CANNP News. Carolinas Association of Neonatal Nurse Practitioners. for just the meeting room, food and AV package was almost $15,000.

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1 CANNP News Carolinas Association of Neonatal Nurse Practitioners President s Message: Judy Philbrook, NNP-BC I am excited about writing this as your new president! I have been looking through old newsletters and thought it might be interesting to provide a little history. CANNP was established 23 years ago! The first Board was composed of Kris Barends (president), Steve Kilb (vice president), Harriet Smalls (treasurer), Tony Graham (secretary) and Tina Hunsucker (member at large). CANNP was formed to: 1) establish an organization to facilitate professional development, education and research for the neonatal nurse practitioner; 2) to provide a communication network for exchange of ideas regarding practice, education and the professional role of the neonatal nurse practitioners; and 3) to participate in the legislative activities regarding nurse practitioner scope of practice specifically in the neonatal care area. Membership dues were $25.00; renewal in subsequent years was $20. We have increased our dues this year to $ CANNP offered conferences 2 times/year initially, but changed to an annual conference in Conferences have provided educational offerings on hot topics throughout the years. They have also offered the opportunity to network and talk with our colleagues at other hospitals. They have also become more expensive in 1995, the estimated budget for the conference was $3275. Last year, the cost for just the meeting room, food and AV package was almost $15,000. CANNP once had a legislative committee and a more formal report from representatives from both states at our annual conference. We now include legislative updates that influence our practice in our newsletter. We have had national representation through NANN and NANNP and have had updates from the individuals involved. Hot topics have included certification, licensure, credentialing, education and reimbursement. There are only 2 other states hat have neonatal nurse practitioner organizations Florida and Texas. We are among the minority, but that gives power! The CANNP Board is committed to the mission of the organization. We can not do it alone though. We need you to join or maintain your membership and participate. We need to take charge and become active in our local and national organizations and health care institutions. Together we can achieve our goals! I hope to see you at the annual conference in Greenville, SC! Volume 14 Issue 1 February 2014 Special points of interest: 2014 Conference PEER Recognition Award Officer Reports Educational Feature Inside this issue: Officer Reports Conference Highlights Peer & Scholarship Award 3 4 Educational Offering 5 Practice Site Updates 6-7 NANNP Update 8 Membership Application 9

2 Officer Updates CANNP Board CANNP Board elections were this past fall. We did not receive an influx of nominees, so we did a little juggling and coercing! CANNP bids a sad farewell to Annette Kibler. Annette served as treasurer from 2006 to 2010 and president from 2010 to She retired from MUSC this fall. We wish her much happiness as she begins this new chapter in her life. Treasurer s Report: Tara Marion-Short Current Balance $25, Vice President's Report: Judy Philbrook Membership: CANNP had 58 members in It is time to renew your membership. A membership application form is enclosed in this newsletter or you may obtain one from our website. Also, please mail practice site updates to by May 31, 2014 for the next newsletter. I would also love to see members volunteer to write an article for this newsletter. Website: Remember to visit the website... Conference information, forms for nominations and newsletters can be found there! The website address is cannp.org. Your new board consists of: President Vice President Secretary Treasurer Judy Philbrook Alisa Starbuck Kathy Connelly Tara Marion-Short Member-at-Large Sharon Rush Welcome to Sharon Rush! Sharon is a NNP at CFVMC. She came to CFVMC from Bangor, Maine in Sharon worked as a staff/charge nurse and then attended the NNP program at MUSC. She graduated in Secretary s Report: Kathy Connelly Minutes from the last annual business meeting will be displayed outside of the conference room at the 2014 Conference. Membership applications must be received by or at the annual conference. Applications will be considered late after the conference and a $5.00 late fee will be assessed to members who have not renewed their membership by this deadline. The address for renewals and correspondence is: CANNP c/o Judy Philbrook 6474 Summerchase Dr Fayetteville, NC Please encourage all members of your team to join or rejoin and be active in this worthwhile organization. Reminder letters will be mailed to those members who fail to renew their membership for 2014 by the time of the annual conference. Save the Date! The 2014 MUSC Pharmacology Conference will be in Nov. Dates to be announced. Page 2 CANNP News

3 Conference Highlights 2014 The 2014 conference Footprints in the Carolinas will be held at the in Greenville, SC on April 10 and 11th. Please see the side column for the conference agenda. Members of the conference planning committee are: Kris Barends. APRN, NNP-BC Susan Collins Joerger, MSN, APRN, NNP BC Charlene Wells, MSN, ARNP, NNP-BC Deb Baldwin, NNP-BC Allison Carman, NNP-BC Dawn Allen, NNP-BC Dory Ferry, NNP-BC Treasure Snyder, NNP-BC Bridgett Allen, RNC, BS The committee has worked hard to ensure a wonderful conference. Join us in Greenville for a great conference, a chance to network with colleagues from North and South Carolina, continuing education credits and perhaps some shopping or sight seeing. Brochures have been mailed. If you did not receive one, please check the website for conference information. *Reminder* Please bring a door prize/gift basket from your NNP team. Carolinas Association of Neonatal Nurse Practitioners Thursday April 10, 2014 April 10 and 11, How do we Safely Improve Care in the NICU: Focus on CQI Project Reese Clark, MD Clinical Approach to Neonatal Cardiac Issues Break Bryan Ohning, MD, PhD My Job is Neonatal Management: What Role does Culture Play? Jacqui Hoffman, DNP, ARNP, NNP-BC Lunch/CANNP Meeting National Trends in Family Support, Milestones Chart Dana Beatty, RN, NICU Through the Eyes of Families: A Parent Panel Break Rachel Balck, EdD, Dana Beatty, RN Is It Worth Dying For? Tips and Tolls for Stress Management in a High-Stress World Bobbie Rhodes, RN, MS, BSN Friday April 11, Optimizing Respiratory Outcomes in Late Preterm and Early Term Infants Lucky Jain, MD Short Gut and Feeding Tolerance Break Erin Kevan, MD Understanding the New Genetic Testing R Curtis Rogers, MD Illicit and Prescription Perinatal Substance Abuse Lunch Jacqui Hoffman, DNP, ARNP, NNP-BC Nourishing Infants at Risk: The Late Preterm Infant Pamela Price, PhD, RD, LD, CNSC Hirschsprungs and Anorectal Malformations Robert Gates, MD Page 3 CANNP News

4 Peer Recognition Award It is time for the annual CANNP Peer Recognition Award. The award nomination forms can be found on-line at the CANNP website: cannp.org. Recipients of this award have been pleased that colleagues took the time to recognize them for their contribution to the team. Please consider nominating a well deserving colleague for this meaningful award. This is your chance to recognize and honor a member of your team. Please consider each team member, their dedication to your unit and infants, efforts to improve or maintain personal education and education for other team members, involvement in unit projects or committees and personal commitment to the continued development of the advanced practice role. Applications should be mailed to: Alisa Starbuck 1289 Black Mountain Rd Pilot Mtn, NC Applications must be postmarked by April 1, The award will be announced and presented during the business meeting at the annual conference on April 10th. CANNP PEER Recognition CANNP Scholarship CANNP Research Grant The purpose of this award is to recognize an individual who has returned to school to enhance their role as an NNP and provide them with a scholarship award for financial assistance. CANNP is seeking applications from practicing NNPs who are current members of our organization and are currently enrolled in an educational program seeking an undergraduate or graduate degree. The purpose of the CANNP Research Grant is to assist members who are involved in research by providing help with funding ($ ) for their project. Applicants must be CANNP members for at least two years. Applications are due by May of each year and award notification takes place by August 1st. The award recipient will receive a $ monetary award. The award presentation will be made on April 18th at the business meeting held during the conference. Applications and additional information can be found on the CANNP website. Completed applications should be mailed with current curriculum vitae to: Alisa Starbuck (see address above). Applications must be postmarked by April 1. The CANNP Grant Application can also be found at the CANNP website. Completed applications can be mailed to Alisa Starbuck (see address above). For questions about either of these awards, please check the web site for additional information and/or Alisa Starbuck at or Judy Philbrook at Volume 14 Issue 1 Page 4

5 Educational Feature: Development of a Titration Guideline in an Effort to Decrease Length of Time Neonates Receive Dopamine, Dobutamine, and Hydrocortisone: A Multidisciplinary Quality Improvement Initiative Christine Jones, MSN, NNP-BC Background: In January of 2013, the neonatal nurse practitioner group at Wake Forest Baptist Medical Center attended a presentation given by the pharmacy department regarding a new hydrocortisone dosing guideline that was implemented in the NICU. During this presentation, the NNP group learned the remarkable impact of these guidelines and realized there was a reduction in the length of time and the average dosing of hydrocortisone in our patient population. Following this presentation, further multidisciplinary discussion took place with a focus on determining other methods that could possibly yield a reduction in hydrocortisone use. The NNP group agreed the development and initiation of standardized titration orders for dopamine and dobutamine could potentially expedite weaning and therefore subsequently lead to earlier tapering and discontinuation of hydrocortisone. This concept was developed after realizing our practice for titrating dopamine and dobutamine drips varied from provider to provider. This inconsistency often led to misinterpretation from nursing staff, confusion among practitioners, and missed opportunities to wean. Purpose: cortisone. Methods: A multidisciplinary team was formed consisting of neonatologists, neonatal nurse practitioners, pediatric pharmacists, neonatal nurses, and nurse educators. Monthly meetings were held and the following titration guideline was developed for computerized physician order entry to treat hypotension. Dopamine/Dobutamine-NICU Usual range 2 to 20 mcg/kg/minute Start dopamine/dobutamine at mcg/kg/minute and titrate by 1mcg/ kg/minute every 30 minutes to maintain blood pressure means from to. Notify NNP/ MD for means less than or greater than. Notify NNP/MD if dopamine/ dobutamine reaches 15 mcg/kg/min. Notify NNP/MD prior to turning dopamine/dobutamine off. Maximum dose is 20 mcg/kg/minute. An in-depth literature review was completed, and unfortunately evidence based research was lacking on the subject of titrating vasopressors in the neonate. According to Noori & Seri (2012), There is little evidence on what vasoactive medications to use in what patient and when, at what dose to start, how to titrate the drug, and what parameters to measure (p. 221). The above guideline was developed based off recommendations from the The NNP group, along with the pharmacy department developed a titration guideline with a global aim to standardize order entry for dopamine and dobutamine to include titration and notification parameters in an effort to improve communication, prevent errors in order entry, increase nursing autonomy, improve nursing education regarding hypotension, and most importantly reduce the length of treatment time for inotropic agents and hydropediatric pharmacy department, current practice, and the NeoFax drug manual. The titration dose and interval was chosen due to the known rapid metabolism of dopamine and dobutamine and serum half-life of 2-5 minutes. On May 1 st, 2013 the order set for the guideline went live and was available in the computerized order entry system for use. Prior to this, staff nurses were provided extensive education that required pre-implementation and post-implementation testing. Staff nurses also completed surveys prior to implementation and following in an effort to assist in tracking progress. Data was collected and analyzed on the first 20 patients who received dopamine, dobutamine, hydrocortisone, or a combination thereof and were compared to 20 patients that received the same treatments prior to implementation of the guideline. Outcomes: Upon completion of data analysis, differences in infant characteristics were compared among the pre (n=20) and post (n=20) implementation groups. The pre-intervention group consisted of 16 males and 4 females and the post -intervention group consisted of 11 males and 9 females. The mean gestational age was 31.7 weeks and 28.7 weeks respectively. Average birth weights between the two groups were 2,220 grams and 1432 grams. Of the infant characteristics compared, only the differences in birth weight was statistically relevant (P < 0.045). Page 5

6 Educational Feature (cont) Practice Site Updates All patients in the study group received dopamine. In the preimplementation group 5 patients received dobutamine, and 6 received hydrocortisone. In the postimplementation group, 7 patients received dobutamine and 6 received hydrocortisone. Although not statistically significant there was a reduction noted in length of treatment time and the average dose of hydrocortisone. A decrease of 26.7% was noted in length of treatment time for dopamine, and a decrease of 31.6% was noted with dobutamine. Regarding hydrocortisone there was a 32.4% decrease in length of treatment time and a decrease in the average dose by 10.6%. It is of importance to note, the post implementation group was significantly smaller in birth weight and a reduction in treatment time was still observed. A total of 94% of the nursing staff received education prior to implementation of the new guideline. When comparison of pre and posttest results were compared, a significant increase in test scores was noted at 31.3% (P <0.0001). Furthermore, pre and post nursing surveys demonstrated a dramatic increase in nursing autonomy, increased feelings of being an active team member, and an increase in feelings that orders were written more clearly. Conclusion: Although this study did not show a statistically significant reduction in length of treatment time for inotropic agents and hydrocortisone, the results are promising, and the use of a standardized titration guideline can have an impact on hypotension management in the neonate and nursing autonomy. Further research is needed using a larger sample size for rigorous statistical analysis. Reference: Noori, S., & Seri, I. (2012). Neonatal blood pressure support: The use of inotropes, lusitopes, and other vasopressor agents. Clinics in Perinatology, 39, Editor s note: This article discusses a PI project that was done in the NICU at Wake Forest Baptist Medical Center. The author is working on a manuscript to publish this information in greater detail. Board of Nursing Info For questions about advanced practice legislative changes, please follow one of the following links to the Board of Nursing in your state: ing/ WakeMed WakeMed is having an awesome year. We will be expanding our beds to a total of 46 and our renovations to our new space will be complete by Feb. 20 th where we will have 24 single room beds available for our patients and parents. We are excited about our new space and invite you to come & visit if you are in the neighborhood! Construction is underway at WakeMed North where there will be a 6 bed Special Care Nursery. We will be hopefully hiring 4-5 new NNP s sometime toward the end of this year to staff the new hospital. Desi Wolfe tied the knot with Jason Newberry this fall. Desi Newberry & Tracey Robertson are now part of the faculty at ECU for the NNP program and they are being published: Look for it! Newberry, D.M., Young, T.E., Robertson, T., Levy, J., & Brandon, D. (2014). Evaluation of neonatal peripherally inserted central catheter tip movement in a consistent upper extremity position. Advances in Neonatal Care. 14(1), Michelle Howe became a grandmother this year. She says it is the best thing ever! We are pleased to announce the hiring of a new NNP to our practice, Catherine Barnes. She joins us from Commonwealth Neonatology in Richmond VA. She obtained her MSN from State University of New York at Stoneybrook NY in Michelle Howe, Leanne Gongalez, Marlene Heggie & Tracey Robertson have been instrumental in starting the STA- BLE program through the Simulation Lab. New Neonatologist: Jonathan Seigel: Jonathan joined us this summer. Page 6 CANNP News

7 He completed his residency at UNC and his fellowship at Duke. He is a very welcomed addition to our family. Ginger Rhodes-Ryan joined our group full time as our Clinical Research Coordinator for Neonatology. She remains casual at Rex Hospital SCN. Rex Hospital The comings, goings and changes at Rex Hospital have been many over the last 6 months. We would like to welcome 2 new members to our Neonatology Team: Dr. Claudia Cadet. She comes to Rex from Mount Sinai Hospital in New York City where she has just completed her fellowship. She also just welcomed a new baby daughter on December 4, Dr. Marie Ambroise Thigpen joins our group from Pediatrixs in Florida. She and her family are settling in and enjoying the Raleigh area. We are sad to say good-by to our Lead Practitioner Ginger Rhodes- Ryan. After more than 13 years at Rex she is leaving to take a clinical research position. We are pleased she will continue to work prn with our group. Dr. Laurie Dunn has stepped down as the Medical Director of the Nurseries at Rex. She continues to be involved with many of the varied QI projects for the nurseries and neonatology group. Dr. Stephen Parsons has stepped into the role of Medical Director for the Nurseries at Rex. He continues to be busy with committees, QI projects and now the duties of the Director. Cape Fear Valley The past 6 months here at Cape Fear Valley has brought several big changes to the medical team. We have sadly had to bid Joan Lucas NNP-BC a happy retirement. We say farewell to Joan as a colleague but not as a forever friend. Joan retired in January after 22.5 years of service to the Health System, with the past 18.5 of those years as a valuable NNP on the medical team. We wish her the best of luck and many happy years of retirement. She also welcomed her first grandson into this world in December, so she has plenty of baby experience to offer, and will have time on her hands to enjoy him. On a happy note, the group welcomes two newcomers to the team. Jennifer Porter and Tiffany Horne graduated from Eastern Carolina University with their MSN in the Neonatal Nurse Practitioner program in December. They both have done their practical experience here with us as students, and are currently preparing to sit for the NCC certification exam in the near future. They are both homegrown girls from our own NICU nursing staff. We look forward to them joining the medical team, and let the orientation begin. Good luck to you both, we know you got this! Another one of our own NICU nurses, Donna Parker RNC is currently a student at ECU in the NNP program. Her projected graduation is December of 2014, and will join the medical team in the spring of She has just started her clinical experience here with us this semester. Study hard and we are excited about what the next year will bring for you. Vickie Poston NNP-BC has also welcomed a new grandson to the family from daughter Kristina, as the family continues to grow. No Vickie, retirement is not an option for grandma time, vacations will have to do for now. Congratulations Poston family! Denice Gardner NNP-BC happily celebrated the graduation of her youngest child Brian with a degree in Physics from UNC-CH in December. Yes Denice there is a Santa. Brian already is employed in his field of study and is exiting the parent payroll. Congratulations Gardner family! Last but not least, Wendy Brock is ambitiously taking on the DNP program at ECU, with expected completion in August Way to go Wendy, keep writing those papers!

8 . The National Association of Neonatal Nurse Practitioners (NANNP) had a fantastic 2013 and has many projects and initiatives lined up for a successful During the upcoming NANNP Council Midyear Meeting, we will work to strategize their goals and priorities for 2014: Increased Presence & Visibility NANNP is fiercely dedicated to the needs of our members and is making a stronger push to have an increased presence at the events that address the topics and issues that are important to our industry, including: NEO: The Conference for Neonatology, the AANP National Meeting and the NONPF Annual Meeting. Please be sure to stop by our booth in the exhibit hall to say hello! NANNP has also been asked to serve as a Co-Provider for the Neonatal Faculty and Clinical Leadership Forum that will take place as part of the Neonatal APN Forum in Washington, DC in May. Membership Value An important milestone was celebrated last fall for the first time NANNP membership topped over 1,200! As we carry this momentum into 2014, our focus remains with you - our valued member. Throughout the year NANNP will be introducing new, exciting opportunities to conveniently provide you with access to information and resources that can benefit you. Publication and Product Development NANNP has been working to revise the "Orientation and Competencies Toolkit for Neonatal Nurse Practitioners" due to changes in national NP and Population-focused NP competencies. This tool kit covers the NNP's knowledge and skills using the novice to expert continuum as the basis of measurement or performance evaluation. Also, in response to changes in education standards, revisions to the Education Standards and Curriculum Guidelines for Neonatal Nurse Practitioner Programs have also been in development. The purpose of the guidelines document is to define the minimum standards necessary for education of a neonatal nurse practitioner. These are anticipated to be released in February Recent work and policy statements by NANNP and NANN (the National Association of Neonatal Nurses) on workforce, education, competency and fatigue will culminate in a Neonatal APRN Position Statement and White Paper. The position statement will articulate the role, preparation and scope of practice of the Neonatal APRN (NNP and CNS). The White Paper discussed the current barriers to practice and the future of the neonatal APRN profession and will serve as a strategic plan for NANNP and NANN. Anticipated release for both documents is Q1, NANN is also completing work on the Preemie Discharge Module. This free resource will be made available to clinicians and hospitals to standardize the discharge process for families. The module will include printed and website resources on topics such as breastfeeding in the hospital and at home, skin care, selecting a primary care provider and follow up. Diagnostic teaching tools are included to support bedside teaching on neonatal specific diagnoses such as ROP, IVH, and RDS/BPD. Anticipated release is Q1, Also in development is the 2 nd edition of the NNP Workforce Survey, the Neonatal Clinical Nurse Specialist (CNS) Competencies and Education Standards, a Position Statement regarding Medication Safety in the NICU, and a webinar series on Pharmacology. For more information on NANNP please visit

9 Membership Application CANNP celebrates its 23rd anniversary in 2014! The Association provides a communication network for exchange of ideas regarding Neonatal Nurse Practitioner practice. Our goal is to facilitate professional development through education and research. Your affiliation helps to expand membership services. By joining or renewing your membership in 2014 you will be taking an active role in supporting CANNP goals. Please print clearly or type the following information: Name Address City State Zip code Phone Work Home Employer Fee: $35.00 Renewal NNP New Member Student I agree to allow my name to be released for mailing lists for conferences: Yes No Please enclose check payable to: CANNP c/o Judy Philbrook 6474 Summerchase Dr Fayetteville, NC 28311

10 Carolinas Association of Neonatal Nurse Practitioners 6474 Summerchase Drive Fayetteville, North Carolina Volume 14 Issue 1 Page 10

CURRICULUM VITAE Catherine L. Witt, MS, NNP-BC. CERTIFICATION: NCC Certification (NNP) 1987-Current NRP Regional Instructor STABLE Lead Instructor

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