NK6
Practice Guidelines NK6
Provide one example, with supporting evidence, of how clinical nurse(s) implemented a professional organization’s specialty standards or guidelines in the organization.
Example: Critical Care Clinical Nurses Implement the American Heart Association Guidelines to Hypothermia Protocol
Professional Organization Standards or Guidelines
The critical care clinical nurses at Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) implemented the American Heart Association (AHA) specialty guidelines to the hypothermia protocol.
Delivering focused, safe, and effective post resuscitation care requires an interdisciplinary approach. Policy discrepancies and a lack of organizational standards led Logan Jenkins-McNanna, BSN, RN, CCRN, Clinical Nurse, Surgical Intensive Care Unit (SICU); Heather Evans, BSN, RN, Clinical Nurse, Medical Intensive Care Unit (MICU); Kevin Norman, RN, Clinical Nurse, SICU; and Sarah Cogburn, BSN, RN, Clinical Nurse, MICU, to review the AHA’s therapeutic hypothermia guidelines.
In early March 2021, Jenkins, Evans, Norman, and Cogburn did an extensive review of CHI SVHS hypothermic policy and compared it to the AHA’s hypothermic guidelines. During their review, the clinical nurses wanted to recommend these AHA guideline changes for policy review, including maintain a mean arterial pressure (MAP) over 90, obtain an electroencephalogram (EEG) as soon as possible, and discontinue potassium replacements four hours prior to warming. (Evidence NK6-1, AHA Hypothermia Guidelines) Jenkins, Evans, Norman and Cogburn made recommendations and clarifications to bring to the next Intensive Care Unit (ICU) Specialty Council.
On March 25, 2021, the ICU Specialty Council met. Jenkins presented the critical care nurses’ recommended changes and clarifications on the current CHI SVHS hypothermia protocol to Syed Mustafa, MD, Medical Director of Critical Care. Mustafa was to follow up and review the recommended changes for approval or other changes.
Shortly following the ICU Specialty Council meeting, a surge in coronavirus (COVID-19) took place at CHI SVHS. The entire hospital put all its focus on resources needed to care for their patients amidst the pandemic, and the review of the hypothermic policy and AHA’s guidelines was put on hold. (Evidence NK6-2, ICU Specialty Council March 2021 Minutes and Roster, Requested Policy Changes)
As COVID-19 numbers steadily decreased and the focus to continue to improve quality and patient outcomes for the patient receiving hypothermic care, Jenkins, Evans, Norman, and Cogburn returned to their previous commitment to implement the AHA’s guidelines to the hypothermia protocol. In March 2022, the ICU Specialty Council convened once again. (Evidence NK6-3, ICU Specialty Council March 2022 Minutes and Roster)
They continued to discuss the need to update the hypothermia protocol and needed to revisit Mustafa’s approval for changes. In May 2022, Mustafa approved policy changes and clarified the modifications for the hypothermia protocol through initialing requested changes. (Evidence NK6-4, Mustafa’s Approval to Recommendations)
Clinical Nurses’ Implementation of Standards or Guidelines
In June 2022, Jenkins worked with Jessica Wilson MHA, HACP, Regulatory Compliance Coordinator, and the Quality Department to make the therapeutic hypothermia policy changes. After all the changes were made to the policy, the changes then needed to go through the Policy Manager approval process. The changes also needed to go back to the ICU Specialty Council for approval. Jenkins brought the changes to the ICU Specialty Council, and the group approved.
Renee Fechuch, MSN, RN, Clinical Director, Critical Care and Emergency Department, and Teresa Lambert, MBA, BSN, RN, Assistant Chief Nursing Officer (role of CNO), and Vice President Patient Care Services, CHI SVHS, then needed to approve the changes, which they did in July 2022. The final step was for the President to approve.
Douglas Ross, MD, FACHE, President, CHI SVHS, and Chief Medical Officer of the market for CHI SVHS, approved the hypothermia policy in July 2022. The policy was updated in the Policy Manager system with the clinical nurses’ AHA guideline recommendations. The ICU Specialty Council then worked with Betty Irvin, BSN, RN, Clinical Informaticist, to make the appropriate changes to the order sets on the units. (Evidence NK6-5, Former and Updated Therapeutic Hypothermia Policies)
In July 2022, CHI SVHS clinical nurses successfully implemented the AHA’s guidelines to the organization’s therapeutic hypothermia policy. This assists CHI SVHS clinical nurses and medical providers to deliver effective post-resuscitation care.