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This is the Becker's Healthcare Podcast,

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created by the team of
Becker's Healthcare,

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a multimedia company devoted to
the people who power us healthcare.

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Four new 15 minute episodes are released
daily containing industry news analysis

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and thought leadership.

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Thanks for listening.
Now here's the episode.

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This is Chris Sosa with the
Becker's Healthcare Podcast.

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I'm thrilled today to be joined by
Joe Wegner, senior Vice President,

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patient Care Services,

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and Chief Nursing Officer at
Blythedale Children's Hospital. Jill,

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thank you so much for joining us today.

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Thanks for having me, Chris.

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Jill,

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could you please introduce yourself and
tell us a bit about your background?

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Sure. As Chris said, I am Jill Wegner. Uh,

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it's hard to believe that this summer I
will have been a pediatric critical care

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nurse for 37 years. My
career has been long,

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um, rewarding and certainly given me
probably more than I have given to it.

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But my, my real passion and my experiences
have always been in the care of,

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um,

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medically complex fragile
children from the bedside to

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airland transports, to
home care nursing, to, um,

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clinical education, to leadership.
Um, and lastly, and finally,

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10 years ago, I found my,

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which I always say is my final
home here at Children's Hospital.

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Jill,

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you're with us today to discuss Dale's
parent and family education program.

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Could you tell me how that evolved
and how it measured success?

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Sure. Um, so as I said, I,

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I have been on both arms
of pediatric healthcare at,

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at the hospital setting at
the bedside, but I've also,

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my earlier years did some home care
cases of some really complex kids,

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and it's a really different environment
when you are in a hospital setting and

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you've got a physician next to you or a
respiratory therapist or another nurse,

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somebody to consult or say, Hey, what
do you think about this? Or say, Hey,

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can you give me a hand? When I was caring
for these complex kids in the home,

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it's really just you. Um,

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and I think it just lended itself as,

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as healthcare landscape
scape has been changing, um,

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and you constantly hear about in the news
about the nursing shortage or the lack

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of access. Um, when I came here as,

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as chief nurse, um,

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one of my main focus was to really
make sure that my nursing team

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was professionally and clinically
competent at the top of their

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game. Um, but my concern was when I,

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we'd take amazing care, uh,
of the kids under our roof,

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but when we transition these
really fragile complex kids,

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children and back into their community,

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I wasn't always so confident that the
care team I was handing them off to was

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as, um, accessible, as
consistent and as competent as,

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um, I felt our families needed them to be.

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So probably about nine years
in, um, about nine years ago,

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I made a pitch to our c e o and our board
of trustees that we really needed to

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ensure that our parents and our
families were really competent,

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but also went home. They couldn't
rely on community providers because a,

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um, it wasn't always consistent. We may
send them home with 24 hours of nursing,

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but maybe realistically they
may get half of that, um,

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available to them in the community
and sometimes even less than that.

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So it kind of started a journey with, um,

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with our team really thinking
about education is so much more

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than just, let me teach you how to
take care of the G-tube, or let me,

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it's more than just let me teach
you how to take care of the,

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your child's tracheostomy
or their ventilator. Um,

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there's so much more than just the
technique. So about nine years ago,

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we launched, we started slowly but
truly launching our program. Um,

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started with, uh,

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a vision and a party of one director, uh,

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assistant director of,
actually, it started a parent,

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parent education through
Angela <inaudible>.

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We started the journey of discovery
and exploration and really

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looking under the covers to really see
what our families really were up against

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when they went home. What did we need
to prepare them for? Um, and as I said,

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the scope is so much more than
just the technical aspects of, um,

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of the skills to care for these,
these medical needs of their children.

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So we launched it with, um, a curriculum.

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We built a state-of-the-art
simulation lab, um,

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that mirrored the, um, exact
replica of their bedside.

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So a lot of our first step in,

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in really training and educating our
families came in, desensitizing them.

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So getting them in a simulated environment
where they could start to practice

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these skills on mannequins,

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start to get the feel of dexterity of
equipment away from child's bedside.

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So a neutral environment. It, it mirrors
what we're seeing at the bedside,

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but is in a completely
simulated environment,

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and it completely opened the
doors. It was a game changer for,

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for their learning abilities. We
brought them in, you desensitize them,

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you decrease their fears,
lessen their anxiety,

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and in the doors to learning open in a
very different way. In addition to that,

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um, so they kind of start out
in our sim lab in the home, uh,

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the hospital sim lab. And
from there we also, um,

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developed a family
resource and library room.

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So a place where they can go on their
own time, um, can be with our education,

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teamwork can be on their own and
they can do some hands-on touch time.

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There's a, a plethora of educational
materials and videos that they can watch.

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So at their own speed and in their
own time really preparing themselves,

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um, really developing their mass and
dexterity of, of working with equipment,

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um, and really enhancing their knowledge.

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And that is such a key pathway
to competence as well as

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competence, um, to take care
of their, their children.

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We're really empowering them as learners.
Um, we, they are adult learners,

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so we, we've adopted a
lot of the different,

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not everybody learns one style or one way.

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So we have incorporated that
into our, into our curriculum

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and our team works. But
one of the other, um,

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things that we learned from our
families and a lot of our curriculum,

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a lot of what we developed has
come from feedback from families.

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It's us talking with them
throughout the process,

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the hospitalization education process,
but also after they're discharged.

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So when they go home, our
education team went back out.

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Sometimes they did home visits pre
and post discharge to figure out

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how do we help you set your home
environment? Where do we make Mark?

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And we kept co meeting their feedback
and their insight into our curriculum.

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Um, another thing that we developed
when we opened our sim lab is we,

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we created a mock home environment.

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So it's great to learn these cares and
be able to care for your child in a

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hospital environment where you've got
suction easily accessible and everything

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is organized at your hospital bedside.

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But when you go home to a fifth floor
walkup apartment in the Bronx, um,

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in a tiny little bedroom,
it's completely different.

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So other aspects of the, um,

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education program curriculum was
really training our parents how to set

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up their home environment for success.

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So our home simulation lab
here in the hospital, um,

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we work that through with them.

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We have purchased equipment and
we help them kind of look at

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possible ways that they can organize
and set up their nurseries and their at

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home, the ease and the
ability for them to,

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to successfully care for their
child in the home environment.

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But I think you said, how
do we measure it as what,

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what's our measure of success? I don't
know that there is any one measure.

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I I, I say if we meet the
mark with this family,

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we are constantly challenging
ourselves in, in reevaluating,

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did we meet the mark?

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What more can we learn from
our parents that we need to do?

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They're really our guides
on this journey. Um,

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they're the ones who are really helping
us understand what they need to know,

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what they need to master, how did it
translate, what we taught them here,

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how did it really translate
to reality in the community?

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And then we feed that back in. Um,

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a lot of our program has been focused
on not teaching them the task,

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developing a custom patient
plan. Every child is different,

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every family is different. Um, every
family's learning style is different.

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So there's no cookie
cutter education plan.

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What we've really done here is
we've really taken the time,

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the energy and the effort
to really customize, do an
assessment of each family,

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um, and then develop an education plan
that works for them. Um, you know,

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covid like everything changed the world,

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but one of the great things that did
come out of covid is this virtual world.

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So how can we tap into
virtual education sessions?

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So maybe the babysitter or
the grandmother can't get in,

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but how can we work with them
virtually to help them learn?

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Yes. Uh,

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it all sounds like the program has come
extremely long way since it started,

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which is only natural.

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And I'm sure the patients who are in
the program are very appreciative of all

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these aspects. Uh, let me transition
to this a little bit. Okay.

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So about how many patients does the
program assist in a given month or in a

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given year?

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So if I really look back when
we, I think the first year we,

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we formally launched our program
with just one coordinator of, um,

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the Child and Family Education program.

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We probably served that first
year about 200 families.

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In addition, we added two educators.

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So one of the things that we had
heard from our families was the every

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nurse of the bedside
taught slightly different.

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What only added to their confusion.

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So what we have done with our education
team is really formalized a standardized

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way of teaching and a
standardized curriculum.

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Not only has the volume of families that
we've touched over the past five years,

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almost tripled, but I really, um,
I'm confident that the quality,

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the quantity, um,

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and the consistency of the education that
we are providing for our families has

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really grown and evolved as well
over the past five to six years.

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Oh, that's fantastic. Jill, on that note,

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could you let me know how have any recent
advances in technology improved the

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program?

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Um, significantly over the, over
the past, you know, nine years,

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as I talked about, one of the, probably
our most major advance was our,

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was our state-of-the-art technology. Um,
in technology was our simulation lab.

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So not only having, um,

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a simul lab that monitors that
models the hospital environment,

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but also now we have a simulation lab
that models the home environment as well

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as the home equipment.

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Another barrier our families often face
is when we don't have any control of the

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medical equipment that is
provided on the community side.

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So you may have used a certain
feeding pump, a certain IV pump,

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a certain ventilator at our hospital,
but then when we transition home,

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we don't often have control over
the equipment you get in the home.

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So what we've also done in our home
simulation lab is we take the equipment,

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we've purchased the equipment that
they could potentially go home on,

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and we have the opportunity to train them
on it here before they're discharged.

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Um, we've launched a digital platform, um,

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where we are doing everything about our
program is really about customizing the

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education plan for the child
and the family in front of us.

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So we are creating digital videos and
digital platforms for our families,

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teaching them training videos
that are specific to their child.

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So when they go home, maybe
today I this for, for,

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for the first month, I have this
set of nurses and then maybe this,

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this my second month home,

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I've got a whole new fleet of home
care nurses coming in who don't know my

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child.

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So we give them educational tools that
they can use as well for the community

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providers that are
coming into the home. Um,

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another huge challenge for our families
is medications. So, believe it or not,

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our little, these little children,
little complex children go home on a,

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a significant amount of medications.
Um, so what we have done, and,

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uh, we've created,
we've worked with a, um,

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a company that we have customized
a medication record for that

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child. So literally it is
an electronic schedule, um,

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for the parents to keep track of
when their medications are due,

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what are some of the side effects
that they need to look for,

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and all of the information that they
need to know about that medication is,

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is there. And that, um, that
library, that medication, um,

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program is actually translatable
into other languages. Um,

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so it's really been a game changer
for helping our parents organize their

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child's medication regime and the safety
of medication administration again,

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in the home. Um,

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and then we've invested a lot in our
family resource libraries. I say, um,

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adult learners come in
all different forms.

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Some like paper and pamphlets and
some like electronic devices. So our,

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our family resource room really has
captured, um, some of our old hand,

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you know, old school hands-on, uh,

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paper handouts or booklets and pamphlets
to read, as well as a collection of,

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um, extensive electronic,
um, library that,

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that focuses on kind of the diagnoses,

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that common diagnoses that we're
seeing here and some of the, um,

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equipment and things that
the kids are going home on.

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Jill, I also understand there are
plans to scale the program mm-hmm.

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<affirmative>.

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So what is the scope that Blythedale
Children's would be considering,

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and what steps need to be
taken to make that successful?

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Okay, so great question and probably, um,

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really our next vision for the next
several years is really going to

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be investing in the transition
from home to hospital to home.

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And how do we ensure that the
community is ready to, to care for,

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for this child beyond our
walls? So as we said it,

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the first really starts
with the confidence and
confidence of our parents. Um,

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but our next phase that we are
really, um, diving into is really, um,

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looking at the home care providers.

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So primarily our first focus is
gonna be on home care RNs, um,

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and EMTs and paramedics in the community.
So remember that parent hits 9 1 1,

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it's the community E M T or paramedic
that's kind of the first responder to that

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home. So our respiratory, um,

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assistant director of respiratory
is in, in combination with our, um,

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child and family education coordinator
coming up with a curriculum.

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And we're designing a plan.

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We can get community EMTs
and paramedics here on site,

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put them through our sim lab,
through the use of our sim lab, um,

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enhancing their, their skills.

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So when they're called to the
community to take care of these, um,

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to tend to these medically
complex children in the
community, they've got some,

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we're really enhancing
their knowledge base.

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And the second is the home
care RNs. As you know,

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the nursing predominantly the
home care population is really

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adults. Pediatrics are a
very small pool of that.

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So on top of home care
agency struggling to have a,

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uh, uh, the volume of nurses,

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it's even harder to really have that
volume of nurses that have the clinical

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skillset and capabilities and competencies
to take care of these medically

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fragile children.

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So developing a curriculum where ideally
we can get them in here and trained in

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our sim lab, and then ideally
get them to the bedside.

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So they're actually partnering
with our nurses to take care,

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learn how to take care of that child
before they meet them in the home for the

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first time. So one of the great, um,

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another great talk about
doors opening. Um, uh, uh,

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one of the directors of
nursing and myself, um,

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had the opportunity to apply for a,

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a nurse innovation fellowship that
is sponsored by the University of

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Pennsylvania, Johnson and Johnson and
the Wharton School of Business. Um,

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and it was a national application
and we were selected. There is, um,

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10 cohorts from across the nation,

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and we were one of the hospitals
that were selected to participate.

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So for the next year, we're
working with a really, um,

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high level team through this fellowship.

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And our focus is going to
be exactly this trans the,

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the successful transition of a home
of a child from the hospital to home.

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What challenges are we
facing and how do we,

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how do we really focus on
the community piece and, um,

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bring that up to the competence
level that is needed. Um,

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so that's another great avenue that,

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that we're gonna be partnering with
to kind of help us figure this,

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this solution as design the
solution, um, for a problem that is,

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is not only, um, in our immediate
area, but across the New York state,

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and it's a national problem.

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This ability to care for these medically
fragile children in the community is

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just not something that's unique to
Dale. It really is a national problem.

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Um, and we really,

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all we wanna do is establish
ourselves as the center of excellence.

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And we just wanna write the roadmap
that then we would love to share with

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children's hospitals
across the nation. Um,

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this isn't proprietary to blythedale,

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we're really doing this
immediately for our kids,

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but really I want to be able to
craft that roadmap that anybody can

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pick up and say, the, this is what we've
learned here, just roll this forward.

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Um, I think after we,

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once we move beyond the RNs and
the EMTs and paramedics, you know,

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it's like an onion. Um,

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you get into these rural communities
and there may be one community pharmacy,

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um, pediatric medication,

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and the compounding of these medications
for our children are very complex.

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So there's also a whole pharmacy
education level of how do we,

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when we're transitioning these
children to the community,

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how does our pharmacist partner with the
community pharmacist to make sure that

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they are competent and able to, um,

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they have the skillset and the knowledge
to prepare the medications that the

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child needs. And then you've
also got the pediatrician piece.

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So sometimes in these rural
communities, there may be one,

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one family pediatrician, maybe,

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maybe a handful that maybe have never
even taken care of a child with a

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tracheostomy or a central
line or a ventilator. So
there's also that whole, um,

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really looking at the entire

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health community that we are transitioning
over the care of these children

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to, and how do we enhance
that? How do we do that,

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that handoff more efficiently
and effectively in making
sure that we're handing

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them off to competent caregivers?

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Jill, thank you so much for
sharing your insights today.

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We definitely cannot wait to
share them with our audience,

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and I look forward to
connecting with you soon.

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00:19:25,320 --> 00:19:27,180
Oh, Chris, thank you
so much. A lot of fun.

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00:19:32,380 --> 00:19:35,590
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top of organizations to keep learning,

325
00:19:35,740 --> 00:19:37,270
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00:19:37,740 --> 00:19:40,950
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00:19:41,110 --> 00:19:45,070
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