Staff from three health systems share their insights for standardizing education, and care for pediatric patients
By Kaitie Sanders
“It’s incredibly important to standardize care and, in our case, standardizing onboarding education, which then standardizes care,” Kelli Hosford, NICU supervisor educator at WakeMed Health and Hospital’s Raleigh, NC location, says.
Standardizing care across medical facilities using evidence-based practice (EBP) is often a top priority, and can present challenges for single-location hospitals, but health systems have many other factors to consider when preparing staff to provide the best care possible to their patients. Staff from three systems around the US shared insights from their process of streamlining pediatric care education.
WakeMed consists of several facilities around the Raleigh area, and includes a level 4 NICU, a PICU, pediatric rehab facilities, a pediatric-only ED, special care nurseries, and several primarily adult care facilities. Hosford and Sarah Sutphin, NICU supervisor educator at WakeMed Raleigh, have spent the last two years standardizing the NICU onboarding program for the Raleigh campus, and have recently begun the process of expanding that model to neonatal nurses system-wide.
While Mercy Health System and Memorial Hermann Health System are further along in their standardizing process, staff from all three of these organizations echoed the same crucial themes for organizations and systems looking to ensure their staff in all departments and locations receive the same education. Mercy spans four states including 30 emergency departments (Eds) serving all ages, two children’s hospitals, and several pediatric Eds. Memorial Herman covers 270 care delivery sites around Houston, Tex.
Communication is Key
According to Sophie Harris, clinical educator for Memorial Hermann, their system has had a solid foundation of standardization for the last four years and having all staff on the same page was crucial to getting the organization to this point. Lauren Fowler, clinical performance improvement specialist serving all children's hospitals across Mercy Health, agreed.
“I think one of the biggest challenges that we have in moving to one standard is our own clinical expertise team members struggling to let go of things that they might have developed or created on their own,” Fowler says. “So finding ways to incorporate that is certainly important.”
Memorial Hermann re-evaluates their paths for NICU, general pediatrics, and PICU education every three “cycles,” which is roughly every year. To keep communication as clear and open as possible, nurses are sent a survey for their feedback on the program, and education staff from all locations are included in discussions using the PDCA (Plan Do Check Act) method.
“Because we do those frequent reassessments, we're able to further standardize the program,” Harris says. “Everybody is at the table. All of the educators at each one of our organizations are all there. We have a big whiteboard, lots of sticky notes.”
WakeMed has also used large group meetings as they begin to expand their Raleigh NICU education plan to two other locations across the system.
“We’ve used productive think tank meetings, actual process meetings, and then going forward everybody's thoughts are accounted for, represented, and valued because they're all part of the process,” Hosford says. “I think as long as there’s a mindset from the beginning that everybody that is already involved on their separate campuses has ownership and has worked hard for whatever system they already have in place… You honor that and move forward together. That way, you're not bulldozing anyone.”
The Importance of Balance
Communication is crucial for developing programs in general, but also for identifying specific needs for individual units, staff, and communities. Mercy is currently pursuing standardized fellowship across all care spaces; the NICU program has been piloted, and development for other areas is in process.
“I think one of the biggest lessons I learned is with our EDs when we were developing the course set for that minimum standard,” Fowler says. “A lot of them are caring for a subset of children in a predominantly adult space. So we recognize that this isn’t their only education; it's not just kids. How can we make sure they have exactly what they need in the event that a child would come into their space for a particular scenario, without teaching them everything they could ever want to know? Just finding that balance, is an ongoing lesson.”
Just as the needs of individual units are different, so are the needs of individual learners. WakeMed’s NICU onboarding program consists of two tracks, low acuity, and high acuity. The low acuity class is required for all new graduates entering the nurse residency program. Six months after completing that, they move on to the high acuity class to build on those foundational skills. Nurses transferring from other organizations, however, may have the skills in place to skip the low acuity class, or both altogether, so the programs are optional for those clinicians.
Community needs also come into play when standardizing education and procedures. For state-specific systems like Memorial Hermann, Harris says they are able to rely on local organizations like the Southeast Texas Regional Advisory Council to help them stay on track for care status and awareness of issues facing the populations they treat.
“We can have overlying problems we need to address that I can't see at the local level, but when I'm looking at my state agency, they can help us identify things such neonatal mortality and maternal mortality. Things where we could make a difference and see if there needs to be a little bit more education that topic.”
Larger systems like Mercy, however, have far more community-specific issues and regulations to follow, so Fowler says they try to focus on national-level EBP knowledge from organizations such as the National Association of Neonatal Nurses (NANN) and the American Academy of Pediatrics (AAP) to guide their policies and standards. However, state laws on topics such as maternal and newborn drug screening can create challenges.
“It's taken us months and months to try and develop one policy and standard around that, taking into account all of the state laws,” Fowler says. “Before bringing the topic to the education team, we had legal counsel weigh in so the nuances by state were already clearly defined.”
Phased, Hybrid Education
Once all key staff are in the loop and individual needs have been accounted for, all three systems have implemented variations of phased education curricula combining in person and online, self-paced learning.
WakeMed has broken the low and high acuity classes into several curricula by complexity and topic, using Pediatric Learning Solutions (PLS) courses to support in-person learning. Each group of courses assigned is due the day before an in-person class in which the facilitators answer any questions, have further discussions, and complete hands-on activities and simulations.
“We broke the courses down into a system that would coincide with how they would learn on the floor so that it would be a process that would seem comprehensive and cohesive,” Sutphin says.
Mercy and Memorial Hermann also use PLS courses as “pre-work” for group learning, some in-person and some via Zoom due to the COVID-19 pandemic. Harris says this combination of online and in-person learning has been valuable not only for onboarding and continuing education, but for staff members needing a learning plan to improve their knowledge, skills, and performance.
“We'll do a learning plan and we'll supplement with the PLS modules, then have them do a care plan or walk-through exercises with their clinical coaches to help to get them where they need to be so that we can retain them,” Harris says.
After implementing online courses, all three systems shared improvements in the time and money spent educating staff as well as the improvements to learning in general. The combination of these organizations’ efforts to communicate clearly across locations, evaluate organization and individual-specific needs, and implement a layered education plan have helped them achieve this.
“They come prepared and ready to discuss the topics and then move right into the skills portion of it,” Hosford says. “We've been able to cut the in-person days in half from what they were. Now we do four-hour days. I definitely think their knowledge retention and attention to the actual subjects is so much greater because they can pace themselves.”