To Whom It May Concern:

Transcription

1 COLLEGE OF NURSING 99 JONATHAN LUCAS STREET MSC 160 CHARLESTON SC Outstanding Dissertations and Capstone Projects Selection Committee American Association of Colleges of Nursing One Dupont Circle, NW Suite 530 Washington, DC September 30, 2013 To Whom It May Concern: I am honored to submit the nomination of Courtney Satterfield, DNP, APRN, CPNP-PC, a graduate of the 2013 MUSC College of Nursing DNP program for the AACN Excellence in Advanced Nursing Practice Award for her outstanding capstone project Screening for Vitamin D Deficiency in Children with Epilepsy: Improving Adherence to AAP Clinical Guidelines. Dr. Satterfield s project continues to have a huge impact on care delivery and patient outcomes in the clinic where it was implemented as can be discerned from her results. Background: Vitamin D deficiency causes rickets in children and is increasingly associated with diseases and autoimmune conditions. Certain health conditions and medications increase the risk of deficiency and insufficiency. Despite the AAP Guidelines, screening and supplementation of children with epilepsy remains inconsistent. The purpose of this practice improvement project was to determine if an educational intervention could improve provider adherence to American Academy of Pediatrics 2008 clinical practice guideline recommendations to screen children with epilepsy for Vitamin D deficiency. Methods: The PRECEDE-PROCEED theoretical framework was used to develop the project methods. This project took place in an outpatient pediatric neurology clinic in an academic health center in the southeast U.S. Provider adherence to the guideline was determined by searching a clinical database using a systematic cross-search of ICD-9 codes for the percentage of Vitamin D laboratory tests ordered for patients with epilepsy before and after an educational intervention. An educational intervention outlining current AAP clinical practice guidelines on screening for Vitamin D deficiencies was presented during a scheduled clinic meeting. Four physicians and four nurse practitioners attended. Detailed messages and posters outlining the project purpose and activities followed the meeting. Booster s were sent at 2 and 4 weeks post-intervention to all clinic staff. The intervention period lasted 6 months, followed by another systematic search to determine differences in screening rates. 1

2 Results: The percentage of patients whose Vitamin D levels were measured increased from an average of 6.9% from to 13.6% in the first 6 months of 2013 following the intervention, reflecting an increase of 97%. Implications for Practice, Education, and Policy: An educational intervention to improve provider adherence to clinical practice guidelines is an effective means to promote consistent practice and quality care and change practice. Data collection was the biggest challenge, as the clinical database does not recognize CPT codes, necessitating a comprehensive keyword search of 11 lab codes for Vitamin D levels in order to capture all tests. Part of the education was consistency in CPT coding, creating a major limitation in this part of the assessment. Improvements in technology and billing systems would improve accessibility and interpretability. The providers have fully adopted the guidelines as a part of their practice protocols. Future reminders and statistical updates will ensure the continued success of this performance improvement project. In conclusion, Dr. Satterfield s project is easy to sustain and has the support of all providers in the clinic. The project not only led to improvements in health and delivery of care but identified the lack of Vitamin D dosing guidelines for children with vitamin D deficiency. Dr. Satterfield was innovative and contacted the Pediatric Endocrinology Division to seek expert opinion and then shared expert dosing recommendations with the Pediatric Neurology Division. The providers quickly adopted the recommended dosing and have been ensuring children with epilepsy are screened and treated for vitamin D deficiency with adequate supplementation and ongoing monitoring. Personally I know the project will continue, as I am one of the providers in the clinic! It can also be easily replicated in other clinic settings. I look forward to watching Dr. Satterfield s growth as an advanced practice nurse and her continued translation of evidence into practice. Sincerely, Gigi Smith, PhD, APRN, CPNP-PC Director, MSN/DNP Programs Assistant Professor MUSC College of Nursing 99 Jonathan Lucas Street MSC 160, 1002 HOT Charleston, SC Phone: (843) Fax: (843)

3 Mary Courtney Robinson Satterfield, DNP College of Nursing Medical University of South Carolina AACN Personal Statement In recent years, Vitamin D has received increasing attention from health care professionals due to the alarming prevalence of insufficiency and deficiency in the general population. As a student preparing to be a Pediatric Nurse Practitioner (PNP), I became both interested in and concerned about the implications of Vitamin D deficiency in the pediatric population. While reviewing the literature, I learned that although the American Academy of Pediatrics (AAP) does not recommend universal screening for children, certain groups are at increased risk of deficiency. Substantial evidence-based research revealed that children with epilepsy taking antiseizure medications are particularly susceptible to this vitamin deficiency and should be routinely screened with laboratory tests. These findings prompted discussion with the Pediatric Neurology Clinic at a large academic medical center. Although providers were aware of the AAP recommendations, a protocol for routine screening had not been implemented in the clinic. This specialty clinic represented an ideal setting in which to implement a practice improvement project focused on the goal of increasing provider adherence to the guidelines. Interventions to implement the AAP clinical practice guideline were effective in improving provider adherence to Vitamin D laboratory testing for children with epilepsy. Successful implementation resulted largely from provider support and enthusiasm for the change, and these factors are essential to any successful practice change. The providers have fully adopted the guidelines as a part of their practice protocols and intend to continue checking statistics annually to assess continued efforts. The sustainability of this important practice improvement ensures highest quality of care for children with epilepsy. With increasing evidence regarding damaging effects of Vitamin D deficiency and insufficiency, implications for early detection and treatment are potentially life changing for not only this vulnerable population, but for all children. This project is currently under review with the Journal of Pediatric Health Care for publication consideration. Dissemination of this successful practice change is important as an exemplar of effective educational intervention and potential for future practice changes in a variety of settings. As a primary care PNP, the knowledge gained from this experience enhances my awareness and identification of children at risk for Vitamin D deficiency and establishes a foundation for prevention and ongoing practice improvement wherever I practice. 3

4 MARY COURTNEY SATTERFIELD, DNP 194 Recess Drive Ladson, South Carolina (843) EDUCATION MEDICAL UNIVERSITY OF SOUTH CAROLINA, Charleston, SC Doctor of Nursing Practice, received August 2013 specializing in preparation to practice as a Pediatric Nurse Practitioner Cumulative GPA: 4.0 VIRGINIA COMMONWEALTH UNIVERSITY/MEDICAL COLLEGE OF VIRGINIA, Richmond, VA Bachelor of Science in Nursing, received December 2003 SALEM COLLEGE, Winston-Salem, NC Bachelor of Arts, received May 1997 Cum laude ACADEMIC CLINICAL EXPERIENCES IN PEDIATRIC PRIMARY CARE NAVAL PEDIATRIC HEALTH CLINIC, Goose Creek, SC PNP Student (January 2013-July 2013) SUMMERVILLE PEDIATRICS, Summerville, SC PNP Student (August 2012-December 2012) MEDICAL UNIVERSITY OF SOUTH CAROLINA CHILDREN S CARE CLINIC, North Charleston, SC PNP Student (January 2012-August 2012) COASTAL PEDIATRIC ASSOCIATES, Mount Pleasant, SC PNP Student (August 2011-December 2011) ACADEMIC CLINICAL EXPERIENCES IN PEDIATRIC SPECIALTY CARE MEDICAL UNIVERSITY OF SOUTH CAROLINA PEDIATRIC NEUROLOGY, Charleston, SC MEDICAL UNIVERSITY OF SOUTH CAROLINA PEDIATRIC ENT, Charleston, SC MEDICAL UNIVERSITY OF SOUTH CAROLINA PEDIATRIC ORTHOPEDICS, Charleston, SC MEDICAL UNIVERSITY OF SOUTH CAROLINA PEDIATRIC ER FAST TRACK, Charleston, SC DNP PRACTICE IMPROVEMENT PROJECT Screening for Vitamin D Deficiency in Children: Improving Provider Adherence to AAP Guidelines Completed July 2013 Successfully implemented practice change in a pediatric neurology clinic to screen all children with epilepsy for Vitamin D deficiency per AAP Clinical Practice Guidelines. RN WORK EXPERIENCE PALMETTO PRIMARY CARE PHYSICIANS, North Charleston, SC Registered Nurse, Urgent Care Clinic (April 2012-September 2013) Prioritize and provide nursing care for multiple patients in a busy urgent care setting. Triage patients and establish acuity. Communicate with all members of the healthcare team to ensure continuity and quality of care. Initiate and manage IV infusions according to physician orders. Administer medications according to physician order. Educate patients regarding diagnosis and anticipatory guidance. 4

5 Telephone Triage Nurse (October 2006-April 2012) Triaged telephone calls from or about PPCP patients after office hours and offered appropriate healthcare advice based upon assessment questions, triage protocols, symptom guidelines, health history and nursing knowledge. Contacted on-call physicians as necessary regarding patient care and disposition and assisted physicians with scheduling, called in prescriptions, reported critical test results/lab values and documented all of these appropriately in chart along with any verbal orders. Documented detailed accounts of all telephone conversations with patients as part of their permanent medical record and notified patient's primary care physician about the events. Registered Nurse, Primary Care Office (April 2006-October 2006) Provided nursing care for one physician and one physician's assistant in a busy primary care office. Responded to telephone messages daily in addition to above responsibilities and coordinating patient care for two providers. MEDICAL UNIVERSITY OF SOUTH CAROLINA CHILDREN'S HOSPITAL, Charleston, SC Clinical Nurse Coordinator, Neonatal Intensive Care Unit/Special Care Nursery (March 2005-December 2005) Provided conscientious nursing care to premature and term newborns in a 38 bed Level III NICU including assessments, medication administration, management of intubated infants on mechanical ventilators, monitoring central arterial and venous access, administering feedings, obtaining blood samples, starting IVs. Provided developmental care for the babies in this environment and supported and educated families about the special immediate and ongoing needs of their infants. Communicated effectively with all members of the health care team including physicians, nurse practitioners, other nurses, social workers, pharmacists and support staff to ensure optimum care for the neonates. VIRGINIA COMMONWEALTH UNIVERSITY MEDICAL CENTER/MEDICAL COLLEGE OF VIRGINIA HOSPITALS, Richmond, VA Clinical Nurse I, Newborn Intensive Care Units (December 2003-October 2004) Provided nursing care to premature and term infants in a 40 bed Level III NICU including assessments, management of infants on ventilators, medication administration, obtaining blood samples and starting IVs, monitoring central lines, administering feedings. Participated in educating families about the special care needs of their infants. Communicated nursing findings with all members of the health care team including physicians, nurses, nurse practitioners, social workers, pharmacists and support staff. LICENSES AND CERTIFICATIONS South Carolina Registered Nurse License #R American Heart Association BLS for Healthcare Providers 5