Magazine article The Exceptional Parent

Transition Nursing Care Program Helps Reduce Hospital Readmissions: In July 2011, Matheny Received a Grant from the New Jersey Health Initiatives Program of the Robert Wood Johnson Foundation to Develop, with the Cooperation of Acute Care Hospital Partners, a Model to Improve Transitions to and from Acute Care Hospitals for Adults with Chronic Neurologic Disabling Conditions

Magazine article The Exceptional Parent

Transition Nursing Care Program Helps Reduce Hospital Readmissions: In July 2011, Matheny Received a Grant from the New Jersey Health Initiatives Program of the Robert Wood Johnson Foundation to Develop, with the Cooperation of Acute Care Hospital Partners, a Model to Improve Transitions to and from Acute Care Hospitals for Adults with Chronic Neurologic Disabling Conditions

Article excerpt

In March 2012, George Bracken, a 34-year-old with Lesch-Nyhan disease, was taken to the emergency room at Morristown Medical Center in Morristown, NJ, for right upper quadrant pain and fever. He was subsequently admitted to the hospital with pneumonia. This would have been a serious condition for anyone, but, for George, because of his disorder, it was potentially life-threatening.

Lesch-Nyhan is a rare and devastating genetic syndrome characterized by severe dystonia, spasticity, speech impairment, renal disease, varying degrees of cognitive deficit and the hallmark symptom - compulsive self-injury. "Lesch-Nyhan behavior is triggered whenever the patient is in pain or under any personal distress," says Jeanne Lavelle, RN, the Matheny Medical and Educational Center's transition care nurse for hospitals. "Not being able to breathe is pretty stressful. George has a lot of extra movement related to his LN, and his dystonia is unrelenting." Matheny is a special hospital and educational facility in Peapack, NJ, for children and adults with medically complex developmental disabilities.

Lavelle was on the scene at Morristown to advise the staff about these issues as the key player in Matheny's transition nursing care program. In July 2011, Matheny received a grant from the New Jersey Health Initiatives Program of the Robert Wood Johnson Foundation to develop, with the cooperation of acute care hospital partners, a model to improve transitions to and from acute care hospitals for adults with chronic neurologic disabling conditions. The grant period ended June 30, 2013, but, based on the program's success, Matheny has continued to fund and expand it by creating a division within the nursing department that is integrating its specialized resources to improve transitions during all healthcare encounters. And the program has been expanded to include children.

Because of Bracken's dystonia, says Lavelle, "he tends to create wounds. If I hadn't been at the hospital when he was admitted, it's likely he wouldn't have had his safeguarding equipment. I was able to work with the nursing staff and say, 'This what you have to watch for' and 'This is what we do at Matheny'. So, they knew what our treatment plan was."

Bracken's respiratory distress made it imperative that he be intubated. His parents had traveled to Morristown from the Baltimore area, and, according to Lavelle, "his mother had a lot of difficulty" with the intubation process. "The medical staff was in the room, and they were waiting for a decision from her. I was driving, about 10 minutes away. When I got there, she just needed emotional support and someone to explain why he needed it, and then he was intubated right away." (Intubation is the insertion of a tube into an external or internal opening of the body in order to add or remove liquids).

Evelyn Bracken, George's mother, recalls that, "the day they wanted to insert the tube down George's throat was a very emotional day for me. When they first wanted to do it, I just sat there crying, not knowing what to do or say. I had a call into Dr. Eddey (Gary E. Eddey, MD, Matheny vice president and chief medical officer), and very shortly afterwards, Jeanne came into the room and explained to me why they wanted to do it and held me as I cried. She is a very compassionate person, and I'm so glad that she is a part of Matheny so she can give patients and parents the compassion and knowledge she gave to me."

During his hospitalization, George had a G-tube (gastrostomy) inserted through his abdomen in order to provide nutrition directly to his stomach. "This was actually treating the cause of his admission," Lavelle explains. "He developed pneumonia most likely because he had been micro-aspirating, even though that's not why he went to the hospital initially."

After George was stabilized on a ventilator, he needed to have his breathing tube removed so that he could breathe on his own. …

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