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We hope you enjoyed the first issue of NANN E-News sent in March. This month, we've included an important update on a Joint Commission Universal Protocol from Lauren Gresh, NANN member and NANN E-News editor.
Don't forget to forward this newsletter to a friend or colleague. Thank you for being a member of the only nonprofit association exclusively for neonatal nurses!
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| Feature Article |
 Surgical Site Marking: A Joint Commission Universal Protocol
Is your institution compliant with the Joint Commission's latest protocol for surgical site marking? In 2003 the Joint Commission issued its Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery, following an August 1998 sentinel-event alarm on wrong-site surgery. The alert identified risk factors that could lead to wrong-site surgeries, most involving a breakdown in communication between the patient or family and the surgical team. Other factors included a lack of policy for site marking, lack of a verification process in the operating room, incomplete patient assessments, emergency cases, unusual physical characteristics, time pressures to complete surgery, and staffing issues.
In July 2008, an updated protocol was approved and went into effect January 1, 2009. Among the new and clarified requirements are changes to the preprocedure verification process, instructions for marking the procedural site, and more guidelines for taking a time-out before the procedure.
Nurses have a crucial part in this safety initiative. "It is most important that there be cooperative openness between the surgeon and the nurses," says Tom Russell, MD, executive director, American College of Surgeons. "The two groups must both take responsibility, and if there are questions, they should stop and clarify to be sure everyone is on the same page. No one should make assumptions."
Surgical site marking is one element of preventing wrong-site surgery. The rationale is that "marking the procedure site allows staff to identify without ambiguity the intended site for procedure." The marking is for all procedures involving an incision or percutaneous puncture or insertion. Even if the procedure incision is at midline but involves organ laterality, the site should be marked and laterality noted.
The site marking should
- occur in collaboration with the patient or family
- take place before the patient is moved to the location where the procedure will be performed
- be done by a licensed practitioner or provider who is able to perform the intended procedure and will be directly involved in the procedure
- be at or near the procedure site
- be visible after completion of skin preparation and draping.
In some cases patients cannot be easily marked, for example,
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when the patient is an infant who is less than 40 weeks corrected age and is at risk for permanent tattoo from a marker
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when it is technically or anatomically impossible or impractical to mark the site (e.g., mucosa, perineum, teeth)
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when the surgery involves minimal-access procedures to treat a lateralized internal organ, whether percutaneous or through a natural orifice (e.g., to treat a congenital diaphragmatic hernia)
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when interventional procedures for which the catheter or instrument insertion site is not predetermined (e.g., cardiac catheterization) are being performed.
For these patients an alternative process must be identified. This process may include a temporary unique wrist band placed on the side of the procedure site and containing the patient's name and second identifier for the intended procedure and site. During the procedure time-out, the site marking is identified and confirmed to be correct for the procedure and patient.
As NICU nurses, we can help ensure that surgical site marking, including alternative banding, is completed before sending our patient for a surgical procedure. We may also be present during the time-out if the procedure is done in the NICU, so we need to be aware of the practice changes and our hospital standards.
For information on the development and the details of the protocol, click here. For links to program-specific versions of the updated protocol, click here.
Lauren Gresh, editor of NANN E-News , is a clinical nurse specialist in newborn infant intensive care at Children's Hospital of Philadelphia, Philadelphia, PA.
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| Update from NANN's April Board Meeting |
 Lori Armstrong, MSN RN, NANN President
The NANN Board of Directors meets face to face twice per year and by conference call four times per year. During these meetings decisions are made on finances, publications, organizational liaisons, the annual conference, and other issues of strategic importance. Staff members record the proceedings and make sure that the directions of the board are carried out.
The most recent board meeting took place April 30 via conference call. The board finalized some details of the 2009 budget and discussed the 2009 conference. Six travel grants of $500 each for the 2009 conference were approved (for more information, visit the NANN Web site). Appointments to the 2010 Conference Planning Committee were approved, with Patricia Clifford, MSN RNC, as chair. Deborah Sansoucie, EdD RNC NNP, was also approved as liaison to the American Academy of Pediatrics Perinatal Section. Several NANN products were discussed, including the exciting new "Ask the Professor" Webcast series. Also on the agenda were NANN's presence on the Facebook social networking site and some improvements to NANN's awards program.
The charge of the board is to make decisions about the initiatives of the association in accordance with NANN's mission, purpose, and values. The board also focuses on investing the association's resources to meet the needs of its members and to advance projects that are identified as critical to the neonatal nursing profession. Look for updates about future board meetings and the projects being shepherded by the NANN board in other issues of NANN E-News. And, as always, please direct any questions to me at President@nann.org.
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| Ask the Professor Webcasts Provide Continuing Nursing Education Credits |
NANN's Ask the Professor© Webcasts, a series of engaging presentations on care-centered topics, will increase your knowledge of the neonate and enhance your nursing practice. The Webcasts are moderated by Andrea C. Morris, MSN RNC CCRN, and delivered by experts whose presentations were the best attended and highest rated at NANN's 2008 conference. Each Webcast includes a comprehensive presentation, answers to commonly asked questions, "office hours" with the faculty, and immediate access to your certificate for one continuing nursing education (CNE) credit. The April Webcast considered the appropriate use of antimicrobial agents. Plan now to take advantage of the Webcast on infant feeding practices that will be launched Monday, May 25.
"Can You Read the Cues? Infant-Driven Feeding Practices," presented by Susan Ludwig, OTR, and Kara Ann Waitzman, OTR/L, will describe a developmentally supportive infant- and family-driven approach to oral feeding. Historical perspectives on feeding in the NICU will be discussed, as well as current literature that supports moving beyond past practice. Feeding readiness, the quality of feeding, and caregiver support during feeding will be illustrated using the Infant-Driven Feeding Scales developed by the presenters. Appropriate feeding techniques and their effect on changing feeding culture in the NICU will also be covered.
Upon completion of this presentation, you should be better able to
1. recognize the influence of past feeding practices on feeding quality and outcome
2. identify how to utilize the Infant-Driven Feeding Scales©
3. describe two appropriate oral feeding techniques.
 The Ask the Professor Webcasts are supported through an educational grant from Abbott Nutrition, a division of Abbott Laboratories, Inc.
Each Webcast is available for 1 month following the launch date. The fee for each Webcast and faculty exchange is $30. Participation scheduled around a staff or chapter meeting can also be arranged, and group rates are available. For information on future Webcasts and to download a flyer about the series to post on your unit, click here or contact a NANN Member Services representative at 800/451-3795.
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| NANN's 25th Anniversary Celebration |
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To celebrate our 25th anniversary in style, NANN promises a night to remember. You won't want to miss this extraordinary evening of greeting old friends, reminiscing about how things used to be, honoring the organization's legacy, celebrating our achievements, and dancing the night away. Many of the organization's inspiring leaders will be attending, including the founding members who have helped NANN grow and thrive.
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| Scholarships Awarded to NNPs |
 For the second year in a row, NANN has awarded two scholarships to deserving NNPs to attend nurse practitioner programs. The Lundbeck Inc. (formerly Ovation Pharmaceuticals) Neonatal Nursing Career Path Scholarship was awarded to Taryn M. Edwards, BSN RNC, of Wilmington, DE, and Motria Alexandra Lonchyna, BSN RN, of Silver Spring, MD.
 Taryn Edwards is Clinical Nurse III at Children's Hospital of Philadelphia. She is chair of the NICU Breastfeeding Committee and a member of the Maternal-Child Health Leadership Academy (only 19 mentor-mentee pairs are chosen worldwide for this prestigious program). She also serves on several other committees in her unit. One colleague said of her, "If I had a critically ill infant, I would want Taryn to be caring for my child."
 Motria Lonchyna is an RN II at Children's National Medical Center in Washington, DC, an ECMO and PRISMA specialist, and a nursing preceptor; she is also bereavement certified. Her nurse manager remarked, "In my tenure as manager, I very clearly recall one or two interviews that left me with the thought that the interviewee was clearly destined to make a difference. Motria was one of those."
NANN received many excellent applications for these scholarships, and the committee had a difficult time choosing just two. Thanks to all who applied and to members of the scholarship review committee for their time and dedication.
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Brighter Tomorrows Story Contest Winner
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Congratulations to Joyce Stein, BSN RN, winner of NANN's 2009 Brighter Tomorrows Story Contest! Joyce is a staff nurse in the Holden NICU at the University of Michigan Health System, Ann Arbor, MI. Her story, "Looking Back and Remembering," recounts her experiences caring for Jennifer, a full-term infant with several complex conditions. Jennifer recently celebrated her 21st birthday. Look for the story in the summer issue of NANN Central, and read all the story submissions by clicking on the link at the bottom of the meetings page at www.nann.org.
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| NANN Launches New Online Career Center |
NANN has launched a new and improved interactive version of its job board, Career Central. With its focus on neonatal nursing professionals and companies, Career Central offers NANN members--and the industry at large--an easy-to-use and highly targeted resource for online employment connections.
For job seekers, Career Central is a free service that provides access to employers and jobs in the neonatal nursing profession. In addition to posting their resumes, job seekers can browse and view available jobs based on their criteria and save those jobs for later review if they choose. Job seekers can also create a search agent to provide e-mail notification about jobs that match their criteria.
Employers can post jobs online, search for qualified candidates based on specific job criteria, and create a resume agent that alerts employers by e-mail when a candidate has posted a resume with matching criteria. They also benefit from online reporting that provides job activity statistics.
As a registered job seeker or employer, you also have access to the National Healthcare Career Network (NHCN), a network of more than 60 top healthcare associations and professional organizations. NANN's alliance with the NHCN increases your reach to more than 1,500 job postings and more than 7,000 resumes, giving you more control over your career advancement and a one-stop location for finding targeted high-quality candidates. Click here to visit the new site.
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| NANN Balloting Opens May 26 |
This year your vote is doubly important, with 2 election ballots scheduled to run concurrently, electing both NANN and NANNP leaders. NANN will elect 3 directors-at-large, and NANNP will elect 4 council members. These leaders will influence NANN and NANNP's direction over the next 2 years. Electing the best leaders for the association is your right and your obligation as a member.
Please watch for e-mail notification of the election at the end of May, which will include log-in instructions and a link to the easy-to-use online ballot. Members without e-mail will receive their log-in instructions in the mail. After you log in, you will have access to the ballot. If you are a NANNP member, you will have access to both the NANN and NANNP ballots. It takes only a few minutes to complete the ballot, so don't postpone voting! Voting will end June 19.
NANN and NANNP are growing in many wonderful ways. Please do your part by choosing the leaders that you believe are the most qualified to lead your association into the future.
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| NANN Awards: Acknowledge a Colleague |
"We do not believe in ourselves until someone reveals that deep inside us something is valuable, worth listening to, worthy of our trust, sacred to our touch."--e e cummings
NANN members are talented, accomplished professionals with a wide variety of achievements. Awards are an important way to acknowledge our members' achievements and also to encourage others to strive to achieve. NANN values its members' expertise and accomplishments and strives to provide the recognition that they deserve. But first we need to hear from you about your deserving colleagues.
Please take a moment to submit a nomination for an accomplished colleague or chapter. Applications are available on the NANN Web site. Applications must be received at the NANN office by June 1, 2009. Don't miss this opportunity to recognize your peers!
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Neonatal Pediatric Transport Exam Now Available
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The National Certification Corporation (NCC) announces the debut of a new subspecialty examination in neonatal pediatric transport leading to the Certificate of Added Qualification in Neonatal Pediatric Transport (C-NPT) credential. The exam is open to nurses, nurse practitioners, physicians, respiratory therapists, and paramedics.
The new exam will be introduced in two time frames: (1) an introductory testing period from August 5 to September 5, 2009, with an application deadline of June 30, 2009; (2) an open enrollment period beginning July 5, 2009, with on-demand computer testing beginning November 20, 2009.
Register online on the NCC Web site or by mail (NCC, PO Box 11082, Chicago, IL 60611). For the introductory testing, the registration fee is $150. Following the introductory period, the fee will be $185. It will remain at $150 for those currently certified by NCC.
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NANN Represented at Nurse in Washington Internship Program
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Karen McDonald, MSN NNP-BC, and Joyce Stein, BSN RN, members of NANN's Health Policy and Advocacy Committee, attended the Nurse in Washington Internship Program (NIWI) in Washington, DC, March 29-31. The program was sponsored by the Nursing Organizations Alliance, of which NANN is a member. More than 100 nurses from more than 30 states and a variety of nursing specialty organizations participated. The purpose of the program was to provide training on how to advocate with legislators regarding nursing and health care issues. A panel of legislative staff members affiliated with several senators gave specific strategies for helping individual nurses and nursing organizations become more visible in policy making.
Look for Karen and Joyce's article in the summer 2009 issue of NANN Central for highlights from the conference and tips on how you can become involved. If you have questions for NANN's Health Policy and Advocacy Committee, e-mail NANNAdvocacy@nann.org. Join the Advocacy Listserv in the Members-Only section of the NANN Web site at www.nann.org.
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| New Resource for Parents of Preemies |
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 Supporting You and Your Preemie, a new Milestone Guideline
brochure for premature babies, is now available in English and Spanish on the NANN Web site.
Developed by the Preemie Health Coalition (of which NANN is a member) as part of its ongoing efforts to create resources for parents of preemies, the brochure encourages families to be active observers of their premature baby's development, to focus attention on their child's strengths, and to be aware of areas where they need more support. The brochure contains guidelines for converting milestones for full-term infants into milestones for premature infants. It also offers questions that parents can raise with their child's trusted healthcare provider to foster open communication. Like their full-term peers, premature babies are individuals who develop at their own pace and in their own way. Parents of preemies need to be reassured that although all children develop skills in a predictable sequence, the rates at which they develop vary.
Please check out the brochure and pass the link on to parents who will benefit from the information.
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| New Product: Core Curriculum for Neonatal Intensive Care Nursing, 4th Edition |
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The fourth edition of the Core Curriculum for Neonatal Intensive Care Nursing, by M. Terese Verklan and Marlene Walden, will be available in late May.
Perfect as a resource in the field or for exam preparation, this authoritative reference from the American Association of Critical-Care Nurses, the Association of Women's Health, Obstetric, and Neonatal Nurses, and NANN includes in-depth coverage of the most common neonatal disorders and their management. The concise outline format highlights the essentials of each condition including definition, etiology, pathophysiology, signs and symptoms, diagnostic tests, treatments, and outcomes to help you find important information quickly.
- New and updated content on late preterm infants, neurologic disorders, and ventilatory strategies provide the latest information from the field for more effective patient outcomes.
- Coverage of key content on the neonatal intensive care nursing certification exam prepares you for test success.
- Information on families, ethics, legal issues, research, case management, and the transition to home emphasizes the importance of total care of the neonatal patient and family.
Visit the NANN Web site for more information.
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| Chapter Accomplishments |
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Read about the impressive accomplishments of NANN Chapters in 2008!
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| Helpful Hint: Food Storage Bags Keep Babies Warm |
In order to reduce postnatal hypothermia caused by excessive evaporative heat lost at delivery, recommendations have been made to place infants, while they are under a radiant warmer, in occlusive polyethylene bags or wraps from the shoulders down without drying the body first.
Various products are used by hospitals, including the NeoWrap by Fisher and Paykel Healthcare. Some hospitals have opted to use resealable food storage bags (e.g., Ziploc bags) as a less expensive alternative. The bags should be made out of polyethylene in order to allow the transmission of the radiant heat waves through the bag to keep the baby warm. Care should be provided to avoid injury from the resealable zipper area of the bag.
Look for more Helpful Hints in future issues of E-News!
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