Hello from Brazil: Strong leadership with a focus on quality care

Patsy Stinchfield, a Pediatric Nurse Practitioner from Children’s, is in San Jose Rio Preto, Brazil to help the Hospital de Base better control their post-operative infection rates. The following is Patsy’s third update from Brazil.



It is hard to believe we have been here just four days and three days in the Hospital de Base.  I write this late in the day after a 16 hour day with the amazing CV ICU team at the hospital (that’s what everyone does on their vacation in Brazil, right?!).  The Children’s Heartlink program has a beautiful vision to bring the best cardiovascular care to children and our time here proves that many strides have already been made.

The passion and leadership of Dr. Ulisses Croti, the solo pediatric CV surgeon, is driving best practice in this hospital and the region on many fronts. The multidisciplinary team in this unit loves their work and it shows.  They do have more infections than they should — and we are leaving no stone unturned in trying to find out why — but as usual, there is no smoking gun, but many “fixable” issues.

Our focus this week on infection prevention in the CV ICU and pain management has been so fulfilling.  Dr. Kurachek and I have developed a subtle look we give each other when we realize they are doing a process better than we do in the US.

For example, each patient has a poster up of individual goals for the next shift on where to maintain the blood pressure, etc.  We admire their openness and willingness to take all advice on behalf of patient improvements.  There is no defensiveness or resistance to change.  The focus is clearly on quality care for tiny patients with big heart defects.

The complexities of the surgical procedures and the post-op care are like a great ballet–everyone knows their part and plays it elegantly. There are a number of fine tunings we will offer to get them from good to great but their culture of attention to quality will get them there faster.

Today, Dr. Kurachek provided a formal lecture on pain and sedation and I presented a formal lecture on blood stream infection prevention. We have been hammering the importance of hand hygiene all week and have appreciated the amount of time their ID doc and Infection Control nurse have given us.

We have had numerous conversations with small groups of staff with everything from considering a hospital acquired infection an emergency, to when do you stop antibiotics, to what is Empiric precautions, to what are the Fentanyl versus Morphine considerations (clearly that last one was Kurachek’s!).

What is impressive is the multi-disciplinary turn out for our talks.  My talk had 15 in attendance on the unit including intensivists, cardiologists, housekeeping staff, nursing, techs, therapists, students and infection control specialists.  They were very interested and able to learn together.  I was able to observe in the micro lab as well as the entire sterilization process, which is done well–bar coded and everything!

Dr. Kurachek was able to do morning rounds, meet with a vascular surgeon about non-surgical lymphedema treatment, do his pain talk twice, role play with me on how one points out a potential patient safety risk to a colleague and end the day with our team doing Safety rounds–and that was before dinner!

It has been a great day once again.  Big day tomorrow as we tour the new children’s hospital and help them prepare to prevent risks there.

Ciao for now (that rhymes!)


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