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]. 3 4 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]. 5 6 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) 7 8 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 9 10 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. 11 12 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.