Innovative Practice - Track # 6
From Warm Hearts to Cold Hands: A Chilly Beginning
9:35 am - 10:35 am
From Warm Hearts to Cold Hands: A Chilly Beginning
Angelina Daco, RN, CCTN; Majorie Jolicoeur, MSN; Susan Pilkington, RN, BSN, CCRN, ValleyCare Health System
Therapeutic Hypothermia after Cardiac Arrest (HACA) requires cooling the body to 32–34°C and to maintain
that temperature for a set period of time (recommended 12–24 hrs). Mild therapeutic hypothermia improves
short-term neurological recovery and survival in patients resuscitated from cardiac arrest of presumed cardiac
origin.
What was learned at ValleyCare Health System:
- HACA works
- Protocols and bundles are amazing tools
- The ongoing need to change protocols based on emerging research and new evidence
- Don’t be afraid to continue to learn and make positive changes
- Use evidence to engage medical staff
- Create a protocol that fits your hospital
- Importance of an ED–ICU collegial relationship based on agreements and establish protocols
- Educational resource binders and clinical support are key
Blood Management: Evidence Based Transfusion Practices
10:55 am - 11:55 am
Blood Management: Evidence Based Transfusion Practices
Nicole Brocato, RN and Peter J. Mazolewski, MD, John Muir Health
John Muir Health’s blood management practices were driven by both administrative reasons — cost and
regulatory compliance, and clinical reasons — misunderstanding of risk benefit ratio, no formal blood
management training for clinicians, a measurable risks associated with each transfusion and inappropriate,
excessive transfusions. Studies showed blood transfusions increase patient morbidity and mortality.
Results from the program included an 18% reduction in system-wide blood use and $1.9 million savings in
acquisition costs. John Muir Health’s next steps will be to continue working with physicians and the nursing
staff to share data and to keep moving the culture forward.
Handouts:
Transfusion Order Form
Blood Transfusion Policy
Data Driven Quality Improvement in Obstetrics
2:20 pm - 3:20 pm
View the video of this session
Data Driven Quality Improvement in Obstetrics
Elliot Main, MD, California Maternal Quality Care Collaborative
Dr. Main described reasons for a >100% increase in California’s maternal mortality since 1999 and the
disparities by race/ethnicity. Reasons for the increase were attributed to BMI, underlying medical problems
and the increase rate of cesarean births. Dr. Main suggested the single best tool to capture the attention of OB
Providers is a discussion on maternal mortality.
Recommendations for California Birth Facilities:
- Improve readiness to hemorrhage by implementing standardized protocols (general and massive).
- Improve recognition of OB hemorrhage by performing on-going objective quantification of actual blood loss during and after all births.
- Improve response to hemorrhage by performing regular on-site multi-professional hemorrhage drills.
- Improve reporting of OB hemorrhage by standardizing definitions and consistency in coding and reporting.
Additional areas for improvement include:
- Preeclampsia management
- DVT / PE prevention
- Obesity in pregnancy
- CPR in the second half of pregnancy, especially for ED staff
- Cardiovascular disease/ Cardiomyopathy recognition and treatment
- Address the increasing rate of cesarean births
Link to complete list of presentations and highlights from the 2010 Exchange
Download a pdf of the complete Highlights of the 2010 Exchange