Pediatric perspectives

Pediatric
WINTER 2012
Perspectives
A d v a n c i n g Pa t i e n t Ca r e S e r v i c e s a t S t . L o u i s C h i l d r e n ’ s H o s p i t al
Focusing
on the
positive
See page 3
On the
Cover
 Michele Herndon, BSN, RN, and Kyle Crow are
St. Louis Children’s Hospital is
recognized among America’s best
children’s hospitals by Parents magazine
and U.S.News & World Report. For more
information about nursing opportunities
at a Magnet hospital, visit:
StLouisChildrens.org/jobs
Winter 2012
Volume 9, No. 1
 Editorial board
Terry Bryant, MBA, BSN, RN, NE-BC
Professional Practice and Systems
Lisa Chapman, BSN, RN
Emergency Unit
Emily D’Anna, PharmD
Clinical Pharmacy
featured on the cover of the newly-designed Pediatric
Perspectives. Michele worked in the Ambulatory
Procedure Center at the time this photo was taken,
but recently transferred to Trauma Services.
Inside This issue
Medication matters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Death: the unspoken word . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
The complexity of hemolytic-uremic syndrome. . . . . . . . . . . . 8
Research spotlight: examination of a relaxation
method for very preterm infants . . . . . . . . . . . . . . . . . . . . . . 10
Spotlight on Shared Leadership . . . . . . . . . . . . . . . . . . . . . . 12
Angie Eschmann, RN
Clinical Operating Room
Robin Foster, MSN, RN, CPNP-PC, CDE, CPN
General Medicine
Jeanne Giebe, MSN, NNP-BC, RN
Newborn ICU
Peggy Gordin, MS, RN, NEA-BC, FAAN
Vice President, Patient Care Services
Beth Hankamer, MSN, BS, RN, CAPA
Clinical Education
Lisa Henry, MSN, RN, PNP-BC
Healthy Kids Express
Dora O’Neil, BSN, RN, CCRN
Cardiac ICU
Christina Patrick, MSN, RN, CPN
Clinical Education
Lisa Steurer, MSN, RN, CPNP-PC, CPN
Professional Practice and Systems
To add or remove a mailing address, contact
Arvella Robinson, [email protected]
Expressions of appreciation
What are you thankful for?
With the start of the New Year, St. Louis Children’s Hospital staff were asked
to share what they are grateful for most. Here’s what they said:
• • •
I’m grateful for spending each day working with amazing people. I get to meet
patients and families from all around the country. I help kids feel better and
get stronger.
—Jackie Bryce, DPT, PT, Physical Therapist, Therapy Services
• • •
I’m grateful for my never ending desire to help people by delivering care.
—John Newton, BSN, RN, Staff Nurse 8 West, General Medicine
Pediatric Perspectives is published by the
St. Louis Children’s Hospital Communications
and Marketing department. Please direct
inquiries to:
600 S. Taylor Ave., Suite 202
St. Louis, MO 63110
314.286.0417
314.286.0420 (fax)
© 2012, St. Louis Children’s Hospital
• • •
With each new year, I thank God for blessing me with a loving husband, healthy
and strong-charactered children and faithful friends. I continue to be grateful for
my calling as a nurse, allowing me to contribute to others’ lives in a job that has
purpose, challenge and opportunity.
—Cheryl Kelley, BSN, RN, Staff Nurse Risk Management/Compliance
Pediatric Perspectives
From Peggy
Starting a New Year
with gratitude
The past year has been filled with
challenges, both for St. Louis Children’s
Hospital as an organization, and for
many of us personally. It is easy to
look at our circumstances and feel
threatened, sorry for ourselves, or
resentful. However, I believe there
is an alternative that is much more
appealing. The antidote to all those
negative feelings is gratitude.
When we succumb to self-pity or
resentment, we poison ourselves and
those around us with negative energy,
draining the very resources we need
to overcome the challenges we face.
In contrast, running down the list of
things for which we can be grateful is
a source of energy, and can help us
face our challenges with the attitude
needed to overcome adversity.
Personally, I am grateful for my life,
family, friends and colleagues here.
I am grateful for having a comfortable
home and not worrying where my next
meal will come from. I am grateful
for working at a world-class children’s
hospital where everyone is dedicated
to creating a superior experience for
our patients and families through safe
care, effective care and exceptional
service. I am grateful that all of the
people that I work with are kind, caring
and committed to helping me and
each other be the best that we can be
for every patient, every family, every
day. I am grateful for having a spiritual
foundation that helps my personal life
and my work every day.
A view from the 10th floor at St. Louis Children’s Hospital: Shana Simpson, BSN,
RN, and her patient Kyler Campbell.
In the media, we see many images
of ideal families, celebrations and
gatherings, filled with plentiful food,
gifts and love. Often, we come to
believe that this is what we are entitled
to, and that it is the reality for many
people. However, most people have
both happiness and some pain in their
lives. Life presents all of us with both
blessings and losses over the years.
If we can learn to focus on our
blessings, while accepting the
challenges and losses as part of being
alive, we will all be much happier. We
can choose our perspective, and
I personally choose to be grateful.
I hope you will, too!
Wishing you all the best for 2012!
Peggy Gordin, MS, RN, NEA-BC, FAAN,
is SLCH’s Vice President of Patient Care Services.
She can be reached at [email protected]
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Pediatric Perspectives
 transformational leadership
Medication matters: pediatric pharmacy
One size does not fit all when it
comes to the practice of pharmacy
in pediatrics. Pharmacists are involved
in the care of all patients receiving
a medication in the hospital. The
review of every medication order
is especially important in a children’s
hospital, where “one size does not
fit all” and each medication, dose,
and formulation must be patientspecific and child-friendly. Both the
inpatient hospital pharmacist and
clinical pharmacist roles are essential
in providing optimal medication
therapy management and prevention
of medication errors.
Inpatient hospital pharmacist
The inpatient hospital pharmacist
evaluates all orders sent to the
pharmacy, alerting prescribers of
any safety concerns and facilitating
the safe preparation, storage and
delivery of all medications. While
dispensing medications seems simple
enough, the process of preparing
and delivering a medication is
actually quite complex. A pharmacist
must review each medication order,
taking into account the patient’s
age, weight, allergies, diagnoses
and other medications. Preparation,
packaging, formulations, regulations
and documentation are all different
in the hospital than local pharmacies,
as many patients are receiving
intravenous (IV) medications, IV fluids,
parenteral nutrition, chemotherapeutic
agents and life-sustaining medications.
Pharmacists supervise preparation
of these products, paying close
attention to compatibility, appropriate
drug concentrations and rates of
infusion. Often, oral medications not
Pharmacy Technician Trudy Harris pumps a fluid base in order to make a standard
concentration antibiotic stock bag.
commercially available as liquid
products need to be compounded and
prepared as individual doses. Inpatient
hospital pharmacist roles can also
include management of investigational
drug therapies, review and preparation
of chemotheraphy, supervision of
technology associated with dispensing
medication and participation on
hospital committees. Additionally,
all pharmacists at St. Louis Children’s
Hospital are trained in medical
emergency management and
respond to all codes.
Clinical pharmacist
The clinical pharmacist is integrated
into the care team in order to
understand all aspects of a patient’s
clinical status and care plan. Clinical
pharmacists round daily with the care
team, assisting in the selection of the
most appropriate medication therapies
and collaboratively monitoring
patients’ responses to these
medications (i.e. efficacy, side effects).
Optimal medication management is
ensured by providing drug information
and serving as a link between direct
Pediatric Perspectives
care providers and inpatient pharmacy.
In addition, clinical pharmacists play a
critical role in education and training
– precepting pharmacy residents and
students, serving as adjunct faculty
at pharmacy schools, providing
education to physicians and other
health care professionals, and assisting
in medication teaching with patients
and families. Clinical pharmacists
are responsible for the on-call
pharmacokinetics service, managing
therapeutic drug monitoring
and answering after-hour clinical
medication management questions.
Aside from direct patient care activities,
clinical pharmacists are actively
involved in numerous committees,
research and drug utilization reviews,
development of standardized order
sets, policies and guidelines and
community outreach (i.e. flu clinic,
support groups, camps).
SLCH Pharmacists answer:
“What do you consider the most
rewarding aspect of your job?”
• • •
“Proactively addressing medicationrelated issues before they are a
concern or develop into an error.”
• • •
“Being able to assist in finding and
providing a solution to a complicated
medication situation.”
• • •
“Knowing that you made a difference
in a family’s life…whether it is by
simplifying a complex medication
regimen, taking the time to review
a patient’s medication list with a
parent or helping a family become
more comfortable managing their
child’s illness.”
Brandy Bratcher, PharmD, visits with 4-year-old patient Sophie Kirk. Clinical
pharmacists can help explain medication side effects and simplify complex
medication regimens.
Four-year graduate pharmacy school
training begins following two or more
years of undergraduate pre-pharmacy
education. Prospective candidates
must take an entrance examination in
order to apply to PharmD programs.
During pharmacy school, every
graduate completes a minimum of
one year in experiential rotations
(similar to medical students) in a
variety of practice areas including
acute care, community pharmacy,
hospital pharmacy, ambulatory care,
management and industry. Those
completing program requirements
will graduate with their Doctor of
Pharmacy degree (i.e. PharmD) and can
practice as pharmacists after passing
a pharmacist’s licensure examination
(boards) as well as state specific
jurisprudence (law) examinations.
Some pharmacists pursue
postgraduate residency, which
allows the resident to perform
as a licensed pharmacist while
training under the supervision of
an experienced preceptor (similar
to medical residents). During their
residency, residents develop skills
and competence in providing optimal
pharmaceutical care to a variety of
patients in various hospital settings,
thus accelerating growth beyond
entry-level experience. Two years
of residency can be completed for
specialization in a particular area, such
as pediatrics. Completion of one or
two years of residency is considered
standard training to practice as a
clinical pharmacist.
For additional information, contact Emily D’Anna
at [email protected]
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Pediatric Perspectives
 structural empowerment
Death: the unspoken word
Staff bridges fears to provide
quality bereavement care
Grief is overwhelming, often avoided
and sometimes denied. Health-care
professionals can find it difficult to
admit that despite every effort, not all
children can be saved. Most parents
and families see the death of a child
as incomprehensible. Bereavement
support after the death of a child is
vital to the continuum of quality care
at St. Louis Children’s Hospital (SLCH).
Sadly, grief does affect many SLCH
families. Accidents, trauma, suicide,
extended illness and infant death claim
the lives of approximately 160 children,
or 1 percent of patients admitted
to the hospital every year. Early
efforts to approach the challenges of
bereavement care came from pioneers
in the Newborn ICU, Hematology/
Oncology and later in the Pediatric
ICU. In time, it became apparent that
a more centralized program, which
allowed variability specific to patient
populations and individual units, was
the most consistent and appropriate
way to deliver bereavement care.
Parents often act as partners in the
delivery of care at SLCH, so it is not
surprising that funding for the current
Bereavement Program came as a result
of a family’s own grief over the tragic
loss of their youngest son. In January
1994, 3-year-old Drew Schmidt was
diagnosed with a serious brain tumor.
Seven months later he died, leaving
his parents to deal with overwhelming
grief. Their own struggle to find
support after their son’s death led to
an impassioned effort to provide better
bereavement care for other families
and siblings in grief. As a result, Tom
and Stephanie Schmidt endowed the
Drew Schmidt Children’s Bereavement
With help from staff, Oakes Ortyl, a patient in the Cardiac ICU, makes a hand
print next to his sister’s hand print. (photos taken by Becky Ortyl, Oakes’ mother)
Fund. Other generous sponsors
include the Anonymous Wings
and Bereavement Endowment Fund
and St. Louis Children’s Hospital
Foundation.
The Bereavement Program is facilitated
through the Social Work/Chaplaincy
department and led by a bereavement
coordinator. Key players in the success
of the program are the front-line
staff from unit-specific bereavement
committees and Chaplaincy staff. The
Bereavement Program addresses both
immediate and follow-up grief care,
taking into consideration individual,
cultural and spiritual needs. At the
time of a patient’s death, the staff and
chaplain provide psychosocial support
and offer various mementos and
grief literature to families. Follow-up
bereavement care is provided for
24 months after the death of a child
and involves phone calls, mailings
and special memorials.
The bereavement room, located on
the lower level of the hospital, offers
a newer service to grieving families.
Within a home-like environment,
families can privately grieve. Families
using the bereavement room express
how beneficial it is to have a private
place away from the stress and difficult
memories of the hospital environment
while coming to terms with their loss
and beginning the grieving process.
Following a staff member’s referral,
Chaplaincy staff secure the room and
attend to the families. Uses for the
room include:
• after-death support and extended
family time with the child
• a place for families to wait with their
child until the funeral home arrives
• a location for families of neonates
undergoing terminal extubations
An Interfaith Memorial Service is
another service coordinated through
the Bereavement Program benefitting
Pediatric Perspectives
• • •
“Things that were hard to bear
are sweet to remember.”
– Seneca the Younger
both staff and families. Held bimonthly
on the second Tuesday, the Memorial
Service honors children who have
died within the previous two months.
Through mailings or email, families
and staff are invited to the services.
During the service, the name of
each child honored is read aloud
and remembered. Special readings,
music, lighting of candles and sharing
of memories by families and staff
underscore the love that is felt for
these children.
While experiencing the death of
a child in the hospital environment is
devastating, skilled and compassionate
bereavement care can help grieving
families. Here are words from some
of the families supported by the
Bereavement Program:
“Although Ava was here for only
a short time, we were able to make
memories that have stamped our
hearts and minds forever.”
Isla prepares her hand print for the keepsake. She visits her brother Oakes almost
daily. Although in the midst of caring for their son, the Ortyl’s have established
a foundation, The Mighty Oakes Heart Foundation, to benefit children with heart
defects and their families.
“My child died and St. Louis Children’s
Hospital let me and his dad spend
more than an hour with him, which
was very important to me.”
“Thank you for everything! Words
will never be enough to express
the amazing care Eli received!”
For additional information, contact Dora O’Neil,
BSN, RN, CCRN at [email protected]
Bereavement support services
n
Special mementos of child offered at time of death
n
Baptisms, dedications or other requested spiritual rites
• Plaster and/or ink hand/foot prints
n
• Lock of child’s hair
One-on-one psychosocial/spiritual support at time of death, along with initial bereavement support literature
• End of life/postmortem professional photos –
Now I Lay Me Down to Sleep & The Jeremy Project
n
• Unit-specific personalized mementos and other
supportive items
- Newborn ICU: bead bracelet/dog tag
n
- PICU/CICU: engraved heart pendant –
“You are loved beyond words and missed beyond
measure, your life was a blessing, your memory
a treasure.”
• SLCH Interfaith Memorial Services (honors individual
children two to three months after death)
- CICU: sibling memorial teddy bears
• Summer memorial picnic
- Oncology: memory book – “True Greatness”
n
Referrals to family/sibling support groups
- EU: special resources for sudden accidental/
traumatic deaths
At least one home follow-up phone call, more if family need is identified
24-month bereavement follow-up via grief support mailings at 1, 3, 6, 9, 12 and 18 months postmortem
n
Bereavement events
• Unit-specific memorial services
(Newborn ICU/Oncology)
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Pediatric Perspectives
 exemplary professional practice
The complexity of hemolytic-uremic
syndrome
Shiga-like toxin associated HUS accounts for about 90 percent of all cases in children.
Hemolytic-uremic syndrome (HUS) is
an illness caused by toxin-producing
bacteria, such as E. coli O157:H7 and
Shigella that destroy red blood cells.
Most people are infected through
the GI tract by eating contaminated
food, typically beef, or drinking
contaminated water. Ingestion of
unpasteurized milk or milk products
also can lead to HUS. In the United
States, more than 70 percent of all HUS
cases are caused by E.coli O157:H7
and another 20 percent are caused
by Shigella. HUS principally affects
children under the age of 5, is more
common in the summer months and
more frequent in rural areas. It is
important to note that approximately
10 percent of patients with an E.coli
O157:H7 infection will develop HUS.
The patient with HUS begins the
course of illness with non-specific
abdominal pain and vomiting.
Progression to bloody diarrhea is
frequent and often the symptom that
brings a child to the hospital.
Other organs also may be involved
in this disease process. Significant
central nervous system involvement
(i.e. seizures, stroke and coma) is
seen in up to 20 percent of children
with HUS and are all associated
with increased mortality. GI tract
complications may include bowel
necrosis or perforation, peritonitis or
intussusception. Cardiac dysfunction
may occur due to fluid imbalance
within the patient.
HUS treatment is supportive and
antibiotics are NOT given. Antibiotics
would cause any remaining bacteria
to die, releasing increased amounts of
toxin and thus exacerbating symptoms.
Stool and blood cultures are obtained
as well as a rapid screen for Shiga
toxin-producing bacteria. Treatment
includes early fluid resuscitation at
high volumes in order to dilute the
effects of the toxins and increase
perfusion to the kidneys. A balance
between maintaining adequate renal
perfusion and not overloading the
patient with fluids must be achieved.
Careful attention to electrolytes, urine
output, diuretic use and fluid balance
restriction are all methods to help
achieve fluid and renal perfusion.
Patients are given blood and platelets
as needed to maintain normal blood
counts. Peritoneal dialysis is instituted
for patients developing renal failure
and continues until renal function
improves. Some patients will require
a kidney transplant if significant renal
damage has occurred.
Other causes of HUS
Shiga-like toxin associated HUS
accounts for about 90 percent of all
cases in children. This is sometimes
known as diarrhea-associated HUS.
The remaining 10 percent of HUS
cases are distinguished by an absence
of diarrhea. Often the children
present with a history of respiratory
infection, fever and vomiting. Renal
complications are less severe. Infection
with Streptococcus Pneumoniae is the
most common cause of atypical HUS.
There are also some genetic forms of
HUS resulting from mutations in genes
associated with complement proteins.
Treatment with certain post-transplant
medications like cyclosporine,
tacrolimus or cytotoxic drugs like
mitomycin C, bleomycin, or cisplatin
can also cause atypical HUS.
Pediatric Perspectives
In the United States, more than
70 percent of all HUS cases are
caused by E.coli O157:H7 and
another 20 percent are caused
by Shigella.
Case study
“Carter” is a healthy 5-year-old male who has had
and has mild, non-pitting edema of hands
bloody diarrhea, nausea and vomiting for two
and feet. Carter’s mucous membranes are slightly
days. He has not been running a fever. Carter was
dry, and his abdomen is diffusely tender.
seen at an outside hospital, where he received
three NS fluid boluses before transfer to St. Louis
As suspected, his stool culture comes back
Children’s Hospital. He has had no urine output
positive for E coli 0157:H7. His other cultures are
for more than 24 hours. Carter’s mother reports
all negative. Carter is started on D5 NS at 2L/m2
that he hasn’t been around anyone who is sick
on admission and transitioned to TPN and lipids
and that he lives at home with his parents and
on hospital day seven. After four days, the TPN
siblings. The boy had developed an inguinal rash
and lipids are discontinued, and Carter is on a
the day before he was admitted. Upon arrival
regular diet. On hospital day two, Carter received
to St. Louis Children’s, the following tests were
a broviac and a peritoneal dialysis catheter.
obtained: RFP, CBC, stool culture, Rotavirus
He was on peritoneal dialysis for seven days.
PCR and blood culture. His chest and abdominal
Throughout his hospitalization, Carter received
X-rays were clear. An assessment revealed vital
four PRBC transfusions. He and his family
signs of temp 36.8, HR 114, RR 34, BP 117/63,
received assistance in dealing with his illness and
and sats 100%. Overall, he looks ill. His skin
prolonged hospitalization from Social Services
is erythematous, excoriated in the inguinal area
and the Family Resource Center.
Families are often overwhelmed with
the potential severity of HUS; therefore
it is important for health professionals
to understand the clinical course of
the disease. Initially, the platelet count
will normalize, renal function is then
restored, and finally a steady rise in the
hemoglobin levels occurs. Thus, it is
not uncommon for blood transfusions
to be required later in the course of
the disease. Parents and caregivers
mistakenly believe that this means the
child is getting worse when it is actually
a normal progression of the disease.
HUS symptoms usually begin five to 10 days after the onset of diarrhea
and are the result of endothelial damage.
Complication
Mechanism
Results
Acute Renal
Injury/Failure
Toxin from the bacteria attacks
the endothelial lining of the
blood vessels, creating microscopic “leaks.”
~ May be mild with hematuria
and proteinuria
~ May be severe with significant
renal failure and oliguria/anuria
Thrombocytopenia
Endothelian damage leads to
platelet activation and platelets
are consumed as small clots
are formed.
~ 40,000–140,000 platelets/cmm
~ No other active bleeding present
beyond bloody diarrhea
Microangiopathic
Hemolytic Anemia
Red blood cells are damaged
as they flow.
~ Hemoglobin levels typically
< 6-8 g/dL
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Pediatric Perspectives
 new knowledge, innovations and improvement
Research spotlight: examination of a
relaxation method for very preterm infants
Preterm infants are at increased risk
for significant neurobehavioral and
cognitive impairments, including
academic underachievement,
behavioral problems and poor
executive function. Up to 60 percent
of children born very preterm (< 30
weeks estimated gestational age),
experience cognitive impairments,
a wide variety of learning disabilities,
and social and emotional difficulties.
Environmental factors, such as stress
in the Newborn ICU, may play a
role in altered brain maturation and
neurobehavioral outcomes. A feasibility
study has shown promising results in
exploring the safety and suitability
of a novel relaxation technique in
hospitalized very preterm infants born
less than 30 weeks gestation in a level
IIIC Newborn ICU.
Interventions aimed at decreasing
stress in the Newborn ICU environment
are essential. Previous research has
supported the use of infant massage
in the more healthy preterm infants
equal to or greater than 32 weeks
post-menstrual age. Alternatively,
Therapeutic Touch (a non-contact
touch method of balancing and
increasing the body’s energy to
promote healing), Gentle Human
Touch (containment or still, gentle
touch without stroking or massage),
and TAC-TIC therapy (Touch and
caressing-tender in caring—including
gentle, rhythmic, and systematic
stroking) have been studied in younger,
more acute Newborn ICU patients,
with small samples and limited or
inconsistent results. It is these very
preterm infants who are at the highest
risk of developing adverse neurological
outcomes and who would most
likely benefit from a stress-reducing
relaxation touch.
Babies with positive and negative cues by timepoint
Positive
Negative
12
10
8
6
4
2
0
Baseline
1 minute
2 minutes
3 minutes
4 minutes
5 minutes
5 minutes
post
10 minutes
post
Recently, a novel alternative to
providing comforting touch to
hospitalized preterm infants was
introduced called the M Technique®,
a structured mindful relaxation
technique designed for fragile
intensive-care patients who are unable
to tolerate conventional massage.
Unlike massage, the M Technique
incorporates pressure, number and
sequence of structured strokes.
It is easy to learn and completely
reproducible, making it ideal for
research. However, no studies to
date have examined the safety and
feasibility of the M Technique in
hospitalized, very preterm infants.
The long-term goal is to establish
a safe and effective protocol for the
delivery of the technique, based
on infant readiness cues of the
hospitalized preterm infants in
a level IIIC Newborn ICU.
With support from the St. Louis
Children’s Hospital Foundation, a pilot
study was conducted using a sample
of 10 very preterm infants born at
less than 30 weeks gestation. Trained
study personnel consisted of an
interdisciplinary group of neonatal
developmental care experts with
a combined average of more than
20 years of neonatal experience,
including neonatal nurse practitioners,
occupational therapists and physical
therapists. Preliminary results revealed
a significant overall decrease in heart
rate and respiratory rate in the infants,
as well as decreased behavioral state
scores, which indicated a more quiet
sleep state. In addition, negative infant
behavioral cues decreased and positive
infant behavioral cues increased
throughout and at the end of
Pediatric Perspectives
Up to 60 percent of children born
very preterm experience cognitive
impairments, a wide variety of
learning disabilities, and social and
emotional difficulties.
the intervention. Next steps include
additional research with a larger sample
size and randomization to determine
its short-and long-term effects relating
to stress reduction, brain growth and
neurobehavioral development.
Approximately 750 infants are admitted
to the Newborn ICU at St. Louis Children’s
Hospital annually and nearly 25 percent
are delivered prior to 30 weeks gestation.
However, the M Technique is not limited
to preterm or term infants; it has been
tested in various health care settings and
among all age groups. This innovative and
potentially cost-effective intervention has
the potential to benefit all areas of the
hospital (i.e. pain relief for cancer patients,
palliative care/hospice, Pediatric ICU, etc.).
In addition, parents can be easily trained
to deliver the M Technique, providing
them an opportunity to learn a relatively
inexpensive and potentially life-long
therapeutic intervention. This technique
also will provide parents with the tools to
empower them to actively participate in
their child’s health care management.
For additional information, contact Joan Smith, MSN,
RN, NNP-BC, at [email protected]
____________________________________
Read about one Newborn ICU nurse’s
personal experience by visiting
www.fromthebedside.org,
a new hospital page
dedicated to sharing
stories about patient
care at St. Louis
Children’s Hospital.
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Pediatric Perspectives
Spotlight on Shared Leadership
St. Louis Children’s Hospital is about to
embark on its third anniversary of the
Shared Leadership Councils. It will be
a monumental time because it is the
first transition year for new co-leads and
members of the five Shared Leadership
Councils.
Shared Leadership, however, is more
than just a council structure. It is a
philosophy where the best decisions in
an organization come from front-line
staff, and leadership facilitates those
decisions to fruition. Our structure
and our philosophy are unique in that
the Shared Leadership Councils are
composed of members from all patient
care services, not just nursing. This is
because a multidisciplinary approach to
decisions leads to the best outcomes for
both the patients and the organization.
The following are a few of the projects
and programs that have come about as a
result of the Shared Leadership structure,
along with the new council co-leads.
Professional Standards Council:
Responsibilities include
professional behavior,
work environment and
employee engagement.
Major Projects and
Accomplishments:
Co-Leads: Michelle
LaGrone, MDiv, Social
The Professional
Work; Theresa Reisinger,
Standards Council has
RN, OR (not pictured)
focused their efforts
upon creating a culture of “professional
presence” among all staff. They
have addressed topics ranging from
professional appearance to establishing
professional boundaries with our families.
In addition, the council has assisted in
developing standards and resources
to streamline processes for accessing
interpretive services for non-English
speaking patients.
Patient Safety Council:
Responsibilities
include the
review and
analysis of
safety event
trends and the
Co-Leads: Tricia Kreikemeier,
development
BSN, RN, 7W;
Anna Webelhuth, PharmD,
of safety culture
Pharmacy
standards.
Major Projects and Accomplishments:
The Patient Safety Council initiated
a multidisciplinary team that performs
periodic “Safety Walk Rounds” on each
unit. A “Good Catch” program also was
created to reward staff for reporting nearmiss safety events that could potentially
harm a patient.
Performance Improvement Council:
Responsibilities
include quality
monitoring
and process
improvement
of all employeeCo-Leads: Crystal
and patientBuesking, BSN, RN, CPN,
7W; Stephanie Vilmer,
related
Psychology
initiatives.
Major Projects and Accomplishments:
The Performance Improvement Council
has standardized the orientation packet
for all families upon admission so that
important information about hospital
operations is communicated consistently.
The council is currently working on
streamlining the procedures for ordering
home health equipment that patients will
need upon discharge. This process will
assist in ensuring a timely and efficient
discharge process.
Clinical Practice Council:
Responsibilities
include development
of evidence-based
practice standards,
guidelines and
procedures.
Co-Leads: Barbara Gavillet,
RN, RNC-NIC, Newborn
Major Projects and
ICU; Elizabeth Ziegler, MS,
Accomplishments:
CCC-SLP, Therapy Services
Due to the sheer
volume of clinical practice issues,
the council developed a tool to help
prioritize projects that will enhance
the quality of patient care. Thus far,
intravenous therapy documentation has
been revised in the electronic record
to capture important clinical data and
new evidence-based standards for
suctioning patients with artificial airways
have been implemented.
Education Council:
Responsibilities
include planning the
education related
to the work of the
other councils
and developing
educational plans for
required education.
Co-Leads: Peggy Conroy,
BSN, RN, 8E; Genny Dillard,
Child Life Services
Major Projects and Accomplishments:
The Education Council has created
a Shadowing Program that provides
staff the ability to spend a work shift
with members of a different discipline.
This program helps to build a deeper
understanding and perhaps empathy
for staff holding other responsibilities.
The Education Council also is an integral
part of the development and planning for
the annual multidisciplinary Perspectives
in Pediatrics Conference.
For additional information, contact Lisa Steurer,
MSN, RN, CPNP-PC, CPN at [email protected]
A special thank you goes to departing council co-leads whose service has been invaluable over the last two years: Sue Griffard, BSN,
RN, RNC, Answer Line; Jim Burns, MT, (ASCP), BS, Laboratory; Mary Mintun, MSN, RN, Cardiac ICU; Donna Petersen, RRT-NPS, AE-C,
Respiratory; and Amy Westfall, OTD,OTR/L Therapy Services.
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