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Thursday, Mar 28, 2024

Lynne M. Scott

At a time of enormous change and uncertainty for the health care industry, the San Fernando Valley region is home to many who are embracing the challenges boldly with new ideas and fresh vision. The 10 innovators profiled in the following pages are emblematic of the important work performed by health care workers every day. They are working to improve care and lower costs — and answer the urgent need for a better health care system. It’s not often that nurses can take matters into their own hands. But that’s just the kind of nurse leader Lynne M. Scott has been all her life. Rather than leave it to hospital administrators or doctors to uncover and develop practices that could help save lives, this clinical nurse specialist and nurse administrator from Kaiser Permanente -Woodland Hills led her own research team to do just that. As co-chair of the hospital’s Nursing Practice Council, which has been around for more than 15 years, Scott has helped create evidence-based practices that have not only changed nursing practice at the hospital and beyond, but in all likelihood, have also saved numerous lives. Evidence-based practice is not just the stuff of research journals. Every year, thousands of people die in hospitals for reasons other than what brought them into the hospital in the first place. When clinicians follow specific protocols, however, infection rates decline and hospital death rates drop. Today, check-lists are becoming a common way to reduce poor outcomes. At KP-Woodland Hills, the council’s efforts led to new oral care practices to reduce the incidence of ventilator-acquired pneumonia (VAP), one of the most common causes of death for intubated patients in an intensive care unit. Patients who acquire VAP in an ICU have a mortality rate of 46 percent, according to the Institute for Healthcare Improvement, the Cambridge, Mass.-based nonprofit that identifies and studies new models of patient care. By studying the literature and conducting interviews with doctors and dentists, the council created an entirely new protocol for oral care of patients on ventilators. This protocol included, for the first time, the use of Chlorhexidine, an oral rinse, which when used to wash a patient’s mouth at least twice a day, led to decreased chance of infection and pneumonia. “Something that seems so insignificant can have huge significance,” Scott said. “The use of Chlorhexidine had implications in preventing infection in patients in the ICU, especially here where we have so many frail elderly patients.” In fact, as a result of the council’s work, KP hospitals in Southern California were using this evidence-based care before IHI included the recommendation for Chlorhexidine in what it calls a care “bundle,” processes that when implemented together lead to better patient outcomes. Such evidence-based practices sound good on paper. The trick is to make sure nurses use them — not just once in a while, but every time. To help nurses adopt the new life-saving techniques, Scott and her group created a pneumonic device: “Brush to clean, followed by Chlorhexidine, swab in between.” In the past year, Scott and the rest of the council —uniquely made up of mostly bedside nurses, not nurse managers — has gone on to investigate evidence-based practice for tube-feeding. The group hopes to not only publish its findings, but to see it adopted by other institutions. One important recommendation the hospital is already using is to make sure the patients’ heads are always raised 30 degrees before beginning the feeding, Scott said. But that step is not part of any official protocol today and it’s not always done, leading, sometimes, to aspiration or even malnutrition. If Scott has her way, the new process will be implemented not only at Kaiser but beyond.

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