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International Quality Improvement Collaborative for Congenital Heart Surgery

International Quality Improvement Collaborative for Congenital Heart Surgery. Vision. Facilitate a collaborative of healthcare teams from around the world creating a culture of patient safety & quality for children receiving congenital heart surgery in developing world countries. Mission.

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International Quality Improvement Collaborative for Congenital Heart Surgery

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  1. International Quality Improvement Collaborative for Congenital Heart Surgery

  2. Vision Facilitate a collaborative of healthcare teams from around the world creating a culture of patient safety & quality for children receiving congenital heart surgery in developing world countries

  3. Mission Our mission is to reduce mortality and major complications for children undergoing congenital heart surgery.

  4. Objective Create tailored QI strategies to reduce mortality and major complications for developing world programs. Employ a telemedicine platform to facilitate distance learning, dialogue, disseminate knowledge & skills.

  5. Drivers of Mortality Team-based Practice through Nurse Empowerment Reduce Surgical Site Infections and Bacterial Sepsis Safe Operative Practices

  6. Key Driver Diagram Change Strategies Key Drivers Aim Utilize a surgical safety checklist to prompt and document evidence-based process measures (i.e. antibiotics given within 60 minutes of surgical incision) Safe Perioperative Practice Focus on hand hygiene for ALL clinical personnel in contact with patient care. Reduction In 30 day mortality associated with congenital heart surgery Reduce Surgical Site Infections & Bacterial Sepsis Empowering nurses Evidence-based nursing practice Scripting nurses in ward and ICU on how to give reports Accurate 24hr total patient intakes and outputs Accurate daily recording of patient weight Effective Communication-SBAR Team-based Practice

  7. Learning Modules Contain QI strategies for each of the 3 drivers that impact mortality. Each module contains a series of 3 educational sessions (one session/webcast). Sessions advance from beginning, intermediate, and advance-level of learning & acquisition of skills.

  8. Core Curriculum Webinars Team-Based Practice Clear Communication & Effective Teamwork Postoperative Care: Important Nursing Considerations Crisis Resource Management Principles Reduce Surgical Site Infections and Bacterial Sepsis Hand Hygiene Prevention of Central Line -Associated Bloodstream Infections Prevention of Surgical Site Infections Safe Perioperative Practice Implementation of a surgical safety checklist for congenital cardiac surgery (Modules I & II)

  9. Advanced Modules Pain Management and Nutrition Post-operative Respiratory Management and Prevention of Pneumonia Fetal Circulation and Physiology Arrhythmias

  10. Timeline for Webcasts The color of each Learning Module corresponds to the date the topic will be presented during that month’s webcast. For example, Team-based practice will be the topic 2/16 and 5/18.

  11. Participating Centers Founding Sites 2010 Sites 2011 Sites

  12. Cumulative Site Participation *Graph captures only sites that have entered > 10 patients into the IQIC Database.

  13. Cumulative Number of Surgical Procedures Month

  14. Advanced Nursing Module I Cardiac Embryology, Fetal Circulation, and Anatomy & Physiology January 19, 2011

  15. Today’s Presenters • Lisa McCabe, MSN, RN-BC, CCRN • Nurse in the Cardiovascular Program at Children’s Hospital Boston since 1985 • Recognized as a clinical expert (Staff Nurse III) and served as Education Coordinator in the CICU for 14 years • Staff Nurse III in the Inpatient Cardiovascular Unit and is now a • Clinical Nurse Specialist Inpatient Cardiovascular Unit • Extensive experience presenting on topics related to pediatric cardiovascular care locally, nationally, and internationally. • Coordinated educational offerings for the Cardiovascular Program at Children’s Hospital, the institution-at-large and other professional nursing agencies and organizations • Nancy J. Braudis, RN, MS, CPNP, CCRN • Clinical Nurse Specialist in the Cardiovascular Intensive Care Unit (CICU) at Children’s Hospital, Boston • She has a passion for teaching and mentoring nurses in the CICU and beyond • Earned her advanced degree from Boston College • Developed an interest in research related to improving nutritional outcomes in infants with hypoplastic left heart syndrome and developed an algorithm • She was the principle investigator of a study to test the safety and efficacy of the feeding protocol. • She has presented both nationally and internationally on this topic • Recently published her findings in Pediatric Critical Care Medicine • In 2009 she was the recipient of the “Outstanding Nursing Investigator Award.”

  16. Cardiac Embryology

  17. Objectives The goals for reviewing cardiac embryology are: • To understand the factors that can affect normal development of the heart. • To understand the complex nature of fetal cardiac development. • To understand how heart defects can occur in fetal development.

  18. Etiology & Incidence of Congenital Heart Disease • Majority of cardiac development occurs between week 4 and 7 of fetal life • Congenital heart disease occurs in 8 out of 1,000 live births • 2-3/1000 are considered “critical”

  19. Causes of Congenital Heart Disease • Chromosomal anomalies • Genetic defects • Family history • Effects of drugs or maternal illness • 85-90% Unknown

  20. Associated Abnormalities • Chromosomal disease or syndrome • Extracardiac anomalies in 20-45% of congenital heart disease • look for other anomalies of limbs, kidneys, gastrointestinal tract, lungs, vertebra, palate, etc.

  21. Family History:Assessing Risk Factors • Family history of congenital heart disease • Maternal history of congenital heart disease

  22. Familial Risk • Incidence of congenital heart disease in siblings: 2% • Increased incidence of congenital heart disease in siblings with left sided obstructive lesions: 8-14% • Offspring of parent with congenital heart disease: 8-14%

  23. Environmental Exposure • Maternal illness • First trimester rubella • Insulin-dependent diabetes • Maternal cytomegalovirus • Systemic lupus erythematosus • Maternal phenylketonuria

  24. Environmental Exposure • Drugs associated with congenital heart disease • Certain anti-seizure medications • Certain mood stabilizing medications • Alcohol

  25. Cardiac Development

  26. Fetal Life:Week 1 • Fertilization • Genetic mixing • Movement of blastocyte • Implantation

  27. Fetal Life:Week 2 • Deeper implantation • Primitive placenta forms

  28. Fetal Life:Week 3 • Primitive umbilical cord develops

  29. Fetal Life:Week 3 • Three layer disk • Endoderm • Mesoderm • Ectoderm

  30. Endoderm:Inner Layer • Primitive intestinal tube • Mucous membranes • Glands • Lung buds • Urinary tract • Yoke sac

  31. Heart and vascular system Dermis Subcutaneous tissue Muscles Skeleton Sex glands Lymph glands Kidneys Connective tissue Blood cells Mesoderm:Middle Layer

  32. Ectoderm:Outer Layer • Epidermis • Hair • Sebaceous glands • Sweat glands • Nervous system

  33. Cardiogenesis • Primitive heart

  34. Cardiogenesis • Dextro looping = normal looping

  35. Atrial Septation(Day 28) • Septum primum • Septum secundum • Endocardial cushion tissue

  36. Errors during Atrial Septation • Secundum Atrial Septal Defect • Primum Atrial Septal Defect • Mitral Valve defects • Tricuspid Valve defects • Complete Atrioventricular Canal

  37. Truncal Septation(Day 28-35) • Right and left conus swellings • Right and left conotruncal ridges

  38. Errors during Truncal Septation • Truncus Arteriosus • Tetralogy of Fallot • Double Outlet Right Ventricle • Transposition of the Great Arteries • Pulmonary Stenosis • Pulmonary Atresia • Aortic Stenosis Tetralogy of Fallot

  39. Ventricular Septation(Day 33-37) • Muscular tissue • Membranous tissue

  40. Errors during Ventricular Septation • Ventricular Septal Defects • Muscular • Membranous • Subpulmonary (conal septum) • Atrioventricular Canal type

  41. Arch Formation(Week 4) • Initially, six pairs of brachial arch arteries • 1st, 2nd, and 5th pairs disappear, forming ligaments that hold the heart in place

  42. Third Aortic Arch Forms: • Common carotid artery • External carotid artery • Internal carotid artery

  43. Fourth Aortic Arch Forms: • Part of final aortic arch • Proximal portion of right subclavian artery

  44. Sixth Aortic Arch Provides: • Proximal segment of the branch pulmonary arteries • Ductus arteriosus • Pulmonary blood flow via the branch that develops lung buds

  45. Errors in Arch Formation • Coarctation of the aorta • Interrupted Aortic Arch • Aortic atresia • Patent Ductus Arteriosus • Vascular ring

  46. Fetal heart resembles postnatal heart in structure and function by Day 44 Fetal Development

  47. Questions ?

  48. Fetal Circulation

  49. Objectives The goals for reviewing the physiology of fetal circulation and postnatal circulation are: • To understand blood flow in the fetal circulation • To understand the change in blood flow that occurs in the first days and weeks of postnatal life • To understand the process by which the structures of fetal circulation close.

  50. Fetal Structures • Placenta • Umbilical vein • Ductus venosus • Foramen ovale • Ductus arteriosus • Umbilical arteries

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