Boston Children’s Nurses: Local care, global teaching

Boston Children's nurses demonstrate care techniques to an audience of thousands. Photo courtesy of Toni Imprescia, RN, CCRN

In a hospital in Guatemala—3,400 miles from Boston Children’s Hospital—a group of Boston Children’s nurses is teaching a class on how to use surgical safety checklists to improve safe perioperative practice.

Another group of nurses and physicians is sitting in on the same class, 10,000 miles away in Viet Nam. From Bangladesh to El Salvador, clinicians don’t need to leave their hospitals to benefit from the expertise of Boston Children’s staff—they just need a computer and an Internet connection.

The idea to have Boston Children’s nurses produce and broadcast educational webinars to hospitals in resource-limited countries started with Patricia Hickey, PhD, MBA, RN, FAAN, vice president of Cardiovascular/Critical Care Services, and Kathy Jenkins, MD, MPH, senior vice president and chief safety and quality officer. When the two attended the Global Forum on Humanitarian Medicine in Geneva in 2008, they discussed how the hospital could make a difference in the global health landscape. Although they encountered representatives from many countries who were interested in learning from Boston Children’s, the cost of traveling to each interested hospital was always going to be prohibitive—but the cost of broadcasting online to all of them at once was minimal.

Hickey and Jenkins, who continue to lead the program internationally, assembled a team to produce the webinars, led by Jeanne Ahern, RN, CCRN, nurse manager in the Cardiac Intensive Care Unit (CICU), Toni Imprescia, RN, CCRN, clinical educator, and Jason Thornton, RN, MSN, CCRN, nurse manager in the Medicine Intensive Care Unit.

Putting together a pilot

The webinars began with a goal: to reduce 30-day mortality associated with congenital heart surgery. “Once the primary goal was established,” says Thornton, “Drs. Hickey and Jenkins shaped the three key drivers: preventing infections, improving surgical safety, and enhancing communication.”

For the launch of the program, the team developed beginner, intermediate and advanced courses for all three key drivers. The course on improving safe perioperative practice focuses on the use of surgical safety checklists. The course on reducing surgical infections was developed primarily by Debra Morrow, RN, CICU infection control project coordinator, and Gail Potter-Bynoe, the hospital’s Infection Control manager.

The team-based practice course stresses enhanced communication and nurse empowerment, and uses video clips to create scenarios dealing with post-operative complications. Boston Children’s nurses (including Imprescia and Thornton) act out scenarios using a patient simulator, identify the problem and practice possible interventions stressing the communication techniques being presented in the webinar.

Showtime

While the team includes Boston Children’s physicians, including Shawn Rangel, MD, assistant in Surgery, and David Roberson, MD, associate in Otolaryngology, the broadcasts are produced and presented primarily by groups of nurses who are experts in the fields being covered.

“The Modules we’ve created have been made by nurses,” says Imprescia. “The day of the presentation, the nurse responsible for the lecture is the lead speaker, and we always have a group of nurses on-hand, prepared to answer any questions from viewers around the world. The benefit to being live instead of pre-recorded is that we have a pretty vigorous back-and-forth with the staff in each of the locations.

And the audience for these monthly webinars is truly worldwide. During the program’s pilot phase in 2008 to 2009, they broadcast to only five locations—Guatemala, Belarus, India, Pakistan and Beijing. By the time the program formally launched in January 2010, clinicians at 14 sites, including the Ukraine, the Dominican Republic and Uganda, were participating. By the end of 2011, the number was 24, and it’s expected to top 30 before the end of 2012.

The webinars are offered free of charge, with the only price of admission being that the participating sites enter surgical patient data and attend all webinars. Those data are confidentially maintained and analyzed in a registry at Boston Children’s, and participating sites receive reports every six months, letting them know how they’re performing compared to the rest of their counterparts around the world, and outlining how their performance has improved.

“This experience has been extraordinary for our nurses,” says Hickey. “They’ve been able to foster collaboration among thousands of colleagues in emerging cardiac surgical programs and positively impact care for thousands of children. The international quality improvement collaborative reminds us of how privileged we are to work at Boston Children’s and the rewards of giving back in such a meaningful way. This is an ideal model for replication across a broad spectrum of pediatric practice.”

Looking toward next season

“We’ve learned a lot from the data, but there’s a great deal we can still learn,” says Thornton. “We’re hoping to see outcomes improve even further, with fewer infections, increased nurse empowerment and an increase in perioperative safety. As a long-term result, it’s possible that the participating sites would start to take on more challenging cases that they haven’t been able to treat in the past.”

“This experience has been extraordinary for our nurses. They’ve been able to foster collaboration among thousands of colleagues.”

The webinar team has also had the opportunity to visit a number of the participating sites, which Imprescia says is critical to personalizing their broadcasts. “We do our best to be culturally aware. What we do in Boston may not work in other places, so the site visits help us tailor our methods for specific audiences.”

Since the launch, more than 2,000 nurses and physicians have participated in the webinars, resulting in enhanced care for more than 13,000 children across the globe. In 2011, the team completed a new “Year 2” series of modules that took their audience deeper into more advanced techniques and care. “When I was asked to be part of this project, I was honored,” says Imprescia. “Nursing is held in such high regard at Boston Children’s, and this is an amazing chance for us to lead the way when it comes to global health.”

For more great stories about the role of nurses in health care, check out The Boston Globe’s 2012 Salute to Nurses.