Baclofen  Pump  Program  at  Boston  Children’s  Hospital  Establishing  a  Nurse  Prac;;oner  Directed  Program  to  Manage  Baclofen  Pumps  in  a  Large  

Pediatric  Medical  Center  Kris%n  Buxton,  MS,  RN,  CPNP-­‐AC/PC  and  Ann  Morgan,  MS,  RN,  CPNP-­‐AC/PC  

 

Kris%n.buxton@childrens.harvard.edu  

 Team  of  2  dedicated  NPs  with  Medicine  and  Neurosurgery  backup  

Inpa;ent  Management  Outpa;ent  Management   Family  Centered  Educa;on  

Surgical  Management  

Program  Management  

Quality  and  Safety  

Acute  Management/Troubleshoo;ng  

•  NP  meets  pa%ent/family  upon  first  sugges%on  of  pump  and  gives  family  full  educa%on  and  take  home  materials  about  baclofen  pump  

•  NP  aKends  ini%al  Neurosurgical  mee%ng  with  pa%ent  to  provide  further  educa%on  

•  NP  sees  pa%ent  during  trial  day,  provides  further  educa%on  

•  NP  follows  pa%ent  during  inpa%ent  stay  post-­‐opera%vely.    Extensive  teaching  is  performed.  

•  Further  teaching  is  provided  as  needed  during  outpa%ent  visits.  

•  Consistency  and  frequent  face-­‐to-­‐face  %me  with  the  Baclofen  Pump  NPs  enhances  the  pa%ent  rela%onship  and  builds  trust  in  the  program  for  the  family  

•  Ensure  ITB  dose    is  in  pa%ent  orders  and  on  medica%on  list  for  all  inpa%ents  and  team  is  aware  of  the  baclofen  pump  and  dosing  

•  Ensure  pa%ent  is  not  due  for  refill  during  inpa%ent  stay.    Refill  as  needed.  •  Assist  with  post-­‐op  management  aPer  pump  placement  •  Adjust  pump  for  tone/spasm  management  for  pump  pa%ents  following  

orthopedic  surgery  •  Assist  with  plan  for  ITB    withdrawal  management  within  scope  of  prac%ce  •  Staff  educa%on  

•  Manage  policies  and  competencies  related  to  baclofen  pump  •  Maintain  database  of  pa%ents  •  Track  numbers  monthly  •  Maintain  programmers  throughout  hospital  (updates,  date/%me  

checks,  etc)  •  Establish  standard  of  care  throughout  the  hospital  for  baclofen  

pump  pa%ents  •  Staff  educa%on  •  Maintain  QI  ini%a%ves  •  Perform  research  related  to  children  with  baclofen  pumps  •  Presenta%ons  at  local  and  na%onal  conferences  

•  Assess  all  pa%ents  regularly  and  as  needed  to  determine  if  there  may  be  an  issue  with  the  system  

•  Assumes  a  leadership  role  in  troubleshoo%ng  problema%c  pumps  with  both  the  coordina%on  of  the  diagnos%c  work-­‐up  and  implementa%on  of  a  prescribed  treatment  program  

•  Consult  to  admiVng  service  re:  withdrawal/issues  and  plan  

•  Consult  with  neurosurgery  in  cases  of  concern  

•  Review  choice  of  40ml  pump  vs  20ml  pump  pros/cons  for  each  pa%ent  

•  Evaluate  pa%ent  response  at  trial  •  Consult  re:  ini%al  dose  of  pump  based  on  trial  results  and  pa%ent  

condi%on  •  Collaborate  with  neurosurgery  re:  repair  plans  for    malfunc%oning  

systems  

•  On  call  24/7  to  ensure  pump  concerns  are  promptly  addressed  by  the  most  expert  clinicians  

•  Track  refills  to  ensure  no  empty  pumps  •  Teaching  for  families  and  staff  around  early  withdrawal  

recogni%on  and  management  •  Limited  number  of  staff  can  access  programmers,  

therefore  limi%ng  errors  

•  Pre-­‐pump  teaching  •  Dose  adjustments  (weekly  post-­‐op  un%l  therapeu%c)  •  Perform  and  track  pump  refills    *benchmark  =  no  empty  pumps  •  Assess  pump  func%on  at  every  visit  •  Troubleshoo%ng  as  needed  •  Referrals  and  order  maintenance  for  pa%ents  using  home  care  

pump  management  

235  pa%ents