2.50
Hdl Handle:
http://hdl.handle.net/10755/162655
Type:
Presentation
Title:
An Evidence-Based Pediatric Oral Rehydration Protocol
Abstract:
An Evidence-Based Pediatric Oral Rehydration Protocol
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Fulcher, Julie, RN, C, BSN
P.I. Institution Name:Lehigh Valley Hospital
Title:Staff Nurse
Contact Address:2545 Schoenersville Road, Bethlehem, PA, 18017, USA
Contact Telephone:(484) 884-2522
Co-Authors:Mark Gutekunst, RN, CEN; Kathy Herron-Buttillo, RN, BS, CCRN; Diana Haines, RN, MSN, CEN; Georgine Fontaine, RN, BSN, CEN; Sharon Hoffner, RN, BS; Brian Joho, RN, BA; Shawna Murphy, RN, BSN, DO; Jennifer Zambo, DO; Patricia Matula, RN, MSN; Joanna Bokovoy
[Clinical Paper Presentation] Clinical Topic: Nurses in this emergency department (ED) were concerned that most pediatric patients seen for mild to moderate dehydration were rehydrated using intravenous (IV) fluids rather than being offered oral rehydration. In fact, a one-month review of ED visit data indicated that most mild to moderate dehydrated pediatric patients were rehydrated with IVs. Their physician colleagues were supportive of the simple idea of oral rehydration, but requested further evidence on its effectiveness. Looking to the literature, a team of ED nurses found several randomized controlled studies and a recent systematic review supporting the effectiveness of oral rehydration over IV rehydration in mild to moderately dehydrated pediatric patients. The purpose of this project was to further investigate, create, and implement an interdisciplinary, evidence-based oral rehydration protocol for pediatric patients.

Implementation: The ED practice council formulated the clinical question using the PICO method as follows: Would patients age six months to 14 years of age presenting to the emergency department with mild to moderate dehydration benefit from treatment with oral rehydration versus intravenous rehydration to improve patient satisfaction and decrease length of stay, cost, and number of hospital admissions? The literature was reviewed for relevant evidence on oral rehydration. The evidence was summarized and clinical experts from major pediatric institutions were contacted for input. A draft of the evidence-based protocol was then presented to an interdisciplinary team composed of ED nurses and ED physicians, a pediatrician, a clinical pediatric nutritionist, a clinical information analyst, and the nurse research specialist. Using recommendations from this group, the protocol was revised and submitted to the hospital's Institutional Review Board for consideration. It was granted exemption from full Board review.

Outcomes: This six-month project is currently in progress. The following variables are currently being measured: Critical interval times, age, chief complaint, discharge diagnosis, degree of dehydration, if IV therapy was initiated, number of times patient vomited during protocol, and patient refusal. Community education concerning dehydration and rehydration is being done each time the protocol is implemented, using an education plan which includes demonstration of oral rehydration and rewritten discharge instructions. Each parent and nurse receives a survey using 5-point Likert scale questions to rate their satisfaction with the protocol. Although data collection are still in progress, implementation of this protocol shows a trend towards positive patient outcomes (rare hospital admissions or return visits within 48 hours), high level of family satisfaction (mostly 4's and 5's on a 5-point Likert scale) and reduced painful stimuli (rare need for intravenous rehydration).

Recommendations: Evidence-based practice is a unique and important approach to clinical care and a significant part of a Magnet status hospital. Support from management and nurse researchers has been vital to the initiative's success. This first collaborative effort between interdisciplinary caregivers has provided a foundation for additional efforts to change practice in the emergency department. A successful implementation and positive patient outcomes for this protocol have resulted in implementation at other network ED sites.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleAn Evidence-Based Pediatric Oral Rehydration Protocolen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162655-
dc.description.abstract<table><tr><td colspan="2" class="item-title">An Evidence-Based Pediatric Oral Rehydration Protocol</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Fulcher, Julie, RN, C, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Lehigh Valley Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Staff Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2545 Schoenersville Road, Bethlehem, PA, 18017, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(484) 884-2522</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">julie_m.fulcher@lvh.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Mark Gutekunst, RN, CEN; Kathy Herron-Buttillo, RN, BS, CCRN; Diana Haines, RN, MSN, CEN; Georgine Fontaine, RN, BSN, CEN; Sharon Hoffner, RN, BS; Brian Joho, RN, BA; Shawna Murphy, RN, BSN, DO; Jennifer Zambo, DO; Patricia Matula, RN, MSN; Joanna Bokovoy</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Paper Presentation] Clinical Topic: Nurses in this emergency department (ED) were concerned that most pediatric patients seen for mild to moderate dehydration were rehydrated using intravenous (IV) fluids rather than being offered oral rehydration. In fact, a one-month review of ED visit data indicated that most mild to moderate dehydrated pediatric patients were rehydrated with IVs. Their physician colleagues were supportive of the simple idea of oral rehydration, but requested further evidence on its effectiveness. Looking to the literature, a team of ED nurses found several randomized controlled studies and a recent systematic review supporting the effectiveness of oral rehydration over IV rehydration in mild to moderately dehydrated pediatric patients. The purpose of this project was to further investigate, create, and implement an interdisciplinary, evidence-based oral rehydration protocol for pediatric patients.<br/><br/>Implementation: The ED practice council formulated the clinical question using the PICO method as follows: Would patients age six months to 14 years of age presenting to the emergency department with mild to moderate dehydration benefit from treatment with oral rehydration versus intravenous rehydration to improve patient satisfaction and decrease length of stay, cost, and number of hospital admissions? The literature was reviewed for relevant evidence on oral rehydration. The evidence was summarized and clinical experts from major pediatric institutions were contacted for input. A draft of the evidence-based protocol was then presented to an interdisciplinary team composed of ED nurses and ED physicians, a pediatrician, a clinical pediatric nutritionist, a clinical information analyst, and the nurse research specialist. Using recommendations from this group, the protocol was revised and submitted to the hospital's Institutional Review Board for consideration. It was granted exemption from full Board review.<br/><br/>Outcomes: This six-month project is currently in progress. The following variables are currently being measured: Critical interval times, age, chief complaint, discharge diagnosis, degree of dehydration, if IV therapy was initiated, number of times patient vomited during protocol, and patient refusal. Community education concerning dehydration and rehydration is being done each time the protocol is implemented, using an education plan which includes demonstration of oral rehydration and rewritten discharge instructions. Each parent and nurse receives a survey using 5-point Likert scale questions to rate their satisfaction with the protocol. Although data collection are still in progress, implementation of this protocol shows a trend towards positive patient outcomes (rare hospital admissions or return visits within 48 hours), high level of family satisfaction (mostly 4's and 5's on a 5-point Likert scale) and reduced painful stimuli (rare need for intravenous rehydration).<br/><br/>Recommendations: Evidence-based practice is a unique and important approach to clinical care and a significant part of a Magnet status hospital. Support from management and nurse researchers has been vital to the initiative's success. This first collaborative effort between interdisciplinary caregivers has provided a foundation for additional efforts to change practice in the emergency department. A successful implementation and positive patient outcomes for this protocol have resulted in implementation at other network ED sites.</td></tr></table>en_GB
dc.date.available2011-10-27T10:31:53Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:31:53Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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