Monica is a 2016 graduate of the statewide Indiana University Degree Completion Option (Consortium) from the Northwest campus. She is a staff nurse in the Cardiothoracic Intensive Care Unit at the University of Chicago Medicine (UCM), a large urban medical center in Chicago. Monica has been happily married for 20 years and has two daughters. Her youngest daughter is in high school and plays on a travel softball team. Her older daughter is a student at Indiana University Purdue University Columbus campus, and plans to study nursing. She enjoys spending time with family when she is not working at UCM. Monica plans to attend graduate school to obtain a master’s degree as a Family Nurse Practitioner.
Capstone evidence-based practice (EBP) projects are required of students in the final course in the Consortium. Students write a proposal to change nursing practice based on evidence using an interprofessional practice (IPP) team. Monica’s Capstone project was titled, The Impact of Active Physical Therapy on the Extracorporeal Membrane Oxygenated Patient in the Adult Intensive Care Unit.
The purpose of Monica’s project was to identify the ECMO patients who were eligible for passive range of motion (PROM), active physical therapy and or ambulation. A multidisciplinary team, created policies and protocols that dictate the appropriate standards of care in EBP to achieve the best possible patient outcomes and solidify a protocol that encompasses input from key disciplines.
The growing use of extracorporeal membrane oxygenation (ECMO) nationally and internationally has been documented in the Extracorporeal Life Support Organization (ELSO) registry. ECMO is a form of partial cardiopulmonary bypass used for long-term support of respiratory and/or cardiac function. ECMO use in adults as a rescue therapy in the setting of cardiac, pulmonary, or cardiopulmonary failure in adults has experienced a resurgence following the relative success of ECMO in the pediatric population. The use of ECMO is increasing in patients who exhibit severe respiratory failure; and traditional ECMO management has been associated with high-dose sedation and immobilization resulting in critical illness myopathy. ECMO support for patients in the intensive care unit (ICU) requires a balance of care from many disciplines.
Since Monica has implemented this EBP project, the inter-professional practice (IPP) team at UCM has created guidelines on patient eligibility for safely ambulating while on ECMO, and securing the emergency support staff to manage any unforeseen events. A panel of inter-professional staff members include occupational therapists, physical therapists, perfusionists, surgeons, respiratory therapists, nurses, nursing management, and ECMO specialists. The nurses along with the IPP team, are in the process of creating staff development education for nursing and support staff on safely ambulating ECMO patients. The impact of Monica’s work in improving patient outcomes is yet to be seen, however the groundwork has been laid for IPP using EBP to improve survival rates for vulnerable patients in a complex health care system.
Jennifer is a May, 2016 graduate of the Indiana University RNBSN degree completion program from the IUPUI campus. Jennifer is currently working as a circulator and charge nurse in the OR at IU Health-Methodist where she also serves as neuro specialty coordinator part time. Jennifer has also worked in the ER at Riley Hospital for Children and as a legal assistant prior to returning to school to pursue a career in nursing. Now that Jennifer has graduated with her BSN, she plans to pursue her CNOR certification, a certification for professional achievement for peri-operative nurses, and the Career Advancement Program (CAP) program at IU Health. Additionally, she hopes to serve on the Mercy Ship, a hospital ship providing urgently needed surgeries for the world’s poorest countries.
Jennifer and her husband of 27 years had the opportunity to backpack across Europe this summer with their four children, who have all of whom share her enthusiasm for hiking. In addition to their daughter who is a nurse in Alaska, Jennifer and her husband have a son in medical school and two other children in undergraduate programs with their sights set on healthcare.
In the final (Capstone) course of the RN-BSN Completion Option, students work with their managers and an inter-professional team on an evidence-based practice (EBP) project. Jennifer’s EBP project was titled, The Effects of Cleaning Products on Surgical Site Infection Rates. The purpose of this project was to reduce the risk of a surgical site infection (SSI) for surgical patients by changing the current practice of cleaning between cases with PDI Sani-cloth plus wipes to a new practice of a terminal clean with bleach. A review of the surgical site infection (SSI) rates for the neurosurgery core, which was the focus of Jennifer’s project, actually showed a decline in SSI rates from 2014 to 2015. However, Jennifer’s inter-professional team decided to conduct a thorough literature review for best practices that could continue to move their SSI rates toward 0%. Although, evidence from the literature review did not support a need for a change in how the operating room (OR)suites are currently cleaned, it showed overwhelming support for a multifocal approach to reducing SSIs, including strict adherence to Surgical Care Improvement Process (SCIP) measures and hospital policies regarding cleaning practices and hospital acquired infection (HAI) reduction.
The team’s multifocal proposal for a change in practice began with the assembly of a multi-disciplinary team that will meet quarterly to review SSI rates and adherence to current cleaning and HAI reduction policy. The project team also proposed transparency in quarterly SSI rates for each surgical core, a reminder to surgeons about keeping personal items out of the OR suites, a recommendation for a policy for cleaning of lead aprons, and a recommendation to purchase washable keyboard covers.
While the leadership team involved with Jennifer’s EBP project still plan to move forward with the recommendations in an effort to continue to move the SSI rates closer to 0%, implementation has been delayed from the original timeline established by the team. Although, the impact on SSI rates is yet to be determined, the evidence gathered by Jennifer for measures to promote SSI reduction rates will certainly be invaluable as the team moves forward with implementation.