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%[email protected]
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
