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Tuesday, April 12, 2016

Nursing In The 21st Century

Posted By: Advancing Care

Westchester Medical Center Health Network’s nurses are innovating and transforming patient-centered care.

By Mary McIver Puthawala, RN, BSN


With Nurses’ Week fast approaching (May 6-12), let’s try an experiment. Close your eyes and contemplate what a nurse represents to you. Whatever thoughts may have followed, chances are they don’t include ones of nurses as modern, technological pioneers, like some of those at Westchester Medical Center Health Network (WMCHealth).

“We ask our nurses to speak up and identify obstacles that stand in the way of them doing their best, and to think differently about what we can do together to make it better,” says Patricia Wrobbel, DNP, MBA, RN, Senior Vice President for Patient Care Services and Chief Nursing Executive at WMCHealth. This brainstorming initiates new and innovative solutions, thus challenging the status quo. “When speaking of innovation and transformation, people think of advancing care and technology, and in that regard, we’re doing amazing things.”

Emergency Department

Consider the task of making sure every single tube of blood drawn (and there are thousands drawn each week) is collected efficiently; for the correct patient; has accurate, clear labeling; and is not lost in the controlled chaos that defines every ED.  Matt Landers, MS, RN, FNP & CEN, Senior Director of Nursing in Emergency Services at Westchester Medical Center (WMC), understood the need and developed an innovate solution that includes state-of-the-art technology. “What we wanted to do is decrease the amount of time for the nurse to collect the specimens and increase accuracy,” says Landers. He and a team of colleagues developed and instituted a system of bar codes to ensure accuracy and helped make the ED more precise, efficient and able to send patients back home sooner.

Upon admission to the ED, each patient is issued a bar-coded bracelet, which is linked to that patient’s medical records. When a blood test is ordered, the nurse or a technician brings a workstation directly to the patient’s bedside. When the order is verified on the patients’ medical records, his or her bar code is scanned, confirming the order. Then, the test-tube labels are printed, right there, and everything is scanned again, so the lab knows exactly when the test samples are drawn and who drew them — all at the patient’s beside. The result is higher quality of care, less time in the ED for the patient, reduced waste, and less patient discomfort.

At Good Samaritan Hospital, a Member of the Westchester Medical Center Health Network, when a patient enters the Emergency Department a combination of vital signs are done and repeated during their stay. These are documented in the hospital’s Connect Care electronic medical record.  If they are out of the “normal” range, a Best Practice Alert opens in the computer screen for all providers to review. This best practice alert has specific instructions as to what needs to be done in terms of next steps in the patient’s care.

Intensive Care Unit

WMCeHealth, WMCHealth’s telemedicine program, which launched in October 2015, is state-of-the-art when it comes to the electronic Intensive Care Unit (eICU). The eICU consists of experienced ICU nurses monitoring each patient in all of the adult ICUs at WMC and MidHudson Regional Hospital, a Member of the Westchester Medical Center Health Network, remotely.

Lisa Lapolla, RN, CCRN, DNP

Lisa Lapolla, RN, CCRN, DNP

Each ICU bed has a screen where the patient can see, and even have a conversation with, the eICU nurse, when appropriate. Also, the eICU nurse has the medical records for each patient, as well as immediate lab results. Algorithms help alert the eICU nurse to potential critical changes in the patient’s health. The process, far from replacing the top-notch care the patients are already receiving from their bedside ICU staffs, provides an additional set of eyes, to improve patient safety and overall quality of care.

“We’ve had some good catches,” says WMC Staff Nurse Lisa Lapolla, RN, CCRN, DNP,  such as when they’ve caught critically ill patients trying to get out of bed, or they’ve been able to alert the nurse in real time when game-changing lab values are reported.

At St. Anthony Community Hospital, a Member of the Westchester Medical Center Health Network, specially trained nurses use ultrasound-guided technology to insert all peripherally inserted central catheter (PICC ) lines. This is done at the patient bedside and prevents the patient from undergoing an interventional/surgical procedure.

Burn center

The nursing staff at Westchester Medical Center’s Burn Center utilizes breakthrough technology to save lives and decrease hospital stays. In the Burn Center, Aine McLernon, MS, FNP-BC, NP in Burn Surgery, performs bronchoscopies with a disposable, fiberoptic, flexible tube with video assist. This allows direct visualization and accurate assessment of the burn patient’s airway for potentially life-threatening injuries, thus reducing wait time for other procedures, minimizing the risk of infection and sparing the patient from further invasive and unnecessary procedures.

Aine McLernon, MS, FNP-BC

Aine McLernon, MS, FNP-BC

Another example is the use of regenerative medical devices, specifically, Matristem Burn Matrix. Matristem is applied to burn wounds, providing an extracellular matrix to stimulate wound healing. This eliminates the need for a variety of skin grafting procedures. Says McLernon, “It has the potential to not only accelerate healing, but also reduce the length of the hospital stay, pain medications, and the nursing care required.”

Education

Innovations are also being made in parent education, communication and family-centered care. For example, sometimes the good intentions of parents can conflict with the medical needs of their children. “This is not their home,” says Erin Facelle, RN, MSN, Nurse Manager of Pediatrics at Maria Fareri Children’s Hospital, a Member of the Westchester Medical Center Health Network. Children have different needs in the hospital than they do at home. For instance, a parent might not want the nurse to wake a child for a treatment, even though the child’s treatment protocol requires it.

An interdisciplinary team including key nursing staff of the Children’s Hospital identified 10 areas of care in which the parents can learn of the potential risks faced by their children and actions to take to prevent injury. Areas of education include fall prevention and infection prevention. The resulting program, called “Partnership for Safety,” was developed to help make parents partners in their children’s care.

“It’s a cooperative program for patients and their families to ensure patient safety and positive outcomes,” says Linda Hurwitz, RN, MS, NEA-BC, Vice President of Nursing at Maria Fareri Children’s Hospital.

With “Partnership for Safety,” families will be shown a short film and given one or more “Speak up for Safety” cards, written in both English and Spanish. Each card features an area of care-relevant risk to the child and illustrates how the family and the staff work together to prevent harm, such as preventing falls in an unfamiliar medical environment. Families become partners with the doctors and nurses in caring for their children, and everyone performs to a higher standard of care. The program is so innovative that it will be presented at an international family-centered care conference this summer.

“Our staff is doing amazing things,” says Wrobbel. “It’s very satisfying. Everything that the nurses do here matters. They truly make a difference.”