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Studying Snot

Nurse researchers discover a safer way to collect influenza specimens.

IN THE EVIDENCE: Geraldine Summers, RN, (left) emergency department nurse; Erin Smith, RN, emergency department nurse; and Paula Terzigni, RN, clinical director, all at the Greater Baltimore Medical Center, teamed up to find the best procedure for influenza specimen collection. Their results changed hospital policy and made the process safer for nurses. courtesy Greater Baltimore Medical Center
"When people congratulate me, I tell them that I owe it all to snot!" said Geraldine Summers, RN, an emergency department nurse at Greater Baltimore Medical Center (GBMC).

Why are people congratulating Summers and why does olfactory ooze get all the credit? Summers, along with other ED nurses at GBMC, recently completed an evidence-based initiative on influenza specimen collection. The findings from their initiative have caused changes in GBMC policy. Their study has received widespread attention due to its timeliness; just as their research ended, the rise of the rock star of influenza strains, H1N1, was beginning.

"When we first started researching, H1N1 was not very well-known. It was just complete dumb luck that we did this research just as H1N1 was gaining notoriety," said Susan Gray, RN, literature reviewer for the initiative.

Now, H1N1 has to share the spotlight with Summers, a 17-year veteran to nursing. Both regional and national healthcare conferences have requested for Summers to present her findings. This past March, she presented her findings at the Maryland Patient Safety Conference in Baltimore. Making her national debut in September, Summers went to San Antonio to present her findings at the 2010 Emergency Nurses Association.
Seeing Something Wrong

"When I first saw how we did influenza specimen collection, I thought to myself, 'This will not do!'" explained Summers.

Influenza specimen collection policy at GBMC called for one of two methods. The first option utilizes the DeLee suction catheter. As a suction procedure, GBMC policy requires nurses to use a splash-resistant mask while using the DeLee catheter. The other option for influenza collection was having the patient blow his nose into a sterile cup held by the nurse. Summers had her sights set on this latter and cruder means of influenza specimen collection.

"I approached my boss on possibly doing an evidence-based initiative on the best means of influenza specimen collection. She got back to me almost immediately and had three little words for me: 'Go for it!'" said Summers.

Once she got the approval from her supervisor, Summers had to surround herself with a team of nurses to help carry out the initiative. GBMC staff involved in the project were Kristi Singer RN, Erin Smith RN, Holly Wheeler, RN. Co-authors for the project were Susan Gray RN, John Lau, RN, and Paula Terzigni, clinical director.

"Here is a situation where some staff nurses had the opportunity to change protocol; it has been rare in the past few years that staff nurses are the ones who get to do that sort of stuff. It makes sense though; we are the ones who are at the bedside. We get see how things are done day-in and day-out," said Gray.

Impeccable Timing

After receiving her boss' approval, Summers had to work to unite some disparate parts of GBMC. Summers and her team played matchmaker between the ED, the institutional review board and various labs in the hospital.

The first task was for the group to hack their way through the requisite heaps of institutional review board paperwork. Oddly enough, Summers' proposed study came across the institutional review board's desk at just the right moment; the arrival of H1N1 made influenza specimen collection a critical issue. The team's application did not sit on the desk long.

"Timing was everything on this project. As a result of H1N1, our application bounced back from institutional review only 3 times rather than the typical 10 times," said Summers.

Once institutional review cleared Summers' proposed study, the next task was to find a way to run parallel influenza tests in the lab. The initiative called for influenza specimen to be collected via both of GBMC's approved methods. From there, the lab would test both specimens, allowing Summers and her team to determine if one collection method had a higher degree of accuracy. Funding these additional tests without passing the costs to the patient was a problem. Oddly enough, this potential roadblock was, just like the institutional review board, a non-issue.

"Our lab agreed to run 20 specimens at no additional charge to the patient; they were able to run duplicates because of their own quality control requirements," explained Summers.

The final gatekeeper for this evidence-based practice initiative was the patient; although the initiative had made it through institutional review and the lab, the patients still had to consent to having both specimens collection tests performed. Again, Summers and her team had impeccable timing with their initiative. With swine flu becoming all the rage for media outlets, patients were inundated with concern for H1N1.

Summers proudly explained, "Patients had to sign an informed consent form. In the course of the entire study, no patient turned us down. The patients were very agreeable."

Studying Snot

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