A Team approach to caring for pediatric patients

with musculoskeletal infections (MSI) and the role

of the MSI nurse coordinator in monitoring

discharge medications.

Mary A. Jones, BSN, RN Naureen G. Tareen MPH, CCRP

Children’s Medical Center

Department of Orthopaedic Surgery

Purpose

To evaluate the impact of Evidence-Based

guidelines and multi-disciplinary team

education on the standardization of antibiotic reconciliation at patient discharge

Background and Significance

• In July 2012, under the leadership of Dr. Lawson Copley MD, Orthopaedic Surgery established a Multi-Disciplinary, Evidence-Based Musculoskeletal Infection (MSI) guideline program at CMC

• Multi-Disciplinary Team: Pediatrics, Orthopaedics, Infectious Disease, Emergency Medicine, Rheumatology, Radiology, Pharmacy, Nursing, Social work, Physical therapy

• The program defined and implemented standardized criteria for diagnosis, treatment and follow-up care of patients diagnosed with deep musculoskeletal infection (Osteomyelitis, Pyomyositis, Septic Arthritis and Abscess).

• Key components: MSI Guidelines & Family centered Care Program

Multi-Disciplinary Team

Medical Providers

Physical therapist

Case Manager

Nursing

Patient

and

patient’s

family

Family Centered Care

A Family Centered Care program was developed with the family

involved directly with the MSI team during daily rounds.

MSI Volumes & Measures

Inpatient volumes

July 2012 – June 2014 = 312

• Osteomyelitis: 134

• Septic Arthritis: 82

• Pyomyositis: 31

• Abscess: 65

Appropriate Empiric Antibiotic (inpatient)

15% 2002-2004

85% 2009

92% 2012 - 2013

Children’s MSI Guideline Program achieved Joint Commission Disease Specific Care Certification in July 2014

Has the distinction of being the first pediatric Joint Commission certified Musculoskeletal Infection Program

in the nation

Patient Satisfaction

Customer Satisfaction Survey (August 2013 – August 2014)

Response rate (204 respondents) : 92.3%

Overall Rating of Hospital Experience: 86.2%

“We are very thankful! To all the doctors

and nurses who treated our son. Best

healthcare experience I have ever seen.”

“Every nurse, doctor, tech, maintenance

person was absolutely Amazing.”

Role of MSI Nurse Coordinator

1. Central point for coordination of services

2. Regular communication between the care team

3. Ensuring optimal post care

A dedicated nursing resource (MSI nurse) monitors the continuum of care by providing coordination, communication and education to the care team

Antibiotic Reconciliation

Key factors to disease resolution:

• Prompt diagnosis and early initiation of appropriate treatment

• Ensuring the correct discharge antibiotic (type, dose and duration)

• Compliance to home medication regimen

Methodology

• Longitudinal, quantitative study design

• Standardization of antibiotic at discharge (type, dose, duration)

• 2 time periods:

Phase 1: July through September 2012 (first 3 months of the MSI program)

Phase 2: January through March 2014

Methodology

• Medication records reviewed of all MSI patients during the study time periods

• Interventions between the study time periods:

1. Hospital-wide education meetings targeting the providers and nursing staff. 2. MSI nurse reviewed the accuracy of all discharge prescriptions.

Results

July – September 2012

31

28

26

27

28

29

30

31

32

Yes No

Correct discharge Abx

Totalpatients

January – March 2014

51

12

0

10

20

30

40

50

60

Yes No

Correct discharge Abx

Totalpatients

Conclusions

Phase 1 : July – September 2012

Discharge Antibiotic Compliance rate = 53%

Phase 2: January – March 2014

Discharge Antibiotic Compliance rate = 81%

Standardized guideline-driven approach to care, regular care team education and a dedicated MSI nurse has resulted in a 28% increase in compliance rate

Nursing Implications

Collaboration “the way in which Physicians and nurses interact with each other in relation to clinical decision making”

“Securing “good” nurse physician relationships” Nursing Management July, 2003

Evidence based guidelines help to standardize approach to treatment

Education of staff members is an ongoing process

A team approach to care leads to consistent communication across the care continuum

Family centered care is essential for comprehensive care

Reconciliation of discharge medications by the MSI nurse helps to ensure appropriate antibiotic treatment