What Is the PICU But the People?

from Practice Update, Summer 2006

The Denver City and County Building has a Shakespearean quote engraved at its entrance that reads, “What is the city but the people?” So it is for any human institution. The Pediatric Intensive Care Unit (PICU) at The Children’s Hospital is no exception. In fact, it is exceptional and unique in the Rocky Mountain region.

The medical, nursing and ancillary staff in the PICU make the service provided to ill children and their families more than just a place that boasts the newest life-saving technology. There is something to be said for a group of people that work well together, respect each member of the team, and take personal accountability for their individual roles. It is a rarity in a medical environment as stressful, emotion-laden and open to change as a PICU to have a sense of harmony, trust and respect as exists in the PICU at The Children’s Hospital. We also strive to extend the qualities of our staff to our community, because the care of children is an interest and responsibility of the entire circle of caregivers.

Not Your Ordinary Nurses

There is something special about the nursing staff in the PICU at Children’s. From the newest of nurses to our seasoned veterans of 35 years, that “something special” attracts and retains the quality staff that all nursing managers seek. PICU nurses are truly invested in the unit as exemplified by their involvement in unit-based and house wide committees including.

• The Primary Nursing Committee addresses the need for continuity of nursing care in the PICU.
• The nursing-led Bereavement Committee follows up with families who have lost a child.
• PICU nurses are also involved in the interdisciplinary Practice Council, the Education Committee, the Quality Improvement Committee, the Outreach Taskforce, the house wide Ethics Committee and the Research Committee.

Every one of our nurses achieves and maintains the status of current Pediatric Advanced Life Support Provider. An additional 35 percent of our nurses have completed the Trauma Nursing Core Course and/or the Emergency Nursing Pediatric Course. Also, many of the PICU nurses are pursuing the prestigious Critical Care Registered Nurse (CCRN) designation which is a professional certification specific to the practice of pediatric critical care. Not only are the nurses involved and educated, they are excellent caregivers and patient and family advocates. They truly invest themselves in their primary patient’s care whether it is providing the most diligent and progressive nursing care, identifying needed resources, helping families to feel empowered or just sitting down and listening. This level of excellence contributed to The Children’s Hospital achievement of Magnet Status for Nursing Excellence in October 2005. The designation, awarded by the American Nurses Credentialing Center (ANCC), recognizes quality patient care and exemplary nursing leadership.

So, What’s the Secret?

A few team members reflect:

• “The nurses enjoy working here.”
• “They are trustworthy and confident.”
• “There are many experienced nurses who take an active role in patient care.”
• “The nurses are well trained in pediatric specific care.”
• “They build close relationships, and often families look to the nurses for answers to their questions.”
• “Many of us have options to practice all over the nation. We work here because we are happy and the focus is on excellence in patient care.”
• “It’s not only the patients who keep me here. I like the people I work with, there is more collegiality with physicians and other nurses, more autonomy and the technology is always advancing.”

The Excellence Continues With the Ancillary PICU Staff

The pharmacy service in the PICU is a model example of efficiency. When medication orders are written, the medication arrives almost instantly, ensuring the patient receives the benefit of the medication quickly. PICU pharmacy leader Pam Reiter, PharmD, is involved with education of pharmacy, medical and nursing staff. She is a member of the Sedation/Children’s Outcomes Research (COR) Committee and a member of the PICU-based interdisciplinary Practice Council who meet monthly to institute changes in accordance with up-to-date research and best practices.

The PICU at The Children’s Hospital utilizes a dedicated dietitian. Heather Skillman, MS, diligently ensures that each patient is getting the best nutrition based on the patient’s age, diagnosis and position in his or her course of illness. Work is based on the most innovative, up-to-date practices and professional literature. Heather has created enteral feeding guidelines which support initiation of early enteral nutrition, and has proposed a change in practice supporting starting enteral feeds on patients on Extra Corporeal Membrane Oxygenation (ECMO) and paralytics.  The physician and nursing staff greatly value and rely on the recommendations of the dietician as an integral member of the PICU team.

Social Worker Amanda Rosengren, MS,  spends a lot of her day talking with families and staff. Her caring manner assists with difficult family situations and serves as a resource for anyone who needs her. Amanda’s involvement in the house wide Organ and Tissue Donation Council, the Ethics Committee and the Child Protection Team (CPT) link her to the relevant social issues faced by families in the PICU. The Children’s Hospital CPT is the only hospital-based multidisciplinary team in Colorado that provides evaluation, diagnosis and treatment to suspected victims of child abuse.

Child Life Specialist Karen Konvolinka, MS, CCLS provides services for patients, parents and siblings to help decrease the stress and anxiety associated with illness and hospitalization. Services for patients in the PICU and their siblings include the use of developmentally appropriate therapeutic play and preparation sessions to increase coping and adjustment; providing a weekly parent group is one way the needs of parents are met.  When end of life care becomes necessary, providing emotional support and meaningful expressive activities for siblings to enable their inclusion in this experience is an important and unique feature of child life programming in the PICU.

Registered Nurse Winna Vander Laan’s thoroughness in the case management process assures that the needs of every patient are being addressed and that care is coordinated. She facilitates the discharge to home or transfer to another facility for patients. Winna is also an active member of the Nurse Liaisons to the house wide Ethics Committee.

A highly skilled team of respiratory therapists care for patients in the PICU. The respiratory therapists are an integral part of the PICU team involved in the airway and ventilator management of critically ill patients. The respiratory therapists collaborate with other healthcare team members to establish and promote an interdisciplinary team approach in planning, and implementation of respiratory therapy for patients in the PICU. The respiratory therapist, in conjunction with other members of the PICU team, is currently involved in a quality safety initiative to establish a ventilator associated pneumonia protocol. They also work with patients and families to educate them on the equipment and intervention needed following discharge.

Every child in the PICU benefits from the care of each and every one of our team members. The entire team joins the physicians for rounds on every patient each morning, and individual families are invited to join rounds on their child as well. We also value community caregivers by including primary care physicians and staff from referring hospitals as part of the team that cares for the children of our community.

The PICU at The Children’s Hospital is a paradigm for a team who believes in and works together toward our mission to provide high quality innovative care to critically ill children and their families. We collaborate as a team and work to advance critical care through education and research.

Again, Shakespeare’s eloquence applies:   “Our remedies oft in ourselves do lie…”