During International Stroke Conference (ISC) last year (2020) I presented a poster with the findings of my study, which was published in Journal of Radiology Nursing in September 2020 titled: “Heparin flush use in Transfemoral Cerebral Angiography Survey.” I conducted this study with help of my colleagues: Lori Madden, Director of Nursing Science at UCDMC and Kendra Schomer, Critical Care Pharmacist at UCDMC. I also used help from Karen Van Leuven, my former DNP program advisor at USF, who continues to be my mentor since I graduated in 2014, and whom I initially consulted regarding the idea for this study. She was also one of the co-authors of the manuscript. From the results of this worldwide survey, I found out that there were no standard protocols across stroke centers identifying optimal heparinized saline flush solution concentration, preparation, and documentation.

I guess my poster presentation was noticed by the ISC program committee as I had been chosen to participate in an educational session(s) for the American Heart Association’s annual ISC and received speaker’s invitation. They asked me to provide a presentation on a topic:

“Standardization Improves Patient Safety.” Not exactly knowing if this statement was correct, I changed the title of my presentation to: “Standardization and patient safety.” While conducting literature search, I learned that standardization in health care was a huge initiative launched by the World Health Organization (WHO) in 2007 and it was called The WHO 5s High Project, which included the following:

• Managing concentrated injectable medicines (concentrated injectables)
• Assuring medication accuracy at transitions of care (medication reconciliation)
• Performance of the correct procedure at the correct body sites (correct site surgery)
• Communication during patient care handovers
• Improved hand hygiene to prevent health care-associated infections

Without even realizing it before, it seems like I was previously somehow involved in most of the above and other standardization initiatives. As far as managing concentrated injectables, I conducted the survey regarding standardization of heparinized saline concentration, preparation and documentation. Based on the findings from my study, there is a paucity of evidence supporting use of a specific concentration of heparinized saline solution. The used concentration of heparinized saline solution for cerebral angiography ranges from no heparin added to concentration exceeding 5 units/ml. The most frequently used concentration of heparinized saline is 2 units/ml, and the least frequently used concentrations are 3 units/ml and >5 units/ml. The Institute for Healthcare Improvement (IHI) recommends standardizing heparinized saline concentration and storage of one standard concentration on each unit to decrease confusion. According to IHI, use of pre-mixed solutions lowers the risk of an adverse drug event. Institute for Safe Medications Practices (ISMP) recommends only use of commercially prepared, pre-mixed IV solutions of unfractionated heparin. Based on my study findings, more than quarter (26.5%) of respondents reported not having readily available premixed heparinized saline flush despite above recommendations, and only 20.3% of respondents noted using only premixed bags of heparinized saline solution.

Universal protocol implementation was a topic of multiple presentations I provided to peri-operative staff while working as a peri-operative Clinical Nurse Specialist (CNS) in one of Chicago suburbs trauma I centers. I was also involved in few root cause analysis events regarding wrong site or side surgery. At the same time (2005-2006), I developed a surgical handoff table to improve communication between pre-op, operating room (OR) and recovery room nurses. A lot of my colleagues at that time used my handoff tool to write their BSN or MSN final projects. At the time of the handoff table introduction to our surgical department staff, we had Joint Commission survey visitors, and one of the surveyors was really impressed with this idea so she asked for a copy of this tool to share with other facilities. Since then, different formats of the same handoff tool including WHO Surgical Safety Checklist have been introduced. Nowadays similar forms of the same handoff tool are being used in the areas performing procedures/surgeries (clinics, OR, emergency department, radiology, cardiac catheterization lab, GI lab, and so on).

As a peri-op CNS I was also involved in the implementation of Surgical Care Improvement Project (SCIP) core measures, which are now part of a standardized routine peri-operative patient management (e.g., use of peri-operative beta blockers, antibiotic prophylaxis, prevention of peri-operative hypothermia and hyperglycemia, and few others) and only few people like myself remember what SCIP was. I participated in the quality and process improvement projects to enhance the patient outcomes based on evidence-based practice (EBP) including peri-operative diabetic protocol and peri-operative therapeutic temperature management protocol implementation. Moreover, I conducted a study “Comparison of accuracy and variability of the temporal artery, urinary bladder, and distal esophageal thermometer readings in the adult colorectal surgical patients,” which I presented at the Therapeutic Temperature Management Congress in Barcelona, Spain in October 2008.

In 2013, I published a review article discussing then and still controversial topic of anesthesia modality used for the patients with acute ischemic stroke (AIS) undergoing endovascular revascularization therapy. Based on my clinical observation at that time, the nurses were not equipped with skills to provide sedation to this complex group of patients especially that there was no evidence at that time showing benefits of endovascular therapy (EVT) for AIS patients. While others were debating the superiority of sedation vs. general anesthesia utilization during these procedures and superiority of different mechanical thrombectomy devices, I voiced my concerns while discussing nursing considerations and logistics of these procedures, which ultimately could have influence on the patients’ safety and outcomes. Subsequently, I conducted and published findings of a nationwide survey in 2016 to see what others around the country were doing as far as anesthesia choice for EVT was concerned. As it turns out, other stroke centers were struggling with the same problem. In conclusion of my study, I proposed creating educational opportunities for nurses with specialty in neuro-endovascular nursing.

In summary, not being aware of it I made a significant contribution to standardization in healthcare. My recent presentation at the ISC 2021 helped me to realize that over the years I have been writing and presenting on topics closely linked to standardization in healthcare. Finally, the answer is “Yes,” standardization of processes and environment in healthcare improves patients’ safety, which I discovered during literature review I conducted while preparing for this presentation. Before getting there, however, I published few articles in the Journal of Radiology Nursing including two research studies that helped me to start my journey and open doors to other venues.