Evidence

Steps Forward in Consistently Safer Care

In the first 10 months after its inception in March 2023, the RN HAC (Hospital Acquired Conditions) Committee achieved an impressive 40 percent reduction in HAC events, propelling Lurie Children’s forward on its journey to becoming a High Reliability Organization. In addition to providing consistently safer care – the ultimate goal – this HAC reduction translates to an estimated $2.9 million in savings.

Led by Stephanie Jones, MS, RN, RNC-NIC, CBC, Michael Olsen, MS, RN, CPN, and Kristen Psujeck, MSN, RN, CNL, CCRN, the committee engages frontline nurses and respiratory care practitioners by conducting monthly rounds called “Prevalence Days.” During these rounds, every patient in inpatient areas is assessed for risk of developing six HACs (Central Line Associated Blood Stream Infections, Catheter Associated Urinary Tract Infections, Unplanned Extubations, Falls, Hospital Acquired Pressure Injuries and Peripheral Extravasations). Since initiation of the RN HAC Committee, 6,169 patients have been assessed, 5,679 evidence-based interventions took place to mitigate HAC risk, and an average of 167 nurses interacted with each Prevalence Day. Findings from Prevalence Day are communicated at multidisciplinary roundtables and shared with HAC leads for awareness and follow-up.

Their progress continues. Within the past year, the committee broadened its focus to include a seventh HAC (Codes Outside the Intensive Care Units) in their risk assessment rounds. They also added night shift Prevalence Days in the three intensive care units to engage evening and night staff in HAC prevention efforts, and included respiratory care practitioners.

“The involvement of front-line nurses and partnership with families in HAC prevention efforts are key to our continuing success in reducing harmful events,” said Tierney Lofgren, BSN, RN, Neonatal Intensive Care Unit (NICU). “Families often share with us that they appreciate that extra set of nurses checking on their child. The more eyes on a patient, the more opportunities there are to ensure evidence-based prevention care is occurring. Working together, we are fostering a safe environment that leads to better care and better outcomes.”

Leading Genetics Research to Improve Care

Advanced Practice Provider (APP) Erika R. Vucko, MSN, APRN, FNP-BC, AGN-BC, Division of Genetics, Genomics, combines her clinical leadership with advancing care through research to lead Lurie Children’s Phenylketonuria (PKU) Clinic. It is one of the largest PKU clinics of its kind in the nation, providing long-term care for approximately 350 patients ranging in age from infancy to adulthood. PKU – a rare, inborn error of metabolism disorder caused by an enzyme deficiency - places patients at risk for neurocognitive deficits, as well as ADHD, anxiety and depression. As with many other rare diseases, it takes dedicated patient advocates, like Vucko, to push for advancements in disease understanding and treatments that improve patients’ lives.

Vucko is the Principal Investigator on multiple clinical and observational studies that aim to improve understanding and treatment of patients with PKU. The clinical trial Vucko spearheads is evaluating in adolescents the enzyme replacement therapy that was recently FDA-approved in adults. “Currently, we only have dietary management for teens with severe PKU and it is difficult to maintain,” says Vucko. “Through our clinical trial, we hope to provide an effective treatment that addresses the root cause of this disorder.”

The observational studies Vucko leads include long-term follow-up of PKU patients through the National Institutes of Health (NIH)-funded Phenylalanine Families and Researchers Exploring Evidence (PHE-FREE) Consortium. As the seventh site being added to the PHE-FREE Consortium, Lurie Children’s is the only site within the consortium that has an APP as co-principal investigator. “This study focuses on the neurological component of PKU and what it means to patients,” she explains. “It is an excellent opportunity for our patients to contribute to the understanding of their condition.”

“To be invited to be PI on clinical trials when few if any other sites also list an APP as a PI, is a testament to the expertise I have gained through my years of running the PKU clinic, as well as through years of clinical trial work as a sub-investigator. I would be naïve – given the physician-dominated landscape - to not acknowledge the important role Dr. Barbara Burton has had as my mentor and advocate to help me be recognized and trusted with these opportunities. It is meaningful to me to be PI, as it is a milestone I didn’t think was attainable when I first started based on my title,” reflects Vucko.

In addition to her leadership at Lurie Children’s, this year Vucko became the inaugural President of Clinical Genetics Advanced Practice Providers, a national association that supports, fosters, promotes and expands the advanced practice provider (APP) role in clinical genetics and genomics. She is sought after for her PKU expertise to serve on industry advisory boards, furthering the understanding and treatment of PKU that leads to improved lives for children with this condition. Vucko exemplifies how expanding the role of APPs can shape the future and significantly enhance patient care.