University of Virginia Health System

In this hot month of August, let's talk about something cool...therapeutic hypothermia (TH). The Patient Care Committee recently approved a Clinical Practice Guideline for Adult Hypothermic Therapy after Cardiac Arrest, https://www.healthsystem.virginia.edu/intranet/pi/guidelines/clinguide/cpg_hypothermia.pdf.

Nationally, outcomes following cardiac arrest are poor, with only 3-27% of patients surviving to discharge (Collins & Samworth, 2008). The implementation of TH is based on evidence that neurological outcomes and mortality are significantly improved following induced hypothermia after cardiac arrest. With TH, the core body temperature is reduced to less than 35⁰C. The effects of hypothermia are a reduction in respiratory rate, heart rate and consciousness and decreased metabolic rate. The decrease in metabolic rate decreases oxygen consumption and carbon dioxide production. The result of this is that cells survive longer and there is less global damage from hypoxia. New recommendations are that cardiac arrest patients who have return of spontaneous circulation and remain unconscious should be considered for TH between 32⁰-34⁰C for 12 to 24 hours.

Mark Adams, Clinician IV, in the CCU, shares two patient success stories. One young patient experienced cardiac arrest while working outdoors. He was cooled using intravascular cooling system and walked out of the hospital 9 days later. A 67 year old man suffered cardiac arrest while shopping. He came to us unresponsive and, after receiving TH, fully recovered and celebrated his 46^th wedding anniversary several days before leaving the hospital.  

Watch the news clip about this cool new technology, http://www.box.net/shared/static/ahhla7rksc.wmv, seen on WVIR-TV, NBC.

New Defibrillators

The Health System achieves excellent outcomes with in-hospital Code 12 and cardiac arrest response. These outcomes are generated by excellent staff supported by ongoing education, innovative technology and a critical review of all deaths. A graphic depiction of these impressive outcomes will be shared in our ANCC report.


NRCPR is National Repository of Cardiopulmonary Resuscitation  

This summer, the Health System, led by the Resuscitation Subcommittee, Life Support Learning Center (LSLC), Clinical Engineering, Nursing Education, and Supply Chain has embarked on a system-wide project - replacing our current mix of cardiac monitor-defibrillators with a single device. This transition is occurring in two phases.  Phase 1 ended on June 30 as the Philips MRX monitor - defibrillator became the primary device used in-hospital for routine, urgent, and emergent care. Phase 2 will occur in late August to early September in the Primary Care Center, West Complex and out-patient settings.

The Philips MRX monitors can be used in all patient care scenarios, e.g. ECG monitoring, cardiac pacing, electrical cardioversion and defibrillation, in all patients, ranging from the neonate to the adult. In addition, the devices can function in both automatic external defibrillation (AED) and manual (advanced) modes.  The device itself is quite easy to use, requiring no more than a 30 minute training period. The Philips MRX joins the University (Medical Center, Medical School, and academic grounds) AED System, which is largely equipped with the Philips FRX (AED).  Additionally, many local EMS agencies use the MRX, making urgent and emergent care more continuous from a device perspective.

The introduction of the Philips MRX is an important advance for the Medical Center. Health care providers now have a single advanced device when needed for emergent patient care scenarios, regardless of the location of care.  Check out the LSLC's site to learn more: http://www.healthsystem.virginia.edu/internet/lslc/Philipsdevices/MRXupdated/Philipshome.cfm.

Ongoing Developments

New Staffing and Scheduling System

Several weeks ago I announced our new staff scheduling software system (http://www.atstaff.com/), that will help us automate our staff scheduling process. As you know, creating a staff schedule is a laborious and time consuming process. By using this software, staff will be able to submit schedules on-line, and both communication and the processes for assigning pool staff will be enhanced. In addition, managers will be able to integrate patient volumes and throughput with staff schedules.

Nicole Henley, Clinician IV, the MICU's scheduler, is enthusiastic about the new system. Nicole was one of the many staff, schedulers and managers who participated in the system selection process. "The system is user-friendly and intuitive. Staff will be able to access it from work and home. Staff with set schedules will be able to see their anticipated schedules for years to come! And, when you need to make a schedule change, the system will help you identify colleagues whose schedules would allow them to change with you. This system will save tons of time for Schedulers, Managers, and staff!" 

Click to see who joined us in July.

Debbie French, Clinician III, on 5 East is the first recipient of the Psychiatry Residents' Nursing Commendation Award. Dr. Kurt Micell says, "We wanted to have an award for some of our most helpful colleagues-the nurses.  We appreciate the efforts of all our nursing staff and are especially happy to congratulate Debbie on this accolade." Congratulations Debbie.  This is a wonderful example of interdisciplinary collaboration.

I am pleased to share the news that David Simmons has been named the Nurse of the Year for Community Service by the National Black Nurses Association (NBNA).  David will receive this award at the NBNA's 36^th Annual Institute and Conference in August.  The theme of this year's conference is "Nursing Practice: The Prevention and Management of Chronic Diseases" and will take place in Las Vegas this year.  Congratulations David! This is a wonderful and well deserved honor!

I hope you will help me celebrate our Health Unit Coordinators on August 20 from 1400 to 1530 in the Dining Conference Rooms. This year we have two awards: Health Unit Coordinator of the Year 2008 and Health Unit Coordinator Customer Service Award 2008.