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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
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