- Email: [email protected]
PICC is a four letter word: the development of a vascular access team
Session Abstracts
JOURNAL OF RADIOLOGY NURSING
apply the art. Measurement of the effectiveness of this combination of art and science requires a sound documentation tool. Documentation of sedation is not restricted to nursing alone. It is multidisciplinary, involving information from the patient, the family, the physician directing the sedation, and hospital departments such as health information and quality management. To develop this type of documentation tool, duPont Hospital for Children formed an interdisciplinary committee in 2001. The Sedation Task Force expanded an existing form to meet the safety and quality requirements of the Joint Commission on Accreditation of Healthcare Organization’s (JCAHO) standards on sedation. The resulting Sedation Assessment and Flow Sheet requires documentation of the health history, the physician’s evaluation of the patient immediately before sedation, a sedation medication order, and the nurse’s charting through the entire process until discharge. In addition, the form is printed with a carbon copy, which is submitted to the quality management department for analysis and quarterly reporting. This documentation tool received favorable comments during a recent JCAHO survey. It has provided a wealth of information for ongoing process improvement and a detailed history of sedation at this hospital.
Pediatric Sedation: Evolution of Nursing Practice Cindy Sanders, MSN, RN, Laura Wagner, BS, RN Children’s Healthcare of Atlanta, Atlanta, GA
Results:
# of patients enrolled # of positive responses % of positive response Complications
PO Caffeine 82 69 84% 0
IV Caffeine 114 67 59% 0
IV+PO Caffeine 7 7 100% 0
Total 203 143 70% 0
Conclusion: Administration of caffeine is effective in managing paradoxical hyperactivity to IVPB in children. The best results were in the small subgroup that received both oral and IV therapy. Further investigation is required to determine whether combined oral and IV therapy is warranted and whether confounding factors such as blood sugar and caffeine intake at home inhibit the effectiveness of this treatment.
Colonography
The art and science of pediatric sedation is truly an evolutionary process. Ongoing changes with regard to JCAHO standards, institutional requirements, medication availability, and other considerations have led to many modifications in nursing practices in radiology. The presenter provided findings gathered during a benchmarking study conducted two years ago and then replicated this year. The participants in the study were nurses in radiology departments providing large amounts of pediatric sedation. Analysis of these findings was presented as it related to medications administered, credentialing of staff, percentages of patients sedated, and other factors. Additionally, the role of sedation services in radiology was discussed as it related to changes in registered nurse practice.
The Caffeine Challenge: ‘‘Dew’’ You Believe It Works? Michelle Niewinski, BSN, RN, Theresa Schultz, RN, Kevin Baskin, MD, Robert Towbin, MD, Robin Kaye, MD The Children’s Hospital of Philadelphia, Philadelphia, PA Background: Paradoxical hyperactivity is an idiosyncratic reaction to intravenous pentobarbital (IVPB) sedation characterized by extreme inconsolable irritability and hyperactive behavior, similar to that seen in attention deficit hyperactivity disorder. Paradoxical reactions are more often seen during the recovery phase but can occur during induction. Stimulants are known to increase concentration and improve self-control in hyperactive children. Objective: In an IRB-approved prospective study, the presenters evaluated the effectiveness of a stimulant, caffeine, in treating paradoxical hyperactivity to IVPB sedation in children.
54
Methods: From April 2001 to December 2002, children sedated with IVPB for diagnostic imaging and interventional procedures were eligible for enrollment. IVPB was given either as a single agent or in combination with midazolam or midazolam and fentanyl citrate. Caffeine was administered either orally, IV, or combined. A positive response was recorded if symptoms (agitation, crying, or hyperactivity) decreased within 40 minutes of caffeine administration. Response time was characterized as immediate (within 10 minutes), early (11-20 minutes), late (21-30 minutes), delayed (31-40 minutes), absent (>41 minutes), or unknown (no time or response recorded).
Colleen Sasso, BSN, RN, CRN Department of Veterans Affairs, San Francisco, CA Colon cancer is the second leading cause of cancer deaths among men and women in the U.S., and 93% of cases occur in people age 50 and over. Most colon cancers can be prevented if precursor colonic polyps are detected and removed. But recent studies demonstrate that fewer than 40% of the people who should be screened do so on a regular basis. Reasons for this are many, but the most prominent is that they are uncomfortable with some of the tests, especially colonoscopy. CT colonography (virtual colonoscopy) was introduced in 1994 and is being evaluated as a promising new tool for colorectal cancer and polyp detection that might encourage more patients to undergo screening. CT colonography uses data acquired from helical CT images and combines these with sophisticated software to generate two- and threedimensional views of the colon. This presenter discussed current screening tools for colorectal screening, benefits and techniques of CT colonography, and future direction of this promising screening modality.
PICC is a Four Letter Word: The Development of a Vascular Access Team Nancy Costa, BSN, RN, CRNI, Elizabeth Ferguson, BSN, RN, CRNI Methodist Hospital, Indianapolis, IN A pilot program was developed in 1997 to study the safety and feasibility of establishing a specially trained team of nurses to
www.radiologynursing.org
JUNE 2004
JOURNAL OF RADIOLOGY NURSING place peripherally inserted central catheters (PICCs) at the bedside. The project was pursued in part at the request of the interventional radiologists because of their concern about increasing requests for these line placements. The popularity of PICCs increased after the establishment of a dedicated team to the point that orders doubled within the first year. In 2001, the team submitted a proposal to the hospital administration to formalize the PICC team service. An office cum outpatient procedure room was set up in an unused radiology room. Supplies are charged to the patient and credited to the PICC team cost center. Inpatient PICC orders are generated electronically and printed out in the PICC team office. An electronic database is used to record patient data for tracking and outcomes monitoring. With these developments, the PICC team has become a ‘‘department within a department.’’ The presenters discussed the elements necessary to establish a successful venous access team. Several published studies corroborate that the most cost effective means of providing PICC line service is to use a team of nurses to place them at the bedside and refer only the toughest cases to IR. A vascular access team cannot flourish if it is merely proceduredriven, but it must be committed to promoting improved patient outcomes through education, advocacy, and research.
Session Abstracts
chaos has in the field of health care and helps students to understand how you can bring about order in any chaotic situation. Chaortic leadership skills are something that every radiology nurse and nurse manager must have to understand and survive in the ever-changing chaotic world of radiology nursing. It helps you to understand the sources of chaos in radiology, your role in chaos, and steps you can take to manage chaos in your department. Even though there have been radiology nurses for over 20 years, the role of the radiology nurse is to provide stability and continuity (order) to patient care, but, in the radiology environment, we are a source of chaos unto ourselves. The presenter gave an overview of the University of Pennsylvania Medical Center, a 500-bed regional trauma center and a top hospital in the country according to US News and World Report. The presenter discussed chaortic leadership theory and practice that was first described by Dee Houck and showed how to apply the principles of chaortic leadership. Finally, the presenter discussed strategies for success as a radiology nurse when working in a small facility and for radiology nursing leaders whether they are supervisors of a small staff or managers of a large diagnostic and interventional department.
Islet Cell Transplantation
Compassion Fatigue: Nurse Grief.Who Cares? Barbara Rubel, MA, CBS, CPBC
Virginia L. Girard, RN
Griefwork Center, Inc., Kendall Park, NJ
University of Pennsylvania Medical Center, Philadelphia, PA
The loss of a patient or a coworker through sudden death can be a shattering experience. The purpose of this presentation was to provide information on compassion fatigue. This presentation covered the affect of repeated traumatic death on nurses. The presentation was divided into two parts. In the first part, the presenter reviewed nurses as disenfranchised grievers, identified characteristics of an effective helper, listed communication skills in sudden loss situations, explored death notification after a sudden loss, and learned common grief reactions of health professionals after repeated deaths of patients. Case studies presented illustrated cumulative trauma of patients and the emotional residue of exposure to working with suffering.
Diabetes is an autoimmune disease that causes destruction to the islet cells in the pancreas. The pancreas has two functions: islet cells make insulin (a hormone) and digestive enzymes to break down carbohydrates. Diabetes has two classifications: type I and type II. Type I diabetes is insulindependent, and type II is noninsulin dependent. Islet cell transplantation is focusing only on type I diabetes. Diabetes is a debilitating disease that has devastating effects on people. Those who have type I diabetes cannot make insulin and are completely dependent on adjusting their blood sugars by exogenous insulin (insulin shots). If these people were offered a better lifestyle, becoming free from having to take insulin shots, would most diabetics take the risk? Islet cell transplantation is an experimental procedure that is not relatively new and could offer a person with diabetes a better lifestyle. The only problem is that this is an experimental procedure, and the recipients must weigh the risks to the benefits. Some risk factors are having to take insulin shots daily and having to normalize blood sugars. The presenter suggested that islet cell transplantation is a risk work taking.
In the second part, the presenter discussed personal history of loss and the psychological consequences of helping, and examined suggestions for self-care. The experience of patient or coworker death rarely gets the attention it deserves. This experiential presentation focused on the psychosocial impact of traumatic grief on nursing professionals. At the end of this session, the participants should understand vicarious trauma and how the grieving process is influenced by personal loss history and work style.
Nursing Leadership in Radiology: Applying the Art of Chaortic Leadership
Occurrence Management: Moving toward Continuous Quality Improvement Judy Dye, MA, BS
Patrick J. Glickman, BSN, RN
University of Arizona Medical Center, Tucson, AZ
University of Pennsylvania Medical Center, Philadelphia, PA The Art of Chaortic Leadership is from an article by Dee Houck that first appeared as ‘‘The Art of Chaortic Leadership’’ (Chapter 7) in On Mission and Leadership. Chaortic leadership is a term that highlights the link between chaos and order. It allows the class to understand the role and effect that
VOLUME 23 ISSUE 2
How do complex systems fail and how do you prevent it from happening? How can the study of errors, adverse events, and ‘‘near misses’’ affect patient care? A well-designed occurrence management program, designed to capture and analyze information to identify systematic problems and gain management’s commitment to removing the cause, can give you
www.radiologynursing.org
55
JOURNAL OF RADIOLOGY NURSING
apply the art. Measurement of the effectiveness of this combination of art and science requires a sound documentation tool. Documentation of sedation is not restricted to nursing alone. It is multidisciplinary, involving information from the patient, the family, the physician directing the sedation, and hospital departments such as health information and quality management. To develop this type of documentation tool, duPont Hospital for Children formed an interdisciplinary committee in 2001. The Sedation Task Force expanded an existing form to meet the safety and quality requirements of the Joint Commission on Accreditation of Healthcare Organization’s (JCAHO) standards on sedation. The resulting Sedation Assessment and Flow Sheet requires documentation of the health history, the physician’s evaluation of the patient immediately before sedation, a sedation medication order, and the nurse’s charting through the entire process until discharge. In addition, the form is printed with a carbon copy, which is submitted to the quality management department for analysis and quarterly reporting. This documentation tool received favorable comments during a recent JCAHO survey. It has provided a wealth of information for ongoing process improvement and a detailed history of sedation at this hospital.
Pediatric Sedation: Evolution of Nursing Practice Cindy Sanders, MSN, RN, Laura Wagner, BS, RN Children’s Healthcare of Atlanta, Atlanta, GA
Results:
# of patients enrolled # of positive responses % of positive response Complications
PO Caffeine 82 69 84% 0
IV Caffeine 114 67 59% 0
IV+PO Caffeine 7 7 100% 0
Total 203 143 70% 0
Conclusion: Administration of caffeine is effective in managing paradoxical hyperactivity to IVPB in children. The best results were in the small subgroup that received both oral and IV therapy. Further investigation is required to determine whether combined oral and IV therapy is warranted and whether confounding factors such as blood sugar and caffeine intake at home inhibit the effectiveness of this treatment.
Colonography
The art and science of pediatric sedation is truly an evolutionary process. Ongoing changes with regard to JCAHO standards, institutional requirements, medication availability, and other considerations have led to many modifications in nursing practices in radiology. The presenter provided findings gathered during a benchmarking study conducted two years ago and then replicated this year. The participants in the study were nurses in radiology departments providing large amounts of pediatric sedation. Analysis of these findings was presented as it related to medications administered, credentialing of staff, percentages of patients sedated, and other factors. Additionally, the role of sedation services in radiology was discussed as it related to changes in registered nurse practice.
The Caffeine Challenge: ‘‘Dew’’ You Believe It Works? Michelle Niewinski, BSN, RN, Theresa Schultz, RN, Kevin Baskin, MD, Robert Towbin, MD, Robin Kaye, MD The Children’s Hospital of Philadelphia, Philadelphia, PA Background: Paradoxical hyperactivity is an idiosyncratic reaction to intravenous pentobarbital (IVPB) sedation characterized by extreme inconsolable irritability and hyperactive behavior, similar to that seen in attention deficit hyperactivity disorder. Paradoxical reactions are more often seen during the recovery phase but can occur during induction. Stimulants are known to increase concentration and improve self-control in hyperactive children. Objective: In an IRB-approved prospective study, the presenters evaluated the effectiveness of a stimulant, caffeine, in treating paradoxical hyperactivity to IVPB sedation in children.
54
Methods: From April 2001 to December 2002, children sedated with IVPB for diagnostic imaging and interventional procedures were eligible for enrollment. IVPB was given either as a single agent or in combination with midazolam or midazolam and fentanyl citrate. Caffeine was administered either orally, IV, or combined. A positive response was recorded if symptoms (agitation, crying, or hyperactivity) decreased within 40 minutes of caffeine administration. Response time was characterized as immediate (within 10 minutes), early (11-20 minutes), late (21-30 minutes), delayed (31-40 minutes), absent (>41 minutes), or unknown (no time or response recorded).
Colleen Sasso, BSN, RN, CRN Department of Veterans Affairs, San Francisco, CA Colon cancer is the second leading cause of cancer deaths among men and women in the U.S., and 93% of cases occur in people age 50 and over. Most colon cancers can be prevented if precursor colonic polyps are detected and removed. But recent studies demonstrate that fewer than 40% of the people who should be screened do so on a regular basis. Reasons for this are many, but the most prominent is that they are uncomfortable with some of the tests, especially colonoscopy. CT colonography (virtual colonoscopy) was introduced in 1994 and is being evaluated as a promising new tool for colorectal cancer and polyp detection that might encourage more patients to undergo screening. CT colonography uses data acquired from helical CT images and combines these with sophisticated software to generate two- and threedimensional views of the colon. This presenter discussed current screening tools for colorectal screening, benefits and techniques of CT colonography, and future direction of this promising screening modality.
PICC is a Four Letter Word: The Development of a Vascular Access Team Nancy Costa, BSN, RN, CRNI, Elizabeth Ferguson, BSN, RN, CRNI Methodist Hospital, Indianapolis, IN A pilot program was developed in 1997 to study the safety and feasibility of establishing a specially trained team of nurses to
www.radiologynursing.org
JUNE 2004
JOURNAL OF RADIOLOGY NURSING place peripherally inserted central catheters (PICCs) at the bedside. The project was pursued in part at the request of the interventional radiologists because of their concern about increasing requests for these line placements. The popularity of PICCs increased after the establishment of a dedicated team to the point that orders doubled within the first year. In 2001, the team submitted a proposal to the hospital administration to formalize the PICC team service. An office cum outpatient procedure room was set up in an unused radiology room. Supplies are charged to the patient and credited to the PICC team cost center. Inpatient PICC orders are generated electronically and printed out in the PICC team office. An electronic database is used to record patient data for tracking and outcomes monitoring. With these developments, the PICC team has become a ‘‘department within a department.’’ The presenters discussed the elements necessary to establish a successful venous access team. Several published studies corroborate that the most cost effective means of providing PICC line service is to use a team of nurses to place them at the bedside and refer only the toughest cases to IR. A vascular access team cannot flourish if it is merely proceduredriven, but it must be committed to promoting improved patient outcomes through education, advocacy, and research.
Session Abstracts
chaos has in the field of health care and helps students to understand how you can bring about order in any chaotic situation. Chaortic leadership skills are something that every radiology nurse and nurse manager must have to understand and survive in the ever-changing chaotic world of radiology nursing. It helps you to understand the sources of chaos in radiology, your role in chaos, and steps you can take to manage chaos in your department. Even though there have been radiology nurses for over 20 years, the role of the radiology nurse is to provide stability and continuity (order) to patient care, but, in the radiology environment, we are a source of chaos unto ourselves. The presenter gave an overview of the University of Pennsylvania Medical Center, a 500-bed regional trauma center and a top hospital in the country according to US News and World Report. The presenter discussed chaortic leadership theory and practice that was first described by Dee Houck and showed how to apply the principles of chaortic leadership. Finally, the presenter discussed strategies for success as a radiology nurse when working in a small facility and for radiology nursing leaders whether they are supervisors of a small staff or managers of a large diagnostic and interventional department.
Islet Cell Transplantation
Compassion Fatigue: Nurse Grief.Who Cares? Barbara Rubel, MA, CBS, CPBC
Virginia L. Girard, RN
Griefwork Center, Inc., Kendall Park, NJ
University of Pennsylvania Medical Center, Philadelphia, PA
The loss of a patient or a coworker through sudden death can be a shattering experience. The purpose of this presentation was to provide information on compassion fatigue. This presentation covered the affect of repeated traumatic death on nurses. The presentation was divided into two parts. In the first part, the presenter reviewed nurses as disenfranchised grievers, identified characteristics of an effective helper, listed communication skills in sudden loss situations, explored death notification after a sudden loss, and learned common grief reactions of health professionals after repeated deaths of patients. Case studies presented illustrated cumulative trauma of patients and the emotional residue of exposure to working with suffering.
Diabetes is an autoimmune disease that causes destruction to the islet cells in the pancreas. The pancreas has two functions: islet cells make insulin (a hormone) and digestive enzymes to break down carbohydrates. Diabetes has two classifications: type I and type II. Type I diabetes is insulindependent, and type II is noninsulin dependent. Islet cell transplantation is focusing only on type I diabetes. Diabetes is a debilitating disease that has devastating effects on people. Those who have type I diabetes cannot make insulin and are completely dependent on adjusting their blood sugars by exogenous insulin (insulin shots). If these people were offered a better lifestyle, becoming free from having to take insulin shots, would most diabetics take the risk? Islet cell transplantation is an experimental procedure that is not relatively new and could offer a person with diabetes a better lifestyle. The only problem is that this is an experimental procedure, and the recipients must weigh the risks to the benefits. Some risk factors are having to take insulin shots daily and having to normalize blood sugars. The presenter suggested that islet cell transplantation is a risk work taking.
In the second part, the presenter discussed personal history of loss and the psychological consequences of helping, and examined suggestions for self-care. The experience of patient or coworker death rarely gets the attention it deserves. This experiential presentation focused on the psychosocial impact of traumatic grief on nursing professionals. At the end of this session, the participants should understand vicarious trauma and how the grieving process is influenced by personal loss history and work style.
Nursing Leadership in Radiology: Applying the Art of Chaortic Leadership
Occurrence Management: Moving toward Continuous Quality Improvement Judy Dye, MA, BS
Patrick J. Glickman, BSN, RN
University of Arizona Medical Center, Tucson, AZ
University of Pennsylvania Medical Center, Philadelphia, PA The Art of Chaortic Leadership is from an article by Dee Houck that first appeared as ‘‘The Art of Chaortic Leadership’’ (Chapter 7) in On Mission and Leadership. Chaortic leadership is a term that highlights the link between chaos and order. It allows the class to understand the role and effect that
VOLUME 23 ISSUE 2
How do complex systems fail and how do you prevent it from happening? How can the study of errors, adverse events, and ‘‘near misses’’ affect patient care? A well-designed occurrence management program, designed to capture and analyze information to identify systematic problems and gain management’s commitment to removing the cause, can give you
www.radiologynursing.org
55