We have the same problem. Kids are not getting reassessed in a timely manner, nor are they getting a full set of VS if they are under the age of 3. I just keep sending emails, cc'ing their supervisor indicating that the standard was not met and to ask that they improve on their compliance. I do not discuss consequences with them in the email; I let the Supervisor handle that part. I am only looking at about 30 charts/month, so probably about 15-30% of the ones that are seen in the ED vs going to the Peds Clinic. Those charts are excluded from my QI process as it's a whole different department. We are seeing about 400 kids/month, with over 200 going to peds clinic. 100% of all admitted patients are audited. As far as a tool, I am looking at VS frequency based on acuity, documenting problem focused assessments and reassessments, a full set of VS within 30 minutes of departure from the department, a correct/developmental appropriate pain assessment and reassessment if pain meds are given. I also audit all of the procedural sedations for pediatrics, and all kids that come in via 911.
Unfortunately, this is a lot of manual chart diving/reading, so it takes me all month to produce audit results.
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Steven P. Rogers, RN CEN
Pediatric Emergency Care Coordinator
Olive View UCLA Medical Center
Sylmar, CA
strogers@dhs.lacounty.gov------------------------------