Category Archives: Injury Prevention

Patient Safety Week: Are we safer this year?

By Melissa Hamlin

It’s Patient Safety Week, but for patients and their families every week is safety week. It’s an opportunity for all of us to think about how we can collaborate to eliminate all preventable harm. It’s also a time of reflection:  Are we safer at Children’s Hospitals and Clinics of Minnesota this year than we were last year?

  • In the spring of 2012, we began rolling out bar code medication administration. That continues and is now being implemented on our St. Paul campus.
  • Also in the spring, we joined forces with 33 other pediatric hospitals to address our collective patient safety priorities:  blood stream infections, surgical site infections, urinary tract infections, ventilator acquired pneumonia, pressure ulcers, venous thromboembolism, readmissions, patient falls and adverse drug events. This work will be a continuous process based on evidence and best practice, and we are making a concerted effort to reduce the incidence of these events at Children’s.
  • In early September, the organization began a Daily Leadership Huddle that has provided Children’s leaders with increased awareness of front-line operations, a forum to identify problems and assign ownership for issue resolution and ensure common understanding of the day’s priorities.
  • Our infection control department initiated the “Wash ‘Em Proud” campaign encouraging staff, family and visitors to be active participants in reducing the spread of germs by practicing good hand hygiene.  (Check out our “Wash ‘Em Proud” video here.) As a result of organizational emphasis and awareness on healthcare acquired infections (HAI’s), we saw a significant decrease in the rate of HAI’s at Children’s — a 28 percent decrease from 2011 to be exact.
  • Our Quality and Safety team has begun work to increase awareness and visibility with front-line staff.  Early work is focusing on regular attendance at unit council meetings, transparency around safety events and increased communication.

We’ve made great progress, but we must continue adjusting our strategies to ensure that the patients who come to us are provided with the best, safest care possible.  At Children’s, we are committed to this.

So to answer the question: Are we safer this year than we were last year?  Yes, we are, but we can always make improvements. Here’s to making 2013 even safer!

Happy Patient Safety Week!

Hamlin, MSN, RN, BC, is a patient safety consultant at Children’s. 

Safety first: Holiday shopping for the kids in your life

By Kristi Moline

We’re a few weeks into the holiday shopping season. That came fast, didn’t it? I don’t know about you, but I still have some shopping left. At the top of my shopping list are gifts for my two small children. They’re 3 years old and 6 months old.

Both as a mom and in my role as program manager for injury prevention at Children’s Hospitals and Clinics of Minnesota, I think about safety first when I decide what gets put in the shopping cart.

Like all parents, I want my children to enjoy their toys. I buy toys that are fun and stimulate learning and growth. But, safety rules. Sadly, I’ve seen first-hand what can happen when a child gets a potentially dangerous toy in his grip. It can lead to injury or worse.

While working on this blog post, I learned that 13 kids age 14 and under died from a toy-related incident, according to the U.S. Consumer Product Safety Commission. A startling 262,000 were treated for toy-related injuries in emergency departments in 2011. The usual suspects for causing injuries are non-motorized scooters, toy vehicles and toy balls.

If those of you reading this are anything like me, you probably haven’t finished shopping yet, either. I’ve collected some safety tips – with the help of the CPSC –that I hope will help guide what you put in your shopping cart this holiday season:

  1. Read the label. Buy age-appropriate toys that suit the child’s interest and skill levels.
  2. Small balls and toys with small parts can cause choking. For kids under 3, avoid these toys.
  3. If you give or your child gets anything with wheels – like a scooter, bike or in-line skates – make wearing a helmet a rule. A properly fitted helmet should be worn every time and everywhere. For more information on this, visit our Making Safe Simple website.
  4. Anything containing a magnet can be dangerous and kept away from kids under 14.
  5. Check that toys are of high quality design and construction.
  6. Make sure  instructions are easy to follow; discard toy packaging immediately so it doesn’t become a hazard.
  7. Once playing is underway, supervise children accordingly.

Here’s to a happy and safe holiday season.

Making safe simple booth visit helps prevent at-home emergency

For the past two years, we’ve taken our Making safe simple program to the Minnesota State Fair. For 12 days from dawn until after dusk, we educate fairgoers on ATV, bike, car seat, and household safety.

Our goal is to help families prevent injuries and, in the case of an emergency, how to best respond. We hope no family experiences an emergency. But reality tells us it will and does happen.

Each year, 5,000 children die and another six million are hurt because of unintentional injuries. One in four kids is hurt seriously enough to need medical attention. We believe that, together, we can make safe simple.

That became even more apparent after the fair when we received the following email from Sarah who had visited our Making safe simple booth. Hours within visiting the fair, her family had taken our advice and put it into action to prevent an emergency from escalating. Here’s her story:

THANK YOU for the great, life-saving, or at least, garage-saving safety information your team provided at the Fair. My family and I visited your booth today and took your safety quiz this year. We’ve gone in the past and had fun, but this year it was extra helpful.

I got a “hard” question in the Plinko area and was asked about how to operate a fire extinguisher. I had to think about it a bit, but came up with a passable answer. The volunteer then taught us the PASS acronym about pulling the pin, aiming, squeezing the trigger and sweeping back and forth.

Not eight hours later, I looked out the back window of our kitchen and saw our grill on fire, flames all over the front. My husband and I jumped to our feet, grabbed the extinguisher and knew EXACTLY what to do. The fire was put out safely in just a few seconds—before the flames could jump to the adjacent tree, our garage, fence or the neighbor’s house. Whew!

Please pass my heartfelt thanks along to your wonderful team of fair volunteers. The information they provided helped us calmly and effectively deal with a household emergency—before it became a real emergency. We are all safe and sound tonight because of your help!

Thanks, Sarah, for sharing your story.


Making a safety list and checking it twice

This is a post by Dr. Rod Tarrago, a pediatric intensive care physician at Children’s Hospitals and Clinics of Minnesota.  He is also the Chief Medical Information Officer and is proud to admit he’s a computer geek.  He’s been helping improve the care at Children’s through the use of technology and spends most of his time helping other clinicians improve their understanding of the computer system. He’s the proud father of two young boys and future computer geeks. 

For nearly three years, the Pediatric Intensive Care Unit (PICU) at Children’s has been using a time-tested technique to improve care of patients: a safety checklist. It’s well known that it’s very difficult — if not impossible — for the human brain to truly multitask.

Unfortunately, in an ICU environment, where patients are sick and their illnesses complex, clinicians have to integrate a lot of information and make many decisions on a daily basis. There are also many “typical” tasks that need to be accomplished for every patient, every day.

In order to help the team remember to address all of these items, we’ve been using a safety checklist as part of our work since 2010.  In St. Paul, we go through this checklist during patient rounds.  In Minneapolis, since the unit is larger and busier, we do special “Safety Rounds” later in the workday.

On both campuses, the entire care team, including physicians, nurses, pharmacists, respiratory therapists, and nutritionists, comes together every day to go through the “standard list” of 23 safety items. These include reminders to check the need for IV and bladder catheters, make sure that antibiotics are needed, and order new labs each day. Each clinician specialty “owns” individual items and then brings them to the group for daily discussion, making sure that everyone is on the same page. Initially, we started this project by using a laminated paper checklist that was placed at each bedside. After losing too many checklists, we moved to an electronic checklist that is embedded in each child’s electronic medical record or EMR.

We recently examined 21 months’ worth of data after using the checklists and found some exciting results:

  • By asking whether we really needed catheters, we reduced the use of these catheters by anywhere from 25 to 45 percent. We also found that we used those catheters less.
  • By asking ourselves whether any medications can be given either orally or through a feeding tube instead of through an IV, we cut costs to families. We examined one medication, a diuretic, and found that by using the checklist, we used an IV 46 percent of the time instead of 77 percent of the time.  By using IV catheters less often, we reduce the risk of catheter infections. It’s also less expensive to give a medication orally compared to through the IV.  We saved patients’ families more than $64,000 over the study period by making these changes.
  • By simply discussing the need for antibiotics each day making sure that we identified ahead of time how long the antibiotics should last, we lowered our use of antibiotics.  In fact, by entering this information into the patient’s EMR, we found that we gave one less dose per patient each day.
  • Prior to the checklist, we ordered labs several days in advance. Now, the checklist reminds us to order them each day and discuss the need for each lab.  By doing this,  we reduced the number of labs we ordered by almost six labs per patient per day. This saves a family $500 a day in lab charges.

You may use a checklist at home or to run errands. In medicine, it’s a relatively new concept that’s only beginning to grow in popularity. But in our PICU, it’s the standard.



After rescue, Children’s nurse encourages water safety education

Leah Mickschl

At Children’s Hospitals and Clinics of Minnesota, we encounter life-and-death situations every day.

Earlier this summer, Leah Mickschl, a Children’s RN, experienced a crisis outside our walls. She was at a private neighborhood pool in Lakeville when a 4-year-old boy was discovered at the bottom of the pool.

She was in the right place at the right time.

Mickschl, who works at Midwest Children’s Resource Center, called upon her training and performed CPR on the boy. He had been under water for approximately two minutes, she said. But within seconds of having CPR performed on him, he sputtered water and regained consciousness. The boy recovered, and today, he’s active and healthy.

In July, the Lakeville City Council honored Mickschl for her life-saving efforts. She appreciates the honor and wants to use it as an opportunity to remind people of aquatic safety.

On the day of the boy’s near-drowning, the pool was filled with people – children and adults, she said. No one saw him go under; Mickschl’s own children were only a few feet away.

Leah Mickschl with her family

“Drowning is silent. It’s not like in the movies where you’re thrashing about and calling for help,” Mickschl said.

Unfortunately, drowning is the leading cause of accidental death among children ages 1 to 4, according to the Centers for Disease Control and Prevention. It remains the second leading cause of unintentional injury-related death behind motor vehicle crashes among children 1 to 14.

Mickschl encourages people to check out these water-safety tips from Children’s Dr. Manu Madhok before they head to the pool or lake. She also suggests getting CPR-certified.

“Prevention should always be the goal, but you never know when those skills might be needed,” she said.

Using technology to keep kids safe

This is a post by Dr. Rod Tarrago, a pediatric intensive care physician at Children’s Hospitals and Clinics of Minnesota.  He is also the Chief Medical Information Officer and is proud to admit he’s a computer geek.  He’s been helping improve the care at Children’s through the use of technology and spends most of his time helping other clinicians improve their understanding of the computer system. He’s the proud father of two young boys and future computer geeks. 

Dr. Rod Tarrago

We’ve been using computers to help take care of kids at Children’s for several years. We order medicines, track kids’ vital signs, and look at X-rays on computers. Now, we’re starting to use more advanced technology to make sure we keep kids as safe as possible. Many of the children we treat have complex cases and require various medicines. That can be very confusing and potentially dangerous for those taking care of the patient. Can you imagine trying to keep perfect track of a patient who has more than 30 medicines, especially when doses and times are changing?

Recently, we’ve started using familiar technology – medication scanners – in our Minneapolis Pediatric Intensive Care Unit (PICU). The scanners are similar to those used in other industries where a scanner checks a bar code to make sure it’s the right product. In our case, patients and families may have seen our nurses and respiratory therapists “scanning” the kids’ medicines prior to giving them.  Just as we previously were checking our patients’ ID bands to make sure the right medicine was being given to the right child, we’re now using the computers to make sure that it’s the right medicine at the right time with the right dose via the right route to the right patient. Children’s is the first pediatric hospital in the nation to use this technology.

Our nurses, respiratory therapists and information technology departments worked hard to make sure that the rooms were set up correctly and that the scanners worked for all medicines. They even changed the labels to make sure wrinkles were less likely to interfere with the scanning. They also came up with some creative solutions to lower the volume so that the beeping of the scanners wouldn’t wake up the kids at night.

In the busy Minneapolis PICU, nurses scan more than 2000 medications every week, and this has helped us detect several instances in which medications might have been given early or late.

At Children’s our No. 1 priority is to keep our patients safe and help them get better.  By using our new scanner technology to more safely deliver medicine to the kids, we are staying at the forefront of medicine. Over the next few months, we’ll extend this important technology to other units at Children’s.


Fireworks safety: Avoid the ER on the Fourth of July

This is a post by Dr. Robert Sicoli, co-medical director of our emergency department. Dr. Sicoli is a fellowship trained Pediatric Emergency Medicine physician with over 20 years of experience. This post originally appeared on GoodyBlog

(Credit: iStock photo by rozbyshaka)

While lighting off a few bottle rockets or running around the backyard with a lit sparkler may seem like relatively harmless ways for kids to celebrate our nation’s independence, thousands of people each year are injured by fireworks, many of them landing in an emergency room.

According to the Consumer Product Safety Commission, there were more than 8,600 injuries involving fireworks in 2010. Forty percent of those injuries involved children younger than 15. While the safest bet is taking your family to a public fireworks display, many states allow the use of various types of fireworks for private use. If you live in a state that allows fireworks for private use, following these safety tips while using fireworks will help keep you and your family safe this Fourth of July.


Before use:

  • Make sure the fireworks you buy are ready to use. Avoid kits that require assembly or crafting your own at home.
  • Don’t buy fireworks with brown labels or wrapped in brown paper. Those are usually made for public displays and not intended to be used privately.
  • Always follow the directions on the label carefully.
  • Always light fireworks outside and away from combustibles, like dry leaves and grass.
  • Choose the proper area for the fireworks you’re using (i.e. don’t use bottles rockets in a wooded area or near a busy street).

During use:

  • Don’t let kids under 10 use any type of fireworks, even sparklers. Sparklers burn at a temperature of up to 1800 degrees Fahrenheit, which is hot enough to melt some metals.
  • Light fireworks one at a time, never lash multiple fireworks together, never point them toward another person and make sure to wear eye protection.
  • Keep a hose or bucket of water nearby.

After use:

  • Never try to re-light a “dud.” Wait at least ten minutes and then douse it with water.
  • Soak all fireworks in water before throwing them away.
  •  Store extra or unused fireworks in a cool dry place.

While following these tips will help, sometime injuries happen. The most common areas of the body that are injured tend to be the hands, fingers, eyes, head and face, mostly with burns. If your child gets inured, considering the following:

  • If your child is burned by a firework and the burn is relatively mild (red or irritated skin), rinse it with cool water and apply an antibiotic ointment to the affected area.
  • If the burn is more severe (blistering, peeling and/or very painful) call your doctor or seek medical attention immediately.
  • If smoke or other particles get into the eyes, make sure your child doesn’t rub them; it will only make the irritation worse. Try cleaning their eyes out with cool water, but if your child complains of continued visual problems or is still in pain after flushing their eyes with water, seek medical attention.
  • Smoke inhalation is also another factor to consider when using fireworks. If your child has inhaled smoke, remove them from the smoky area and let them rest in a cool, ventilated area. If they continue to cough, their coughing is severe or they have difficult or labored breathing, consider calling 911 or bringing them to the emergency department.

The Fourth of July is a great time for families to have fun together. Here’s to a safe and happy Fourth!

For additional injury prevention tips, please visit our Making Safe Simple website.

Children’s takes steps to minimize radiation exposure

MRI Scanner

There’s often a lot of information in the media and medical journals about CT scans (known as Computed Tomography) and how they expose children to radiation. Most recently, The Lancet, a medical journal, published a study that reports that children who get multiple CT scans are at increased risk of leukemia and brain cancer.

We know children are more sensitive than adults to radiation exposure and that CT scans are one of the most common and significant medical exposures of children to radiation. We also know that although the risk of radiation from a CT scan is low, it’s not zero. There can be a slight increased risk of cancer later in life.

“We take this seriously, and we do everything we possibly can at Children’s to minimize the level of radiation exposure to our patients while preserving the quality of the images we need,” said William Mize, MD, a pediatric radiologist.

Here’s how:

  • Our scan settings are adjusted according to your child’s size and age.
  • We work under the ALARA (as low as reasonably achievable) principle. Some of the steps we take include limiting the area of exposure to include only the area of specific medical concern and shielding sensitive areas such as breast shielding during chest CT.
  • We don’t recommend a CT scan as a diagnostic test unless it’s necessary. When appropriate, we suggest other imaging tests such as an ultrasound or MRI (or magnetic resonance imaging) which do not use radiation.
  • We continue to re-evaluate our protocols and explore new opportunities for reducing radiation.

For many medical problems in children, the CT scan is invaluable. Often, it’s the only test that can provide the information needed to optimally treat children. There are potential risks and benefits to all medical treatments and procedures.

The CT scan is capable of viewing all the internal organs, which may lead to a diagnosis that was previously only possible with surgery. When we recommend a CT scan, the benefits to a child’s health from the information obtained outweigh the minimal risk associated with the low dose of radiation.

Where kids are concerned, rest assured that their safety and health are our top priority.

For more information about our procedures involving radiology, click here.

To read the Society for Pediatric Radiology’s response to The Lancet article, click here.

Making Halloween safe and fun for your family

Jeri Kayser, a Child Life specialist at Children’s, wrote this post for families.

Halloween is so entrenched in our culture that when you hear the word you are going to get as many diverse opinions about it as there are costumes on the racks at big box stores. There are also countless opportunities to gather information about making this a safe holiday. Additionally, each family is going to develop their own traditions of celebrating, or not celebrating, this holiday. So how can we add to the conversation?

I would argue that there is a developmental perspective that can help guide us as to when children are ready to be part of the festivities and how to best prepare them. Half the fun of having kids in your life is reliving the joys of childhood. Often this eagerness to be a kid again can make us overlook our children’s readiness to participate in Halloween as we buy out all of the fake blood at the store for “the most awesome haunted house ever!” Continue reading