National Nursing Week

2 WINNIPEg FREE PRESS - SATURDAY, MAY 9, 2015 MENTAL HEALTH MATTERS Education Programs in Brandon & Winnipeg crpnm.mb.ca Thankyou, REGISTERED PSYCHIATRICNURSES formakinga difference! Skin-to-skin contact, breastfeeding and early attachment between mother and child give newborn babies the best start in life. A nurse-led collaborative pilot project at Health Sciences Centre (HSC) Women's Hospital is finding that family-centred care is also the best medicine for newborn babies of opiate-addicted mothers who are on methadone maintenance treatment. Clinical nurse specialist Lisa Merrill, who works in the Women's Health Program at HSC, spearheaded the team project after visiting B.C. Women's Hospital, where she was surprised to find that babies and mothers who are on methadone stay together in the postpartum unit following birth. Typically, such babies are separated from their moms within hours after birth and transferred to an intermediate care nursery, where they receive medication to treat withdrawal symptoms. But B.C. Women's Hospital found there's often no need for medication when babies and mothers are cared for together. "So really for best practice we don't want to medicate babies that don't need to be medicated if the best solution is to be with their moms and be skin-to-skin and breastfeeding," Merrill says. Since December, HSC has kept 15 moms and their babies together in the postpartum unit for seven days following birth, rather than send babies immediately to the intermediate care nursery. Seven of those babies were able to go directly home from the postpartum unit without requiring medication. Merrill says that represents a profound improvement. Between 2009 to 2012, moms on methadone gave birth to 44 babies at HSC, and only four of those babies were able to go home without needing medication treatment. "We know that breastfeeding and skin-to-skin care with these babies helps significantly with their withdrawal symptoms. And that's why we embarked on doing this, because we know that it's best for both moms and babies to be cared for in this way," she says. "And it provides opportunities for the moms to bond with their babies, which is extremely important." Methadone is the gold standard for opiate addiction in pregnancy and it has many benefits, easing symptoms of withdrawal, reducing cravings for opiates and reducing the euphoric effects of opiates, which means patients are less likely to succumb to cravings. There's an obvious stigma attached to addiction, particularly for pregnant women, but Merrill says addiction is more widespread than many people realize, and it affects all walks of life. "We have pharmacists, physicians, nurses— it's a whole gamut of people who are on methadone and you would never know because they function totally normally every day." The pilot project has reduced stress for moms, since they don't have to travel back and forth to visit their babies in the hospital. And it's had an enormous positive impact on patient flow through the intermediate care nursery, where babies often stayed for two or three weeks — and sometimes two months or more, depending on the severity of their withdrawal symptoms and the number of medications there were on. Merrill says the collaboration between the nursery and the Family-Centred Mother & Baby Unit (FCMBU) has been the best part of the project. "The babies were cared for in the nursery — and are cared for in the nursery if they have to go there for medication therapy — but it's a different program, so we have the babies that are covered under the Child Health program and then we have the babies who are normal, healthy, fine, and they're covered under the Women's Health program, so we really had to work collaboratively to sort this out," she says. "Everyone in both programs, including physicians, nurses and allied health staff has really embraced the opportunity to make this happen. All staff have been fantastic to work with and have really raised the bar as far as care for these mothers and babies because they think it's the right thing to do." Brad Link, manager of patient care for the Intermediate Care Nursery, says that collaboration has had wide- scale benefits. "From an operations perspective, this essentially opened up patient flow in the sense that we could care for more babies," he says. Nurses from the FCMBU assess each baby and if they determine that a higher level of care is needed, babies are immediately transferred to the intermediate care nursery for treatment. "It's really quite an impressive process that we've put in place where the baby doesn't wait," Link says. "The baby comes down and is seen and assessed by a physician quickly." Susan Harrison, manager of patient care for the FCMBU, Perinatal Relief Team and the Breastfeeding Service at Women's Hospital, says her nurses have been delighted with the results of the project. "Their area of expertise is keeping babies skin-to-skin and supporting breastfeeding and they were actually really excited to be part of this pilot," she says. "It's a huge difference in how close the mothers are and in helping the breast milk come in and just how the babies withdraw less." Harrison says the project is a great example of how nurses work collaboratively to provide the best care. "We are putting our patients first." ● Compassionate Collaboration Project provides best care for moms and babies By Pat St. Germain - For the Free Press "We have very low staff turnover. I think a part of that is our team is very passionate about what we do and is very dedicated," she says. "There is a passion for people to work with the patients and follow them through their journey." In addition to her work on the front lines, Carta is highly involved in several educational initiatives. She has played a key role in developing clinical practice guidelines and helps educate emergency room and intensive care staff at hospitals around the province about regional standards for burn care. She has also presented a number of case studies at several national conferences. Carta is actively involved in research dedicated to finding new ways to improve wound care for burn patients, including more easily removable dressings. She is also part of a project to create a Canadian Burn Network that would standardize wound care policies and guidelines across the country. "It's quite exciting," she says of the initiative. "We're hoping to provide a forum for knowledge sharing so we can have online discussions across Canada." As if that isn't enough, Carta has several other projects on the go. She hopes to become more active on the issue of burn prevention and says some of the most serious burn injuries, including those caused by camp fires, are preventable. She is also helping to spearhead a pilot project that will see tablet computers used to educate burn patients and their families to reduce anxiety prior to surgery and assist them through the recovery process. The project is slated to be rolled out sometime in the next year. ● << Continued from page 1 Above: The collaborative team includes (from left) RN Tina Vieira, Family-Centred Mother & Baby Unit manager of patient care Susan Harrison, RN Karen Favaro, Intermediate Care Nursery manager of patient care Brad Link, clinical nurse specialist Lisa Merrill, RN Kelly Myshkowsky and RN Shelley Sawich. Photo by Darcy Finley MAY 11 - 17, 2015 MAY 11 - 17, 2015 NURSING WEEK NATIONAL

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