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A Perfect Match

(L-r) Nurse Coordinator Denise Cummings, bone marrow transplant program; Avigan; Beth and Michael Padellaro (with daughter, Taylor); and Rojas

Under ordinary circumstances, Michael Padellaro and Chriszelda Rojas would probably never have met. A financial analyst, Padellaro resides in North Andover, Massachusetts, with his wife and three children; Rojas, a single mother of two who works part time while attending school, lives in the Houston suburb of Deer Parks, Texas.

But when Padellaro was diagnosed with chronic myelogenic leukemia (CML) five years ago, circumstances led to their lives becoming entwined.

“When the doctors first told me that I had CML and needed a stem cell transplant, I thought chances were one of my three brothers or my sister would be a match,” says Padellaro. “But none of them matched, so the doctors turned to a national database of unrelated donors.”

One of the names on that list was Rojas's. A regular blood donor, Rojas had registered to donate bone marrow after watching a friend's brother die while waiting for a match. Now, doctors discovered that she was a perfect match for Padellaro.

Rojas underwent general anesthesia so that doctors could pull marrow from her pelvic bones for the transplant. “I was only sore the next day,” she says, adding that it felt like she had just “worked out really hard” and that she was at her son's football game two days later, and back at work soon afterward.

Her stem cells were immediately transported from Houston to Boston, where BIDMC clinicians infused them into Padellaro the next day. He spent the next several months in the hospital, receiving another “boost” of Rojas's stem cells earlier this year after Rojas agreed to donate a second time.

“It's just amazing that not only once – but twice – someone you don't even know would do this for you,” marvels Padellaro.

After the one-year required waiting period expired, the two learned each other's identities and began talking monthly by phone – and this past Dec. 9, not even a nor'easter could stop their joyful reunion at BIDMC, attended by Padellaro's physician, David Avigan, MD, hematology/oncology, and team.

“Patients often feel a need to meet their donor and express their thanks,” Avigan told those gathered. “As a team that takes care of patients, it's nice for us, too, to be able to see such a reunion take place.”

“I am overwhelmed by the generosity for someone to do what she's done to help extend someone's life,” added Padellaro's wife, Beth.

Rojas just smiled modestly. “I had the easy part,” she said, noting Padellero's long recovery that has led to his current remission. “But I highly recommend that everyone donate stem cells. You can really make a difference.”

To learn more about donating: www.marrow.org

 

“Triggers” Program Enhances Patient Safety

A Rapid Response Team on CC7 gathers in response to a “trigger” event. (L-r): Priya Roy, MD, Rachel Cockerline, RN, Adrian Gardner, MD, and Corey Palmer, RN

There’s a new watchword in BIDMC’s ongoing efforts to maximize patient safety: “triggers.” The collaborative program, developed by clinicians in BIDMC’s departments of medicine, surgery and patient care services, formalizes the process by which rapid response teams of senior clinicians assess patients on general units who display an acute change
in condition.

Unlike “code” teams, which perform resuscitation following cardiac arrest, the rapid response team’s function is more proactive.

“Early intervention can be significant in reducing patient mortality,” explains intensive care specialist Michael Howell, MD, who is coordinating the program’s implementation at BIDMC. “The triggers program states which early warning signs ‘trigger’ an immediate intervention [see list below.] By sending a team when these signs first appear, we can prevent up to 80 percent of cardiac arrests.”

As CC6A Clinical Nurse Specialist Jeanne Quinn, MS, APRN, BC, recently told The Boston Globe, “A trigger is not about excitement and drama; it’s about intervening before there’s drama.”

Earlier this year, an interdepartmental steering group that included Howell; Director of Professional Practice Development Patricia Folcarelli, RN, PhD; Department of Medicine Vice Chair for Quality Mark Aronson, MD; Primary Care Chief Resident Jessica Clement, MD; Department of Surgery Vice Chair of Education and Quality Donald Moorman, MD; and hospitalist and BIDMC Resuscitation Committee Chair Julius Yang, MD, brought rapid response teams to BIDMC and set guidelines for the rapid response process:

When a “trigger” occurs, the nurse calls the rapid response team: a house officer, senior nurse and, if needed, respiratory therapist.

The team evaluates the patient, implements a care plan documented on a special form and notifies the attending physician.

“Multiple caregivers provide an extra blanket of protection through early evaluation,” says Moorman, an early proponent of the program, who notes that collaboration between medical and surgical staff distinguishes BIDMC’s program.

During a three-week pilot on several BIDMC units, 61 triggers occurred among 47 patients. In 2/3 of cases, rapid response immediately changed the course of treatment.

While other hospitals have instituted similar programs, Aronson notes that at BIDMC, “It is usually the patient’s own care team that responds. Also, our documentation system lets nurses and residents sign off on the same note.”

Those involved in the program are pleased that “nurse concern” is an independent trigger. “We are allowing nurses to play a proactive role and get a consistent response from physicians,” says Folcarelli.

Patient safety coordinators (nurses working with BIDMC’s department of health care quality) review “trigger” events to examine whether they could have been avoided. “We are asking, ‘How could we have prevented this from becoming a Code Blue?’” says Yang.

Clinicians received training prior to the program’s rollout last fall. Howell and hospitalist Anjala Tess, MD, with medicine residents Inga Lennes, MD, and Amanda Pressman, MD, are developing a Web-based curriculum to help residents recognize and manage “triggers.”

Department of Surgery Chairman Josef Fischer, MD, FACS, and Chair of Medicine Mark Zeidel, MD, who oversaw a similar program at the University of Pittsburgh Medical Center Presbyterian, are championing triggers at BIDMC.

“When we rolled out our program in Pittsburgh, we noticed a decrease in codes and an improvement in mortality rates,” says Zeidel. “I’m gratified that BIDMC’s surgery, medicine and patient care services staff are partnering to seek the same results here.”

[The above article was adapted from Nursing News Brief.]