Nurses Making a Difference
Date: May 7, 2010
Some nurses direct implementation of new technologies, lead efforts to increase patient safety, or train colleagues to respond to emergencies.
While bedside, patient-centered care remains the foundation of nursing, providers throughout the Johns Hopkins Health System are expanding the profession’s boundaries. Some nurses direct implementation of new technologies, lead efforts to increase patient safety, or train colleagues to respond to emergencies ranging from pediatric traumas to terrorist bombings.
In the following profiles, we’ve selected a nurse to represent each of our hospitals and health care organizations to highlight some of these noteworthy endeavors.
Eboni Clark, R.N., M.S.
The Johns Hopkins Hospital
Led the effort to reduce surgical site infections and improve overall patient care
After seven years in clinical and administrative nursing roles, Eboni Clark has been leading patient safety efforts for all four operating room suites since 2008.
With a master’s degree in health systems management, Clark leapt at the chance to analyze clinical outcomes in the perioperative setting. “Very rarely do you have the opportunity to start a project and stick with it from the beginning to the end,” she says. “As an administrator, it was easy to take direction and launch initiatives, but I wanted to know the impact of those initiatives.”
Clark has a knack for poring through data to pinpoint patterns of practice that can cause harm. The goal, she says, is to “reveal that harm in an evidence-based way so that you can institute education to improve outcomes.”
While versed in statistics and information systems, Clark also uses her interpersonal skills as she leads the effort to permanently reduce the hospital’s fluctuating rate of surgical site infections.
“One of my roles is to engage administrative leadership as well as clinical frontline staff and foster discussion,” Clark says.
Clark has paved the way for an audit of surgical skin prep procedures in the OR. She has also helped administrative leaders to understand that such a seemingly simple procedure is subject to any number of adverse incomes, depending on the patient’s condition and clinicians’ level of compliance with sterile procedures.
Kimberly Coursen-Antinone, R.N., M.S.
The Johns Hopkins Hospital
Assumed the role of technical advisor for Psychiatry as it transitioned to the POE and the electronic patient records system
Kimberly Coursen-Antinone fell into her role during the Department of Psychiatry’s transition to the Patient Order Entry system.
“At meetings, someone suggested that I became the informal information technology person,” she says. From then on, physicians regarded Coursen-Antinone as the go-to person for nearly everything they needed entered into the provider order entry system.
As Psychiatry next took steps toward an electronic patient records system, Coursen-Antinone recognized that her IT skills remained in demand. She wrote up her own job description, ran it by nursing and medical leadership, and has since served as Psychiatry’s clinical informatics project manager. In September, Psychiatry became the first Hopkins Hospital department to launch its clinical documentation program.
As staff adapt to the system, regulatory standards are revised and technology evolves, her informal job description has expanded to include “sales manager, psychologist, and athlete,” Coursen-Antinone says.
Wearing her “sales manager” hat, she assesses new information management tools and pitches ideas to her colleagues. As “psychologist,” Coursen-Antinone reminds those resistant to change that using electronic records is not about “what’s best for the user, but what the best way to care for the patient is.”
It’s also Coursen-Antinone’s responsibility to educate staff, so she runs from place to place, teaching refresher courses, planning classes for the next crop of attending physicians and preparing to roll out electronic records in all of Psychiatry’s day hospitals.
Coursen-Antinone is also laying the groundwork for “a unified vision throughout the institution so that all Hopkins affiliates share one electronic platform.”
Carol Hege, R.N.
Johns Hopkins Community Physicians at Wyman Park
Played a key role in developing and implementing the Anticoagulation Management Service, now in most Johns Hopkins Community Physicians practices
As far back as 1997, Carol Hege started working on anticoagulation initiatives, becoming part of a team that implemented the first anticoagulation practice for the Johns Hopkins Community Physicians. Two years later, she piloted use of a point-of-care blood-testing device that helps determine the needed dose of Coumadin, a blood thinner, for the patient. Over time she has been actively involved in building the Anticoagulation Management Service and has trained and verified the competency of most of JHCP’s 25 other AMS nurses.
The model for patient care developed by Hege, a certified anticoagulation management specialist, and her colleagues has been adopted throughout the Anticoagulation Management Service, which is now in place at 16 Community Physician practices.
Now Hege and her colleagues are rolling out an anticoagulation management care template as part of Community Physicians’ electronic patient records system. The template will provide caregivers with increased decision support, safety prompts, and integration with patient outreach and tracking tools present in the EMR. “Now, we have the whole picture built into the system,” Hege says.
Zeina Khouri-Stevens, R.N., M.S.N., Ph.D.
Johns Hopkins Bayview Medical Center
Led the implementation of Smart Pump technology.
A year before Hopkins Bayview switched to a new generation of infusion pumps in February, Zeina Khouri-Stevens, director of nursing for surgical services and neurosciences, was already orchestrating the switch.
With the ability to deliver IV fluids and meds safely and accurately, the Smart Pumps themselves were an easy sell. But replacing 477 pumps and 1,300 lines on seven hospital units called for Khouri’s blend of leadership skills and clinical knowledge.
Over the past five years, the Lebanese native has juggled administrative duties and a host of projects while managing a staff of 200. Her research on the relationship between critical thinking and clinical decision making is at the heart of projects like the Smart Pump.
To prepare for the changeover, Khouri built consensus and cooperation in biweekly meetings with staff from Nursing, Pharmacy, Clinical Engineering, IT and other departments.
“Everyone loves the new pumps,” says Khouri, who drew from 17 years in critical care and trauma to make the Joint Commission-mandated pump swap as comfortable as possible for patients. “They’re easy to use and make you think before you act.”
As the project neared its go-live date, Khouri made sure that the 900 nurses she helped train had not only mastered the pumps but had anticipated patients’ response to them. “They need to know that this new technology helps nurses do their jobs better and keeps keep patients safe.”
Voula McDonough, R.N.
Designed and mapped out emergency response strategies for hospital staff and now collaborates on emergency management projects with the National Library of Medicine
Voula McDonough has a mind for detail and a vivid imagination. As clinical educator for Suburban Hospital’s emergency, trauma and pediatrics services, she has used those talents to map out elaborate response plans for a wide range of disaster scenarios.
Putting herself in the enemy’s shoes, “I go through scenarios in my head,” she says. Then, McDonough flips it around: “If this was a bombing, for example, how could I control a particular hospital entry?”
Should a dirty bomb release biological or radiological contaminants, Suburban is prepared to receive victims with a plan that includes McDonough’s maps for decontamination and triage staging areas. “Mapping diagrams out has become my trademark,” she says.
Emergency preparedness involves overcoming emotional hurdles as well, and McDonough, who also supervises frequent drills for Suburban care givers and staff, has had to reassure staff that by following proper procedures, there is little chance of becoming exposed to biological or radiological contamination through patient contact. She has also steered them through the rough terrain of emergency triage, where life and death decisions become much harsher than under more ordinary circumstances.
Under McDonough’s guidance, Suburban’s emergency response capabilities have been expanded through Bethesda Hospitals’ Emergency Preparedness Partnership, which includes the resources of the National Institutes of Health and the National Naval Medical Center.
The alliance has also led to McDonough’s collaboration on several emergency management research projects with National Library of Medicine engineersthat includes an electronic system for finding lost patients.
Mary Peroutka, R.N.C.-OB
Howard County General Hospital
Created perinatal hospice program
As a labor and delivery nurse at Howard County General, Mary Peroutka participates in some of the most joyous moments of family life. But she also supports parents through miscarriages and stillbirths in her role as the hospital’s perinatal bereavement coordinator.
Last year, the staff nurse of 20 years launched a new service for parents who know through genetic testing that their fetus has a fatal condition. The Rising Hope Perinatal Hospice Program, the first of its kind in Maryland, offers support during and after pregnancy to families that choose to continue such pregnancies. Although many babies with conditions such as trisomy 13 or trisomy 18 die before birth, some can live for hours or days.
Rising Hope services include resources for spiritual support and guidance in creating memories of the baby through photography and personal mementos. Such care helps parents adjust to the reality of their infant’s mortality while honoring his or her brief life, Peroutka says. She is part of a team that includes obstetricians, perinatologists, neonatologists, social workers, mental health therapists and hospice professionals.
“Hospice isn’t a place, it’s a way of thinking about care,” Peroutka says.“Perinatal hospice is a whole way of thinking about the pregnancy and what it is that families want. We help families decide what’s really important for them to accomplish with this baby in the time that they have together, a time that is often as short as several minutes.”
Megan Quick, R.N.
Johns Hopkins Children’s Center
Improving training in pediatric trauma response
While Megan Quick is a leader in the pediatric intensive care unit, both as a charge nurse and member of the transport team, newcomers also know her as an innovative educator and mentor.
This past year, the 12-year PICU veteran helped update the emergency beeper training course that prepares nurses to work on pediatric rapid response teams. The old program required nurses to read through a packet of information and answer questions about case studies. The new method uses patient simulators to ready nurses for the intense, highly charged scenarios they encounter.
Rather than reviewing possible situations with a mentor, nurses now improve hands-on clinical skills such as using defibrillators. Quick says simulated pediatric emergencies also allow trainees to practice communicating more effectively with team members and other providers.
“Each time you go off the unit for an emergency, you enter a different culture with its own values and personalities,” she points out.
“Everyone wants to do the best thing for the patient, but they may have different ways of doing it.”
Quick also mentors six nurses that she supervises. In addition to helping them manage the clinical and emotional aspects of their critical care jobs, she advises them on such goals as international work. Quick recently completed her 11th volunteer mission for Operation Smile, an overseas charity program to surgically repair facial deformities such as cleft lips and cleft palates.
Lou Ann Rau, R.N.
The Johns Hopkins Home Care Group
Develops remote patient monitoring programs to improve home care
During the recent February blizzard, home care nurse Lou Ann Rau secured help for a frail elderly woman with severe bedsores, thanks to electronic documentation technology that she helped implement. When a Bayview geriatrician reviewed Rau’s digital photos of the woman’s bone-exposing ulcers, he immediately arranged for the patient to receive the inpatient care she needed.
As hospitals discharge patients with complex conditions earlier, there is a growing need for ways to better manage their home care. At any one time, roughly half of Hopkins’ 400 adult home care patients have postsurgical wounds, ulcers or ostomies (surgically created openings to eliminate waste) that require professional attention.
Rau is the home care system’s authority in wound, ostomy and continence nursing. She helped develop a remote wound-monitoring system operated by laptop computers that nurses carry into patients’ homes. Now, she is setting up new home care technology to measure patients’ blood pressure, blood sugar and other vital signs.
“Daily monitoring will give us tighter control over some patients with tenuous conditions that nurses see only two or three times a week,” she says. “Whenever possible, we try to prevent re-hospitalization.”
Rau calls her nursing career “Hopkins born and bred.” After stints in dental hygiene and pharmaceutical sales, she graduated from the school of nursing’s accelerated degree program in 1993 and worked in the hospital’s transplant unit. Two years later, she transferred to home care services, where she received her training in wound and ostomy management. —Stephanie Shapiro and Linell Smith