BWH is known for innovation in patient care, research and education. For this month’s “Innovation” issue, Heart & Science gathered updates on some of the many forward-thinking initiatives and projects in place or gearing up across BWH that involve nurses or members of Patient Care Services.
“Love at First Sight” in the NICU
After NICU nurse Stephanie Shine, RN, gave birth to her baby Sam at BWH at 26 weeks, all she wanted was to see and hold her son. But weighing just one pound and two ounces, Sam was separated from Shine immediately after birth in order to receive life-saving care from Shine’s colleagues. Shine herself was also sick from complications at the time.
Fewer than two years later, Shine has brought a technology to the NICU that she hopes will help keep moms and premature babies better connected during their time in the NICU, while also alleviating moms’ stress levels. She has begun a randomized study, called “Love at First Sight,” in the NICU involving a HIPAA-compliant form of Google Glass—a wearable computer technology in the form of eyeglasses. While dads or birth partners wear Glass—while holding their newborns or speaking with the care team—moms can see what is going on through their partners’ eyes in real-time using a tablet, hopefully feeling more connected and involved with their babies’ care and progress.
Continuous Virtual Monitoring
Typically, when a patient is at risk of falls or other safety issues, a patient care assistant sits with the patient to monitor and prevent harm.
Last fall, the Department of Nursing partnered with Information Technology, care team members, patients and families to pilot a new way to keep patients safe while providing them with more privacy.
A new portable monitoring device called a Continuous Virtual Monitor (CVM) is made up of a portable monitor located in the patient’s room. The monitor live-streams images to two large screens located in a centralized monitoring location. It provides continuous real-time observation of patients with safety concerns without recording or storing any video footage.
Patient care assistants watch the screens and are trained to intervene using a two-way speaker when they see patients engaging in unexpected or dangerous activities. They provide verbal redirection, reminders and prompts to keep patients safe.
The pilot is underway on 14 inpatient units, with more than 200 staff having been trained on the system. To date, more than 55 patients have been monitored by CVM. And so far, it’s getting positive results. The pilot units have not experienced any patient falls or use of restraints since implementation.
CVM was one of 10 projects funded by the Brigham and Women’s Physicians Organization (BWPO) Care Redesign and Incubator Startup Program (BCRISP). Established in 2013, BCRISP encouraged teams of frontline clinicians to submit proposals for projects that improve quality of care and reduce health care costs.
Comprehensive Preoperative Lumbar Spine Class
Another forward-thinking BCRISP project is a class designed for patients undergoing elective lumbar surgical procedures. Often these patients only receive education about their procedure and recovery during their procedure visit, but with so much information being shared with them during what can be a stressful time, it’s often difficult for patients to absorb all of the information they’re receiving. So BWH is now offering education to these patients ahead of time—with additional goals of improving discharge time to before noon and shortening length of stay.
The initiative is a collaboration among Nursing, Orthopedics and Neurosurgery, led by Mary Anne Murphy Kenyon, MPH, MS, RN, ONC, nursing director of Tower 16AB. Classes are offered to patients prior to surgery and feature a physical therapy video and other informative educational materials, such as the top 10 things to know before surgery. Those unable to visit BWH for the classes will be able to watch them online beginning in March.
The pilot, which also includes BWFH patients, is working in close collaboration with the Weiner Center for Preoperative Evaluation.
Interpreter Services Tracking System
Interpreter Services is piloting a new system that is enhancing its ability to respond to unexpected needs throughout the hospital. The web-based Interpreter Services Tracking System (ISTS) enables all members of the team, including dispatchers and interpreters, to view all pending requests in real-time.
ISTS also gives the department the ability to spot potential volume peaks in certain areas of the hospital. This can happen especially in the Tower, when an interpreter may get paged from three different locations within 30 minutes. With the new system, the office can send another interpreter to help meet the need.
Communication among the whole team becomes seamless and transparent. This new system enables interpreters to work more efficiently, allowing deployment while interpreters are in the field. Request statuses can be updated remotely in real-time. Request time, interpreter deployment time and duration of interpretation are all documented and time-stamped in the system, allowing the development of quality benchmarks.
PEA POD: Non-invasive Infant Body Composition Assessment
BWH’s Department of Pediatric Newborn Medicine is preparing to implement an innovative new way to determine body composition in infants weighing 1–8 kg. It will also provide better information about babies’ nutritional intake, allowing care providers and researchers to study how these factors relate to long-term outcomes, such as neurodevelopment.
The “PEA POD” is a safe, non-invasive test that enables a clinically stable infant to be weighed and then placed in a chamber to measure volume. After an assessment is completed, an electronic report is generated that includes the infant’s total weight, fat mass and fat-free mass, in addition to body surface area and an estimate of thoracic gas volume.
Dietitians, nurses, nurse practitioners and clinical research staff in the NICU will begin monitoring babies at various points during their hospital stay. The team will start collecting descriptive data with the potential for clinical use in the future.
Interested in getting involved with innovation at the Brigham? Sign up for emails from the iHub, or visit its website at bwhihub.org.
Contributors to this story include Escel Stanghellini, MSN, RN, CPHQ, quality program director; Yilu Ma, director of Interpreter Services, and Sigfredo Salguero, manager of Interpreter Services; neonatal dietitians Hunter Rametta and Deirdre Ellard, and the Pediatric Newborn Medicine’s PEA POD team.