March 8, 2016

We did it!

Texas Children’s Pavilion for Women recently received the Baby Friendly Hospital (BFH) designation – an impressive milestone that demonstrates the value of teamwork and our nurses’ commitment to educating and supporting new mothers on the benefits of breastfeeding.

Launched by the World Health Organization and the United Nations Children’s Fund in 1991, the BFH Initiative encourages and recognizes hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. Baby Friendly USA awards the designation to birthing hospitals that successfully implement the Ten Steps to Successful Breastfeeding.

“While achieving the baby friendly hospital designation was a lengthy four-phase process,” said Women’s Support Services Director Nancy Hurst, “this designation means that we are providing the highest level of care related to breastfeeding education, instruction and support for our patients.”

To meet the rigorous criteria for the BFH designation, the Pavilion for Women implemented numerous breastfeeding practices to ensure our nurses, obstetricians, and pediatricians are well trained to teach mothers how to breastfeed and maintain lactation, even when separated from their infants, which can occur when babies are confined in the neonatal intensive care unit (NICU) for long-term care. Implementing these evidence-based practices required tremendous teamwork between and among departments and staff.

“We collaborated with leaders and staff from all areas of the Pavilion for Women including OB and Maternal Fetal Medicine clinics, labor and delivery, mother-baby units, perioperative services and women’s specialty unit,” Hurst said. “We also educated environmental services, volunteer services and other ancillary areas on what BHF is and what it means for our patients.”

Several evidence-based breastfeeding practices initiated at the Pavilion for Women include:

  • Helping mothers breastfeed within one hour of birth
  • Teaching mothers to respond to their infant’s early feeding cues rather than schedule feedings
  • Encouraging “rooming in” so mothers and infants can stay together 24 hours a day
  • Implementing immediate skin-to-skin contact between mother and baby following delivery
  • Standardizing prenatal education to educate women about the benefits of breastfeeding
  • Providing 20 hours of didactic and skills-based education and instruction to all nursing staff caring for mothers and babies at the Pavilion for Women
  • Feeding infants only breast milk and providing mothers with resources for lactation support prior to leaving the hospital
  • Promoting Breastfeeding Champions Program to inspire nurses to become role models for other nurses by reminding them why it is important to encourage women to breastfeed

“New mothers often times do not succeed in breastfeeding because there are no systems in place to support them,” said Prenatal Education Program Manager Anne Wright. “Since 88 percent of the mothers who deliver at the Pavilion for Women want to breastfeed, it’s important that we implement and sustain practices that ensure their success.”

After giving birth to two sets of twins at the Pavilion for Women, Elizabeth Shackouls recalls how incredibly supportive the nursing staff was in helping her overcome certain breastfeeding challenges after both pregnancies.

“The nurses helped me figure out latch issues and when I became discouraged, they assured me things would be easier with time and supported me through every feeding,” Shackouls said. “Even long after I was discharged, I continued to seek the nursing team’s advice on various issues and always felt like they were there for me no matter what. The renowned nursing staff and the exceptional care they provide patients are instrumental in setting Texas Children’s apart from other hospitals.”

Nurse Girija Babu, who is also a breastfeeding champion in her group, described the journey toward BFH designation as an “incredible” experience.

“By achieving this milestone, we’re ensuring our nursing mothers receive the support they need during and after their hospital stay,” Babu said. “We  are also grateful to our OB providers and anesthesia team for their continuous support in making sure newborns are placed skin to skin on the mother’s chest soon after birth.”

For more information about Baby Friendly USA, click here.

February 23, 2016

22416simulationinside640The neonatal team at Texas Children’s Pavilion for Women is always prepared for special deliveries – taking care of newborns is what they’re trained to do. But earlier this month, the neonatal intensive care unit (NICU) received a special delivery that wasn’t quite what you’d expect.

Texas Children’s Simulation Center hosted an open house to introduce Tory, a high-fidelity infant mannequin, and the newest addition to the first-ever Neonatal Comprehensive In Situ Simulation Program launched at the Pavilion for Women’s Newborn Center. The simulation equipment and supplies were purchased with a generous $200,000 grant from the M.D. Anderson Foundation, which will also support an in situ simulation program for the Emergency Center and Critical Care, as well as one for the NICU in West Tower once a dedicated space for simulation has been identified.

“We’re grateful to our Newborn Center leadership for dedicating a simulation room at the Pavilion,” said Dr. Jennifer Arnold, medical director of the Simulation Center. “Now, our NICU providers can train in their actual practice environments during regular workdays to enhance individual and team performance – particularly in high-risk situations – and improve patient outcomes and safety.”

The in situ simulation program focuses on improving crisis resource management skills, one of which is role clarity. During a code, the potential for confusion and chaos can easily set in as responders attempt to care for a patient in a high-risk medical emergency. Clinicians responding to a code may not always be sure of their roles or the roles of their team members when they arrive, and that’s when in situ simulation training becomes crucial to patient safety and care.

“First, we conducted tests to determine the necessary roles in a crisis, whether it’s a resuscitation or a code,” said Dr. Mona Khattab, one of the in situ simulation program directors for the NICU. “By having the necessary personnel at the code, we alleviate staff overcrowding and ensure optimal efficiency and clear communication are achieved while delivering lifesaving treatment to our NICU patients.”

Inside the simulation room, colored labels – red, yellow and green – are affixed to the floor that encircle the bedside. These labels identify the specific roles of each of the code response participants and directs them to their position on the floor during a medical emergency.

  • The red team consisting of clinicians and nurses stand in the innermost circle closest to the bedside where they provide direct patient care.
  • The yellow team is positioned behind the red team. They support patient care providers by documenting the code, handing over equipment, managing the ventilator and medication and blood prep drawers, and providing mentorship and consultations to the team leader as needed.
  • The green team stands in the back of the room near the code cart and provides overall code and room support to ensure everything is running seamlessly.

“When a text message page is sent, the unit reports to the simulation room as if it were an actual page in the unit to respond to a code,” said Kellie Kainer, assistant director of Nursing for the NICU at the Pavilion for Women. “We give them a brief history of the patient and alert them to the code.”

The in situ simulations will occur every Thursday and last 10 minutes followed by 20 minutes of debriefing. The NICU teams alternate every week and are selected based on their current assignment and the flow of the unit on that particular day.

“We’re focusing on one specific patient case so that everyone gets exposure to that case,” said Dr. Leigh Ann Cates, a neonatal nurse practitioner and a program director for the in situ simulation program. “As our program expands, we hope it will become a model for in situ simulations in other units of the hospital.”

In preparation for this training, all clinicians within the Newborn Center complete an online pre-simulation course through Healthstream. The Simulation Center developed a series of powerpoint presentations covering crisis resource management skills, an orientation to simulation, and what to expect during simulation such as a confidential and psychologically safe learning environment.

February 16, 2016

A year ago, Knatalye and Adeline Mata lay on an operating table at Texas Children’s Hospital conjoined from the chest to the pelvis. For the next 26 hours, a team of surgeons and support staff separated the girls in an historic and intricate procedure meticulously choreographed to ensure that each step of the process would lead to and support the steps to come. Throughout the procedure, the Mata family stood by, waiting and praying for good news.

Just before 10 a.m. on February 18, 2015 the family counted their prayers as answered when they saw their girls, apart for the first time in adjacent rooms in the Pediatric Intensive Care Unit, where they were cared for by a team of specialized nurses. Since then, the almost 2-year-old twins have been discharged from the hospital and are living relatively normal lives in Littlefield, Texas with their parents Elysse and John Eric, 6-year-old brother Azariah and 5-month-old sister, Mia.

“The girls are both doing awesome,” said Dr. Darrell Cass, one of the lead surgeons in the separation case. “Neither have experienced any complications and both are making steady progress.”

Knatalye is beginning to walk, talk and eat by mouth. Adeline is meeting milestones as well. Her lungs are continuing to improve and she is slowly being weaned from ventilator support. Both girls are still undergoing physical and occupational therapy.

Several members of the medical staff involved in the girl’s care got to see how much Adeline and Knatalye have grown and how far they’ve come during a recent visit the Mata family made to Texas Children’s for follow-up appointments with pediatric subspecialists monitoring the twins’ health and development.

Aimee Renaudin, one of Adeline and Knatalye’s primary nurses in the Neonatal Intensive Care Unit, said she is amazed that the girls are doing so well.

“You would never know how they started off their lives together,” she said. “Elysee and Eric have taken such good care of them.”

Dr. Oluyinka Olutoye, the other lead surgeon in the separation case, said it’s a blessing to see how far Adeline and Knatalye have come.

“It’s always a joy to see the changes that have gone on,” he said. “They’ve gone from just being little babies to now trying to walk and talk and interact with you.”

John Eric said his daughters have far exceeded his expectations and that he and Elysee are enjoying being able to care for the girls at home.

“It’s nice to be able to have all of us together and to be able to wake up and know that they’re there,” Elysee said. “It’s fun to be able to be mom and dad, which we didn’t get to do for the first 10 months of their lives.”

The Mata family will return to Texas Children’s this summer for a checkup. During that visit, surgeons will operate on Knatalye, removing the metal struts used to stabilize her rib cage and to close her chest wall.

To read more about their journey click here. See photos from the Mata family’s latest visit to Texas Children’s below.

January 12, 2016

11316perioperativeinside640If you ask Nakeisha Archer, president-elect of the Greater Houston Chapter of the Association of periOperative Registered Nurses (AORN), who inspired her to pursue nursing, there’s one person who comes to mind – her grandmother.

“When I was a little girl, my grandmother shared stories about how she loved taking care of patients in their homes,” Archer said. “She was a private duty nurse and the joy she derived from helping others motivated me to become a nurse.”

After graduating from nursing school with several clinical rotations under her belt, Archer spent six years as a labor and delivery nurse, which included a few years as a travel nurse. Before obtaining her MBA in health care management, she realized her niche was in the operating room (OR).

“I spent a lot of time in the OR as a labor and delivery nurse but I knew there was more to learn,” Archer said. “After completing a perioperative internship program, that’s when my passion for periop began.”

As assistant director of Perioperative Services at Texas Children’s Pavilion for Women, Archer leads a dynamic team of more than 40 nurses who assist with the planning, implementation and evaluation of patient care before, during and after surgery. These activities include patient assessment, creating and maintaining a sterile and safe surgical environment, providing pre- and post-operative patient education, monitoring the patient’s physical and emotional well-being and working closely with the surgical team to provide safe patient care during each phase of the surgical care process. Archer also collaborates with her non-nursing team whose roles are critical to the perioperative process. These include secretaries who schedule new cases, surgical technologists who scrub the cases, and perioperative care technicians and anesthesia technicians who provide specialized team support.

“Perioperative includes the entire surgical experience,” Archer said. “We see between 175 to 210 cases per month which include open, robotic and laparoscopic surgeries to treat a number of gynecological conditions including cancers, urological issues, as well as general surgery, fetal interventions, caesarean deliveries and in vitro fertilization procedures.”

The Pavilion for Women has four Main OR’s, two OR’s in labor and delivery, one procedure suite in the Main OR, and two procedure rooms in the Reproductive Endocrinology and Infertility Clinic. Two more Pavilion for Women Main OR surgical suites will open in May 2016 bringing the total to six OR’s to meet the increasing demand for perioperative services.

Archer says the need to hire and retain experienced perioperative nurses to fill these new positions is one of her top priorities. She says the best way to home “grow” our nursing staff is by providing consistent educational tools and internship programs to cultivate their skills so they can easily adapt to this fast-growing nursing specialty.

“We have a lot of openings right now in periop on the Pavilion side because we’re growing,” Archer said. “Most hospitals that do not have a shortage of experienced OR nurses offer a consistent internship and residency program every six months. When you keep that pipeline going and keep those nurses coming in and consistently train them, they will be ready to be placed in their new roles.”

Since joining the Pavilion for Women two years ago, Archer is thrilled to offer the second perioperative internship program for nurses later this month. This endeavor, which will continue every six months, is part of a joint partnership with Texas Children’s Pediatric Perioperative Services.

When Archer assumes her position as AORN president in May, her passion to advance educational opportunities for nurses will be one of her primary goals.

“One of the things that I think we as leaders don’t always do is have a really good succession plan for our nurse leaders as well as our nurses who are leading at the bedside,” Archer said. “We need to provide them with opportunities to grow and re-energize their periop voices by engaging members around issues that impact them.”

Leading a multi-generational nursing workforce has become a tremendous challenge too. Archer plans to collaborate with nursing leaders to help reframe perceptions about generational differences and to view these attitudinal and behavioral differences as potential strengths.

While much of Archer’s day is spent attending meetings, rounding with nursing and physician staff and staying abreast of all the cases scheduled for each day, she says at the end of the day, her greatest joy is taking care of her patients – just like her grandmother did.

“On a really good day, I can go to our waiting area and have conversations with some of the patients and families, and make sure that things are going well,” Archer said. “That’s really the fun parts of the job. If we could do that all day, it would be really good.”

August 25, 2015

What would you do if your pregnant patient, who was five centimeters dilated, told you in the examination room, “I need to get married before I have my baby?”

For Dr. Karla Wagner and her Maternal Fetal Medicine (MFM) team at Texas Children’s Pavilion for Women, the response to their patient’s request was a no brainer. Instead of saying no, they embraced this rare and exciting opportunity.

“We knew how important it was for our patient to get married before her baby arrived,” said Aimee Jackson, a nurse practitioner and clinical manager for maternal medicine at Texas Children’s Fetal Center. “It wasn’t a matter of, “Can it happen?” It was more like, “It will happen.”

With little time on their side, the MFM staff sprung into action to fulfill their patient’s wedding wish. Within an hour, they pieced together a simple, yet elegant ceremony for expectant mom Stephanie Tallent and her soon-to-be husband Jason Nece.

The couple planned to get married over the weekend, but their plans abruptly changed on August 21 when Wagner discovered during Stephanie’s reassessment exam that she was five centimeters dilated and her baby was still breeched. Luckily, the couple had their marriage license in the car along with a white sundress that Stephanie planned to drop off at the dry cleaners.

With these two items checked off the list, the rest of the components for the ceremony fell perfectly into place.

“Stephanie got the good luck tradition for a bride,” Wagner said. “She borrowed a beautiful pearl necklace from one of my nurses, we found something blue, we decorated the room with flowers, and I gave her a bouquet of roses that I grabbed from my office so she could hold it as she walked down the aisle.”

The staff rounded up the wedding troops to ensure every detail of the ceremony was covered. Texas Children’s videographer Wally Crow and photographer Allen Kramer captured the ceremony, maternal fetal scheduler Ashanti Riggs sang a cappella and the hospital’s chaplain Johnna Faber officiated the ceremony.

Wagner’s primary nurse Susan Hardee Crosky played the “Wedding March” on her cell phone, as Wagner walked her patient down the hallway aisle into Clinical Room 3 where Stephanie and Jason exchanged their vows in front of a congregation of roughly 25 Texas Children’s MFM employees.

At the end of the ceremony, the staff quickly scrawled on a piece of paper, “Just Married” and stuck it on the back of Stephanie’s wheelchair before she was whisked away to the delivery room. Later that afternoon, Stephanie and her husband welcomed their precious baby girl, Sophia, who was delivered by caesarean section.

“I love the maternal fetal department,” Stephanie said. “They pulled everything together at the last minute and did an unbelievable job. We cannot be any happier than we are right now.”

For Wagner, she is proud of her team who went above and beyond to meet the spiritual needs of her patient.

“We value the importance of family and spiritual values,” Wagner said. “We all came together as a team on such short notice to make this couple’s wish come true, while at the same time, meeting the medical needs of our other patients in clinic.”

August 12, 2015

81215BWCameron640Dear Cameron,

Why fit in when you were born to stand out.

One year ago on July 17, you burst into the world. Your daddy raced us to Texas Children’s Pavilion for Women, and just 26 minutes later, you were born. After getting over the initial shock of your quick arrival, it sunk in that my life was changed forever. It was during your first bath that our nurse pointed out your dimples. To this day, your dimples remain one of my favorite things about you. Not only are they an adorable and unique facial feature, they are a constant symbol of your happiness. You are the happiest and smiliest baby I have ever known. You flash your smile and wave at anyone that catches your eye. It’s no wonder that people are so naturally drawn to you.

You have brains in your head. You have feet in your shoes. You can steer yourself in any direction you choose.

It seems like just yesterday you needed me for everything from holding your head up, getting your burps out and marathon nursing sessions. In those early days, I marveled at your every move. Watching you grow, learn and reach milestones has been one of the most rewarding experiences of my life. You’re not walking just yet but have several other skills that you are honing to perfection. Your fierce ball throwing, jumping and speed crawling abilities have given your athletic parents high hopes for a sporty future. Your gravitation towards books warms my heart and I love watching you light up as you explore the words and pictures. “Turn the page” was the first instruction that you consistently followed, but only with your left hand.

Oh, the Places You Will Go

The travel seed has been firmly planted in you. It was on your first out-of-town trip to the Texas Hill Country at 10 weeks of age that we discovered the ridiculous amount of baby gear you require. At four months old, you conquered a 10-hour road trip to Destin, Florida to celebrate Thanksgiving with the family. At six months, we rush ordered a passport for you, as sadly your great grandmother in England passed away. On your first flight, the Dreamliner Captain welcomed you into the cockpit and totally dug your Snoopy bomber jacket. Even though the circumstances for the trip were sad, the extended family fawned over you and happily introduced you to mushy peas. At eight months, your daddy wheeled you up and down the hilly San Francisco streets and you experienced life behind bars in an Alcatraz jail cell. Your passion for the outdoors and new experiences has made me giddy for the lifetime of travel we have ahead of us.

81215BWDearCameron640Family, like branches on a tree we all grow in a different direction, yet our roots remain as one.

You are blessed to receive so much love from your entire family. Your Grammy and Pops enthusiastically swing you at the park, play endless games of peek-a-boo and chase you around in your red sports car. Your Nanny and Grandad love exposing you to music, culture, travel, and puppies. Even though your Nanny swore she wouldn’t be “that Grandma,” she proudly showcases you all over social media. Your free-spirited nanny Sarah lovingly cares for you day after day and encourages you to become whoever it is that you want to be.

To the world you may be one person; but to one person you may be the world.

Cameron, you have taught me to practice patience, to be more selfless and to live in the moment. You have allowed me to trust my Mommy instincts and that it is ok to break “parenting rules.” I am infinitely grateful for the bond you have solidified between your Daddy and me. We are a team and you are our M.V.P. You are generous in your cuddles and sloppy kisses and gentle towards other babies and animals. You are courageous, determined and show resilience when you fail. You delight in your accomplishments and value the praise you receive. I admire these qualities and hope that the baby you are today is an indication of the man you will become.

Your first year felt both long and short and hard and effortless, however the one constant is that my love for you grows at a faster rate than you do. I am so proud to be your mom. As this first chapter in our lives together comes to a close, I will end this letter with the wise words of Dr. Seuss: “Cameron, you’re off to great places, today is your day, your mountain is waiting, so go get on your way.”

Love, Mommy (Julie Griffith)

Click on this image to watch a video slideshow of Cameron’s first year.

81215BWcameronwithparents540

July 28, 2015

72915Zarutski640As a child, we’ve all asked ourselves this question, “What do I want to be when I grow up?”

For Dr. Paul Zarutskie, the newest team member to join the Family Fertility Center at Texas Children’s Pavilion for Women, his interest in reproductive medicine happened unexpectedly.

As a young teenager, Zarutskie dreamed of becoming a pilot and aeronautics engineer who designed missiles. When he was awarded a high school grant to intern in a lab in Philadelphia, a blunder in the paperwork misassigned him to a reproductive endocrinology lab.

“I wasn’t disappointed at all,” Zarutskie said. “The science was so fascinating to me, that I never looked back. I knew this was my calling.”

Since that inspirational moment in his youth, Zarutskie finds tremendous joy helping infertile couples achieve their dream of starting a family. As a tireless patient advocate, pioneering researcher and renowned contributor to the field of reproductive medicine, Zarutskie has devoted much of his career to advancing cutting-edge fertility treatment technologies to help patients achieve the best pregnancy outcomes.

As a reproductive endocrinologist for more than 30 years, Zarutskie has developed innovative treatment protocols, drugs, devices and laboratory procedures, including intracytoplasmic sperm injection and cryopreservation, a technique that freezes and stores sperm and eggs to protect the ability of couples to conceive in the future. Zarutskie was also one of the first infertility specialists in the United States to introduce preimplantation genetic screening services into clinical practice that examines embryos for inherited genetic abnormalties, which in turn, can help identify the healthiest embryo for transfer.

Zarutskie earned his medical degree from Hahnemann Medical College, Drexel University, followed by an OB/GYN residency at Duke University Medical Center and a fellowship in reproductive endocrinology at Harvard Medical School’s Brigham and Women’s Hospital. He served most recently as chief of the Division of Reproductive Endocrinology and Infertility at the University of Washington in Seattle.

After making the 2,343-mile trek to Houston, Zarutskie is thrilled to join such a reputable team of physicians, nurses and staff who share his same passion at the Family Fertility Center.

“I have known Dr. William Gibbons for a very long time and I am impressed with the incredible work being done here, particularly in the area of genetics and reproduction,” said Zarutskie, who is also an associate professor of obstetrics and gynecology at Baylor College of Medicine. “I am privileged to be part of this amazing team and continue to pursue my passion of helping would-be parents achieve their dream of having a baby.”

Beyond the in-depth knowledge and expertise Zarutskie brings to the Family Fertility Center, his approach to patient care helps couples find comfort knowing there is hope beyond infertility issues.

“Dr. Zarutskie is incredibly compassionate and personable, but very intelligent in explaining why I am having trouble getting pregnant,” said Family Fertility Center patient Katie Walford, who was referred to Zarutskie after her friend had successful IVF treatment with him 20 years ago. “I wanted to go with someone who I could trust.”

Besides seeing his patients, Zarutskie has published numerous scientific research articles in prestigious national and international fertility journals. Currently, he is collaborating with research colleagues to explore how obesity and metabolic issues affect oocyte retrieval, as well as how genetic markers are better defining the window of embryo implantation to improve fertilization outcomes.

“I am delighted to have someone of Dr. Zartuskie’s experience and reputation join our Pavilion for Women family,” said Dr. William Gibbons, director of the Family Fertility Center and chief of reproductive endocrinology services at Texas Children’s. “He has the skill set and the experience to enrich our practice and help us continue to provide exceptional care to our patients.”

Click here to watch a video tour of the Family Fertility Center. If you have questions, want to schedule an appointment with Dr. Zarutskie or Dr. Gibbons, or learn more about the benefits available to full-time Texas Children’s Hospital employees, call Ext. 6-7500.