Minding Your P's (Protocol) and Q's (Quality)

Index: Ostomy Wound Manage 2001;47(12):15–16

  Even after more than a quarter of a century in nursing, Marietta Glazer, RN, PhD, CWOCN, celebrates the fact that “it never gets old – there is something new everyday.” She has directed her energy and enthusiasm toward creating a supportive and efficient environment in which she, colleagues, and staff can facilitate care. Marietta’s southern Florida constituency includes many senior citizens who have passed the 100-year mark. The challenges of treating the aged as well as the special needs of ostomy patients are special priorities in Marietta’s scope of practice.

  Memorial Regional Hospital, Hollywood, Fla., is a 684-bed acute care hospital and designated spinal cord trauma center for the area. Marietta, with the assistance of a part-time ET nurse, is responsible for ostomy and wound care patients in the entire hospital facility and the Joe DiMaggio Children’s Hospital, a part of Memorial Regional Hospital. Until recently, she was also the only full-time ET nurse for two other hospitals affiliated with the Memorial Healthcare system. Some of her duties include nursing orientation, teaching, educating staff, and overseeing an ostomy wound team to promote collaboration and division of work.

  As part of her educational efforts, she currently is collaborating with the National Pressure Ulcer Advisory Panel on an initiative entitled, “Avoidable versus Unavoidable Pressure Ulcers,” the first such program, which will be presented in South Florida at Memorial Regional Hospital on February 15, 2002. Marietta also was instrumental in the development of the first ostomy outpatient clinic in the tri-county area.

  “Developing and instituting wound care policies and procedures for an entire healthcare system has become a big chunk of what I do,” Marietta says. “I helped institute AHCPR guidelines on the prevention and treatment of pressure ulcers throughout the system. I also fashioned protocols related to administrative forms, standing order sheets, and quality monitors. It is so gratifying to see nurses take these programs and apply them because they know what to do, how to do it, and why they are doing it and how to document their efforts. This education has empowered them to go forward and elevate the quality of care they provide for their patients.”

  Ostomy patients are especially important to Marietta. She brings them to the forefront by providing pre-operative education on working with stomas, championing pre-operative stoma marking, and counseling patients on how to facilitate a return to a “normal,” if different, lifestyle. After the AHCPR published its guidelines in 1994, Marietta developed an ostomy wound resource team comprised of a nurse from every unit in the hospitals and home care agency in the healthcare system. The team also includes inpatient and outpatient physical therapists, nutritionists, infection control specialists, geriatric specialists, and nurses who work in the OR, Recovery, ER, administration, and education. The team meets on a monthly basis for an hour-long round robin that addresses problems on and among the units and has become a model for other teams under development in the hospital.

  “If, for example, Recovery has a problem with a particular unit, we will do a mini- quality improvement forum to address the issue,” Marietta explains. “The last 5 minutes of the meeting are set aside for new product review.” Minutes from the monthly meetings are sent to nurse managers and the medical director.

  Mandatory skills labs, held four times a year, also nurture on-going educational efforts.

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