Background Virtual reality (VR) and augmented reality (AR) interventions are emerging as promisin... more Background Virtual reality (VR) and augmented reality (AR) interventions are emerging as promising tools in the treatment of pediatric chronic pain conditions. However, in this young field, there is little consensus to guide the process of engaging in the development and evaluation of targeted VR-based interventions. Objective The INOVATE-Pain (Interdisciplinary Network on Virtual and Augmented Technologies for Pain management) consortium aims to advance the field of VR for pediatric chronic pain rehabilitation by providing guidance for best practices in the design, evaluation, and dissemination of VR-based interventions targeting this population. Methods An interdisciplinary meeting of 16 academics, clinicians, industry partners, and philanthropy partners was held in January 2020. Results Reviewing the state of the field, the consortium identified important directions for research-driven innovation in VR and AR clinical care, highlighted key opportunities and challenges facing the ...
BackgroundAccurate intraoperative antibiotic redosing contributes to prevention of surgical site ... more BackgroundAccurate intraoperative antibiotic redosing contributes to prevention of surgical site infections in pediatric patients. Ensuring compliance with evolving national guidelines of weight‐based, intraoperative redosing of antibiotics is challenging to pediatric anesthesiologists.AimsOur primary aim was to increase compliance of antibiotic redoses at the appropriate time and appropriate weight‐based dose to 70%. Secondary aims included a subset analysis of time compliance and dose compliance individually, and compliance based on order entry method of the first dose (verbal or electronic).MethodsAt a freestanding, academic pediatric hospital, we reviewed surgical cases between May 1, 2014, and October 31, 2017 requiring antibiotic redoses. After an institutional change in cefazolin dosing in May 2015, phased interventions to improve compliance included electronic countermeasures to display previous and next dose timing, an alert 5 minutes prior to next dose, and weight‐based do...
Most children undergoing anesthesia experience significant preoperative anxiety. We developed a b... more Most children undergoing anesthesia experience significant preoperative anxiety. We developed a bedside entertainment and relaxation theater (BERT) as an alternative to midazolam for appropriate patients undergoing anesthesia. The primary aim of this study was to determine if BERT was as effective as midazolam in producing cooperative patients at anesthesia induction. Secondary aims reviewed patient emotion and timeliness of BERT utilization. We conducted a retrospective cohort study of pediatric patients undergoing anesthesia at Lucile Packard Children's Hospital Stanford between February 1, 2016, and October 1, 2016. Logistic regression compared induction cooperation between groups. Multinomial logistic regression compared patients' emotion at induction. Ordinary least squares regression compared preoperative time. Of the 686 eligible patients, 163 were in the BERT group and 150 in the midazolam. Ninety-three percentage of study patients (290/313) were cooperative at induc...
BackgroundUncooperative pediatric mask induction is linked to perioperative anxiety. Although som... more BackgroundUncooperative pediatric mask induction is linked to perioperative anxiety. Although some risk factors for uncooperative inductions have been reported, there are no large cohort studies that identify intrinsic patient characteristics associated with cooperation.AimThe primary aim was to identify patient characteristics associated with cooperative mask inductions. The secondary aim was to determine whether preoperative interventions were associated with increased cooperation.MethodsThis retrospective cohort study included patients 2‐11 years old and ASA class I‐IV who underwent mask induction. Our primary outcome of interest was cooperation with mask induction, which was correlated against the Induction Compliance Checklist. The variables analyzed for association with cooperation were age, sex, ASA class, class of surgery, preferred language, and race. Interventions examined for association with induction cooperation included premedication with midazolam, exposure to distrac...
BMJ Simulation and Technology Enhanced Learning, 2021
Augmented reality (AR) has been studied as a clinical teaching tool, however eye-tracking capabil... more Augmented reality (AR) has been studied as a clinical teaching tool, however eye-tracking capabilities integrated within an AR medical simulator have limited research. The recently developed Chariot Augmented Reality Medical (CHARM) simulator integrates real-time communication into a portable medical simulator. The purpose of this project was to refine the gaze-tracking capabilities of the CHARM simulator on the Magic Leap One (ML1). Adults aged 18 years and older were recruited using convenience sampling. Participants were provided with an ML1 headset that projected a hologram of a patient, bed and monitor. They were instructed via audio recording to gaze at variables in this scenario. The participant gaze targets from the ML1 output were compared with the specified gaze points from the audio recording. A priori investigators planned to iterative modifications of the eye-tracking software until a capture rate of 80% was achieved. Two consecutive participants with a capture rate les...
Background: The goal of preoperative fasting is to prevent pulmonary aspiration during general an... more Background: The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes for prolonged NPO times with the aim to suggest improvement strategies by a newly founded fasting task force.Methods: Data from all electronic anesthesia records from 2019 at our institution were reviewed for fasting times. Our NPO instructions follow American Society of Anesthesiology guidelines and are calculated based on the patient’s arrival time (90 min before OR time). Primary outcome was the effective NPO time for clear liquids, secondary outcomes were incidence of delays and the parental compliance with the NPO instructions. Data are presented as median (interquartile range).Results: 9,625 cases were included in the analysis. NPO time was documented in 72.1% with a median effectiv...
This case series examines interactive AR during minor otolaryngologic procedures. Although VR has... more This case series examines interactive AR during minor otolaryngologic procedures. Although VR has been successfully used for pediatric vascular access, removing children from comforting people in the real world has resulted in patient anxiety. AR offers a potential advantage, utilizing distracting holographic images when patients maintain eye contact with parents. The primary objective was to determine the effect of AR on fear during pediatric otolaryngologic procedures. Secondary objectives included evaluating pain; procedure compliance; and patient, parent and physician attitudes toward AR, as well as assessing the feasibility of adding AR to a busy outpatient otolaryngologic clinic. Laryngoscope, 131:E1342–E1344, 2021
Purpose: The purpose of this report is to demonstrate the successful application of virtual reali... more Purpose: The purpose of this report is to demonstrate the successful application of virtual reality to improve physical therapy in the pediatric cardiovascular intensive care unit. Early mobilization and cognitive stimulation improve morbidity of critically ill children. However, maintaining child engagement with these therapies can be challenging, especially during extended intensive care stays. Summary of Key Points: While virtual reality has been successfully used as an analgesic and anxiolytic in the cardiovascular intensive care unit, this report demonstrates its novel use as a tool to augment physical therapy for a child who had been debilitated after heart transplantation. Virtual reality encouraged the child to engage in physical therapy sessions, participate for greater durations, and directly address barriers to discharge. Conclusions and Recommendations for Clinical Practice: While further studies are needed to define best practice, this report demonstrates that virtual r...
Aims The HTC VIVE virtual reality (VR) system is a potential tool for collecting kinematic data d... more Aims The HTC VIVE virtual reality (VR) system is a potential tool for collecting kinematic data during inpatient and outpatient physical therapy (PT). When validated against research-grade systems, the VIVE has a reported translational error between 1.7 mm–2.0 cm. Our purpose was to portabilize the VIVE for room to room PT and validate the motion tracking software. Methods The VIVE was configured on a mobile cart. To validate the motion tracking software, the VIVE sensors (motion tracker, controller, headset) were mounted on a rigid linear track and driven through 10, one-meter translations in the X, Y, and Z axes. Results The mean translational error for all three sensors was below 4.9 cm. While error is greater than that reported for research-grade systems, motion tracking software on the portable VIVE unit appears to be a valid means of tracking aggregate movement. Conclusion Some therapy may require more precise measurements, however, the advantages of portability and accessibil...
BACKGROUND: Long-term opioid use has negative health care consequences. Opioid-naïve adults are a... more BACKGROUND: Long-term opioid use has negative health care consequences. Opioid-naïve adults are at risk for prolonged and persistent opioid use after surgery. While these outcomes have been examined in some adolescent and teenage populations, little is known about the risk of prolonged and persistent postoperative opioid use after common surgeries compared to children who do not undergo surgery and factors associated with these issues among pediatric surgical patients of all ages. METHODS: Using a national administrative claims database, we identified 175,878 surgical visits by opioid-naïve children aged ≤18 years who underwent ≥1 of the 20 most common surgeries from each of 4 age groups between December 31, 2002, and December 30, 2017, and who filled a perioperative opioid prescription 30 days before to 14 days after surgery. Prolonged opioid use after surgery (filling ≥1 opioid prescription 90–180 days after surgery) was compared to a reference sample of 1,354,909 nonsurgical pati...
Background: Combination analgesics are among the most commonly prescribed pain medications in ped... more Background: Combination analgesics are among the most commonly prescribed pain medications in pediatric orthopedic patients. However, combined analgesics do not allow for individual medication titration, which can increase the risk of opioid misuse and hepatoxicity from acetaminophen. Increasingly, the risks of combined analgesics associated with opioid misuse and hepatotoxicity are recognized by the FDA and other organizations. Given these risks, consideration should be made for independent administration of acetaminophen and opioids. Hypothesis/Purpose: The primary aim was to alter the prescribing habits of pediatric orthopedic providers at our institution from postoperative combined opioid/acetaminophen medicines to independent opioids and acetaminophen. Methods: The study took place at a children’s hospital level one trauma center. A multidisciplinary team of health professionals utilized lean methodology to develop a project plan. Guided by a key driver diagram, (1) combination...
Background Living with Inflammatory Bowel Disease (IBD) has been associated with increased psycho... more Background Living with Inflammatory Bowel Disease (IBD) has been associated with increased psychosocial stress among pediatric IBD populations. Elevated psychological stress can exacerbate disease activity and IBD symptoms like abdominal pain, which in turn can negatively impact children’s mental health. There is an increasing need for mind-body interventions that can improve biopsychosocial processes among youth with IBD. Mindfulness-based interventions (MBIs) have been shown to be efficacious in improving emotional distress, pain, and inflammation in a range of pediatric and adult chronic illness/pain populations. Few studies have explored MBIs in pediatric IBD. Using virtual reality (VR) as the medium for an MBI in pediatric IBD has great potential given the increasing prevalence of VR in children’s hospitals, the immersive nature of the technology, and the high acceptability of VR among youth. Aims 1) Assess the feasibility and acceptability of mindfulness-based virtual reality ...
BACKGROUND: Racial and ethnic disparities in health care are well documented in the United States... more BACKGROUND: Racial and ethnic disparities in health care are well documented in the United States, although evidence of disparities in pediatric anesthesia is limited. We sought to determine whether there is an association between race and ethnicity and the use of intraoperative regional anesthesia at a single academic children’s hospital. METHODS: We performed a retrospective review of all anesthetics at an academic tertiary children’s hospital between May 4, 2014, and May 31, 2018. The primary outcome was delivery of regional anesthesia, defined as a neuraxial or peripheral nerve block. The association between patient race and ethnicity (white non-Hispanic or minority) and receipt of regional anesthesia was assessed using multivariable logistic regression. Sensitivity analyses were performed comparing white non-Hispanic to an expansion of the single minority group to individual racial and ethnic groups and on patients undergoing surgeries most likely to receive regional anesthesia...
We describe a patient with acute on chronic respiratory failure after a cardiac arrest who was ca... more We describe a patient with acute on chronic respiratory failure after a cardiac arrest who was cannulated to venoarterial extracorporeal membrane oxygenation. The patient developed right-sided interstitial emphysema with air leak and left-sided hemothorax with secondary atelectasis. A differential lung ventilation strategy was used in which an endotracheal tube was placed in the left main stem bronchus and a bronchial blocker was placed in the right mainstem bronchus. The patient’s overall pulmonary function improved, and he was successfully decannulated from extracorporeal membrane oxygenation. In conclusion, differential lung ventilation may be performed in patients on extracorporeal membrane oxygenation with disparate lung disease as an alternative ventilation strategy.
SummaryBackgroundThe risk of surgical site infections is reduced with appropriate timing and dosi... more SummaryBackgroundThe risk of surgical site infections is reduced with appropriate timing and dosing of preoperative antimicrobials. Based on evolving national guidelines, we increased the preoperative dose of cefazolin from 25 to 30 mg·kg−1. This quality improvement project describes an improvement initiative to develop standard work processes to ensure appropriate dosing.AimsThe primary aim was to deliver cefazolin 30 mg·kg−1 to at least 90% of indicated patients. The secondary aim was to determine differences between accuracy of cefazolin doses when given as an electronic order compared to a verbal order.MethodsData were collected from January 1, 2012 to May 31, 2016. A quality improvement team of perioperative physicians, nurses, and pharmacists implemented a series of interventions including new electronic medical record order sets, personal provider antibiotic dose badges, and utilization of pharmacists to prepare antibiotics to increase compliance with the recommended dose. Pr...
Background Virtual reality (VR) and augmented reality (AR) interventions are emerging as promisin... more Background Virtual reality (VR) and augmented reality (AR) interventions are emerging as promising tools in the treatment of pediatric chronic pain conditions. However, in this young field, there is little consensus to guide the process of engaging in the development and evaluation of targeted VR-based interventions. Objective The INOVATE-Pain (Interdisciplinary Network on Virtual and Augmented Technologies for Pain management) consortium aims to advance the field of VR for pediatric chronic pain rehabilitation by providing guidance for best practices in the design, evaluation, and dissemination of VR-based interventions targeting this population. Methods An interdisciplinary meeting of 16 academics, clinicians, industry partners, and philanthropy partners was held in January 2020. Results Reviewing the state of the field, the consortium identified important directions for research-driven innovation in VR and AR clinical care, highlighted key opportunities and challenges facing the ...
BackgroundAccurate intraoperative antibiotic redosing contributes to prevention of surgical site ... more BackgroundAccurate intraoperative antibiotic redosing contributes to prevention of surgical site infections in pediatric patients. Ensuring compliance with evolving national guidelines of weight‐based, intraoperative redosing of antibiotics is challenging to pediatric anesthesiologists.AimsOur primary aim was to increase compliance of antibiotic redoses at the appropriate time and appropriate weight‐based dose to 70%. Secondary aims included a subset analysis of time compliance and dose compliance individually, and compliance based on order entry method of the first dose (verbal or electronic).MethodsAt a freestanding, academic pediatric hospital, we reviewed surgical cases between May 1, 2014, and October 31, 2017 requiring antibiotic redoses. After an institutional change in cefazolin dosing in May 2015, phased interventions to improve compliance included electronic countermeasures to display previous and next dose timing, an alert 5 minutes prior to next dose, and weight‐based do...
Most children undergoing anesthesia experience significant preoperative anxiety. We developed a b... more Most children undergoing anesthesia experience significant preoperative anxiety. We developed a bedside entertainment and relaxation theater (BERT) as an alternative to midazolam for appropriate patients undergoing anesthesia. The primary aim of this study was to determine if BERT was as effective as midazolam in producing cooperative patients at anesthesia induction. Secondary aims reviewed patient emotion and timeliness of BERT utilization. We conducted a retrospective cohort study of pediatric patients undergoing anesthesia at Lucile Packard Children's Hospital Stanford between February 1, 2016, and October 1, 2016. Logistic regression compared induction cooperation between groups. Multinomial logistic regression compared patients' emotion at induction. Ordinary least squares regression compared preoperative time. Of the 686 eligible patients, 163 were in the BERT group and 150 in the midazolam. Ninety-three percentage of study patients (290/313) were cooperative at induc...
BackgroundUncooperative pediatric mask induction is linked to perioperative anxiety. Although som... more BackgroundUncooperative pediatric mask induction is linked to perioperative anxiety. Although some risk factors for uncooperative inductions have been reported, there are no large cohort studies that identify intrinsic patient characteristics associated with cooperation.AimThe primary aim was to identify patient characteristics associated with cooperative mask inductions. The secondary aim was to determine whether preoperative interventions were associated with increased cooperation.MethodsThis retrospective cohort study included patients 2‐11 years old and ASA class I‐IV who underwent mask induction. Our primary outcome of interest was cooperation with mask induction, which was correlated against the Induction Compliance Checklist. The variables analyzed for association with cooperation were age, sex, ASA class, class of surgery, preferred language, and race. Interventions examined for association with induction cooperation included premedication with midazolam, exposure to distrac...
BMJ Simulation and Technology Enhanced Learning, 2021
Augmented reality (AR) has been studied as a clinical teaching tool, however eye-tracking capabil... more Augmented reality (AR) has been studied as a clinical teaching tool, however eye-tracking capabilities integrated within an AR medical simulator have limited research. The recently developed Chariot Augmented Reality Medical (CHARM) simulator integrates real-time communication into a portable medical simulator. The purpose of this project was to refine the gaze-tracking capabilities of the CHARM simulator on the Magic Leap One (ML1). Adults aged 18 years and older were recruited using convenience sampling. Participants were provided with an ML1 headset that projected a hologram of a patient, bed and monitor. They were instructed via audio recording to gaze at variables in this scenario. The participant gaze targets from the ML1 output were compared with the specified gaze points from the audio recording. A priori investigators planned to iterative modifications of the eye-tracking software until a capture rate of 80% was achieved. Two consecutive participants with a capture rate les...
Background: The goal of preoperative fasting is to prevent pulmonary aspiration during general an... more Background: The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes for prolonged NPO times with the aim to suggest improvement strategies by a newly founded fasting task force.Methods: Data from all electronic anesthesia records from 2019 at our institution were reviewed for fasting times. Our NPO instructions follow American Society of Anesthesiology guidelines and are calculated based on the patient’s arrival time (90 min before OR time). Primary outcome was the effective NPO time for clear liquids, secondary outcomes were incidence of delays and the parental compliance with the NPO instructions. Data are presented as median (interquartile range).Results: 9,625 cases were included in the analysis. NPO time was documented in 72.1% with a median effectiv...
This case series examines interactive AR during minor otolaryngologic procedures. Although VR has... more This case series examines interactive AR during minor otolaryngologic procedures. Although VR has been successfully used for pediatric vascular access, removing children from comforting people in the real world has resulted in patient anxiety. AR offers a potential advantage, utilizing distracting holographic images when patients maintain eye contact with parents. The primary objective was to determine the effect of AR on fear during pediatric otolaryngologic procedures. Secondary objectives included evaluating pain; procedure compliance; and patient, parent and physician attitudes toward AR, as well as assessing the feasibility of adding AR to a busy outpatient otolaryngologic clinic. Laryngoscope, 131:E1342–E1344, 2021
Purpose: The purpose of this report is to demonstrate the successful application of virtual reali... more Purpose: The purpose of this report is to demonstrate the successful application of virtual reality to improve physical therapy in the pediatric cardiovascular intensive care unit. Early mobilization and cognitive stimulation improve morbidity of critically ill children. However, maintaining child engagement with these therapies can be challenging, especially during extended intensive care stays. Summary of Key Points: While virtual reality has been successfully used as an analgesic and anxiolytic in the cardiovascular intensive care unit, this report demonstrates its novel use as a tool to augment physical therapy for a child who had been debilitated after heart transplantation. Virtual reality encouraged the child to engage in physical therapy sessions, participate for greater durations, and directly address barriers to discharge. Conclusions and Recommendations for Clinical Practice: While further studies are needed to define best practice, this report demonstrates that virtual r...
Aims The HTC VIVE virtual reality (VR) system is a potential tool for collecting kinematic data d... more Aims The HTC VIVE virtual reality (VR) system is a potential tool for collecting kinematic data during inpatient and outpatient physical therapy (PT). When validated against research-grade systems, the VIVE has a reported translational error between 1.7 mm–2.0 cm. Our purpose was to portabilize the VIVE for room to room PT and validate the motion tracking software. Methods The VIVE was configured on a mobile cart. To validate the motion tracking software, the VIVE sensors (motion tracker, controller, headset) were mounted on a rigid linear track and driven through 10, one-meter translations in the X, Y, and Z axes. Results The mean translational error for all three sensors was below 4.9 cm. While error is greater than that reported for research-grade systems, motion tracking software on the portable VIVE unit appears to be a valid means of tracking aggregate movement. Conclusion Some therapy may require more precise measurements, however, the advantages of portability and accessibil...
BACKGROUND: Long-term opioid use has negative health care consequences. Opioid-naïve adults are a... more BACKGROUND: Long-term opioid use has negative health care consequences. Opioid-naïve adults are at risk for prolonged and persistent opioid use after surgery. While these outcomes have been examined in some adolescent and teenage populations, little is known about the risk of prolonged and persistent postoperative opioid use after common surgeries compared to children who do not undergo surgery and factors associated with these issues among pediatric surgical patients of all ages. METHODS: Using a national administrative claims database, we identified 175,878 surgical visits by opioid-naïve children aged ≤18 years who underwent ≥1 of the 20 most common surgeries from each of 4 age groups between December 31, 2002, and December 30, 2017, and who filled a perioperative opioid prescription 30 days before to 14 days after surgery. Prolonged opioid use after surgery (filling ≥1 opioid prescription 90–180 days after surgery) was compared to a reference sample of 1,354,909 nonsurgical pati...
Background: Combination analgesics are among the most commonly prescribed pain medications in ped... more Background: Combination analgesics are among the most commonly prescribed pain medications in pediatric orthopedic patients. However, combined analgesics do not allow for individual medication titration, which can increase the risk of opioid misuse and hepatoxicity from acetaminophen. Increasingly, the risks of combined analgesics associated with opioid misuse and hepatotoxicity are recognized by the FDA and other organizations. Given these risks, consideration should be made for independent administration of acetaminophen and opioids. Hypothesis/Purpose: The primary aim was to alter the prescribing habits of pediatric orthopedic providers at our institution from postoperative combined opioid/acetaminophen medicines to independent opioids and acetaminophen. Methods: The study took place at a children’s hospital level one trauma center. A multidisciplinary team of health professionals utilized lean methodology to develop a project plan. Guided by a key driver diagram, (1) combination...
Background Living with Inflammatory Bowel Disease (IBD) has been associated with increased psycho... more Background Living with Inflammatory Bowel Disease (IBD) has been associated with increased psychosocial stress among pediatric IBD populations. Elevated psychological stress can exacerbate disease activity and IBD symptoms like abdominal pain, which in turn can negatively impact children’s mental health. There is an increasing need for mind-body interventions that can improve biopsychosocial processes among youth with IBD. Mindfulness-based interventions (MBIs) have been shown to be efficacious in improving emotional distress, pain, and inflammation in a range of pediatric and adult chronic illness/pain populations. Few studies have explored MBIs in pediatric IBD. Using virtual reality (VR) as the medium for an MBI in pediatric IBD has great potential given the increasing prevalence of VR in children’s hospitals, the immersive nature of the technology, and the high acceptability of VR among youth. Aims 1) Assess the feasibility and acceptability of mindfulness-based virtual reality ...
BACKGROUND: Racial and ethnic disparities in health care are well documented in the United States... more BACKGROUND: Racial and ethnic disparities in health care are well documented in the United States, although evidence of disparities in pediatric anesthesia is limited. We sought to determine whether there is an association between race and ethnicity and the use of intraoperative regional anesthesia at a single academic children’s hospital. METHODS: We performed a retrospective review of all anesthetics at an academic tertiary children’s hospital between May 4, 2014, and May 31, 2018. The primary outcome was delivery of regional anesthesia, defined as a neuraxial or peripheral nerve block. The association between patient race and ethnicity (white non-Hispanic or minority) and receipt of regional anesthesia was assessed using multivariable logistic regression. Sensitivity analyses were performed comparing white non-Hispanic to an expansion of the single minority group to individual racial and ethnic groups and on patients undergoing surgeries most likely to receive regional anesthesia...
We describe a patient with acute on chronic respiratory failure after a cardiac arrest who was ca... more We describe a patient with acute on chronic respiratory failure after a cardiac arrest who was cannulated to venoarterial extracorporeal membrane oxygenation. The patient developed right-sided interstitial emphysema with air leak and left-sided hemothorax with secondary atelectasis. A differential lung ventilation strategy was used in which an endotracheal tube was placed in the left main stem bronchus and a bronchial blocker was placed in the right mainstem bronchus. The patient’s overall pulmonary function improved, and he was successfully decannulated from extracorporeal membrane oxygenation. In conclusion, differential lung ventilation may be performed in patients on extracorporeal membrane oxygenation with disparate lung disease as an alternative ventilation strategy.
SummaryBackgroundThe risk of surgical site infections is reduced with appropriate timing and dosi... more SummaryBackgroundThe risk of surgical site infections is reduced with appropriate timing and dosing of preoperative antimicrobials. Based on evolving national guidelines, we increased the preoperative dose of cefazolin from 25 to 30 mg·kg−1. This quality improvement project describes an improvement initiative to develop standard work processes to ensure appropriate dosing.AimsThe primary aim was to deliver cefazolin 30 mg·kg−1 to at least 90% of indicated patients. The secondary aim was to determine differences between accuracy of cefazolin doses when given as an electronic order compared to a verbal order.MethodsData were collected from January 1, 2012 to May 31, 2016. A quality improvement team of perioperative physicians, nurses, and pharmacists implemented a series of interventions including new electronic medical record order sets, personal provider antibiotic dose badges, and utilization of pharmacists to prepare antibiotics to increase compliance with the recommended dose. Pr...
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Papers by Ellen Wang