This is the Becker's Healthcare Podcast,
created by the team of Becker's Healthcare,
a multimedia company devoted to the people who power us healthcare.
Four new 15 minute episodes are released daily containing industry news analysis
and thought leadership.
From powerful healthcare decision makers Support our show by leaving it a five
star rating and review on Apple Podcast or other platforms you use.
It's a chance to tell us what you like about the show and act on your feedback.
Thanks for listening. Now here's the episode.
This is Chris Sosa with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Joe Wegner, senior Vice President,
patient Care Services,
and Chief Nursing Officer at Blythedale Children's Hospital. Jill,
thank you so much for joining us today.
Thanks for having me, Chris.
Jill,
could you please introduce yourself and tell us a bit about your background?
Sure. As Chris said, I am Jill Wegner. Uh,
it's hard to believe that this summer I will have been a pediatric critical care
nurse for 37 years. My career has been long,
um, rewarding and certainly given me probably more than I have given to it.
But my, my real passion and my experiences have always been in the care of,
um,
medically complex fragile children from the bedside to
airland transports, to home care nursing, to, um,
clinical education, to leadership. Um, and lastly, and finally,
10 years ago, I found my,
which I always say is my final home here at Children's Hospital.
Jill,
you're with us today to discuss Dale's parent and family education program.
Could you tell me how that evolved and how it measured success?
Sure. Um, so as I said, I,
I have been on both arms of pediatric healthcare at,
at the hospital setting at the bedside, but I've also,
my earlier years did some home care cases of some really complex kids,
and it's a really different environment when you are in a hospital setting and
you've got a physician next to you or a respiratory therapist or another nurse,
somebody to consult or say, Hey, what do you think about this? Or say, Hey,
can you give me a hand? When I was caring for these complex kids in the home,
it's really just you. Um,
and I think it just lended itself as,
as healthcare landscape scape has been changing, um,
and you constantly hear about in the news about the nursing shortage or the lack
of access. Um, when I came here as,
as chief nurse, um,
one of my main focus was to really make sure that my nursing team
was professionally and clinically competent at the top of their
game. Um, but my concern was when I,
we'd take amazing care, uh, of the kids under our roof,
but when we transition these really fragile complex kids,
children and back into their community,
I wasn't always so confident that the care team I was handing them off to was
as, um, accessible, as consistent and as competent as,
um, I felt our families needed them to be.
So probably about nine years in, um, about nine years ago,
I made a pitch to our c e o and our board of trustees that we really needed to
ensure that our parents and our families were really competent,
but also went home. They couldn't rely on community providers because a,
um, it wasn't always consistent. We may send them home with 24 hours of nursing,
but maybe realistically they may get half of that, um,
available to them in the community and sometimes even less than that.
So it kind of started a journey with, um,
with our team really thinking about education is so much more
than just, let me teach you how to take care of the G-tube, or let me,
it's more than just let me teach you how to take care of the,
your child's tracheostomy or their ventilator. Um,
there's so much more than just the technique. So about nine years ago,
we launched, we started slowly but truly launching our program. Um,
started with, uh,
a vision and a party of one director, uh,
assistant director of, actually, it started a parent,
parent education through Angela .
We started the journey of discovery and exploration and really
looking under the covers to really see what our families really were up against
when they went home. What did we need to prepare them for? Um, and as I said,
the scope is so much more than just the technical aspects of, um,
of the skills to care for these, these medical needs of their children.
So we launched it with, um, a curriculum.
We built a state-of-the-art simulation lab, um,
that mirrored the, um, exact replica of their bedside.
So a lot of our first step in,
in really training and educating our families came in, desensitizing them.
So getting them in a simulated environment where they could start to practice
these skills on mannequins,
start to get the feel of dexterity of equipment away from child's bedside.
So a neutral environment. It, it mirrors what we're seeing at the bedside,
but is in a completely simulated environment,
and it completely opened the doors. It was a game changer for,
for their learning abilities. We brought them in, you desensitize them,
you decrease their fears, lessen their anxiety,
and in the doors to learning open in a very different way. In addition to that,
um, so they kind of start out in our sim lab in the home, uh,
the hospital sim lab. And from there we also, um,
developed a family resource and library room.
So a place where they can go on their own time, um, can be with our education,
teamwork can be on their own and they can do some hands-on touch time.
There's a, a plethora of educational materials and videos that they can watch.
So at their own speed and in their own time really preparing themselves,
um, really developing their mass and dexterity of, of working with equipment,
um, and really enhancing their knowledge.
And that is such a key pathway to competence as well as
competence, um, to take care of their, their children.
We're really empowering them as learners. Um, we, they are adult learners,
so we, we've adopted a lot of the different,
not everybody learns one style or one way.
So we have incorporated that into our, into our curriculum
and our team works. But one of the other, um,
things that we learned from our families and a lot of our curriculum,
a lot of what we developed has come from feedback from families.
It's us talking with them throughout the process,
the hospitalization education process, but also after they're discharged.
So when they go home, our education team went back out.
Sometimes they did home visits pre and post discharge to figure out
how do we help you set your home environment? Where do we make Mark?
And we kept co meeting their feedback and their insight into our curriculum.
Um, another thing that we developed when we opened our sim lab is we,
we created a mock home environment.
So it's great to learn these cares and be able to care for your child in a
hospital environment where you've got suction easily accessible and everything
is organized at your hospital bedside.
But when you go home to a fifth floor walkup apartment in the Bronx, um,
in a tiny little bedroom, it's completely different.
So other aspects of the, um,
education program curriculum was really training our parents how to set
up their home environment for success.
So our home simulation lab here in the hospital, um,
we work that through with them.
We have purchased equipment and we help them kind of look at
possible ways that they can organize and set up their nurseries and their at
home, the ease and the ability for them to,
to successfully care for their child in the home environment.
But I think you said, how do we measure it as what,
what's our measure of success? I don't know that there is any one measure.
I I, I say if we meet the mark with this family,
we are constantly challenging ourselves in, in reevaluating,
did we meet the mark?
What more can we learn from our parents that we need to do?
They're really our guides on this journey. Um,
they're the ones who are really helping us understand what they need to know,
what they need to master, how did it translate, what we taught them here,
how did it really translate to reality in the community?
And then we feed that back in. Um,
a lot of our program has been focused on not teaching them the task,
developing a custom patient plan. Every child is different,
every family is different. Um, every family's learning style is different.
So there's no cookie cutter education plan.
What we've really done here is we've really taken the time,
the energy and the effort to really customize, do an assessment of each family,
um, and then develop an education plan that works for them. Um, you know,
covid like everything changed the world,
but one of the great things that did come out of covid is this virtual world.
So how can we tap into virtual education sessions?
So maybe the babysitter or the grandmother can't get in,
but how can we work with them virtually to help them learn?
Yes. Uh,
it all sounds like the program has come extremely long way since it started,
which is only natural.
And I'm sure the patients who are in the program are very appreciative of all
these aspects. Uh, let me transition to this a little bit. Okay.
So about how many patients does the program assist in a given month or in a
given year?
So if I really look back when we, I think the first year we,
we formally launched our program with just one coordinator of, um,
the Child and Family Education program.
We probably served that first year about 200 families.
In addition, we added two educators.
So one of the things that we had heard from our families was the every
nurse of the bedside taught slightly different.
What only added to their confusion.
So what we have done with our education team is really formalized a standardized
way of teaching and a standardized curriculum.
Not only has the volume of families that we've touched over the past five years,
almost tripled, but I really, um, I'm confident that the quality,
the quantity, um,
and the consistency of the education that we are providing for our families has
really grown and evolved as well over the past five to six years.
Oh, that's fantastic. Jill, on that note,
could you let me know how have any recent advances in technology improved the
program?
Um, significantly over the, over the past, you know, nine years,
as I talked about, one of the, probably our most major advance was our,
was our state-of-the-art technology. Um, in technology was our simulation lab.
So not only having, um,
a simul lab that monitors that models the hospital environment,
but also now we have a simulation lab that models the home environment as well
as the home equipment.
Another barrier our families often face is when we don't have any control of the
medical equipment that is provided on the community side.
So you may have used a certain feeding pump, a certain IV pump,
a certain ventilator at our hospital, but then when we transition home,
we don't often have control over the equipment you get in the home.
So what we've also done in our home simulation lab is we take the equipment,
we've purchased the equipment that they could potentially go home on,
and we have the opportunity to train them on it here before they're discharged.
Um, we've launched a digital platform, um,
where we are doing everything about our program is really about customizing the
education plan for the child and the family in front of us.
So we are creating digital videos and digital platforms for our families,
teaching them training videos that are specific to their child.
So when they go home, maybe today I this for, for,
for the first month, I have this set of nurses and then maybe this,
this my second month home,
I've got a whole new fleet of home care nurses coming in who don't know my
child.
So we give them educational tools that they can use as well for the community
providers that are coming into the home. Um,
another huge challenge for our families is medications. So, believe it or not,
our little, these little children, little complex children go home on a,
a significant amount of medications. Um, so what we have done, and,
uh, we've created, we've worked with a, um,
a company that we have customized a medication record for that
child. So literally it is an electronic schedule, um,
for the parents to keep track of when their medications are due,
what are some of the side effects that they need to look for,
and all of the information that they need to know about that medication is,
is there. And that, um, that library, that medication, um,
program is actually translatable into other languages. Um,
so it's really been a game changer for helping our parents organize their
child's medication regime and the safety of medication administration again,
in the home. Um,
and then we've invested a lot in our family resource libraries. I say, um,
adult learners come in all different forms.
Some like paper and pamphlets and some like electronic devices. So our,
our family resource room really has captured, um, some of our old hand,
you know, old school hands-on, uh,
paper handouts or booklets and pamphlets to read, as well as a collection of,
um, extensive electronic, um, library that,
that focuses on kind of the diagnoses,
that common diagnoses that we're seeing here and some of the, um,
equipment and things that the kids are going home on.
Jill, I also understand there are plans to scale the program mm-hmm.
.
So what is the scope that Blythedale Children's would be considering,
and what steps need to be taken to make that successful?
Okay, so great question and probably, um,
really our next vision for the next several years is really going to
be investing in the transition from home to hospital to home.
And how do we ensure that the community is ready to, to care for,
for this child beyond our walls? So as we said it,
the first really starts with the confidence and confidence of our parents. Um,
but our next phase that we are really, um, diving into is really, um,
looking at the home care providers.
So primarily our first focus is gonna be on home care RNs, um,
and EMTs and paramedics in the community. So remember that parent hits 9 1 1,
it's the community E M T or paramedic that's kind of the first responder to that
home. So our respiratory, um,
assistant director of respiratory is in, in combination with our, um,
child and family education coordinator coming up with a curriculum.
And we're designing a plan.
We can get community EMTs and paramedics here on site,
put them through our sim lab, through the use of our sim lab, um,
enhancing their, their skills.
So when they're called to the community to take care of these, um,
to tend to these medically complex children in the community, they've got some,
we're really enhancing their knowledge base.
And the second is the home care RNs. As you know,
the nursing predominantly the home care population is really
adults. Pediatrics are a very small pool of that.
So on top of home care agency struggling to have a,
uh, uh, the volume of nurses,
it's even harder to really have that volume of nurses that have the clinical
skillset and capabilities and competencies to take care of these medically
fragile children.
So developing a curriculum where ideally we can get them in here and trained in
our sim lab, and then ideally get them to the bedside.
So they're actually partnering with our nurses to take care,
learn how to take care of that child before they meet them in the home for the
first time. So one of the great, um,
another great talk about doors opening. Um, uh, uh,
one of the directors of nursing and myself, um,
had the opportunity to apply for a,
a nurse innovation fellowship that is sponsored by the University of
Pennsylvania, Johnson and Johnson and the Wharton School of Business. Um,
and it was a national application and we were selected. There is, um,
10 cohorts from across the nation,
and we were one of the hospitals that were selected to participate.
So for the next year, we're working with a really, um,
high level team through this fellowship.
And our focus is going to be exactly this trans the,
the successful transition of a home of a child from the hospital to home.
What challenges are we facing and how do we,
how do we really focus on the community piece and, um,
bring that up to the competence level that is needed. Um,
so that's another great avenue that,
that we're gonna be partnering with to kind of help us figure this,
this solution as design the solution, um, for a problem that is,
is not only, um, in our immediate area, but across the New York state,
and it's a national problem.
This ability to care for these medically fragile children in the community is
just not something that's unique to Dale. It really is a national problem.
Um, and we really,
all we wanna do is establish ourselves as the center of excellence.
And we just wanna write the roadmap that then we would love to share with
children's hospitals across the nation. Um,
this isn't proprietary to blythedale,
we're really doing this immediately for our kids,
but really I want to be able to craft that roadmap that anybody can
pick up and say, the, this is what we've learned here, just roll this forward.
Um, I think after we,
once we move beyond the RNs and the EMTs and paramedics, you know,
it's like an onion. Um,
you get into these rural communities and there may be one community pharmacy,
um, pediatric medication,
and the compounding of these medications for our children are very complex.
So there's also a whole pharmacy education level of how do we,
when we're transitioning these children to the community,
how does our pharmacist partner with the community pharmacist to make sure that
they are competent and able to, um,
they have the skillset and the knowledge to prepare the medications that the
child needs. And then you've also got the pediatrician piece.
So sometimes in these rural communities, there may be one,
one family pediatrician, maybe,
maybe a handful that maybe have never even taken care of a child with a
tracheostomy or a central line or a ventilator. So there's also that whole, um,
really looking at the entire
health community that we are transitioning over the care of these children
to, and how do we enhance that? How do we do that,
that handoff more efficiently and effectively in making sure that we're handing
them off to competent caregivers?
Jill, thank you so much for sharing your insights today.
We definitely cannot wait to share them with our audience,
and I look forward to connecting with you soon.
Oh, Chris, thank you so much. A lot of fun.
It's so important for leaders at the top of organizations to keep learning,
stay sharp, grow their networks,
help our audience better do this in a more simplified, personalized,
and meaningful way. Becker's Healthcare has launched my B h c,
it's your trusted Becker's healthcare experience and more with content,
connections, events, and learning opportunities.
Join the community free of charge@www.my dot becker's hospital
review.com, and we'll see you there.