Approved Projects for Physicians with a Relationship with Nicklaus Children's Hospital

The following projects are currently approved for ABP Part 4 MOC Credit through the Portfolio Sponsorship Program. Unless otherwise stated, these projects are only available to physicians with a relationship to Nicklaus Children's Hospital.


Project Title:
Pediatric Residents' Knowledge and Proficiency of Epinephrine Auto-injector Administration and Handling: A QI Project

Project Expiration Date: May 31, 2017
Approving Board: ABP
Project Description:

Patients diagnosed with anaphylaxis are often discharged from the hospital with prescriptions for epinephrine autoinjectors (EAI). The purpose of this study was to evaluate the baseline knowledge of pediatric residents regarding proper handling and administration of EAI, and to assess their knowledge after providing them with a formal one-on-one training at the time of discharge. Since education among providers and patients is needed, we believe that efforts to improve the correct use of EAI among providers responsible for training is an essential component to ensuring that patients and families receive the most accurate guidance on how to use this life saving device. The goal of this project is: To increase the percentage of residents who are confident in how to properly use and care for an Epinephrine auto-injector from baseline to 70% or higher over a 3 week period All residents participating on the study will receive one-on-one education by Allergy and Immunology Fellow of the proper administration and handling of Epinephrine autoinjector. Materials and tools Used: Attached can be found the training tool (questionnaire) used for measuring resident’s knowledge on the proper use and handling of epinephrine autoinjector.

Completion Criteria:

Completing of 2 cycles, Participation in meetings, review of the data or implementation of the plan.

To participate, contact the Project Leader: Hanadys Ale, MD


Project Title:
Decreasing Empiric Use of Vancomycin in Late Onset Sepsis

Project Expiration Date: March 30, 2017
Approving Board: ABP
Project Description:

Starting in the 3rd week of October 2016, we educated residents on unit guidelines for LOS at the onset of the NICU rotation and implemented a LOS checklist to assess provider behaviors in the evaluation and treatment of episodes of suspected LOS (see attached checklist and guidelines). The lead resident in the project met with each group of residents at the beginning of their NICU rotation to explain the importance of adherence to LOS guidelines, including the limited indications for the use of vancomycin as well as the adverse effects associated with the overuse of this antibiotic. We then explained the methodology of data collection including the indications to fill out a LOS checklist and where to find it and return it. We engaged the residents by providing reminders in their workstations to fill out the checklist for cases of suspected LOS (stickers on the computers). The residents would then be prompted to bring the checklist to rounds, thus prompting a discussion with the attending about appropriate evaluation for LOS and the choice and duration of antibiotic treatment. The checklist included an area that had to be filled out 48 hours after initiating antibiotics, thus prompting the resident to discuss with the attending if it was appropriate to continue antibiotic treatment depending on whether or not there was a microbial indication.

Completion Criteria:

Completing of 2 cycles, Participation in meetings, review of the data or implementation of the plan.

To participate, contact the Project Leader: Jessica Barreto, MD


Project Title:
Decreasing Antibiotics Use by Standardizing Diagnosis and Management of Ventilator Associated Infection in the NICU

Project Expiration Date: May 31, 2019
Approving Board: ABP
Project Description:

We will target activities related to the primary drivers “hospital ASP and ID consultant participation” and improving “adherence to unit guidelines”.

  • Intervention 1: Develop algorithms for diagnosis and management of VAI The existing literature does not offer specific criteria for the diagnosis and management of VAI in the newborn period. Diagnosis of VAP is based on the definition provided by the Center of Disease Control for infant <1 year, which requires a combination of radiologic, clinical and laboratory criteria. Additionally, we developed an algorithm for the management of infant with suspected VAI adapted from the “Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-Associated Pneumonia” created by the American Thoracic Society Documents.
  • Intervention 2: Education and discussion of algorithm with staff. Conduct an educational campaign with the nursing staff, residents and attending physicians on the appropriate diagnosis and treatment of ventilator associated infection following the developed diagnosis criteria and management algorithm. The educational objective will highlight the difficulties.
  • Intervention 3: Implementation of Guidelines We will use the checklist that was developed in October of 2016 for the iNICQ project. The checklist was modified to evaluate if the presence of a prior ETA positive culture was included in the decision of selecting the empiric antibiotic treatment for infant with VAI.

Completion Criteria:

We anticipate conducting a minimum of 6 PDSA cycles during the 6-months period starting July 1st 2017. Completion Criteria include: - Participation in one of more of the interventions - Attendance of QI meetings to review data and provide feedback - Educating staff and fellows re. the interventions and its tools/checklists/ criteria.

To participate, contact the Project Leader: Adolfo R. Llanos, MD


Project Title:
Improving Accuracy of Location of Peripherally Inserted Central Venous Catheters Using a Tip Locating System (TLS) During Placement

Project Expiration Date: May 31, 2019
Approving Board: ABP
Project Description:

Studies in adults and adolescents of Peripherally Inserted Central Catheters (PICC) found a right atrial malposition rate of 18% and other malpositions at 13.4%. in pediatrics, correction of these malpositions is a time consuming process and involves discomfort to the family and patient. Additional time is needed by the bedside and PICC nurses, ordering physicians, radiology techs and radiologists. Furthermore, additional healthcare supplies are used which leads to increased waste and costs. The PICC line tip termination point is determined by external measures on the patient body (estimates) rather than real time tip location devices during PICC insertion. The aim of the project is to evaluate and compare the rate of malpositioned PICCs on the first attempt after introduction of an Ultrasound-guided Tip Locating System (TLS) compared to the baseline data gathered before its use.

To participate, contact the Project Leader: Dr. Michael Leoncio


Project Title:
Decreasing the Oversuse of CXR in Children (3y-18y) with Uncomplicated Asthma

Project Expiration Date: June 30, 2018
Approving Board: ABP
Project Description:

Preliminary data from 2016 show that there is overutilization of CXR in the Nicklaus Children’s Hospital Emergency Department (ED) and Urgent Care Centers (UCCs). The numbers of ordered CXR in cases of uncomplicated asthma are significantly higher than the national benchmark. This leads to increased exposure of children to unnecessary radiation and increased cost of care. Despite the presence of Asthma national Guidelines, there is lack of adherence to the guidelines. This could be due to multiple factors including: (1) Lack of education of providers (2) Perceived expectations of parents by the providers and (3) other historic practice patterns (4) Fear of missing diagnosis (5) Fear of litigation. This project aims at decreasing the number of CXR ordered for children with uncomplicated asthma.

To participate, contact the Project Leader: Dr. Mario Reyes


Project Title:
Decreasing the Oversuse of CXR in Young Children (1m - 1 y) with Uncomplicated Bronchiolitis

Project Expiration Date: June 30, 2018
Approving Board: ABP
Project Description:

Preliminary data from 2016 show that there is overutilization of CXR in the Nicklaus Children’s Hospital Emergency Department (ED) and Urgent Care Centers (UCCs). The numbers of ordered CXR in cases of uncomplicated bronchiolitis are significantly higher than the national benchmark. This leads to increased exposure of children to unnecessary radiation and increased cost of care. Despite the presence of new AAP Bronchiolitis Guidelines since 2015, there is lack of adherence to the guidelines. This could be due to multiple factors including: (1) Lack of education of providers (2) Perceived expectations of parents by the providers and (3) other historic practice patterns (4) Fear of missing diagnosis (5) Fear of litigation . The aim of this project is to decrease the number of CXR ordered in patients with uncomplicated bronchiolitis between 1m-1year of age. This project is only opened to hospital physicians staff.

To participate, contact the Project Leader: Dr. Mario Reyes


Project Title:
Improving Documentation of Newborn Screen in a Free Standing NICU

Project Expiration Date: December 31, 2015
Approving Board: ABP
Project Description:

Newborn Screening (NBS) is a highly successful public health program that requires timely confirmatory testing, diagnosis, and clinical management so that optimal long-term outcomes can be achieved. NICU population represents a challenge for the eddcative implementation of NBS. Contrary to infants admitted to the regular newborn nursery, who are born healthy, full-term and > 2500g; infants admitted to the NICU are sick and/or premature and/or low birth weight with a prolonged hospital stay. The interventions routinely used in these settings such as blood transfusions, NPO, and TPN solutions have the potential to affect the NBS results and may lead to delay in diagnosis and clinical management. Our analysis of NBS documentation in the NICU in January 2015 revealed a 35% rate of documentation of NBS obtained during hospitalization. The aim of thsi project is to improve the NBS documentation in the NICU to 90% over the next 12 months.
To participate, contact the Project Leader: Dr. Magaly Diaz-Barbosa


Project Title:
Improvement in the Safe and Efficient Management of Acute Scrotal/Testicular Pain

Project Expiration Date: December 31, 2017
Approving Board: ABP
Project Description:

Delays in the definitive diagnosis of testicular torsion can lead to poor outcomes and loss of function. All members of the Emergency Department team may not recognize the acute and emergent nature of this condition. Baseline data indicate that there is room for improvement in the time from presentation to the ED until final U/S read and report. The goal of this project is to improve the time required between presentation to Nicklaus Children's Hospital ED and the time of definitive diagnosis for patients presenting with acute scrotal pain to rule out testicular torsion. An institutional standard pathway is created and the project will aim at increasing adherence to the standard pathway.
To participate, contact the Project Leader: Dr. Jefry Biehler


Project Title:
Severe Sepsis Bundle Implementation at Nicklaus Children’s Hospital

Project Expiration Date: May 31, 2019
Approving Board: ABP
Project Description:
Sepsis is a dangerous systemic infection that often leads to poor patient outcomes, including mortality. Severe sepsis is a significant problem among acutely ill children. A bundle for recognition, initiation and continuation of treatment of severe sepsis based on national guidelines has been created at Nicklaus Children's Hospital but not yet implemented. The goal of the project is to Implement severe sepsis bundle at Nicklaus Children's Hospital thereby improve sepsis-related outcomes.
To participate, contact the Project Leader: Dr. Bala Totapally