Authors: Mary Kautto, MA, BSN, RN; Rhonda Cady, PhD; Alejandra Eppinger, RN Instruc(onal  Tools  for  Baclofen  Pump  Educa(on  

Background  •  Many  consumers  living  with  an  Intrathecal  Baclofen  Pump  (ITB)  live  in  rural  areas  and  informa=on  about  ITB  care  and  complica=ons  is  limited.  

•  Call  centers  triage  numerous  calls  about  alarms  and  how  to  care  for  someone  with  a  pump.  

•  As  inclusion  con=nues  to  evolve  along  with  advancements  in  healthcare  technologies,  there  are  situa=ons  in  which  “just  in  =me”  type  training  is  needed  for  caregivers.  

•  With  a  new  Personal  Care  AGendant  (PCA),  a  consumer  moving,  or  staff  turnover  in  group  homes,  hand-­‐off  communica=on  may  be  incomplete.  

•  An  evidence  based  easy  to  access  educa=onal  tool  is  needed.  

Poster  #  1958470  

Proposed  Educa(onal  Tool  •  Develop  a  mul=faceted  tool  that  can  cater  to  mul=ple  learning  styles.  

! Video  for  auditory  learners,  such  as  a  barcode  on  educa=onal  tools  to  allow  it  to  be  accessed  electronically.  

! Laminated  card  with  trouble  shoo=ng  =ps  as  visual  reference  

Competency  Tool  •  Competency  Tool  will  be  developed  to  measure  understanding  for  nursing/care-­‐giving  staff  before  beginning  care  of  pa=ents  with  Baclofen  pumps.  Facili=es  may  be  encouraged  to  incorporate  this  as  an  annual  competency.  

•  Self-­‐test  to  assess  knowledge  level  about  ITB  and  learning  completed  or  need  for  remedia=on.  

•  The  following  ques=ons  will  be  assessed  using  a  teach-­‐back  technique  (having  caregiver  verbalize  understanding):  

! What  are  some  indica=ons  for  a  Baclofen  pump?  

! What  are  common  signs  and  symptoms  of  withdrawal?  

! What  are  appropriate  ac=ons  to  take  when  pump  alarm  sounds?  

Conclusion  •  Through  implementa=on  of  these  tools  and  resources,  we  hope  to  improve  the  safety  and  quality  of  life  for  those  who  u=lize  Baclofen  pumps.    

•  By  increasing  provider  and  caregiver  awareness  and  educa=on,  clients  will  be  beGer  managed  regarding  maintenance,  troubleshoo=ng,  and  handling  emergencies  pertaining  to  ITB  therapy.  

The  Next  Steps  U(lize  Plan  Do  Study  Act  Model  of  Change:    •  PLAN-­‐Discuss  implementa=on  of  educa=onal  tool  with  the  following  stakeholders:  Hospital  that  ins=lled  pump,  group  home,  on-­‐call  nurse  triage  line,  and  educators  for  staff  at  both  sites.    

•  DO-­‐Try  tool  out  for  6  months  with  group  home  and  a  assess  knowledge  gained  by  group  home  staff  through  a  small  ques=onnaire  given  by  educators.    

•  STUDY-­‐Assess  efficacy  through  ques=onnaire  assessment  before  and  aXer  tool  implementa=on  as  well  as  through  measurement  of  calls  to  nurse  triage  line.  Seek  input  from  both  hospital  and  group  home  staff  about  response  to  tool  and  sugges=ons  for  improvement.    

•  ACT-­‐If  tool  proves  effec=ve  incorporate  use  into  statewide  policy  for  group  home  and  hospital.  Make  adjustments  to  tool  based  on  feedback.    

References  •  Boast,  P.,  &  PoGs,  C.  (2011).  Connec=ng  cost  and  quality  through  automated  discharge  instruc=ons.  Healthcare  Financial  Management,  65(8),  114-­‐118.  

•  Borowski,  A.,  LiGleton,  A.,  Borkhuu,  B.,  Presedo,  A.,  Shah,  S.,  Dabney,  K.  Lyons,  S.,  McMannus,  M.,  &  Miller,  F.  (2010).  Complica=ons  of  intrathecal  baclofen  pump  therapy  in  pediatric  pa=ents.  Pediatric  Orthopaedics,  30(1),  76-­‐81.  

•  Cleghorn,  G.  D.,  &  Headrick,  L.  A.  (1996).  The  PDSA  cycle  at  the  core  of  learning  in  health  professions  educa=on.  Joint  Commission  Journal  on  Quality  Improvement,  22(3),  206-­‐212.  

•  GilleGe  Children's  Specialty  Healthcare.  (2013).  Intrathecal  Baclofen  Pump  Implanta=on.  Retrieved  from  hGp://www.gilleGechildrens.org/default.cfm?pid=1.17.4.7.1.4#ITB%20-­‐%20Intrathecal%20Baclofen%20Pump  

•  Mullarkey,  T.  (2009).  Considera=ons  in  the  treatment  of  spas=city  with  intrathecal  baclofen.  American  Journal  of  Health-­‐System  Pharmacy,  66(1),  S14-­‐22.  doi:10.2146/ajhp0108c  

•  Nakayama,  D.  K.,  Bushey,  T.  N.,  Hubbard,  I.,  Cole,  D.,  Brown,  A.,  Grant,  T.  M.,  &  Shaker,  I.  J.  (2010).  Using  a  plan-­‐do-­‐study-­‐act  cycle  to  introduce  a  new  or  service  line.  AORN  Journal,  92(3),  335-­‐343.  

•  Ridley,  B.,  &  Rawlins,  K.  (2006).  Intrathecal  baclofen  therapy:  Ten  steps  toward  best  prac=ce.  Journal  of  Neuroscience  Nursing,  38(2),  72-­‐82.  

 

For  more  informa(on…  Mary  E.  KauUo,  MA,  BSN,  RN  Clinical  and  Marke(ng  Outreach    GilleGe    Children’s  Specialty  Healthcare    200  University  Ave.  East  |  St.  Paul,  MN  55101  Ph.  651.325.2157  C  651.302.4118      maryekauGo@gilleGechildrens.com    

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Quick  Reference  Card  Complica(ons:  •  Redness,  drainage/pus,  fever,  need  for  dosage  adjustment.  •  Baclofen  adds  to  effects  of  alcohol  and  other  depressant  

medica=ons  (i.e.  an=histamines,  sleep  medica=ons,  pain  medica=ons).  

Common  causes  of  temporary  tone  changes:  •  Illness,  pain,  PMS,  cons=pa=on/gastri=s,  fracture,  stress  

Emergency  Management/Troubleshoo(ng:  •  Check  if  oral  Baclofen  or  Valium  are  available  for  pa=ent.  •  Record  date/=me  alarm  sounded,  contact  provider/24hr.              

Nurse  line.  •  Signs  of  withdrawal  get  worse  hourly:  itching,                                                        

twitching,  “pins  &  needles”  

Ac(vity  limita(ons:  •  Keep  cell  phones/magnets  at  least  1  X.  away.  •  No  hot  tubs,  scuba  diving  •  Cau=on  with  transferring  pa=ent.    

!  Use  abdominal  binder  if  needed.  •  Air  travel  is  allowed.  •  MRI/CT  scans  are  safe.  •  Contact  provider  if  therapeu=c  ultrasound  is  indicated.  Consumers  with  ITB