July 28, 2020

When Nurmeen Khokhr called her pediatrician’s office to schedule a time to come in and get the vaccinations she needed before going off to college in the fall, she was pleased to hear she didn’t have to step out of her car.

A new program called Car Side Care is being piloted at Texas Children’s Pediatrics Cypresswood in Spring and allows patients nine and older to receive vaccinations from the comfort and safety of their vehicles. All patients have to do is make an appointment, answer a few screening questions, get their temperature taken and roll up their sleeves.

“We are providing the same high-quality care in parking spaces outside our practices as we provide inside our buildings,” said Assistant Vice President Sara Montenegro. “In doing so, we are helping reduce patients’ and staff members’ potential exposure to COVID-19.”

The idea for Car Side Care followed a national drop in the number of patients coming in to get their routine vaccinations. When asked, many patients and/or their family members sited fear of being exposed to the virus as their reason for delaying their shots.

Dr. Stanley Spinner, chief medical officer and vice president of Texas Children’s Pediatrics, said he doesn’t blame people for being cautious, but emphasized the importance of routine childhood vaccines does not lessen during a pandemic. In fact, Spinner said, children should be getting them now more than ever with back to school and flu season right around the corner.

“Vaccines are arguably the most effective public health measure we have next to clean water,” Spinner said. “They are that important, and with the pandemic, they are even more so. I would hate to see a child sick with both COVID-19 and something else like the flu.”

In addition to routine vaccinations, getting kids inoculated against the flu is one of the main drivers behind Car Side Care. Prior to the pandemic, patients needing a flu vaccine often would call their pediatrician’s office, make a nurse’s appointment, and drop by and get their vaccine. That won’t work today with COVID-19 when so many extra precautions are necessary to limit exposure.

“Our offices are very cautious about safety precautions, and with that, needed creative solutions to see hundreds of children for flu vaccine and childhood immunizations quickly, without needing to come in our facilities,” Montenegro said. “Care Side Care is a perfect way to handle this and to hopefully remain on top of the upcoming flu season by vaccinating as many children as possible.”

Car Side Care was launched as a pilot at Texas Children’s Pediatrics Cypresswood and has grown across more than 15 Texas Children’s Pediatrics sites, as we work closely with our landlords to allocate parking spaces to support this program.

Each location will designate four parking spots a couple of times a week to patients wanting to come by and get their vaccines. An appointment will be necessary as well as a COVID-19 screening. Patients and anyone else in the vehicle will be required to wear a mask. Clinicians will wear a mask, goggles and a protective gown. The program has also been expanded from caring for older children to caring fo children of any age over the past two months.

“Texas Children’s Pediatrics has done a very good job at continually finding ways to provide the care our kids need in the safest possible environment,” Spinner said. “Our families seem very happy with the modifications we’ve made thus far and they seem pleased with our commitment to maintain the quality of care we’ve always provided.”

Khokhr said she was very pleased with her Car Side Care experience. It was convenient and gave her the sense of safety she needed to get the shots required by her school.

“I’m glad Texas Children’s Pediatrics is doing this,” she said. “I think it will help ease the nerves of a lot of patients who want to come in and get their vaccines.”

Diana Lopez shares her role as a clinical product evaluation coordinator in Supply Chain, and how she and her team collaborate to ensure the organization has adequate supplies to support daily operations during COVID-19. Read more

July 27, 2020

As we near the end of summer and schools share their plans for reopening, there are, undoubtedly, many questions parents and caregivers have due to COVID-19’s impact on our communities. There are certainly no easy, one-size-fits-all answers to these questions. After all, we are facing an unprecedented situation. Both the American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC) have published guidance documents addressing safety measures that schools and parents can practice to mitigate risk. These measures do just that – mitigate – but they cannot eliminate all risk of acquiring COVID-19.

Dr. Galit Holzmann, associate director of Infection Prevention at Texas Children’s Hospital West Campus, addresses many top-of-mind questions in a blog found here. These and many others are common questions and considerations for parents and caregivers of school-aged children. There is understandable uncertainty for parents regarding whether schools will or should physically open, and whether they should send their children to school if/when physical reopening occurs.

Ultimately, the decision of whether to send a child back to school will be a personal one for each family, incorporating the overall physical and emotional health of the child, presence of high-risk underlying medical conditions in household members, the ability to learn virtually, the extent of community spread, the family structure and finances, and parent’s/child’s comfort level.

Since March 6, Texas Children’s Supply Chain Team has worked hard to ensure the organization has enough supplies to care for our patients during the COVID-19 pandemic. Now, four months later, Texas Children’s is still going strong.

With the increasing demand for N-95 masks and other personal protective equipment (PPE), the hospital’s PPE supply has grown significantly since the COVID-19 pandemic began. In early March, Texas Children’s had 10,000 N-95 masks on hand. As of July 22, the organization has 521,000 N-95 masks, which is the largest supply of masks in the Texas Medical Center. The Supply Chain also secured 3 million procedure masks and 1.2 million isolation gowns.

Much of this success is credited to the Supply Chain’s multi-tiered strategy for acquiring products. Texas Children’s obtains PPE in many different ways. The organization can source it through our Group Purchasing Organization (GPO), which most hospitals in the country do, or it can go out into the marketplace to secure aggressive deals.

“Prior to the COVID-19 pandemic, Texas Children’s primarily acquired N-95 masks from a single company,” said Bert Gumeringer, Texas Children’s senior vice president for Facilities Operations. “Since the pandemic, we are now sourcing PPE from three different U.S. suppliers, which has eliminated our need to purchase PPE product from China. If one of our suppliers can’t provide us with PPE, we have two other resources to meet our needs.”

Gumeringer and other leaders meet at least twice a week to discuss PPE and stay abreast of new developments in the global market. They meet daily with our PPE suppliers to discuss plant status, FDA approvals and incoming shipments. Despite rumors of PPE shortages swirling on social media, Gumeringer says there is no shortage.

“There is PPE out there if you know how to acquire it,” Gumeringer said. “Our Supply Chain team is doing an excellent job of helping us acquire product so we can support patient care. We have a good system in place.”

While Supply Chain continues to grow our PPE inventory, Dr. Judith Campbell says it is important for employees and staff to be mindful of their use of PPE and engage in conservation practices as much as possible. Many organizations like Texas Children’s are using a lot of PPE , especially N-95 masks.

“We are using 2,500 N-95 masks per day, which is the highest usage rate in the Texas Medical Center,” said Campbell, medical director of Infection Control and Prevention at Texas Children’s. “To conserve our supply, we encourage our staff to use a clean procedure mask over their N-95 when an N-95 mask is recommended, for example, when seeing a patient under investigation (PUI) for COVID-19.  After evaluating the PUI, remove the outer procedure mask, to extend the use of the N-95 mask.”

Campbell says if we all do our part, we can conserve the N-95 masks and other PPE supplies that we do have, which will help us in the months ahead during this pandemic.

Click here for PPE guidelines on the extended use of N-95 masks in certain patient care locations.

If you ask Michael Pickett, a nurse practitioner in the Pediatric Cardiovascular Anesthesia Section at Texas Children’s, what he enjoys most about his job, he’ll be quick to say – his passion for innovation and the interdisciplinary collaboration with his colleagues. Pickett says no matter how big the challenge, staying focused on the end goal is what keeps him going.

“What I like about innovation is you have to expect the unexpected,” said Pickett, who also serves as an innovation mentor for the Texas Children’s Hospital Global Hematology-Oncology Pediatric Centers of Excellence and Nursing Innovative Solutions Council (ISC) at Texas Children’s. “There’s no guarantee that you’re going to be successful. But the hope is that you will be, and you just have to keep working at it.”

When Pickett was a graduate nurse 22 years ago, he says he faced many of the same challenges new nurses encounter when inserting a peripheral intravenous (PIV), performing central venous catheter (CVC) care and maintenance, and accessing a port on a patient for the first time. Back then, he wished there were more simulation training tools available when he was a new nurse.

As a natural innovator at heart, Pickett was determined to turn this vision into reality. Sharing his concepts with frontline innovators at Texas Children’s, Pickett gained the support from nursing colleagues and leaders across the organization who provided continual feedback throughout the innovation process. It quickly became the team’s goal to develop and implement novel skills technique videos partnered with the PIV, CVC and Port Task Trainers designed by frontline innovators that are wearable, cost-effective, durable, realistic and allow all procedural steps trainees would perform. A secondary goal was to document and open-source the innovation process utilized to develop these proof-of-concepts.

After nearly four years of development including more than 20 prototype iterations and pilot surveys, two international presentations and an international SimVentor award, the RediStik Wearable PIV, CVC and Port Trainers were finalized and produced in collaboration with Sawbones®, the leader in medical models for orthopedic and medical education, along with the support from ISC, Entrepreneurship and Innovation teams, Marketing and Legal departments, and hundreds of frontline innovators representing more than 20 different clinical areas at Texas Children’s Hospital.

The Redistik Wearable PIV, CVC and Port Trainers are portable, light weight, skin models that can be placed on a live person, table top or mannequin. The trainers help clinicians master various procedural skills like how to insert a PIV line, access and de-access a port, and how to perform sterile techniques for dressing application and cap changes to prevent pressure injuries and central line associated bloodstream infections.

“When we designed the task trainers, we wanted the experience to be realistic as possible,” said Pickett, lead inventor of the Redistik Wearable PIV, CVC and Port Trainers. “With many of the current simulation task trainers on the market, once they are used a few times, you can see where to stick and it’s just not as realistic. Our task trainers have a needle proof backing to prevent accidental needle sticks and resilient material that allow for over 1,000 punctures per task trainer that can’t easily be seen on the skin model.”

The RediStik PIV, CVC and Port Trainers were piloted in 2019 and are now being used throughout the Texas Children’s system. The nurse residency program has implemented PIV insertion skills training during new nurse orientation using the Redistik PIV trainers. Prior to training, 15 percent of nurses surveyed said they were “confident” on starting PIV lines. After completing training, their confidence level rose to 96 percent.

“We used the PIV and Port Trainers during our annual training and everyone appreciated the hands-on practice,” said Kate Jones, a decentralized education coordinator. “The ability to move the port placement around to increase the difficulty of access and the ability to get blood return made it much more realistic.”

The impact of Pickett’s innovation can also be felt around the globe. The RediStik PIV, CVC and Port Trainers have been piloted at Texas Children’s Global HOPE clinics in Sub-Saharan Africa where the PIV trainer has had a significant impact on improving their rates of PIV extravasations and reducing PIV attempts.

Far reaching impact

Global HOPE Director of Nursing Education Dr. Marilyn Hockenberry said when she learned about the RediStik PIV Trainer she was ecstatic because the rate of PIV attempts was high in her clinics as well as IV extravasation, which is when you are administering a drug, such as chemotherapy, and it seeps into the outer tissues surrounding the injection site causing painful inflammation.

“Children with cancer in Africa don’t have the benefit of a central line,” Hockenberry said. “All chemotherapy is done through a peripheral vein, creating challenges for both our patients and our providers.”

The use of the RediStik PIV Trainer has greatly reduced these challenges, lessening both the number of PIV attempts and IV extravasation incidents. Hockenberry introduced the innovation to her clinics in Botswana, Malawi and Uganda more than a year ago holding regular hands-on training workshops, many of which are still being held today.

During the workshops, clinical staff learn how to put in a peripheral intravenous line, care for the line and confidently administer chemotherapy. Prior to the trainer, staff learned as they cared for patients. There was no way to do hands-on training.

Competencies learned on the PIV trainers have decreased extravasation rates from 42 percent to 5 percent in less than a year’s time. Prior to using the task trainer, only 19 percent of PIVs were obtained with three or fewer attempts compared to 99 percent after the post task trainer assessments.

“If you want to cure cancer in Africa you have to improve IV use, PIV use and the administration of medication,” Hockenberry said. “These devices are great for making that happen.”

Hockenberry added that without people like Pickett and the team of innovators, the progress made in Africa would not have been able to happen. She said Pickett and the innovation team are crucial to the clinical process and have made a significant difference in the lives of our patients around the globe.

“It’s just a great feeling to see how these innovative training tools have benefited our staff and our patients,” Pickett said. “It took a lot of hard work to finally get to this point, but it was all worth it.”

About Redistik

Visit www.texaschildrens.org/redistik to access product details, skills video tips/techniques and data outcomes. Click here to learn more about Sawbones®.

Contact Michael Pickett at mtpicket@texaschildrens.org if you would like to check out one of the RediStik products for staff training.

So many teams at Texas Children’s have stepped up in remarkable ways since the COVID-19 pandemic began. The Section of Palliative Care (Pediatric Advanced Care Team) is no different. In fact, this often unsung group has proven its value like never before as families desire more connection, enhanced communication and extended conversation.

The multidisciplinary team of 23 serves Medical Center Campus, West Campus and The Woodlands hospitals.

“We provide an extra layer of support for families and patients who are going through an illness,” said Claire Crawford, palliative care social worker. “We help with non-verbal expressions of compassion in the absence of touch, which has been in exceptionally high demand since the pandemic began.”

Crawford adds that with new visitation guidelines, parents are often alone when they receive news that’s hard to hear. Therefore, there is a need for even more support. “On top of that, our nurses and doctors are often delivering this news while wearing masks, goggles and other protective equipment so it is even more challenging for them to convey their empathy. This is where we come in.”

Crawford says the team can consult with other health care workers to ensure that dialogue with families is compassionate and connective.

In addition, the goals of the department are to:

  • Provide emotional support for children and families
  • Provide support for difficult hospitalizations
  • Manage distressing symptoms
  • Engage social work resources
  • Help families make difficult decisions
  • Refer to supportive therapies (psychology, music therapy, art therapy, and Pawsitive Play) for patients
  • Enhance quality of life
  • Utilize integrative medicine techniques
Doesn’t palliative care mean “end of life?”

One of the department’s main goals is to educate our patient population on their role and to debunk the myth that palliative care always means that a child may die. “It is true that our services in an adult setting often do mean that the end of life is near, but that is far less the case in a pediatric setting,” said Crawford. “Of course, there are times when we do need do have those discussions, but we are working hard to make sure that when parents hear our name they don’t automatically assume the worst.”

A Texas Children’s dream team

This all-star team is led by Dr. Tammy Kang, section chief of Palliative Care and consists of palliative care specialists, including:

  • Doctors
  • Nurses and nurse practitioners
  • Social workers
  • Chaplain
  • Grief and bereavement specialist
  • Administrators
  • Psychologist
  • Researchers

Crawford said the success of the team is built on respect for one another, friendship and an unyielding dedication to provide the best care to patients.

July 26, 2020

We are in this together

The following passage was written by Texas Children’s Chaplain James Denham.

It’s hard for me to describe just how unwieldy the pandemic is and what we are having to do to navigate. But, really I don’t need to describe it because you know it all too well. We all feel like we are doing things on the fly, responding immediately to immediate changes and crises.  Normally, this isn’t an issue.  But for four months now, we have been uniquely challenged to respond, react, understand, build, rebuild, adjust, rework, add, decrease, distance, rewrite, and then just breathe, all on the fly.  It is a constant challenge.  It’s hard to wrap our minds around what we are doing and what the next step is. I get it, and I feel it too.

Last year, my friend texted me a picture of a sculpture from a place he visited. When I look at the image today, I see there are three people, building what looks like a bike wheel! The outer circle well on its way to being complete, but the inner spokes are curved, bent, unfinished, and being straightened and organized.  The key is, the wheel is still rolling! The visual is stunning. It speaks to me, and I hope you feel like it connects with you too.

Texas Children’s’ response to the COVID-19 pandemic and your personal response to the event are building, growing and changing with each passing day. It’s easy to feel like it is too much or that it is too hard at times.  It seems we go around and around and that we are stuck just holding on.  But it is not too hard or too impossible because ultimately we are responding together.  We rely on each other when the wheel keeps spinning.  We build what we can when we can, and reassess each and every time, knowing we are doing it together.  Perhaps we are building the wheel as it is rolling by wearing masks in public, making each other laugh, sharing encouragement, giving quality (albeit socially distanced) time to that person we pass in the hall we haven’t seen in a while.  Build what you can when you can.

Just as importantly, when you imagine the picture of the bicycle wheel, I hope it is a reminder that we must be understanding with each other and ourselves.  It is hard to do what we are all doing, and sometimes, one cannot build perfect spokes while it is still moving, or complete the spokes in one cycle around.  Remind yourself that what you, and we, are doing is hard and difficult, but that your efforts, your part, your holding on is worthwhile.  In fact, it is extraordinary!  Then take a deep breath and take the next step on this journey.

May you find peace in this chaotic time, and may you find gentleness with yourself as you are building on the move.