412 - Creating a No Hit Zone at Home

Poster Number: 412

John W. Harrington, Children's Hospital of The King's Daughters, Norfolk, VA, United States; Zachary K. Yorke, Eastern Virginia Medical School, Norfolk, VA, United States; Rohan Dod, Eastern Virginia Medical School, Norfolk, VA, United States

Background: The No Hit Zone (NHZ) concept was initiated in 2005 and has been successfully implemented in multiple pediatric hospitals and clinics. Core elements of the NHZ initiative include education and staff training along with posters and informational materials clearly outlining the key rules of a NHZ while also providing evidenced based research and alternatives/tips to spanking/corporal punishment. The message is fairly simple: No adult shall hit a child-No adult shall hit an adult-No child shall hit an adult-No child shall hit a child. General Academic Pediatrics is the primary care pediatric practice at our hospital that sees 20,000 visits of predominantly Medicaid patients annually.

Objective: To broaden the NHZ message so parents can implement the NHZ at home and document this through a signed parental pledge.

Design/Methods: Please refer to the Key Driver Diagram. (KDD) The main steps in the process were to train staff and providers via role play on how to message the NHZ in a natural and non-threatening fashion by matching the message with our already well established reach out and read program and making sure to introduce the first phrase of the NHZ as "no child shall hit an adult". Documentation in the electronic medical record (EMR) by the pediatric provider was tracked for all eligible well visits between the ages of six months and five years of age and nursing provided NHZ information in the depart summary. This is graphically depicted in p charts. We initially started with verbal pledge documentation, but later added a signed pledge. (see attached)

Results: Currently our p charts for the documentation of the NHZ in the EMR has been steadily increasing with nine points above the centerline of 53%. The p chart for the NHZ information in the depart summary has also shown a similar trend. (Not shown here). Our verbal parental pledges were well above 30% initially, but when switched to a signed pledge, dropped precipitously. (Not shown here)Conclusion(s): Our improvement process has been quite robust with implementation of the NHZ into our clinical framework. We should be receiving NHZ materials in both English and Spanish in 2022. We are currently in the process of a PDSA cycle to focus on signed pledges at the 9 and 12 month visits, since it didn't seem reasonable to try and get a signed pledge at every well visit and these two visits are when corporal punishment and spanking are generally initiated. Overall, staff, providers and families seem to appreciate the message and it appears to be a sustainable process that can be spread to our other 28 primary care practices.
Key Driver Diagram
EMR documentation P chart