Results: Both nurses (n=63) and parents (n=68) participated in this study. Records of 195 children who had undergone cardiac surgery were reviewed. Nurses had a high-level baseline home care knowledge that increased immediately after the discharge programme's implementation (T1=24.4±2.89; T2=27.4±1.55; p0.05) after the programme's implementation.

Conclusion: Nurse, parent, and child outcomes were improved after implementation of the structured nurse-led parent discharge programme for parents in India. Structured nurse-led parent discharge programmes may help prepare parents to provide better home care for their children after cardiac surgery. Further investigation of causality and influencing factors is warranted.
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http://dx.doi.org/10.1017/S1047951115002462DOI Listing
August 2016

Establishment of Pediatric Cardiac Intensive Care Advanced Practice Provider Services.

World J Pediatr Congenit Heart Surg 2016 Jan;7(1):72-80

Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

The addition of advanced practice providers (APPs; nurse practitioners and physician assistants) to a pediatric cardiac intensive care unit (PCICU) team is a health care innovation that addresses medical provider shortages while allowing PCICUs to deliver high-quality, cost-effective patient care. APPs, through their consistent clinical presence, effective communication, and facilitation of interdisciplinary collaboration, provide a sustainable solution for the highly specialized needs of PCICU patients. In addition, APPs provide leadership, patient and staff education, facilitate implementation of evidence-based practice and quality improvement initiatives, and the performance of clinical research in the PCICU. This article reviews mechanisms for developing, implementing, and sustaining advance practice services in PCICUs.
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http://dx.doi.org/10.1177/2150135115611356DOI Listing
January 2016

An Overview of Pulmonary Atresia and Major Aortopulmonary Collateral Arteries.

World J Pediatr Congenit Heart Surg 2015 Oct;6(4):630-9

Research in Patient Services and Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCAs) is a rare and complex congenital cardiac lesion that has historically carried a poor prognosis. With advancements in surgical management, we have seen an improvement in the outcomes for children affected by this disease. However, this population continues to present challenges due to the complex anatomy and physiology associated with PA/VSD/MAPCA. This summary of material presented during one of the nursing sessions of the 2014 Meeting of the Pediatric Cardiac Intensive Care Society provides an overview for those in cardiac intensive care units who do not have a large experience with this lesion. We will review the anatomy, physiology, surgical approach, postoperative management strategies, and cardiac catheter intervention options for PA/VSD/MAPCAs. We will also discuss recent innovations that may lead to continued improvement in outcomes for this challenging patient population.
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http://dx.doi.org/10.1177/2150135115598559DOI Listing
October 2015

Nurse and parent perceptions associated with the Parent Education Discharge Instruction Programme in southern India.

Cardiol Young 2016 Aug 12;26(6):1168-75. Epub 2015 Oct 12.

4Family Health Care Nursing,University of California San Francisco School of Nursing,San Francisco,California,United States of America.

Unlabelled: Introduction Parents of children with CHD require home care knowledge in order to ensure their child's health and safety, but there has been no research on how to achieve this in a resource-constrained environment. The aim of this investigation was to compare parent and nurse perceptions of parent readiness for discharge after a structured nurse-led parent discharge teaching programme in India. Materials and methods A pre-post design was used to compare parent and nurse perceptions of parental uncertainty and readiness for hospital discharge before and after introduction of the parent education discharge instruction programme in a paediatric cardiac surgery unit.

Results: Parents (n=68) and nurses (n=63) participated in this study. After the discharge programme implementation, parents had less uncertainty (M=93.3 SD=10.7 versus M=83.6 SD=4.9, p=0.001) and ambiguity (M=40.8 SD=6.8 versus M=33.4 SD=3.7, p=0.001) about their child's illness; however, they rated themselves as being less able to cope with the transition to home (M=24.3 SD=4.1 versus 23.1 SD=2.2, p=0.001) and as having less support at home than that required (M=31.5 SD=9.9 versus 30.9 SD=3.2, p=0.001). Parents' and nurses' perception of parental readiness for hospital discharge were more closely aligned after implementation of a nurse-led discharge programme (r=0.81, p=0.001).

Conclusion: The results of this study suggest that the discharge programme had positive and negative effects on parental perceptions of uncertainty and readiness for discharge. Further examination is warranted to delineate these influences and to design methods for supporting parents during the transition to home care.
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http://dx.doi.org/10.1017/S1047951115002164DOI Listing
August 2016

Pediatric cardiac surgery Parent Education Discharge Instruction (PEDI) program: a pilot study.

World J Pediatr Congenit Heart Surg 2015 Jan;6(1):18-25

University of California at San Francisco School of Nursing, San Francisco, CA, USA.

Background: In developing countries, more children with complex cardiac defects now receive treatment for their condition. For successful long-term outcomes, children also need skilled care at home after discharge. The Parent Education Discharge Instruction (PEDI) program was developed to educate nurses on the importance of discharge teaching and to provide them with a structured process for conducting parent teaching for home care of children after cardiac surgery. The aim of this pilot study was to generate preliminary data on the feasibility and acceptability of the nurse-led structured discharge program on an Indian pediatric cardiac surgery unit.

Methods: A pre-/post-design was used. Questionnaires were used to evaluate role acceptability, nurse and parent knowledge of discharge content, and utility of training materials with 40 nurses and 20 parents. Retrospective audits of 50 patient medical records (25 pre and 25 post) were performed to evaluate discharge teaching documentation.

Results: Nurses' discharge knowledge increased from a mean of 81% to 96% (P = .001) after participation in the training. Nurses and parents reported high levels of satisfaction with the education materials (3.75-4 on a 4.00-point scale). Evidence of discharge teaching documentation in patient medical records improved from 48% (12 of 25 medical records) to 96% (24 of 25 medical records) six months after the implementation of the PEDI program.

Conclusion: The structured nurse-led parent discharge teaching program demonstrated feasibility, acceptability, utility, and sustainability in the cardiac unit. Future studies are needed to examine nurse, parent, child, and organizational outcomes related to this expanded nursing role in resource-constrained environments.
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http://dx.doi.org/10.1177/2150135114554659DOI Listing
January 2015

Nurse decision making regarding the use of analgesics and sedatives in the pediatric cardiac ICU.

Pediatr Crit Care Med 2014 Oct;15(8):691-7

1Department of Nursing, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA. 2Cardiovascular and Critical Care Program, Boston Children's Hospital, Boston, MA. 3Department of Nursing, UCSF Benioff Children's Hospital, San Francisco, CA. 4Department of Cardiology, Boston Children's Hospital, Boston, MA. 5Department of Biostatistics, Harvard School of Public Health, Boston, MA. 6Department of Pediatrics, Harvard Medical School, Boston, MA. 7Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA. 8Department of Anesthesia and Critical Care, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Objective: To describe nurse decision making and patient responses associated with the administration of analgesics and sedatives in the pediatric cardiac ICU.

Design: Prospective nonexperimental mixed methods study of pediatric cardiac ICU nursing practice.

Setting: Three tertiary academic pediatric heart centers in the United States.

Subjects: Pediatric cardiac ICU nurses caring for 217 patients completed 1,330 surveys.

Interventions: Four-item open-ended nurse survey completed each time an as needed dose of an analgesic or sedative was administered, an analgesic or sedative infusion/dose was titrated, and/or a new analgesic or sedative was administered.

Measurements And Main Results: Responses to survey questions were entered verbatim and then collapsed using a consensus process. Collapsing of the data continued until there was a working set of "symptoms," "changes," and "clinical situation managed" categories. Nurses identified 28 symptoms managed with analgesia and sedation. The most frequent symptoms included hypertension, tachycardia, crying, pain, and agitation. Nurses identified 20 patient changes that resulted from their interventions. The most prevalent changes included improved hemodynamics, calm state, sleep, comfort, and relaxed state. Nurses identified 22 clinical situations that they were attempting to manage. The most frequent clinical situations included pain, hemodynamics, procedures, hypertension, and agitation. Nurses responded that 22% of their interventions were influenced by others.

Conclusions: Pediatric cardiac ICU nurses use many nonspecific indicators to describe patient level of comfort collectively. Decisions for managing patient comfort were influenced by their patients' overall hemodynamic stability.
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http://dx.doi.org/10.1097/PCC.0000000000000196DOI Listing
October 2014

Sedative and analgesic use on night and day shifts in a pediatric cardiovascular intensive care unit.

AACN Adv Crit Care 2014 Apr-Jun;25(2):114-8

Sandra L. Staveski is Cardiovascular ICU Nurse Practitioner, Department of Nursing, Lucile Packard Children's Hospital at Stanford, 750 Welch Road, Ste 325, Palo Alto, CA 94304 Tiffany M. Tesoro is Cardiovascular ICU Pharmacist, Department of Pharmacy, Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California. Michael J. Cisco is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California. Stephen J. Roth is Medical Director, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California. Andrew Y. Shin is Attending Physician, Cardiovascular ICU, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California.

Introduction: The use of sedative and analgesic medications is directly linked to patient outcomes. The practice of administering as-needed sedative or analgesic medications deserves further exploration. We hypothesized that important variations exist in the practice of administering as-needed medications in the intensive care unit (ICU). We aimed to determine the influence of time of day on the practice of administering as-needed sedative or analgesic medications to children in the ICU.

Methods: Medication administration records of patients admitted to our pediatric cardiovascular ICU during a 4-month period were reviewed to determine the frequency and timing of as-needed medication usage by shift.

Results: A total of 152 ICU admissions (1854 patient days) were reviewed. A significantly greater number of as-needed doses were administered during the night shift (fentanyl, P = .005; lorazepam, P = .03; midazolam, P = .0003; diphenhydramine, P = .0003; and chloral hydrate, P = .0006). These differences remained statistically significant after excluding doses given during the first 6 hours after cardiovascular surgery. Morphine administration was similar between shifts (P = .08).

Conclusions: We identified a pattern of increased administration of as-needed sedative or analgesic medications during nights. Further research is needed to identify the underlying causes of this practice variation.
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http://dx.doi.org/10.1097/NCI.0000000000000023DOI Listing
June 2015

Implementation of a comprehensive interdisciplinary care coordination of infants and young children on Berlin Heart ventricular assist devices.

J Cardiovasc Nurs 2011 May-Jun;26(3):231-8

Lucile Packard Children's Hospital at Stanford, Palo Alto, California, USA.

Background: Young children supported on a ventricular assist device (VAD) can have prolonged hospitalizations awaiting heart transplantation. The adult VAD literature demonstrates that comprehensive programs optimize transplantation outcomes. The goal of this intervention was to create an interdisciplinary program to optimize care coordination and delivery in young children requiring a VAD.

Method: This study was a case review.

Results: We have supported 8 infants and young children with Berlin Heart VAD. These children's hospitalizations have been more complex than those of our older VAD patients, and they have required intensive care for prolonged periods. An interdisciplinary group evaluated our practices and identified areas for potential improvement. The focus group from our intensive care unit introduced multiple interventions to optimize interdisciplinary care coordination and consistency of practice. These included (1) interdisciplinary care guidelines for chronically, critically ill patients; (2) institution of a primary cardiovascular intensive care unit (CVICU) physician and nurse practitioner system; (3) introduction of a psychological intervention for families to minimize the impact of their extended CVICU stay; (4) implementation of early jejunal feeds; (5) a focused developmental and rehabilitation protocol, 6) implementation of a structured approach to minimizing blood transfusions; (7) increased structure for our interdisciplinary rounds to optimize team communication; (8) comprehensive nursing education including wound care, anticoagulation management, and laboratory draws; and (9) a protocol for off-unit rehabilitative/developmental interventions. These changes in both practice and approach for young VAD patients have also been of benefit to other chronically, critically ill children in the CVICU, as well as to our CVICU team.

Conclusion: Comprehensive interdisciplinary care coordination and standardized practice can be achieved in the critical care setting for complex pediatric heart failure patients who require long-term VAD support.
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http://dx.doi.org/10.1097/JCN.0b013e3181f29a2eDOI Listing
August 2011