Utilizing EPIC to Bridge Care
Coordination with Colorado
School Nurses
Children’s Hospital Colorado’s team of school nurses comes up against real barriers
to coordinating care when students return to school with a new or changed health
condition. They often face delayed access to health information and difficulties in
the process for information exchange ¾or worse, they’re not recognized as a vital
part of the care team.
Working with J.D. Rigdon and Mike Ripperton from the Clinical Applications
Services team, school nurses Christina Baker MS, BSN, NCSN, RN-BC, Christine
Perrault MHA RN NCSN and Sara Kihn, MS RN NCSN, helped to develop the
Colorado Connect program.
This program ensures reliable and consistent delivery of patient health information
through a secure web-based portal that allows school-based nurses and all
members of the care team to view electronic medical records and care needs of any
child treated at any Children’s Colorado location. An initial pilot took place in two
school districts.
By 2018, the program included over 100 schools and 57 school nurses. The team’s
next step: to look at the effect of this access on clinic nurse and school nurse
satisfaction, as well as patient outcomes such as emergency department and
hospital admissions.
CHRISTINA BAKER
Hugs not Drugs
Eat, Sleep, and Console in the NICU at Colorado Springs
In 2018, a multidisciplinary team of nurses and maternal fetal medicine
specialists adopted a new approach to neonatal abstinence syndrome in opioid-
exposed newborns admitted to our Neonatal Intensive Care Unit at Memorial
Hospital in Colorado Springs.
Historically, infants with this syndrome would be treated using Finnegan
Scoring, a withdrawal symptoms checklist. Through a process change using
plan-do-study-act cycles, the team implemented a new tool known as Eat, Sleep,
Console, or ESC, designed to reduce opioids in this population.
By replacing the planned administration of opioids, the ESC tool favors non-
pharmacologic care by emphasizing feeding and family involvement, using
opioids only on an as-needed basis.
The pilot kicked off in May, with the nurses’ patient assignment ratio
decreasing from one nurse per three patients to one per two patients during
implementation. A small group of nurses were trained to do a four-patient
pilot. The team made changes during the pilot based on feedback from clinical
providers and families, expanding the Cuddler Program to support increased
need of consoling. The pilot went live through the full unit in June. The Newborn
Nursery adopted it in October.
This innovative approach not only substantially shortens healthcare costs and
length-of-stay for opioid-exposed newborns, but also drastically decreases their
exposure to pharmacologic treatment. Moving forward, the team will focus on
safe discharges and setting families up for success. They’ll also partner with
obstetric providers to offer antenatal screening for substance abuse, along
with prenatal education and consultation for women and risk of delivering a
substance-exposed newborn.
Of the 62 opioid-exposed
newborns admitted or
transferred to the NICU and
five admitted to the Newborn
Nursery in 2018, 56 were more
than 35 weeks’ gestation
and discharged home. After
implementation of eat, sleep,
console protocols, average
length-of-stay decreased from
22.4 days (n=13) to 9.1 days
(n=43), with an estimated cost
saving of $2.2 million yearly,
and medication use decreased
from 85 percent to 23 percent.
This innovation placed the
team in the top three teams
selected for recognition at the
Children’s Colorado Nursing
Excellence Awards.
CHRIS PERRAULT
SARA KIHN
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