Update Sept 10, 2015
Night Float Study
Lumbar Puncture Sedation and Technique Survey
I am starting a lumbar puncture survey / audit throughout the hospital which will run over the next few months. I am hoping to have your help by completing a short survey form after any lumbar puncture attempts for the next few months.
This is a quality improvement study that aims to find out what our current practices are for lumbar puncture (LP) technique, sedation and analgesia. Lumbar punctures are done throughout BC Children’s and Women’s Hospital for a variety of reasons. There are several ways to perform a LP and its corresponding analgesia or sedation however it is not known what our current practices are. The goal of this survey is to see what the current practices of our hospital are.
I would ask that anyone who performs or attempts a lumbar puncture to please fill out the quick survey form afterwards and place it in the provided receptacle . There should be provided survey forms and either an envelope or box in the procedure room or at the nearby nursing station for completed forms to be placed in. Please fill the forms out as best you can. The duration of this study is approximately 3 months and the data will hopefully inform future lumbar puncture and sedation practices and teaching to improve lumbar puncture success in the hospital.
The surveys should be attached to the LP kits or if there is not on the kit then nearby in an envelope. The completed surveys should be placed in the envelopes in each procedure room on the ward, in the boxes in the PICU and ER and if you do an LP in radiology please put the form in the envelope at the interventional radiology triage station or at the collection spots in PICU/ER/Wards etc.
I have attached a brief information sheet and a copy of the survey form for your interest. Please complete the survey for any lumbar punctures done throughout the hospital, copies of the form should be wherever lumbar puncture kits are in the hospital (Wards, ER, ICU etc.).
If there are any questions or concerns regarding this study, please feel free to contact me.
Overall I hope to use this data to see what is happening with LPs throughout the hospital and try to optimize our success rates for everyone
Thank you for your help if you have any questions just send me an email/text and I will try to help
UBC Pediatrics PGY-3
Asthma BiPAP Study
I just wanted to let everyone know about the asthma and BiPap study which is starting up to today. The study, lead by Dr Seear, is a randomized control trial comparing early BiPap use vs standard ward management for children admitted to hospital with moderate to severe asthma exacerbations.
Starting today, the study will be enrolling patients older than 24 months with a wheezy respiratory presentation, who have a PRAM score of 4-7 four hours after receiving dexamethasone, or a PRAM score of 8 or above one hour after receiving dexamethasone. Patients who meet inclusion criteria will be randomized to receive either BiPap in the ICU or standard asthma management on CTU.
In order to achieve some level of standardization on patients in the standard management group, we need your help! When admitting and managing study patients on CTU, we’re asking residents to do the following:
1. There are pre-printed asthma admission orders which should be used for all study patients. Orders are located in a blue binder in the doctor’s room in the ER, right by the order sheets/progress notes/allergy sheets etc.
2. Dexamethasone 0.3mg/kg/day PO x 3 days should be the systemic corticosteroid choice unless the patient is unable to tolerate oral medications, in which case mehtylprednisolone 1mg/kg/dose IV q6h may be used.
3. If a patient is on an inhaled corticosteroid at home, please continue the inhaled steroid on admission to the ward.
4. Please inform respiratory therapy about any study patients admitted on CTU, as the RTs will be doing PRAM scoring on all study patients every 3 hours.
5. Since PRAM scoring will be done regularly on study patients, we are asking residents to take PRAM scores into account when weaning ventolin. In general, ventolin should be weaned when PRAM is 3 or less.
6. The use of adjunctive medications, such as MgSO4, aminophylline etc is left to the discretion of the CTU teams.
I’ll try and touch base with those of you on CTU/night float in person in the next few days. Please feel free to contact Marie Wright (resp fellow) or myself if you have any questions about the study (my number is 604-838-5476). The respiratory doc on call will be available to troubleshoot any problems overnight.
Thanks for your help!