NR 719 Week 7 Executive Summary Example

Executive Summary: Extend Kilogram-Only Pediatric Weighing to the Suburban and Rural Emergency Departments for $12,276 in the First Year

Student Name

College of Nursing, Chamberlain University

NR 719: Topics in Advanced Practice Leadership II

Instructor Name

Month Day, Year

Executive Summary: Extend Kilogram-Only Pediatric Weighing to the Suburban and Rural Emergency Departments for $12,276 in the First Year

Recommendation

Approve $12,276 to extend kilogram-only weighing of children to the system's suburban and rural emergency departments by October 2027, of which $7,120 is one-time and $5,156 a year is recurring, and direct the urgent care medical director to add a kilogram-only weight field to the ambulatory record upgrade requirements by 31 August 2027.

The Situation

Since January 2027, the shared emergency department record has accepted children's weights only in kilograms. At the original 26-bed department, the scales were locked to kilograms at the same time. At the other two departments they were not, so their nurses now weigh children in pounds and convert by hand into a field that refuses pounds. Hand conversion is the error the change was meant to remove: when pounds are entered as kilograms, a weight-based dose is more than twice what was intended. The system is currently running two routines for the same task, and its 31 float nurses move between them. No harm has been reported at the two receiving departments, but the conversion step behind the original department's near misses is now performed there on every child, every shift.

Three Numbers

At the original department, 93.6% of audited pediatric triage records from February to June were weighed in kilograms, against 57.0% beforehand; weights given by parents dropped from 22.0% of records to 3.6%.

At the suburban department in May, hand conversion from pounds appeared in 31 of 50 audited records, with errors above 10% in 4 of them.

The recurring cost of sustaining the change is $5,156 a year, almost all of it two hours a week of coordinator time at the rural department.

Options

Option A, recommended: complete the change at both departments now. Replace the five scales that cannot be locked, fund a coordinator two hours a week at the rural site and use the suburban site's existing coordinator. First-year cost $12,276; after that, $5,156 annually. Removes hand conversion from all three departments within about eight weeks of approval.

Option B: reverse the January field change so all three departments accept pounds again. No equipment cost. Restores the pound option at the original department, where the change is working, and returns the system to the error mode behind the three near-miss reports filed during the twelve months before January.

Option C: wait a year for more data from the original department before deciding. No cost this year. Leaves two departments converting by hand for at least another twelve months, the riskiest of the three positions.

Risks of the Recommendation

The receiving departments have not yet completed readiness assessments, and spread depends heavily on whether a receiving site sees the change as fitting its own needs (Greenhalgh et al., 2004); each will complete an assessment in August, and either may ask for a later start. The rural department's coordinator hours depend on its next operating budget. Results so far come from a single department compared with its own past, so they show practice changed after the locks rather than proving the locks caused it. And nurses at the original department still round weights to whole kilograms about a third of the time, which this recommendation does not fix.

Next Action

If approved at the 12 August 2027 council meeting, purchasing orders the five scales that week, each department's coordinator completes a readiness assessment by 31 August and both departments lock their scales by 1 October. The coordinator will report the first audit from each new site to the council in November 2027.

Basis

The recommendation follows national guidance that emergency departments weigh children in kilograms and record weights in kilograms (Remick et al., 2018), and published evidence that weight errors in emergency departments frequently lead to dosing errors (Hirata et al., 2019). The full outcomes report, the budget justification and the sustainability plan are attached for reference.

References

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x

Hirata, K. M., Kang, A. H., Ramirez, G. V., Kimata, C., & Yamamoto, L. G. (2019). Pediatric weight errors and resultant medication dosing errors in the emergency department. Pediatric Emergency Care, 35(9), 637-642. https://doi.org/10.1097/PEC.0000000000001277

Remick, K., Gausche-Hill, M., Joseph, M. M., Brown, K., Snow, S. K., Wright, J. L., American Academy of Pediatrics Committee on Pediatric Emergency Medicine and Section on Surgery, American College of Emergency Physicians Pediatric Emergency Medicine Committee, & Emergency Nurses Association Pediatric Committee. (2018). Pediatric readiness in the emergency department. Pediatrics, 142(5), Article e20182459. https://doi.org/10.1542/peds.2018-2459