Category Archives: Injury Prevention

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.

Water safety tips from Dr. Madhok

This is a post by Dr. Manu Madhok, director of the pediatric emergency medicine fellowship program at Children’s Hospitals and Clinics of Minnesota. He’s a board member of the Minnesota chapter of the American Academy of Pediatrics.

Every summer, we read and hear about children who die due to accidental drowning. Sadly, this summer has been no exception in Minnesota.

Drowning is the leading cause of accidental death among children ages 1 to 4. According to the Centers for Disease Control, most drownings among children ages 1 to 4 occur in the pool at home. Drowning remains the second leading cause of unintentional injury-related death behind motor vehicle crashes among children 1 to 14.

While drowning is a tragedy, it’s one that can be prevented. I’ve compiled a list of tips I commonly share with parents and caregivers to make sure their kids are safe in and near the water.

Children ages 1-5

A common misconception is that kids only drown in deep water. A child can actually drown in only a few inches of water.

  1. Always keep children within arm’s reach.
  2. Inflatable aids are not substitutes for adult supervision.
  3. Enforce pool safety rules. That means no running or pushing.

Children ages 5-12

  1. Don’t allow horseplay.
  2. Make sure your child never swims alone and is always within view of an adult.
  3. Children should receive swimming lessons from a qualified instructor.

Open water

  1. Never allow a child to dive in without first checking the depth.
  2. Choose a swimming area that is under a lifeguard’s supervision.
  3. A child should always wear a life jacket while riding in a boat.

Backyard pool

  1. The pool needs to have a 4-foot tall fence surrounding it on all sides.
  2. Use a rigid cover for the pool.
  3. Install complaint, anti-entrapment drain covers.
  4. Pool owners should know CPR.

While kids are our thing at Children’s, we prefer to see them healthy and not to see them in the Emergency Department. Follow these tips so your child doesn’t become a statistic this summer. For more information about injury prevention, please visit our Making Safe Simple website.

For additional resources:

Minnesota Department of Health swimming pool links

Minnesota Department of Health injury data

Centers for Disease Control unintentional drowning data

Water Safety and Young Children

Water Safety for Older Children

Summer Safety Tips – Sun and Water Safety

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

Five tips to avoid sunburns

With all the time kids spend in the sun during the summer, it’s important to know how to protect them from sunburns. At Children’s, we believe in Making Safe Simple — so we’ve put together five tips to help you and your kids avoid sunburn this summer (and what to do if you do happen to get one!).

  • Apply one ounce (two tablespoons) of sunscreen to the entire body 30 minutes before going outside. This gives skin a chance to absorb it. Reapply every two hours, or immediately after sweating heavily.
  • Make your own shade with a wide-brimmed hat or baseball cap. Protect your eyes with UV-blocking sunglasses (the bigger, the better). Just make sure the sunglasses have 90 to 100 percent protection from UVA and UVB rays.
  • Don’t forget to protect areas that are often missed, such as: your chin, nose, ears, scalp, under eyes, shoulders, and on top of your hands. Also apply lip balm with an SPF (Sun Protection Factor) to keep your lips safe.
  • Look for “broad spectrum” sunscreen with an SPF of 15 or higher that includes ingredients that protect you from both UVA and UVB (Ultraviolet A and B) rays. You can also look for the “Skin Cancer Foundation Seal of Recommendation” to help you find the right sunscreen.
  • Don’t be fooled by a cloudy day at the fair. The sun’s harmful UV rays can penetrate through clouds and even a thick fog.
  • If you do get sunburn, aloe vera gel is extremely soothing, nontoxic, and helps heal the skin.

Need more sun-safety tips? Here’s how to protect your kids from dehydration and heat exhaustion.

Children’s rides with Bike Cops for Kids

Children’s CEO Alan Goldbloom helps a child put on a helmet as part of a Bike Cops for Kids event.

Children’s CEO Alan Goldbloom and members of Children’s Trauma Care team joined officers from the Bike Cops for Kids program to give away bike helmets to children in Minneapolis.  Children’s donated 720 bike helmets and 56 bikes to the program this year to encourage kids to wear helmets whenever they are riding.  Officers who see children wearing helmets featuring the “Bike Cops for Kids” sticker will be eligible to win a new bike.

Dr. Goldbloom was joined by Children’s co-medical director of trauma, Dr. David Hirschman, director of trauma services, Malea Anderson, and program manager for injury prevention, Kristi Moline.  They rode alongside Bike Cops, Mark Klukow and Michael Kirchen.  Bike Cops for Kids is a program that encourages safe bike riding, and also helps police officers build positive relations with young people in the community.

Speaking of helmets, make sure your kids know how to wear theirs correctly! Take 30 seconds to review our video on helmet safety.

Keeping your kids safe during the summer

Kristi Moline

Kristi Moline, our injury prevention manager, appeared on the Mom Enough podcast to share tips on how to keep your kids safe during the summer. One of her biggest messages? Wear helmets! And we aren’t just talking to kids here. Parents, as role models, should also wear their helmets.

Kristi is also the star of one of our new public service announcements on car seat safety. You can find that video, and lots of tips on staying safe, on our Making Safe Simple pages.