Standardized Procedure Pediatrics

Standardized Procedure Pediatrics 2standardized Procedure Pediatrics1

Standardized Procedure Pediatrics 2standardized Procedure Pediatrics1

STANDARDIZED PROCEDURE PEDIATRICS 2 STANDARDIZED PROCEDURE PEDIATRICS 11 Standardized Procedure Pediatrics Name United States University Primary Health of Acute Clients/Families Across the Lifespan Course Dr. Maria Luisa Ramira July 4, 2016 Standardized Procedure for Nurse Practitioners: General Policy I Purpose A. To establish a standardized procedure, in compliance with the California Board of Registered Nursing (BRN) and the 11 components of the BRN’s guidelines for Nurse Practitioners (NPs) to perform specified functions without the immediate supervision of a Physician. II Development and Review A. All standardized procedures are developed through the collaborative efforts of the members of the organization’s established interdisciplinary committee (IDC). The IDC will consist of physicians, nurse practitioners, registered nurses and administrative representatives of the organization. B. All standardized procedures will be approved through the IDC made readily available and contain signed and dated approval sheets of all professionals covered by the procedures. C. All standardized procedures will be reviewed every 3 years or more often as necessary by the IDC. D. All NPs and their supervising physicians will signify agreement to the standardized procedures upon hire, annually and with changes as needed as evidenced by a signed and dated approval sheet. E. Signature on the statement of approval and agreement implies the following: Approval of all procedures in the document, intent to abide by the procedures and willingness to maintain a collegial and collaborative relationship with all parties. The signed statement of approval and agreement form will serve as the record of those NPs who have been authorized to perform the procedures. The signature page will be kept on file and readily available together with Standardized Procedures. III Scope and Setting A NPs may manage those functions outlined in the standardized procedures, within their trained area of specialty and consistent with their experience and credentialing. Such functions include assessment, management and treatment of acute and chronic illness, contraception, health promotion and overall evaluation of health status. Additional functions include the ordering of diagnostic procedures, physical, occupational, speech therapies, diet and referral to specialty care as needed. B NPs are authorized to practice standardized procedures in the organization’s Outpatient Clinics. IV Education and Training/Qualifications A NPs must have the following 1 Current California registered nurse (RN) license 2 Certification by the State of California, BRN as an NP 3 Board certification from the American Nurses Credentialing Center 4 NP furnishing number 5 DEA registration number 6 Current Health Care Provider Card from the American Heart Association 7 Credentialed by the organization’s medical staff B In addition to the required education and training all NPs will be required to complete competency validation upon hire and annually. The supervising physician is charged with observing the NP and documenting competency validation. The competency validation checklist is managed, maintained and made available by the Office of Medical Staff as a component of the privilege process. Checklist will be reviewed and updated annually by the IDC. V Supervision and Evaluation A NP is authorized to implement the approved standardized procedures without the direct or immediate observation or supervision of a physician unless otherwise specified within a particular procedure. B Supervising physicians will conduct a weekly case review of a minimum of 10% of each NPs cases for the week. The review will be documented within the electronic medical record and must be completed within 30 days of the visit selected for review. Cases will be selected randomly unless a request for review is received by a medical professional. C No single physician will supervise more than 4 NPs at any one time. VI Consultations A Physician consultation is to be obtained as specified in individual procedures or when deemed appropriate. VII Patient Records A NPs will be responsible for the documentation of a complete electronic medical record for each patient contact/encounter in accordance with existing clinic and medical staff policies. Protocol: Croup initial visit in the outpatient clinic setting I Rationale To assist Nurse Practitioners in the outpatient clinic setting in the differentiation between croup and other upper airway conditions and to establish guidelines for the management of croup in this setting. II Definition Swelling and erythema of the upper airway resulting in narrowing of these airways, usually as a result of viral infection and in some instances bacterial. Most cases are usually mild and self-limiting however, children can be seriously ill or at risk for rapid progression of disease leading to further narrowing of the airways and respiratory compromise. III Epidemiology A Typically occurs in children between the ages of 6 months to 6 years, with a peak incidence between 6 and 36 months. B Most often occurs in the fall and is usually but not limited to parainfluenza type 1 viral infection. C Cases occurring in winter are usually but not limited to influenza A and B viruses D Risk factors include familiar history, parental smoking and male gender. IV History A Symptoms of upper respiratory infection for several days. B Rhinorrhea C Cough D Low grade fever E Symptoms occurring most often at night F Sore throat G Stridor H Intermittent barking, seal like cough V Physical Exam A Barking seal like cough, stridor B Tachypnea C Use of accessory muscles for respiration D Tachycardia E Wheezing F Low grade fever however, can be elevated to 104F G Visualization of mouth and epiglottis normal VI Diagnostic tests A Diagnosis typically made based on clinical presentation B Plain imaging of soft tissue of the neck may display classic pattern of subglottic narrowing (steeple sign) on posteroanterior view. C Pulse oximetry D Laboratory tests are not necessary for the diagnosis of croup however, may be used to assist with differential diagnosis. 1 CBC 2 Viral Serology 3 Tissue culture VII Differential Diagnosis A Epiglottitis B Foreign body aspiration C Retropharyngeal or peritonsillar abscess D Compression due to tumors, trauma or congenital malformations E Angioedema F Asthma exacerbation G Bacterial traceitis VIII Management – According to severity of disease by means of the Westley Croup Score based on the presence or absence of stridor at rest, degree of chest wall retractions, air entry, the presence or absence of pallor or cyanosis and the mental status. A Mild croup (Westley croup score of ≤2) No stridor at rest (although stridor may be present when upset or crying), a barking cough, hoarse cry, and either no, or only mild, chest wall/subcostal retractions. B Moderate croup (Westley croup score of 3 to 7) Stridor at rest, has at least mild retractions, and may have other symptoms or signs of respiratory distress, but little or no agitation. C Severe croup (Westley croup score of ≥8) Significant stridor at rest, although the loudness of the stridor may decrease with worsening upper airway obstruction and decreased air entry. Retractions are severe (including indrawing of the sternum) and the child may appear anxious, agitated, or pale and fatigued. D Impending respiratory failure (Westley croup score of ≥12) Fatigue and listlessness Marked retractions (although retractions may decrease with increased obstruction and decreased air entry) Decreased or absent breath sounds Depressed level of consciousness Tachycardia out of proportion to fever Cyanosis or pallor E Treatment Mild Croup: 1 Single dose of dexamethasone 0.15 to 0.6 mg/kg orally or parentally to a max dose of 10mg. 2 Disposition home with the following instructions: a Fever management with acetaminophen 15mg/kg po every 4-6hrs as needed not to exceed 75mg/kg/day. b Anticipatory guidance of potential worsening and instructions on when to seek care. c Use of humidified air, cool mist or hot stream d Return for follow-up next day. Moderate Croup 1 Follow mild croup guidelines 2 Observe patient for up to 4 hours If improved 3 Disposition home following instructions for mild croup If no improvement a Consult with supervising physician and prepare to administer b Inhaled racemic epinephrine 0.05 ml/kg per dose (maximum of 0.5 ml) of a 2.25% solution diluted with normal saline for a 3ml total volume via nebulizer. c If pulse oximetry is

Paper For Above instruction

Introduction

The standardized procedure for nurse practitioners (NPs) in pediatric care is vital for ensuring safe, effective, and consistent healthcare delivery. The outlined policies and guidelines, developed in compliance with the California Board of Registered Nursing (BRN), aim to delineate the scope of practice, educational requirements, supervision protocols, and clinical management standards, particularly exemplified through the management of the common pediatric condition, croup. This paper explores the significance, development, and application of these standardized procedures within pediatric outpatient settings, emphasizing their role in promoting high-quality patient care and interprofessional collaboration.

Development and Review of Standardized Procedures

The development of standardized procedures involves a collaborative process led by an interdisciplinary committee (IDC) comprising physicians, nurse practitioners, registered nurses, and administrative personnel. This multidisciplinary approach ensures that policies are comprehensive, practical, and aligned with current clinical standards. Regular review every three years, or sooner if necessary, maintains the relevance and accuracy of these procedures, reflecting advances in pediatric care, new evidence, and evolving regulatory expectations.

Scope and Applicability

Nurse practitioners are authorized to independently manage a wide range of functions within their training, experience, and credentialing. These include comprehensive assessment, management, and treatment of both acute and chronic conditions, such as respiratory illnesses like croup. Their scope also encompasses health promotion, diagnostic ordering, referral to specialists, and preventive care, primarily within outpatient pediatric clinics. This autonomy supports timely and accessible care, reducing unnecessary physician workload while maintaining safety and quality standards.

Educational and Credentialing Requirements

To qualify for practice under these standardized procedures, NPs must possess a valid California RN license, national certification, and specific credentials from recognized organizations, including the American Nurses Credentialing Center and the California BRN. Additionally, they must complete competency validations periodically, ensuring current clinical proficiency. These rigorous educational and credentialing standards underpin the safe and effective implementation of scope-of-practice policies.

Supervision, Evaluation, and Quality Assurance

The procedures specify that NPs operate largely independently but under regular physician oversight through weekly case reviews, with a maximum supervision ratio of four NPs per physician. This balance fosters professional autonomy while maintaining accountability and quality assurance. Supervising physicians evaluate clinical performance continually, accompanied by documentation within electronic medical records. Such structured oversight promotes ongoing competence and facilitates corrective feedback when necessary.

Clinical Management: Case Example of Pediatric Croup

The management of pediatric croup exemplifies how standardized procedures translate into clinical practice. Croup, characterized by upper airway inflammation, typically affects children aged six months to six years, with seasonal peaks in fall and winter. Diagnostic challenges are primarily clinical, supplemented by selective imaging and laboratory tests. The management approach employs the Westley Croup Score to stratify severity, determining treatment modalities ranging from outpatient corticosteroids to emergency interventions for severe cases. This case underscores the importance of adhering to evidence-based guidelines that ensure prompt, appropriate, and age-specific responses to common pediatric conditions.

Implications for Pediatric Healthcare

Adoption of standardized procedures enhances pediatric healthcare delivery by promoting consistency, safety, and efficiency. It allows NPs to address common childhood illnesses confidently, reduces delays in care, and supports interprofessional teamwork. Moreover, such protocols facilitate legal and professional accountability, underpinning the scope of practice defined by regulatory bodies. They also foster ongoing professional development, as clinicians stay current with evolving evidence and standards.

Conclusion

The standardized procedures for pediatric nurse practitioners, exemplified through the management of conditions like croup, are integral to the quality and safety of outpatient pediatric care. Developed collaboratively, regularly reviewed, and grounded in current evidence and regulations, these policies empower NPs to deliver competent, efficient, and patient-centered services. As pediatric healthcare continues to evolve, maintaining robust standardized procedures will remain critical for optimizing health outcomes and supporting collaborative practice models.

References

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• Bjornson, C., & Johnson, D. (2015). Croup. Retrieved from https://www.medscape.com
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• Health Care Quality Standards. (2020). Clinical guidelines for pediatric respiratory conditions. National Institutes of Health.