2nd Place Winner
Alberta Health Services
In 2017, Corinne Huedepohl, nurse practitioner (NP), Tone Management Service for Children at Alberta Health Services’ (AHS) Glenrose Rehabilitation Hospital in Edmonton became the first NP in Canada to receive privileges to independently inject botulinum toxin (BoNT-A) for children under anesthesia in an operating room (OR).
Her journey to becoming the first started when her team at the Glenrose identified a goal of improving service delivery by increasing access to care for children experiencing pain related to spasticity and dystonia. The patient population included children with diagnoses of cerebral palsy, spastic paraplegia, spastic quadriplegia, spastic hemiplegia/monoplegia, acquired brain injury or other neurodevelopmental disorders.
At the time, the team faced physician resource limitations which created a barrier to timely care for children in Northern Alberta who benefited from treatment with BoNT-A.
After identifying barriers to care for children requiring this intervention, the next step was listening to stakeholders from the Glenrose and Stollery Children’s Hospital sites, reviewing existing needs, practices and resources as well as existing supporting policies and procedures. By collaborating with team physicians, goals were identified to achieve improved access to care for children requiring BoNT-A, with particular emphasis on more timely access for children experiencing pain.
An education plan to build Corinne’s knowledge and skills was designed and completed over 18 months. After completing this education plan with the team’s physicians, a job addendum and improvement charter was drafted and signed by AHS, Stollery and Glenrose senior management and communicated to relevant stakeholders.
The initiative improved clarity on the role of the nurse practitioner and allowed staff to have a better understanding of how to support the nurse practitioner in the operative services environment.
The job addendum specific to Corrine’s role as most responsible provider (MRP) to admit patients referred to her, manage their care in the OR, perform the procedure, handle consent and orders, became an attachment to the provincial NP role description across Alberta. The addendum was presented to executive leadership at both hospitals and escalated to provincial executive leadership where it was approved and signed off by Dr. Verna Yiu, President and CEO, AHS.
The work was supported by the Zone Advance Practice Nurse leads as an opportunity to test a document to support NPs role. This case was precedent setting for AHS, and will help pave the way for other NP roles.
From the initial discussions in early 2015 until the final document was signed in July 2017, it took a team effort to expand Corinne’s NP role to become an independent provider of ultrasound and/or e-stim guided botulinum toxin injections in the Stollery OR with the support of a pediatric anesthetist and assisted by Stollery and Glenrose nursing staff. Through this process the essential roles of nursing have been established in bridging gaps to improve children’s pain care as part of spasticity management and the NP role in quality improvement essential.
“Corinne stepped forwards to meet the need for more timely care for our patients, committing to a nearly two year education plan despite the potential risk that, being the first, independent practice providing injections might not be approved,” says Dr. John Anderson, Facility Chief, Child Health, Glenrose Rehabilitation Hospital.
Thanks to the changes to Corinne’s role, children experiencing pain are no longer limited by individual physician OR time and can access treatment in a prioritized manner. Today, Corinne performs and supports 50-60 percent of monthly spasticity treatments in the operating room on patients between the ages of 3-17 years. On average, 95 per cent of procedures are completed within window and wait times have been reduced for focal spasticity treatment for pediatric patients.
“She has brought to our team a valued approach and perspective as a nurse practitioner which has improved system efficacy and access to services, but more importantly improved how we make patients and parents partners in their care, how we deliver care compassionately around stressful procedures and ultimately how we are better in treating a child’s pain,” explains Dr. Anderson.
Nominated by: Georgia Davis RN BScN MN |Manager
Nursing Practice & Acute Respiratory Services
Glenrose Rehabilitation Hospital