Patient Experience
Nurse Education Instrumental in First Pediatric Small Bowel Transplant
When Cynthia LaFond, RN, BSN, CCRN, received word that Comer Children's Hospital at the University of Chicago Medical Center would perform its first ever small bowel transplant, she knew that educating the nursing staff would be a key component to a successful patient outcome.
"There really was a tangible level of excitement among the nurses about this because these procedures aren't common," said LaFond, clinical nurse educator in Comer's Pediatric Intensive Care Unit (PICU). "This had to be a huge coordinated effort and we had to make sure everyone was on the same page. Any time you bring in a new patient population, if you don't educate your staff, you are risking patients' safety."
Melissa Roberts, RN, MSN, CPTC, transplant quality and compliance manager, and Pamela Boone, RN, MSN, pediatric liver transplant coordinator, were instrumental in ensuring this education occurred. To kick-start the education process, Boone went to Nebraska Medical Center in Omaha to learn from the staff there how to best prepare for such a high-risk and unique transplant situation. Boone also attended lectures at other medical centers about small bowel transplants, with a mission to gather as much information as possible about how to educate the staff.
"I felt very responsible for preparing our nurses for everything involved in caring for these patients," said Boone. "It was a bit overwhelming because I knew it was going to be a complicated effort. These patients can get sick very quickly so the nurses had to be attuned to very subtle changes."
During the surgery, led by Giuliano Testa, MD, director of Liver Transplantation and Hepatobiliary Surgery, intestine was removed from a living donor to transplant into the pediatric patient at Comer. To prepare for such a groundbreaking surgery, LaFond, and other staff in the Center for Nursing Professional Practice and Research followed a fairly set protocol for creating the educational program for the small bowel transplant.
In October 2009, Boone and Testa introduced the small bowel transplant information at a nursing transplant class held at the Medical Center. Some 30 pediatric nurses attended the seminar. Then in April 2010, about a month prior to the scheduled date for the transplant, 60 nurses participated in an online learning module that introduced the procedure and nursing care in the PICU. Just weeks before the transplant, nurses were able to ask specific questions of Testa during one- to two-hour educational sessions.
Using the online module and other clinical resources related to small bowel transplant, the education team created a bedside reference binder so that nurses could refer to it quickly for a refresher on the procedure and associated nursing care when needed.
"The main focus of the education effort was to learn what these patients look like post-operatively," LaFond said. "We focused on how to keep them safe and the optimal course of treatment."
Nurses learned to pay close attention to the patient's intake of fluids and electrolytes. They documented everything to report back to the physicians.
The nurses involved in the patient's care had most likely encountered transplant patients and patients who had undergone other high-risk surgeries, LaFond said. But the crucial component in the post-operative care of the small bowel transplant patient was "putting it all together."
"As nurses, we are always trying to connect the dots to gain the clearest picture of our patients as a whole," LaFond said. "In this case, the nurses had to make the link from what happened in the operating room to what they saw at the bedside. It is our goal at Comer to always engage in providing continuing education to our dedicated nursing staff so that each time we perform a groundbreaking procedure such as the small bowel transplant, the outcome for the patient improves."
