Question 1

How much does it cost to participate in the COPPER program?

Accepted Answer

Nothing! Participation is free.

Question 2

If antibiotics are prescribed for a patient who has tested positive for a viral illness, our pharmacy’s software raises an alert and contacts the physician to evaluate if the antibiotic is still indicated. Does this satisfy the requirement that our QI/PI plan tracks antibiotics for viral illnesses?"

Accepted Answer

Yes, this satisfies the QI/PI requirement to track antibiotics prescribed for viral illnesses. However, we recommend that sites also share feedback/data with staff at internal meetings. Group sharing might help change behavior and/or improve quality on a broader scale.

Question 3

Our social work and NICU/PICU teams track readmission rates. Does this satisfy the requirement that our QI/PI plan tracks pediatric readmission rates?

Accepted Answer

Since there is a designated team and process for tracking and evaluating readmission rates, this would satisfy the requirement. However, we recommend that sites also share feedback/data with staff at internal meetings. Group sharing might help change behavior and/or improve quality on a broader scale.

Question 4

What does a case review for all critical care transfers out need to look like?

Accepted Answer

One way you could approach this is to have a way to gather and review data on all critical care transfers out. For example, see the "Pediatric interfacility transfer monitoring tool" listed inside the Quality and/or Performance Improvement section of the COPPER Resources. This is a form you can complete for each pediatric transfer out. Then, you can periodically review all these pediatric transfers at staff meetings to discuss the cases and how you feel they went, i.e., was the decision to transfer a good one, in hindsight would you have kept the patient, etc

Question 5

What kind of blood warmer do you recommend for the ED?

Accepted Answer

The blood warmer used at Children’s Hospital Colorado and at Rocky Mountain Hospital for Children is the 3M Ranger with the high flow cartridge so it can be used with push/pull method fluid administration. Please note, the blood warmer is not a requirement for either level of COPPER recognition but is highly recommended.

Question 6

We have 7.0F central venous catheters in the ED and access to 4.0F-6.0F in the PICU. Does that satisfy the requirement to have size 4.0F-7.0F central venous catheters in the ED?

Accepted Answer

Yes, this satisfies the requirement.

Question 7

The COPPER equipment list requires 2.5 and 3.0 uncuffed and 3.5 cuffed ET tubes. Our ED docs would like to have 3.0 cuffed tubes as an option starting at 6-7 kg.  Is there any good argument for or against this move?

Accepted Answer

The rationale to switch to cuffed ETT is that they are reliable and safe to use. They are now also part of PALS recommendations with the important caveat that the cuff pressure can be assessed and kept below 20-25 cm H2O. If your ED is placing uncuffed ETT in with the rest of their equipment and there are overlapping sizes of cuffed and uncuffed tubes, we highly recommend putting the uncuffed tubes in a transparent colored bag (red or otherwise) so that the uncuffed tubes are visually differentiated from the cuffed tubes. In times of stress/high acuity it can help the team make the appropriate equipment choices and hopefully reduce unnecessary errors.

Question 8

Is there a recommended way to separate out the different age groups for flowcharts (in the context of nursing assessment)?  Our current flowcharts separate the ages from- Newborn to 11 months, 12 months - 23 months, 2 - 4 years, 4-6 years, 6 - 11years and then 12 - 17 years."

Accepted Answer

Since this is for nursing assessment purposes, the age breakdown is completely reasonable. It’s important to document work of breathing for the little ones and to keep in mind that the physical exam is extremely important for all kids.

Question 9

Are there specific items that should be addressed for certain age groups that might be addressed differently than adult patients, when it comes to assessment?"

Accepted Answer

Pediatric specific things to keep in mind: there are unique GCS and pain scores for kids. We recommend using the FACES score for pain and remember that the physical exam is very important for all kids. We also recommend having a developmental stages chart on hand for reference.

Question 10

Is there an evidence-based fall risk assessment for specific ages?

Accepted Answer

The main thing to keep in mind is that anyone under the age of 8 should be considered high risk for falls. One validated tool used by hospitals that participate in the Illinois' pediatric readiness recognition program is the GRAF PIF tool which is one of only two tools validated for use with pediatric patients.

Question 11

Are there developmental questions that are wise to address for hospital admissions?

Accepted Answer

We recommend having an ages and stages reference on hand to help with this. The CDC has great resources to help with this (https://www.cdc.gov/ncbddd/actearly/index.html). The Office of Early Childhood at the Colorado Department of Human Services oversees contractors doing early intervention work in each region. You can find local early intervention programs on their website. The COPPER committee also recommends having the TEN 4 FACES graphic on hand as a reference.

Question 12

With respect to the requirement that our hospital has an all-hazards disaster preparedness / emergency operations plan that addresses pediatric issues, what do you suggest we provide for this requirement?"

Accepted Answer

According to the joint policy statement on which all pediatric readiness work is based, the disaster preparedness plan should address pediatric-specific needs within the following core domains:
Availability of medications, vaccines, equipment, supplies and trained providers for children in disasters
Pediatric surge capacity for injured and non-injured children
Decontamination, isolation, and quarantine of families and children of all ages
Minimization of parent-child separation
Tracking and reunification for children and families
Access to specific behavioral health therapies and social services for children
Disaster drills include a pediatric mass casualty incident at least every two years
Care of children with special health care needs
Addressing all of the above in your disaster plan may not be feasible or applicable to your hospital, and that's okay. At a minimum, we would recommend including pediatric surge capacity and pediatric mass casualty incident (MCI) disaster drills in your disaster plan.

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FAQ

COPPER

How much does it cost to participate in the COPPER program?

Our social work and NICU/PICU teams track readmission rates. Does this satisfy the requirement that our QI/PI plan tracks pediatric readmission rates?

What does a case review for all critical care transfers out need to look like?

What kind of blood warmer do you recommend for the ED?

We have 7.0F central venous catheters in the ED and access to 4.0F-6.0F in the PICU. Does that satisfy the requirement to have size 4.0F-7.0F central venous catheters in the ED?

The COPPER equipment list requires 2.5 and 3.0 uncuffed and 3.5 cuffed ET tubes. Our ED docs would like to have 3.0 cuffed tubes as an option starting at 6-7 kg. Is there any good argument for or against this move?

Is there a recommended way to separate out the different age groups for flowcharts (in the context of nursing assessment)? Our current flowcharts separate the ages from- Newborn to 11 months, 12 months - 23 months, 2 - 4 years, 4-6 years, 6 - 11years and then 12 - 17 years."

Are there specific items that should be addressed for certain age groups that might be addressed differently than adult patients, when it comes to assessment?"

Is there an evidence-based fall risk assessment for specific ages?

Are there developmental questions that are wise to address for hospital admissions?

With respect to the requirement that our hospital has an all-hazards disaster preparedness / emergency operations plan that addresses pediatric issues, what do you suggest we provide for this requirement?"

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