In its second year, the Clinical Scholars program at Hudson Valley Hospital Center in Cortlandt Manor, N.Y., enables participants to learn evidence-based practice processes and become leaders of EBP projects.
Clinical scholars or bedside scientists are trained in a yearlong workshop series to develop and implement an evidence-based clinical practice change that generally results in a clinical guideline, policy or protocol. By the end of the program, participants are more familiar with conducting library searches, critiquing and integrating research findings as well as accessing and appraising clinical practice guidelines. Scholars continue their work, promoting EBP standards on the units after they have completed the program.
Developed out of the Research Council at HVHC, this program has been under the direction of Chris Malmgreen, RN-BC, MA, MS, associate director of the Magnet program; Lillie Shortridge Baggett, RN, PhD, academic adviser and professor, Pace University; and Layla Qaabidh, RN, MSN, research consultant.
From Questions to ActionFrom left, Sara Pascica, RN, OB staff nurse; Kathy Webster, RN, CNO, vice president, patient services; Eileen Williamson, RN, senior vice president, Nursing Communications & Initiatives, Nursing Spectrum; Mital Patel, RN, staff nurse; and Alyssa Scofield, RN, ambulatory surgery staff nurse, discuss nursing initiatives and programs at Hudson Valley Hospital Center.
On telemetry unit 2S, clinical scholar Susan Schwerner, RN, staff nurse, raised the clinical research questions, When should a medication be given IV-push or IV-piggyback? What should the standards of care be in these situations in terms of diluents and timing? After an extensive literature search and speaking with several pharmaceutical companies, Schwerner and Malmgreen did not find consistent standards of care with the administration of IV-push or IV-piggyback medications. After speaking with patients about the side effects they were experiencing as a result of giving IV-direct medications, Schwerner realized side effects could be avoided if medications were given more slowly or with a diluent.
In addition, calling them IV-direct medications, rather than IV-push or IV-piggyback medications, helped everyone realize that medications did not always need to be administered at a rapid rate, Schwerner said.
With the assistance of pharmacy, Schwerner and Malmgreen have completed the standards of care for dilaudid for the amount and type of diluent as well as the duration of the push for each IV direct medication. For example, with dilaudid, it would be diluted with normal saline in 10 mL over a 10-minute time period.
As a result of Schwerners efforts, pharmacy staff is developing practice standards for all IV-direct medications. The IT department now is incorporating the standards of care into the hospitalwide electronic system.
Another clinical scholars project from the ICU was originally created with clinical scholar Lorraine Fontana, RN, staff nurse in the ED, as part of the Greater New York Hospital Associations Stop Sepsis collaborative. Malmgreen, identifying the close connection between the care given in the ED and the ICU, encouraged Fontana and ICU nurses to work with ED staff nurses Peggy Lennon, RN, CEN, and Rosa Tyo, RN, BSN. Lennon and Tyo initially were trained by the GNYHA on the Stop Sepsis collaborative.From left, Pamela Lupfer, RN, director of surgical services; Suzanne Mateo, RN, administrative director for nursing; Maryanne Maffei, RN, director of ED/critical care; Maggie Adler, RN, coordinator, standards development; Jeanne Rakotz-Smith, RN, staff nurse, ED; Sue Schwerner, RN, staff nurse, telemetry; and Marie Galante, RN, director of education, discuss nursing initiatives and programs at Hudson Valley Hospital Center.
According to GNYHA protocol, ED nurses identify early signs of sepsis in the ED, and developed a triage tool that helps in the process. If a patient has three or more specific clinical signs, such as a temperature greater than 104 or less than 96.5; heart rate of greater than 90; respirations greater than 20; altered mental status, oxygen levels less than 90, then nurses obtain an order for a serum lactate to be drawn. If the patient has a serum lactate of four or greater, we follow a noninvasive or invasive protocol, depending on the patients condition, Lennon said.
According to Lennon, the GNYHA collaborative has changed the way RNs look at sepsis. Although we know that patients who have these clinical signs may not be septic, we are on high alert and ready to intervene, Lennon said.
In the ICU, clinical scholar Fontana and ICU nurses continue to monitor and care for the patients, following the protocols and trending serum lactate levels, as needed. Sometimes it appears as though we have stabilized a patient in the ED, but when they are transferred to the ICU, its not the case, Lennon said.