Quality improvement (QI) is an iterative process designed to make controlled changes within the health care delivery system to provide patients with high-quality care that meets both their expectations and needs. Clinical Practice in Pediatric Psychology (CPPP) is actively soliciting QI studies to further its mission to promote and support the evidence-based clinical work of pediatric psychologists. This article (a) provides a basic introduction to what QI is and how it fits within ethical health care practice, (b) briefly describes the historical context of QI in health care, (c) discusses how QI serves as a complement to routine evidence-based care, and (d) gives guidance for writing up and publishing QI work. The overarching aim of this article is to promote the submission and acceptance of high-quality QI studies to Clinical Practice in Pediatric Psychology.

In in vitro brain/spinal cord preparations from larval lamprey, locomotor-like ventral root burst activity can be initiated by pharmacological (i.e., "chemical") microstimulation in several brain areas: rostrolateral rhombencephalon (RLR); dorsolateral mesencephalon (DLM); ventromedial diencephalon (VMD); and reticular nuclei. However, the quality and symmetry of rhythmic movements that would result from this in vitro burst activity have not been investigated in detail. In the present study, pharmacological microstimulation was applied to the above brain locomotor areas in semi-intact preparations from larval lamprey. First, bilateral pharmacological microstimulation in the VMD, DLM, or RLR initiated symmetrical swimming movements and coordinated muscle burst activity that were virtually identical to those during free swimming in whole animals. Unilateral microstimulation in these brain areas usually elicited asymmetrical undulatory movements. Second, with synaptic transmission blocked in the brain, bilateral pharmacological microstimulation in parts of the anterior (ARRN), middle (MRRN), or posterior (PRRN) rhombencephalic reticular nucleus also initiated symmetrical swimming movements and muscle burst activity. Stimulation in effective sites in the ARRN or PRRN initiated higher-frequency locomotor movements than stimulation in effective sites in the MRRN. Unilateral stimulation in reticular nuclei elicited asymmetrical rhythmic undulations or uncoordinated movements. The present study is the first to demonstrate in the lamprey that stimulation in higher-order locomotor areas (RLR, VMD, DLM) or reticular nuclei initiates and sustains symmetrical, well-coordinated locomotor movements and muscle activity. Finally, bilateral stimulation was a more physiologically realistic test of the function of these brain areas than unilateral stimulation.

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Purpose Failure mode and effects analysis (FMEA) was used to identify safety risks of unfractionated heparin (UFH) use and to develop and implement countermeasures to improve safety. Methods FMEA was used to analyze the transportation, preparation, dispensation, administration, therapeutic monitoring, and disposal of UFH in a tertiary care, freestanding pediatric hospital. The FMEA was conducted in a stepwise fashion. First, frontline staff mapped the different steps within the UFH use process. Next, key stakeholders identified potential failures of each process step. Finally, using calibrated scales, the stakeholders ranked the likelihood of occurrence, severity, and detectability for each potential failure’s cause. The rankings were used to prioritize high-risk areas on which to focus efforts for improvement countermeasures. Results The analysis revealed 233 potential failures and 737 unique potential causes. After ranking of all identified potential causes, 45 were deemed high scoring. Those 45 causes were further refined into 13 underlying contributing causes. To address the contributing causes, selected team members developed 22 countermeasures. The FMEA showed that implementation of the countermeasures reduced the level of mathematical risk. Conclusion FMEA was helpful in identifying, ranking, and prioritizing medication risks in the UFH use process. Twenty-two countermeasures were developed to reduce potential for error in the riskiest steps of the process.