All Pediatric Medicine Providers
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Pediatric asthma strategic initiative
This initiative combines the compliance with the CMS Core measures for pediatric patients age 2- 17 admitted to inpatient status with primary or secondary diagnosis of Asthma (Use of reliever medication during hospital stay, Use of systemic corticosteroids during hospital stay, and a comprehensive home management plan that includes ALL of these elements: follow-up care, Environmental and trigger control, method and timing of rescue actions, use of controller medications, and use of reliever medications) and compliance with best practice of giving dose of corticosteroids to pediatric patients age 2-17 with primary or secondary diagnosis of Asthma and/or Reactive Airway Disease who were treated in the Emergency Department with 2 or more reliever medication treatments such as Albuterol (admitted and discharged patients)
Clinical practice: Pediatric asthma – inpatient and outpatient management
Pediatric asthma patients (age < 18) will be identified in any Ambulatory Care setting, Emergency Department, General Pediatric Ward or Pediatric Intensive Care Unit (PICU) or throughout the continuum of hospital stay and have standardized interventions of time-sensitive therapy utilizing an asthma severity score to identify patients with mild, moderate, or severe asthma. The clinical approach to asthma in our pediatric population will focus on four components of asthma care: measures to assess (utilizing an asthma severity score) and monitor asthma, patient and family education, control of environmental factors and other conditions that can worsen asthma, and medications. For chronic asthma care, management will be based on the 2007 National Health Lung and Blood Institute (NHLBI) recommendations, using a stepwise approach to assess asthma severity, in which rescue and controller medication doses or types are stepped up as needed and stepped down when possible. All patients in the ambulatory setting and inpatient setting should be discharged with a standardized Home Management Plan of Care.
Clinical practice: Pediatric sepsis/septic shock management
Outlines standardized interventions of time-sensitive therapy based on the American College of Critical Care Medicine Clinical Guidelines for hemodynamic Support of Neonates and Children with Septic Shock including compliance with pediatric sepsis management bundle (screening for SIRS criteria, assessment protocols, and resusciation/ management goals).
- Clinical practice: Pediatric sepsis/septic shock management (loaded 01/13)
WIS: Newborn standing orders policy
A set of medical staff approved standing orders that a nurse may initiate with the birth of a baby. The order set includes routine admission orders to direct initial care of the well newborn plus initial orders to address urgent/emergent clinical conditions that might arise in a newborn.
- WIS: Newborn standing orders policy #12887 (loaded 07/12)
Clinical practice: Newborn hypoglycemia screening and initial management
Outlines screening for hypoglycemia during the first 24 hours of life using evidence based screening criteria that incorporates maternal risk factors, delivery risk factors, and infant characteristics/status with initial management based on point of care glucose values and the presence/absence of defined signs of hypoglycemia.
Clinical practice: Chorioamnionitis management of the well-appearing newborn
All infants born to obstetrical patients diagnosed with chorioamnionitis or suspected chorioamnionitis will have a neonatal chorioamnionitis management plan initiated within the first hour after birth. Once the diagnosis of chorioamnionitis or suspected chorioamnionitis is established the newborn infant will receive an evaluation and antibiotics administration. All ill-appearing babies should receive the full sepsis evaluation and initiation of antibiotics soon after birth. The approach to initiating antibiotics for well term/appearing infants will be as follows: a) blood culture to be drawn soon after birth, ideally within the first hour of life. CBC can be drawn at the same time, or up to 6-12 hours of age; b) the first dose of antibiotics to be administered within three hours of birth.
Clinical Practice: Pulse oximetry screening for congenital heart disease in newborns
It is an expected clinical practice that all newborns greater than or equal to 34 weeks will have pre and post ductal oxygen saturation testing performed after 24 hours of age or immediately prior to discharge. If positive screening (< or = 90% saturation), proceed to order an ECHO in a timely manner (within 24 hours or prior to discharge).
Clinical practice: Screening and treatment of newborn jaundice
Clinical practice: Diagnosis of diarrheal disease in clinical/epidemiologic conditions
Outlines laboratory studies/evaluation of stools for diagnosing adult and pediatric diarrheal disease based on patient’s presenting condition and history.
- Clinical practice: Diagnosis of diarrheal disease in clinical/epidemiologic conditions (loaded 02/12)
Clinical practice: Use of medical imaging for diagnosing appendicitis in pediatric patients
Outlines work-up of suspected cases of appendicitis in patients under 18 years of age including clinical exam, surgical consult, and if advanced imaging is indicated, to utilized ultrasound first (if available). Then if the ultrasound is equivocal or negative (or not available) and there is a reasonable index fo suspicion, a CT scan with IV and without oral contrast is recommended.
- Clinical practice: Use of medical imaging for diagnosing appendicitis in pediatric patients (loaded 02/12)
Clinical practice: Appropriate use of CT imaging in pediatric head injury
Clinical practice: Pediatric fever evaluation and management
Outlines standardized approach and interventions to address all pediatric patients presenting with fever with emphasis on Neonates (0 to 30 days old), young infants (31-60 days old and 61-90 days old), and children (3-36 months old).
- Clinical practice: Pediatric fever evaluation and management (loaded 01/13)
Clinical practice: Pediatric bronchiolitis
Outlines treatment of patients with the diagnosis of acute viral bronchiolitis as recommended by the American Academy of Pediatrics.
- Clinical practice: Pediatric bronchiolitis (loaded 10/11)
Clinical practice: Dysphagia management in the pediatric population
All pediatric patients presenting with sign/symptoms of swallowing/feeding difficulties and/or diagnosed with dysphagia will receive appropriate assessment and intervention to ensure optimal and functional safe swallowing/feeding skills.
Clinical practice: Anesthesia administration
This clinical practice applies to all inpatients and outpatients in any setting for any purpose, by any route that receive anesthesia (including the use of short acting anesthetic agents for procedural sedation) in Banner Health facilities. All inpatients and outpatients within the Banner Health facilities receiving anesthesia will be administered anesthesia by appropriately credentialed providers based on evidenced based practice, or in its absence will practice within consensus guidelines to best serve the safety of Banner Health patients.
- Clinical practice: Anesthesia administration (loaded 02/12)
Clinical Policy: Procedural sedation for therapeutic/diagnostic procedure
This clinical policy applies to both Adult and Pediatric Patients and defines the circumstances under which procedural sedation may be administered and define responsibilities and parameters for the management of the patient requiring procedural sedation for pre-intra-post, short-term diagnostic, or therapeutic procedures including monitoring requirements. This clinical policy has been defined but not yet fully implemented.
Clinical practice: Quantitative and qualitative exhaled carbon dioxide measurements during procedural sedation pediatric and adult patients
It is an expected clinical practice that all inpatients and outpatients of any age and clinical setting receiving anesthesia (moderate, deep, general and regional ((with sedation)) will, in addition to standard monitors, have the ventilation evaluated by continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide. This clinical practice has been defined but not yet fully implemented.
- Clinical practice: Quantitative and qualitative exhaled carbon dioxide measurements during procedural sedation pediatric and adult patients (loaded 10/13)
Clinical Practice: Administration of nitrous oxide/oxygen sedation for pediatric patients
For pediatric inpatients and outpatients requiring minor procedures that cause anxiety and/or pain, nitrous oxide oxygen (N²O/O²) sedation can be used to provide minimal or procedural sedation. Nitrous oxide/oxygen is an analgesic, amnestic and anxiolytic. It is a recommended Clinical Practice that Nitrous Oxide/Oxygen sedation be used following the General Principles Nitrous Oxide/Oxygen Administration for minimal sedation for anxiety and pain management. If a second agent is given along with nitrous oxide/oxygen, additional patient monitoring guidelines and protocols will be utilized as applicable. Nitrous oxide/oxygen sedation will be utilized in cases with an anticipated length of no more than 30 minutes. This clinical practice has been defined but not yet fully implemented, and will not be available at all Banner facilities.
- Clinical Practice: Administration of nitrous oxide/oxygen sedation for pediatric patients (loaded 01/14)
Clinical practice: Appropriate use of inpatient PET scan - pediatric and adult
All patients requiring Positive Emission Tomography (PET) scans will be seen as outpatients rather than inpatients except in rare clinical circumstances, including patients with new diagnoses of lymphoma with symptoms or oncology patients too sick to leave the hospital, both needing staging for urgent inpatient treatment. Inpatient PET scanning should be used in rare clinical circumstances. Outpatient PET scan is appropriate for most patient scenarios.
Clinical practice: Developmental screenings for pediatrics – medical and functional
All pediatric patients (ages 0-8 years) receiving services at Banner Health will receive a comprehensive screening addressing all physical, medical, developmental and functional systems; to promote the patient’s health, wellness, social and emotional health and competencies.
Clinical practice: Identification and management of Suspected Child Physical Abuse and Neglect (SCAN)
It is an expected clinical practice that all pediatric patients suspected of being victims of child abuse and neglect will be stabilized and then evaluated, including a careful and well-documented history, physical examination with detailed documentation, and a thorough search for other signs that may suggest a non-traumatic cause. Consultation with a child abuse pediatrician, pediatric specialist, or pediatrician experienced in this area, if available, may be helpful in determining the best way to proceed with assessment.
- Clinical practice: Identification and management of Suspected Child Physical Abuse and Neglect (SCAN) (loaded 04/13)
Clinical practice: Human donor milk - pediatric
It is an expected clinical practice that all Infants who are 32 weeks and less, weighing less than 1500 grams at birth, and/or have other at risk diagnoses that require admission to a Neonatal Intensive Care Unit (NICU) will receive pasteurized human donor milk when mother’s own breast milk is not available. This clinical practice has been defined but has not yet been fully implemented.
- Clinical practice: Human donor milk - pediatric (loaded 10/13)
Clinical Practice: Initiation, Advancement and Fortification of Enteral Feedings in the Neonates – Pediatric
It is an expected Clinical Practice that premature infants with either a gestational age of 35 weeks or less and/or weighing less than 1500 grams at birth will be managed utilizing trophic feedings, advancement feeding schedules and fortification.