The following article is a part of conference coverage from the National Association of Pediatric Nurse Practitioners (NAPNAP) 42nd National Conference on Pediatric Health Care, held virtually from March 24 to March 27, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading nurse practitioners in pediatrics. Check back for more from NAPNAP 2021.

 

A standardized treatment plan for acute viral gastroenteritis (AGE) can reduce both treatment time and unnecessary resource utilization, according to a poster presented virtually by Brent A Johnstone, DNP, FNP-BC, and Becky Carson, DNP CPNP-PC/AC, at the National Association of Pediatric Nurse Practitioners Annual Meeting (NAPNAP 2021).

The study authors from Cincinnati Children’s developed a clinical decision-making tool to be implemented at 5 urgent care centers as part of a quality improvement initiative. The tool focused on using the clinical dehydration scale (CDS) to indicate the structure of oral rehydration therapy (ORT).

The CDS evaluates 4 characteristics of the patient: general appearance, eyes, mucous membranes, and ability to produce tears. If a patient’s general appearance and eyes appear normal, their mucous membranes are moist, and they can produce tears, they receive a score of zero. The patient receives 1 point for each mild to moderate symptom of dehydration experienced in each of the 4 categories, and 2 points for every severe symptom. If the patient scores more than 5 points, the child is considered severely dehydrated.


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Oral rehydration therapy uses patients’ weight to indicate how much fluids they should consume and at what time interval (Table). Since it is noninvasive, inexpensive, and can be taught to family members to continue treatment at home, ORT is preferable to other treatment methods for AGE, according to the study authors.

Table. Oral Rehydration Therapy Guidelines Based on Weighta

WeightGuidelines
<10 kg10 mL every 5 min x 30 min
10-20 kg20 mL every 5 min x 30 min
>20 kg35 mL every 5 min x 30 min
a If patient vomits, repeat rehydration therapy with half the recommended volume for 15 minutes

Patients aged 6 months to 21 years who presented to the urgent care center with diarrhea with or without vomiting, fever, or abdominal discomfort were included in this quality improvement initiative. All participants included in the study experienced symptoms for less than 7 days.

The clinical decision-making tool was partially based on guidelines from the Centers for Disease Control and Prevention and the Children’s Hospital of Philadelphia (CHOP). Nurses, physicians, and nurse practitioners were educated about the new tool through PowerPoint presentations, lectures, emails, and ongoing counseling.

There were 470 individual cases of acute diarrhea in the 2 months that followed implementation of the clinical decision-making tool, of which 35.3% (n=166) had a CDS score on file. The mean patient age was 5.17 years.

Use of the clinical decision-making tool was linked to a statistically significant reduction in unnecessary resource utilization for patients with AGE, noted the authors. After implementing the new tool, the average time from initial evaluation to discharge was 37 minutes, 24 minutes less than prior to the intervention. Overall, the rate of diagnostic testing was reduced by 6%. In patients for whom a CDS score was documented, the diagnostic testing rate was reduced by 10%.

Visit Clinical Advisor’s meetings section for complete coverage of NAPNAP 2021.

Reference

Johnstone BA, Carson B. Standardized treatment of acute gastroenteritis in pediatric urgent care centers. Poster presented at: NAPNAP 2021; March 24-27, 2021. EP-PI6.