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Abstracts

SGNA’S 38TH ANNUAL COURSE May 6-11, 2011 | Indianapolis, Indiana

WE ARE PLEASED TO PRESENT THE ABSTRACTS FROM SGNA’S 38TH ANNUAL COURSE, SGNA: THE LINK BETWEEN PRACTICE AND CARE. THE DIVERSITY OF THESE TOPICS CERTAINLY REFLECTS THE RICHNESS AND BREADTH OF OUR SPECIALTY.IN KEEPING WITH THE TRADITION OF THE ANNUAL COURSE, WE HOPE THE FOLLOWING ABSTRACTS WILL ENCOURAGE DISCUSSIONS FOR IMPROVING NURSING PRACTICE AND PATIENT CARE OUTCOMES.

Kathy A. Baker, PhD, RN, ACNS-BC, CGRN, FAAN Editor

TRAIN THE TRAINER: THE NURSE quality of care and patient safety; and a growing need MANAGER’S GUIDE TO THE REPROCESSING COMPETENCY to solve the fiscal dilemma of meeting the significant care demands of the patients we serve are just some of Jane Allaire, RN, CGRN the drivers for improved performance. In an effort to James Collins, BS, RN, CNOR improve efficiency, numerous facilities have begun to Michelle E. Day, MSN, RN, CGRN use Lean methods. These methods have been successful Cynthia M. Friis, MEd, BSN, RN, BC in eliminating waste and redundancy in endoscopy work processes resulting in improved financial, patient Patricia Maher, RN, CGRN satisfaction, and safety performance. Identifying the Joan Metze, BSN, RN waste, creating standard work processes, and using data which also serve as benchmarks will provide a The process for reprocessing flexible gastrointestinal baseline for the implementation of Lean methods. An endoscopes, as outlined by the Society of important part of implementing new processes in the Gastroenterology Nurses and Assocciates, will be thor- gastrointestinal unit is facilitating the change process. oughly reviewed. You will have the opportunity to prac- We will provide tips for creating your own project plan tice your skills with guidance from our knowledgeable and include change management principles to support trainers. Tips on how to develop, manage, and deliver your team and make the most of your change efforts. the reprocessing competency also will be discussed.

WHY WE DO WHAT WE DO IMPROVING EFFICIENCY Kristine Arnell Phea Anderson, MS, RN, CGRN Cynthia Di Venti Karen Laing, MA, RN, CGRN Jennifer Schabatka

The evolving healthcare industry is shaped by a variety Share our purpose and passion of becoming competent of factors and challenges, including government man- and proficient gastrointestinal technicians. We will dates for staff efficiency. A high demand for improved explore our roles as part of the endoscopy team in customer service due to increased public scrutiny of both the ambulatory and hospital settings. Our discussion will include what we do as technicians, how DOI: 10.1097/SGA.0b013e318210967a we do it, and most importantly, why we do it.

Abstracts | SGNA’s 38th Annual Course

BOWEL DYSFUNCTION ASSOCIATED authors and manuscript reviewers (or those who want WITH PARKINSON DISEASE to be) insight into what a peer-reviewer looks for in a Jason Baker, BS quality manuscript. The reviewer perspective of how to critique a manuscript will assist experienced manuscript reviewers to refine their review skills as well as A variety of chronic gastrointestinal problems common- promote more successful outcomes for authors submit- ly occur in neurodegenerative disorders such as ting manuscripts for peer review. Parkinson Disease (PD). PD is a progressive disorder of the central nervous system of unclear etiology, although strongly associated with the degeneration of dopaminer- AN EVIDENCE-BASED RESOURCE FOR gic neurons in the substantia nigra. Although PD is GASTROENTEROLOGY NURSES: THE marked by cardinal motor features including tremor, JOANNA BRIGGS INSTITUTE bradykinesia, rigidity, and postural instability, there are Kathy A. Baker, PhD, RN, ACNS-BC, CGRN, FAAN a number of common non-motor symptoms including autonomic dysfunction, cognitive dysfunction, psy- Susan Mace Weeks, DNP, RN, CNS, LMFT, LCDC chosis, and mood disorders. These motor and non- motor disturbances can lead to significant gastrointesti- This session provides an overview of evidence-based nal problems including dysphasia, constipation, and resources and tools available through the Joanna pelvic floor dysfunction. Constipation is the most well- Briggs Institute to support nurses in developing and known gastrointestinal symptom, although its true utilizing evidence-based nursing practices. prevalence and underlying physiology remain poorly described in PD. These gastrointestinal symptoms can contribute considerably to the disability and decreased LIVER LOGIC quality of life in such individuals. Moreover, gastrointestinal symptoms are not always voiced by PD patients Barb Bancroft, MSN, RN, PNP or addressed completely by healthcare providers. Given our aging population and the increased prevalence of PD with advancing age, it is essential for healthcare Did you know that your liver has over 500 func- providers to be more aware of the gastrointestinal prob- tions? The liver synthesizes proteins; stores blood; lems associated with PD, the underlying pathophysiolo- secretes bile; metabolizes hormones, drugs and alco- gy, and effective treatment strategies. hol; and even has the capability to regenerate! Barb will discuss the signs and symptoms of liver disease, diseases specific to the liver, and the liver as an inno- WRITING FOR PUBLICATION WORKSHOP cent bystander in conditions such as heart failure and autoimmune disease. Kathy A. Baker, PhD, RN, ACNS-BC, CGRN, FAAN

GI PROCEDURES FROM A TECH This presentation by the Gastroenterology Nursing PERSPECTIVE editor will discuss the “how-to” of writing for publi- Heith Battles, LPN cation including tips for increasing the success of being published. Gastroenterology nurse authors and members of the editorial board will be present to talk How important is your gastroenterology technician? one-on-one with workshop attendees. Participants will What purpose does she serve in your endoscopy lab? leave with the beginnings of a published manuscript. The endoscopy technician is an important part of the healthcare team, relating to the whole function of the endoscopy lab. Through proper training and continu- ADVANCED AUTHOR AND REVIEWER ing education, the endoscopy technician plays an WORKSHOP important role in patient safety, improved customer service, and overall efficiency of the endoscopy lab. Kathy A. Baker, PhD, RN, ACNS-BC, CGRN, FAAN This presentation will shed both light and life to the endoscopy technician focusing on endoscopic proce- This workshop, facilitated by the Gastroenterology dures including the definition of the endoscopy Nursing editor and editorial board, will offer experienced technician’s role in the endoscopy lab, training of new

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endoscopy technicians, evaluating new personalities in CORNELIA DE LANGE SYNDROME AND THE GASTROINTESTINAL ANOMALIES the endoscopy lab, and problem solving strategies. Sanjay Bhat, MD Shelley Riddle, MBA, BA, LPN, CGN CURRENT EVIDENCE REGARDING HEALTH-RELATED QUALITY OF LIFE (HRQoL) IN HEPATITIS C PATIENTS This presentation will address Cornelia de Lange Syndrome including its causes, history, diagnosis, fea- Patricia Bauch, PhD tures, characteristics, and treatment support. The Lynn Clement, MPH effects on the gastrointestinal system, care and treat- Maureen Cormier, MS, RN, NP-C ment of these patients, and family teaching and sup- Richard Sterling, MD, MSc, FACP, FACG port will also be addressed. A case study and live Tiffany Taskaya, PA-C interview with a family member will contribute to a Fulton Velez, MD unique experience. Lauri Welch, RN, NP

ADVANCED HANDS-ON ERCP We reviewed studies reporting primary HRQoL data among Hepatitis C virus (HCV) patients and assessed Jeanetta Blakely relationships between RHQol, adherence, work pro- Catherine Collins, BSN, RN, CGRN ductivity, and sustained virological response (SVR). Teri Derimanoczy, MSN, RN, FNP-BC, CGRN PubMed search (4/16/2009) terms were: Hepatitis C Deborah Gates, MS, RN, CGRN OR HCV; AND Quality of Life OR QoL OR Health Maria Paulter, BSN, RN, CGRN Related Quality of Life OR hrQoL; AND Productivity Jeanine Penberthy, MSN, RN, CGRN OR Adherence OR Compliance OR General Health Status OR Treatment History. Interferon-based thera- Susan Rivers, BS, ADN, RN, CGRN pies were included. Twenty-nine of 105 articles met Christopher Robbins, BSN, RN, CGRN inclusion criteria: 14/19 (74%) found significantly Sandra Schneider, RN, CGRN lower pre-treatment HRQoL among HCV patients Linda Wiebold, BSN, RN, CGRN compared to controls. Significant on-treatment Heather Yount, RN HRQoL reductions were observed in 13/14 studies testing for significance. Significant associations were found between HRQoL and both on-treatment pro- This session will center on a hands-on equipment ductivity and adherence to therapy. Seven of 9 studies demonstration, focusing on advanced endoscopic retro- that assessed post-treatment HRQoL differences tested grade cholangiopancreatography (ERCP) and its acces- for significance; 6/9 (86%) found significantly better sories, using a step-by-step approach, and discussing RHQoL among patients achieving SVR than those equipment use and potential complications. The thera- who did not respond to treatment. In conclusion, peutic components associated with ERCP can be both HCV patients exhibited poorer baseline HRQoL than complex and challenging. Return demonstration and healthy individuals and frequently reported diminished discussion will center on lithotripsy, entrapped stones, on-treatment HRQoL versus baseline. Most SVR and biliary dilation. Cholidochoscopy, self-expanding patients experienced HRQoL improvements that metal stents, and pancreatic therapies such as stenting approached healthy/well norms. Though data were and dilation will also be discussed. robust for pre-/post-treatment HRQoL, many studies were not adequately powered to study on-treatment HRQoL or its relationship to adherence. While man- GI AND LIVER MANIFESTATIONS OF aging HCV patients, nursing professionals could com- CYSTIC FIBROSIS municate HRQoL benefits of achieving SVR. Molly Bozic, MD Jean Pappas Molleston, MD

This session will review the gastrointestinal and liver manifestations of cystic fibrosis including pancreatic

Abstracts | SGNA’s 38th Annual Course

insufficiency, pancreatitis, liver dysfunction, cirrhosis, PREVENTION AND CONTROL OF INFECTIONS ASSOCIATED WITH ENDOSCOPY and bowel obstruction. Beverly Burt, BS, RN, CIC

ENDOSCOPY ON THE HIGH SEAS: A NURSE’S EXPERIENCE This session will discuss endoscopy-associated infection transmission with specific pathogens such as Debra Brendley, BSN, RN, CGRN Clostridium difficile, Hepatitis B and C, pseudomonas, mycobacterium, and what you can do to prevent this. Endoscopy under normal circumstances presents This session will also discuss how you can minimize many challenges; however, endoscopy aboard the the risk of infection by ensuring equipment is designed United States Naval Ship Mercy multiplied and mag- and maintained properly and that guidelines are strict- nified these challenges. Some of these challenges ly followed. The financial impact of healthcare included untrained staff, limited supplies, no techno- acquired infections will be discussed as well. logical support, lack of disinfecting machines, lan- guage barriers, and cultural differences. One Naval Reserve Nurse was chosen to support Pacific COLLABORATING TO LINK THE WORLD Partnership 2008 on a naval hopital ship as a med- OF PH AND BEST PRACTICES ical-surgical nurse and found herself in the middle of Rebecca A. K. Chandler, BSN, RN, CGRN an unusually complex situation. The space for a unit, gastroenterologist, $250,000 worth of state of the art Ellen Fern, BSN, RN equipment, and her expertize was all she had to work Janet King, BSN, RN, CGRN with. Hear how one Navy Nurse and her new team built a state of the art gastroenterology suite from the bottom up that served over 300 underserved people This session will address the use of pH testing as a from Southeast Asia. tool to effectively diagnose and document abnormal esophageal acid exposure. This class will focus on pH testing and will link an overview of gastroesophageal BASIC HANDS-ON ERCP reflux disease (GERD) to the clinical setting. We will discuss the importance of testing on or off medica- Judith Burris, RN, CGRN tions, and will review how the nurse can individual- Deborah Gates, MS, BS, RN, CGRN ize each study for their particular patients symptoms. Joan Metze, BSN, RN We will review three ways catheter based testing are Jeanine Penberthy, MSN, RN, CGRN used today in selected cases. In addition, we will Linda Wiebold, BSN, RN, CGRN focus on Bravo wireless pH testing with updates on the latest information. Finally, we will review pH Heather Yount, RN impedance and how this newer testing is being used. The faculty will collaborate to provide the best prac- This session will center on a hands-on equipment tices in pH testing for this class using a variety of demonstration focusing on basic endoscopic retro- teaching methods including lecture, looking at pH grade cholangiopancreatography (ERCP) and its tracings, video clips, hands-on, and breakout round accessories. The diagnostic and therapeutic compo- table discussions to assist in this learning process. nents associated with ERCP will be broken down using a step-by-step approach. Through return demonstration, attendees will develop an understand- LINK YOUR COMMITMENT OF OPTIMAL ing of the equipment used and its effects. PATIENT CARE BY EXPANDING YOUR Demonstrations will include initial cannulation, NURSING PRACTICE IN ESOPHAGEAL catheter and guidewire exchanges, guidewire manipu- MOTILITY lations, plastic stent placement, tissue sampling, Rebecca A. K. Chandler, BSN, RN, CGRN sphincterotomy, and occlusion retrieval balloons. Ellen Fern, BSN, RN Janet King, BSN, RN, CGRN

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This session will provide hands on experience in the SAFETY IN THE GI UNIT: ARE YOU PREPARED? motility room setting. Contents will include review of the swallowing process (anatomy and physiology, and James Collins, BS, RN, CNOR motility images both contour and wave forms), ergonomic setup of the motility equipment, techniques used for successful catheter placement, the use This goal of this presentation is to familiarize the of an educational video pre procedure, and a live Associate, Gastroenterology Technical Speciallist demonstration of an esophageal motility procedure (GTS) and Advanced Gastroenterology Technical using high resolution. Specialist (AGTS) with various safety related topics when providing care for the patient in the Gastrointestinal/Endoscopy Unit. Central themes of COURAGE TO BEGIN: NOVICES JOURNEY the program will address emergency preparedness, INTO NURSING RESEARCH AND BEST general safety principals, and risk management con- PRACTICE cerns related to the associate and their role in the unit. Cheri Coleman, BSN, RN Maria Millan, BSN, RN SNAP, CRACKLE, AND POP: The goal of this presentation is to encourage nurses MANAGEMENT OF THE DIFFICULT to begin nursing research and best practice projects. HEPATOBILIARY STONE WITH The presentation will summarize our search for a best ELECTROHYDRAULIC LITHOTRIPSY practice that utilizes a standard simethicone and ster- (EHL) AND LASER LITHOTRIPSY ile water combination for gastroenterology endoscop- James Collins, BS, RN, CNOR ic irrigations. Question formation, literature review, abstract development, collaboration with providers, and formation of a consensus statement will be pre- Endoscopic retrograde cholangiopancreatography sented utilizing an interactive skit. The progress (ERCP) has proven to be a safe and effective method through various hospital committees and end results of managing pancreaticobiliary stones over conven- that include a standard dose of simethicone and ster- tional open surgical procedures, making it the pre- ile water for gastroenterology endoscopic irrigations, dominant method of choice in the treatment of chole- a standarized data entry for providers, and compli- docholithiasis. Upon completion of a sphincterotomy, ance with The Joint Commission standard for label- 85% to 90% of stones can be easily removed with ing on and off the sterile field will be shared. This either a simple basket or balloon catheter; however, presentation is fun and informative with practical tips clearance of large or impacted stones may be quite and tools. challenging and require more than traditional endoscopic maneuvers to clear the duct, such as intraduc- tal shock lithotripsy and/or holmium laser lithotripsy. HOUSE OF DELEGATES WORKSHOP This presentation will acquaint the participant with relevant pancreaticobiliary anatomy, the physiology Catherine Collins, BSN, RN, CGRN of stone formation, devices utilized during stone Kimberly Foley, BSN, RN, CGRN extraction from customary balloons to laser technology, as well as the teamwork necessary for successful performance of stone extraction. This workshop is designed to introduce Delegates and Alternates to the workings of a House of Delegates and its role in a professional society. Basics of parlia- LEGAL AND ETHICAL CONSIDERATIONS mentary procedure will be reviewed and attendees IN THE GI PROCEDURAL AREA will participate in mock sessions of both a House of Donna A. Conroy, RN Delegates and a Reference Hearing. Find out what happens and how you can participate. Catherine Yows, RN, CGRN

This presentation will address legal and ethical considerations in the gastroenterology procedural area.

Abstracts | SGNA’s 38th Annual Course

Professional responsibilities and liabilities associated SPEAK EASY: COURAGE AND COMMITMENT TO PRESENT A with gastroenterology procedures will be discussed. SUCCESSFUL PROGRAM Upon completion, attendees will be able to identify the differences between legal and ethical issues, iden- Nancy DeNiro, RN, CGRN tify governing bodies that regulate licensing issues, Cathy Dykes, MS, RN, CCRC, CCRP, CGRN identify three ethical principals commonly associated with GI procedures, and identify resources available to assist with legal or ethical concerns Do you have good information to share with your colleagues? Are you passionate about something specific in gastroenterology? Are you involved in ENDOSCOPIC LUMEN research? Are you struggling for the best way to pres- RESTORATION/ANTEGRADE- ent your story? Learn some techniques to help you RETROGRADE ESOPHAGEAL DILATION deliver a successful program including advice on writing an abstract, preparing your talk, and how to Rhonda DelCampo, RN, CGRN best use humor, eye contact, timing, and voice inflec- tion in a presentation. Esophageal strictures causing complete obstruction are often difficult to treat using standard dilation techniques. Completely occlusive strictures may devel- ENDOSCOPIC ULTRASOUND: LINKING op after head and neck radiation therapy or THE COMMITMENT TO PROVIDE THE esophagectomy. Lumen restoration may be achieved LATEST TECHNOLOGY endoscopically via antegrade-retrograde techniques. Teri Derimanoczy, MSN, RN, FNP-BC, CGRN In some cases, however, patients may need to undergo a collaborative effort by the gastroenterologist and Judy P. Lindsay, MA, BSN, RN, CCRN, CGRN the ENT surgeon in the operation room for lumen restoration. We will explore the antegrade-retrograde Endoscopic ultrasound (EUS) is different from any dilation in the GI lab as well as the surgical proce- other gastrointestinal procedure, but need not be dure to facilitate alimentary tract patency. bewildering or panic provoking. In this two hour informative session, we will share numerous tips, and “dos and don’ts” gleaned from starting and building AMBULATORY NURSING: NEW an EUS program over the past six years. The presen- COMMITMENT TO PRACTICE AND CARE tation will address what EUS is and why it is important, what is required for an EUS program (i.e. train- Nancy DeNiro, RN, CGRN ing of staff, off-site and on-site training), differences between radial and linear echoendoscopes, fine nee- Recent nursing surveys reveal over 25% of nurses dle aspiration/FNA), differences between needles, plan to reduce their current role in the next three mini probes, and equipment inventory. Staff selec- years, and 15 percent say they will also make a tion, terminology, pathophysiology, and administra- change in their career path. A change of course can tive aspects will also be addressed. offer lifestyle changes, a new focus, or at least a refo- cus of their nursing career. This session examines reasons to consider ambulatory nursing, how ambulato- THE POWER OF ONE: THE COURAGE ry nurses rely on community and commercial AND COMMITMENT TO ABOLISH resources, and what new roles are available for the INCIVILITY IN THE WORKPLACE nurse in the ambulatory setting. Teri Derimanoczy, MSN, RN, FNP-BC, CGRN

A costly and detrimental phenomenon is plaguing our endoscopy departments . . . bullying, incivility, lateral work violence, and work place road rage are just a few of these negative behaviors that are affecting the health and safety of our patients, co-workers, and even ourselves. In this session, you will learn why endoscopy nurses terrorize each other and what

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each of us as an individual can do to end these hostil- THE GI ASSOCIATE: A VITAL LINK BETWEEN PRACTICE AND CARE ities and toxic behavior. Kate Donovan, BS, GTS, AGTS

EUS, VARIX GLUE, COIL, ETC. The gastroenterology associate is an integral part of Thomas DeSimio, RN, CGRN the healthcare team in the gastroenterology and endoscopy practice settings. They perform a variety of delegated technical and patient care related activi- This session will highlight the role of echoendoscopy ties to contribute to optimal patient outcomes. This in the treatment of various disease processes. Novel interactive session will give an in depth overview of therapies being used in a handful of centers around the field of gastroenterology as it pertains to the the world will be presented. associate role. Topics covered will include gastroenterology anatomy and physiology, infection control, endoscopic reprocessing, specimen acquisition, and THE ROLE OF THE REGISTERED NURSE team communication. IN ENDOSCOPIC ULTRASOUND (EUS) DURING PANCREATIC PSEUDOCYST DRAINAGE DEEP ENTEROSCOPY: THE FUTURE IS HERE Thomas DeSimio, RN, CGRN Sharon Downey, BSN, RN

This presentation will addres various methods of performing pancreatic pseudocyst drainage using a vari- This session will describe the dawn of deep ety of available tools and modes. enteroscopy. It will review the anatomy of the normal small bowel and the surgically altered small bowel. Applications for deep enteroscopy will be discussed. STRATEGIES FOR SAFE AND EFFECTIVE Various techniques for accessing and performing SEDATION intervention in the small bowel, including balloon methods, will be demonstrated. Equipment available Deborah Dlugose, RN, CCRN, CRNA on the market today will be presented. Devices still in the developmental stages will be described. Providing safe and effective sedation for patients undergoing gastrointestinal procedures is a challenging part of our practice. Changes in sedation practice COURAGE, COMMITMENT, are driven by the increasing number of cases done COLLABORATION AND TWO MORE CS: each year and the increasing level of responsibilities COLORECTAL CANCER SCREENING AND of nursing roles in these procedures. New definitions THE COLON HEALTH INITIATIVE and standards are being promulgated by various Cathy Dykes, MS, RN, CCRC, CCRP, CGRN groups while pharmacology and technology for sedation care are advancing. This full-day workshop will focus on topics including strategies for patient selec- Approximately 150,000 people are diagnosed with tion, assessment, and preparation; planning for clini- colorectal cancer each year resulting in 50,000 deaths. cal safety; making sense of monitoring; rational titra- As the number of people who undergo colorectal can- tion of medication; rapid response to emergency cer screening increases, there is a corresponding events; effective documentation; and risk management increase in the rate of colorectal cancer found at an strategies from bedside to manager levels. Seminar earlier stage, along with a decrease in the number of content emphasizes critical thinking and problem- deaths from colorectal cancer. Optical colonoscopy is solving skills. Case illustrations from the instructor’s the gold standard for colorectal cancer screening; experiences in sedation care and legal nurse consult- however, my gastrointestinal unit serves a population ing will also sharpen participants’ abilities to provide of 250,000 with only six gastroenterologists. Sentinel sedation care which is both safe and effective. Is your research on virtual colonoscopy (e.g. computed tomo- practice ready to evolve? graphic colonography [CTC]) has been conducted at our facility with equivalent rates of polyp detection

Abstracts | SGNA’s 38th Annual Course

on polyps 6 mm in size as compared with optical plan is used in the construction of the exam, how the colonoscopy. A Congressional grant established the passing score is set, and options for taking the exam. Colon Health Initiative with the goal of offering the Test-taking tips will be discussed and attendees will option of CTC to appropriate patients to increase the have the opportunity to ask questions. rate of colorectal cancer screening. The outcome was a multidisciplinary team that has facilitated a 36% increase in colorectal cancer screening. It took courage AMERICAN BOARD OF CERTIFICATION to think outside the box as we are committed to col- FOR GASTROENTEROLOGY NURSES orectal cancer screening and the collaboration between (ABCGN) ITEM WRITERS WORKSHOP the radiology and gastroenterology departments. Nancy Eisemon, MPH, RN, CNS, CGRN

RECERTIFICATION INFORMATION Learn how to write and critique items for the certifi- SESSION cation examination. Participants will be guided through a step-by-step process to develop quality Jeanie Ebbert, RN, CGRN items (questions). This is a unique opportunity for Shirley Flowers, BSN, RN, CGRN professional growth and challenge. All attendees will Virginia Parkhurst, RN, CGRN meet the volunteer eligibility requirements for Nancy Todd, RN, ARNP, NP-C, CGRN, RN-BC ABCGN’s Item Review Committee, Item Writing Kendall Yoshisato, BA, RN, CGRN Panel, or Panel of Experts for the Role Delineation.

This session will cover information on recertifying for OBESITY AND BARIATRIC SURGERY CGRN status. Updates, tips, and helpful information will be provided. Christopher M. Evanson, MD, FACS, FASMBS

INFECTION CONTROL: WHAT ROLE DOES This session will be a comprehensive overview of THE TECHNICIAN PLAY? obesity and bariatric surgery. Discussion topics include medical comorbidities related to obesity as Cynthia Edgelow, MSN, RN, CGRN well as weight related mortality statistics. We will Kimberly Richarson discuss the most common bariatric procedures in detail, as well discuss post-op statistics and potential issues in bariatric surgical patients. Infection control continues to play a significant role in healthcare. Current statistics estimate that there are thousands of deaths each year attributed to hospital- UNDERSTANDING AND COPING WITH acquired infections. What role does the gastrointestinal BULLYING IN THE WORKPLACE tech have in attempting to decrease these infections? Bonnie Fisher, BSN, RN, CGRN What types of infections are seen in gastroenterology? What is the current approach towards these using evidence based practice–what do we know, what have we Workplace bullying is a problem often not addressed learned? What works and what doesn’t in personal resulting in unhappiness or fear in the workplace, protective equipment choices? What’s new? change of position to another area, or leaving the field of nursing altogether. This presentation intends to address the following: the definition of what is UNDERSTANDING THE VALUE AND and what is not a workplace bully, a profile of the OPPORTUNITIES OF PROFESSIONAL bully and the victim, what to do and how to interact NURSING CERTIFICATION with the bully (what works), what to report to management, and management’s responsibilities. The Nancy Eisemon, MPH, RN, CNS, CGRN author’s own story of bullying will be presented.

Learn the benefits of CGRN Certification. This session will discuss eligibility requirements, how the test

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Abstracts | SGNA’s 38th Annual Course

IS YOUR PATIENT VENTILATING? session will utilize a video and visually-based talk CAPNOGRAPHY USE DURING ENDOSCOPY aimed at all levels, from novice to expert. Julie Flamm, BS, ADN, RN, CGRN Karyn Pechinski, BSN, RN, CGRN Cecelia Pezdek, BS, ADN, MSHA, CGRN APPLYING FOR NURSING CONTACT HOURS

A research study was conducted comparing capnogra- Cynthia M. Friis, MEd, BSN, RN, BC phy and pulse oximetry on 47 randomly selected colonoscopy patients receiving moderate sedation. The This presentation will focus on the fundamental ele- study determined that capnography identifies disor- ments of completing the Application for Nursing dered breathing (hypoventilation, stridor, apnea) up to contact hours through the SGNA Approver Unit. two minutes before desaturation occurs. Pulse oximetry Participants will receive helpful hints on how to best detected 13 episodes of desaturation, whereas capnog- meet the criteria for approval and tips on creating an raphy detected 29 episodes of apnea and 64 episodes of effective educational experience. hypoventilation. The study also examined the correla- tion between apneic events and age, gender, smoking history, past medical history, history of sleep apnea, cur- NATURAL THERAPIES FOR GI AILMENTS rent daily medications, body mass index (BMI), and American Society of Anesthesiologists (ASA) class and Yvonne Garcia, MSN, MBA, ND dosage of versed and fentanyl. A relationship between lower BMI and increased apneic events was identified. Forty-five percent of normal or overweight subjects had This session will review the pathology of common at least one apneic event. Eleven percent of patients gastrointestinal ailments and the natural therapies classified as obese experienced apnea (classified accord- recommended for management such as acupuncture, ing to the World Health Organization BMI classifica- chiropractic, nutritional counseling (foods and drinks tion system). Other factors showed minimal to no cor- to consume or avoid), detoxification, enzymes and relation. Due to the small sample size, we view this as antioxidants: vitamins, minerals, supplements, herbs, an opportunity to expand research for factors that may and remedies. indicate a higher risk for disordered breathing during endoscopy. For gastrointestinal patients, capnography is clearly the best method for ensuring patient safety dur- THE ROLE OF THE NURSE DURING ing moderate sedation and should be the primary tool INTERVENTIONAL BRONCHOSCOPY nurses use to monitor patient ventilation. Elsa Garza, ACNP Mark J. Rumbak, MD THE PANCREAS IS A HARSH MISTRESS

Joyce Flueckiger, RN, APRN BC, CGRN After this session, attendees will be able to appreciate what an interventional pulmonologist does and how she or he can assist during procedures. Topics dis- This session will review endocrine and exocrine func- cussed during this session will include bronchoscopy tions of the pancreas; the etiology of acute, chronic in both intubated and non intubated patients; thoro- pancreatitis and neoplasms; diagnostic criteria; and centesis and chest tube insertion and removal; ultra- treatment of acute and chronic disease and neoplasms. sound guidance for central lines and line changes; pleuroscopy; pulmonary arterial hypertension (PAH); cardiopulmonary stress tests; obtaining access and PANCREATIC STENTS FOR PREVENTION doing heart catheterizations in patients with PAH; OF POST-ERCP PANCREATITIS planning and assistance in the operating room for total lung washout; Wang biopsies; stent placement; Martin L. Freeman, MD, FACG, FASGE balloon dilatation; narrow band imaging; electro- cautery, argon plasma coagulation and laser; rigid This session will review rationale, technique, out- bronchoscopy; and pleur-X catheters. comes, evidence, and pitfalls of pancreatic stents. The

Abstracts | SGNA’s 38th Annual Course

THERAPEUTIC BRONCHOSCOPY AND in a complex environment, and why research and THE MODALITIES OF TREATMENT innovation may be the tactical strategy of survival. Theresa Geil, RN, CGRN

THE LINK BETWEEN DIVERTICULA AND Designed for the experienced pulmonary nurse, this THE GASTROINTESTINAL TRACT course is designed to provide insight into the different Janet Hannah, RN, CGRN modalities available in the endoscopy suite to successfully treat various pulmonary disorders. Diseases, disorders, and the use of ancillary equipment such as the Gastrointestinal (GI) tract diverticula are outpouch- argon plasma coaulator, cryotherapy, and stents will ings in the lining of an organ. They are mostly found be discussed, as well as patient considerations in the large intestine. We are familiar with diverticu- throughout the entire pulmonary procedure process. losis and diverticulitis of the colon. But did you know that diverticula are found in other parts of the gastrointestinal tract? This presentation will review NASH: NOT JUST A CAR YOUR colon diverticulosis and diverticulitis, followed by a GRANDMOTHER DROVE trip through the rest of the GI tract to discover the classifications, histopathology, and pathogensesis of John Goff, MD other diverticuli. The esophagus, stomach, and small bowel will be covered. Zenkers and Meckels divertic- Learn about NASH (nonalcoholic steatohepatitis) ua are two of the main types that will be included. liver disease including how to recognize it, how to Locations, signs and symptoms, and treatments will confirm a diagnosis, how it is affecting many of our be discussed. At the end of the presentation, the patients, and how we are treating it. attendee will understand that diverticula are not just in the colon.

LIVING AN OPTIMAL LIFE: HOW TO HAVE YOUR CAKE, AND EAT IT TOO! SURVIVING AN INFECTION PREVENTION David W. Grotto, RN, LDN SURVEY Marcia Hardick, BS, RN, CSPDT Being tired, stressed, or forgetful; having low libido; or being in pain are just a few of the descriptors for Patient safety initiatives include a focus on decreasing not being at the top of your game. Boomers are rank- the incidence of healthcare-associated infections ing life’s inconveniences and not feeling good as a (HAIs). Decreasing the incidence of HAIs continues greater concern to them than the health challenges to be a major focus as regulatory agencies survey that threaten their very existence. David Grotto, RD, areas at risk for transmission of infection. Creating a LDN, author of 101 Optimal Life Foods, will review culture of safety should encompass infection preven- an add-in more sustainable approach for tackling tion initiatives to protect patients, their families, and those challenges that get in the way of living. healthcare workers (HCWs). Performing infection prevention rounds within a patient care area can identify areas of risk and address opportunities for THE EVIDENCE THAT ISN’T improvement in infection control practices. Studies now confirm that the environment plays a role in the Richard Hader, PhD, RN, FAAN, CHE, NE, BC, transmission of infections. The HCW must be contin- CPHQ ually cognizant of an awareness of dirty/clean and work flow processes to assist with decreasing the risk of transmission of infection and provide a safe envi- Why is there a surging interest in evidence based ronment. This presentation will provide the healthcare? Haven’t we always practiced based within the care worker with a tool to identify the areas of framework of tested science? The answer might sur- potential risk within the patient care and reprocess- prise or scare you. This presentation will focus on ing areas. It will review the chain of infection, com- why evidence based practice is more important than mon microorganisms, and their hierarchy of resist- ever, how we need to think, act, and work differently ance. Examples of procedural barriers and work flow

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to decrease the risk of transmission of infection will training has just begun. I believe SGNA members will also be presented. be interested in Dan’s story and the path it takes. A big part of our consideration for Dan and this new endoscopy technician position are the possibilities SIMULATION BASED TRAINING IN THE this job can bring to his future and the future of GASTROENTEROLOGY PROCEDURE UNIT gastroenterology! Lisa Heard, BSN, RN, CGRN, CPN LEAP AND MRT: THE LINK BETWEEN The use of simulation-based training (SBT) provides INFLAMMATORY DISORDERS AND FOOD healthcare teams with opportunities to practice man- SENSITIVITIES aging complications of endoscopy without risk to Patricia Holland, BSN, RN, CGRN patients. The aviation industry has effectively used SBT and crew resource management to help teams perform effectively in crisis situations. The healthcare This session will describe the Lifestyle Eating And world has adapted this training and effectively uti- Performance (LEAP) program. The program utilizes lized it to assist teams to manage critical events and Mediator Release Testing (MRT) to identify Type IV improve communication and teamwork among care- cell-mediated food intolerance or hypersensitivity givers. This session will describe the benefits and reactions and implement dietary modification for rationale for the use of SBT, highlighting adult learn- relief of associated symptoms. Attend this session to ing theory. Our experience of performing SBT in the learn how this program can be effective for Irritable pediatric endoscopy unit, review of lessons learned, Bowel Syndrome (IBS) as well as many other condi- and benefits of this specialized team training will be tions that may be associated with immunologically- presented. related food sensitivity.

DAN’S STORY: THE TRAINING OF AN ABDOMINAL PRESSURE DURING ENDOSCOPY TECHNICIAN WITH LIMITED COLONOSCOPY LECTURE AND HANDS-ON MEDICAL EXPERIENCE Raymond Hucke, MPH, OTR Sheenagh Hirsch, RN, CGRN James Prechel, GTS Karen Zervopoulos, CMA, CSPDT, CFER, GTS, Sara San Miguel, GIA AGTS Catherine Yows, RN, CGRN

This presentation will follow the story of a young This four hour class will incorporate a formal one man (21 years old) who works in a gastroiontestinal hour lecture along with three hours of hands on (GI)-specific ambulatory surgical center in Central experiences. The lecture will cover the theory behind New Jersey. Dan was hired as a unit clerk and imme- the hands on application, and will provide informa- diately became a popular young man due to his hard tive visual guidance to achieve the objective of each work, dedication, and positive attitude with staff and technique. In the hands on portion of the class, the patients. Gradually, Dan became interested in our GI attendees will get a chance to demonstrate up to 12 procedures, and when an endoscopy technician posi- techniques (time permitting). The lecture and hands tion became available, he stated his strong interest in on portion of the course will offer the attendee prop- obtaining this new position. The Director of Nursing er ergonomics with focus on safety and comfort for and lead endoscopy technician agreed Dan was a the patient as well as the caregiver. The goal of this wonderful worker, but his lack of medical experience course is that all attendees will learn and perform was hard to overlook. After discussion, the decision each technique and be able to take the skill back to was made to train Dan, someone we knew who had their department to perfect and share with cowork- worked hard and deserved a chance. The SGNA ers. It is our suggestion that each attendee wear com- Associates Program/Guidelines and our department fortable clothing as we will be performing the tech- endoscopy technician competencies were reviewed niques on each other. about how to approach our special training of Dan. A preceptor will be assigned to help Dan whose

Abstracts | SGNA’s 38th Annual Course

DYSPHAGIA: WHY SPEECH UNDERSTANDING ESOPHAGEAL PATHOLOGISTS HAVE GONE MANOMETRY WITH CASE ESOPHAGEAL PRESENTATIONS Gerriann Jackson, MS, CCC-SLP Linda Knight, BSN, RN Corinne Pavesic, RN, CGRN

The relationship between gastroenterology and speech pathology is important for our patients. Our ability This lecture will provide a brief overview of to provide cross-disciplinary diagnostic evaluation esophageal manometry followed by case presenta- and treatment planning is critical to our success in tions. Presentation of actual patient procedures will treating dysphagia. This presentation addresses the allow for the discussion of indications for performing the benefits of such a partnership and provides an esophageal manometry, understanding waveform pat- overview of how gastrointestinal (GI) disease impacts terns and interpretation of the findings, trouble the oral pharyngeal phase of the swallows. Video shooting abnormal findings with difficult studies, and clips of fiberoptic endoscopic evaluation of swallow- gaining knowledge of esophageal disorders. Group ing studies and videoflouroscopic swallow studies of interaction and questions will be encouraged patients whose primary dysphagia etiology was the throughout the lecture. Case presentations will esophagus will be viewed. The presentation connects include examples from several different catheter types the functional swallowing behaviors evaluated by speech including high resolution manometry, impedance, and pathologists to GI/esophagogastricduodenoscopy five-channel manometry. (EGD) findings.

ENDOSCOPE CLEANING VERIFICATION ENDOSCOPIC POLYPECTOMY AND TEST STUDY MUCOSAL RESECTION Stephen Kovach, BS Tonya Kaltenbach, MD, MS Natalie Whitfield, PhD

Participants will enhance their knowledge and technical skills in the endoscopic polypectomy and mucosal Widespread use of endoscopes has increased the risk resection of gastrointestinal neoplasia and early can- of transmission of infections, making reprocessing cer. We will demonstrate using slides, images, and critical to routine care of rigid and flexible endo- video to document the importance of endoscopic scopes and infection prevention. The objective of the detection and diagnosis of gastrointestinal lesions. study presented was to determine the real-world Contributing factors of interval cancers; necessary effectiveness of healthcare facilities’ flexible endo- detection, diagnosis and resection tools and equip- scope cleaning procedures by utilizing a residual soil ment; indications for polypectomy and mucosectomy; verification test. Healthcare centers across the United and practical pearls of detection, diagnosis and resec- States were recruited to test the biopsy/suction chan- tion techniques will also be addressed. nel of 10 endoscopes before and after cleaning, but prior to high level disinfection/sterilization, and record the results. Of the 103 endoscopes tested, DO YOU HAVE THE COURAGE AND cleaning removed the majority of the residues found COMMITMENT TO MAKE YOUR PRACTICE prior to cleaning the endoscopes. The most common EVIDENCE BASED? WHAT IS THE residue found before cleaning was blood (56%); PROCESS INVOLVED IN DOING A however, after pre-cleaning, only 4% of the endo- RESEARCH POSTER? scopes yielded a positive result for blood. We con- Janet King, BSN, RN, CGRN cluded that the residual soil verification test is a simple, effective, and easy-to-interpret addition to the cleaning process that allows users to demonstrate This session will address the process used to develop competency with proper reprocessing methods of a research poster. Discussion will focus on a research endoscopes. poster displayed at the 2010 SGNA National Conference. Review of the steps used in reaching the research outcome will be presented.

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THE NEW FACE OF GLUTEN SENSITIVE patients leading to highly satisfied patients and CONDITIONS: CELIAC DISEASE AND BEYOND improved compliance. This workshop covers: opening/closing patient interviews, listening skills, Cynthia Kupper, RD empathic responding, questioning techniques, and top tips to educate patients with impact. Communicate your way to success! In this session, you will learn about advances in the differences between celiac disease and non-celiac gluten sensitivity and their presentation, diagnosis, ANAL INCONTINENCE: THE “UNVOICED” treatment, and management guidelines. Learn how COMPLAINT the quality of life of persons is impacted by following Judy P. Lindsay, MA, BSN, RN, CCRN, CGRN a gluten-free diet and about potential future treatment options. Anal incontinence affects as many as 5 to 20 million people with devastating consequences such as depres- BENCHMARKING: DATA-DRIVEN BEST sion, social withdrawal, and poor quality of life. PRACTICES Learn more about this overlooked, under-diagnosed condition and what can be done to reach out and Karen Laing, MA, RN, CGRN help these individuals. Nancy Schlossberg, BA, BSN, RN, CGRN

NEWLY DIAGNOSED IBD PATIENTS: WHAT Healthcare reform and accreditation requirements THEY NEED TO KNOW increasingly challenge gastrointestinal (GI) nurses and Isabelle Lynch, MBA, BSN, RN associates to focus on the delivery of evidence-based, outcome-oriented, cost-effective quality care. Benchmarking establishes standard metrics and Within the inflammatory bowel disease (IBD) health- enables an endoscopy facility to convert numbers, care community, compliance in newly diagnosed such as cost per procedure and staff ratios, into patients is often problematic. Part of the problem is meaningful information for more effective manage- lack of knowledge of their disease, its process, and/or ment of a GI lab. After first identifying and describ- prescribed medications, or an overall lack of knowl- ing basic principles of benchmarking, this session edge of a combination of these. This presentation will then offers attendees basic tools, tips, and strategies provide information to providers of care for this for developing a simple benchmarking program in patient population, which will be helpful in increas- their own endoscopy suite. Learning from others can ing compliance and appreciation that a diagnosis of help guide us in our decision-making and commit- IBD is not a deal-breaker for a well lived life. ment to identify areas warranting improvements in quality, efficiency, and productivity of physicians, staff, and overall clinical and financial operations. ENDOBRONCHIAL ULTRASOUND (EBUS): THE ALTERNATIVE TO TRANSBRONCHIAL NEEDLE ASPIRATION (TBNA) AND ENGAGING YOUR PATIENTS: SUREFIRE MEDIASTINOSCOPY? STRATEGIES TO RAISE SATISFACTION Shannonlee Maialetti, BSDI, RT(R), RDMS SCORES, DECREASE MISCOMMUNICATION, AND DRAMATICALLY ENHANCE EDUCATIONAL Participants will be able to understand the basics of METHODS EBUS, as well as how it relates to alternative studies, Edward Leigh, MA such as TBNA and mediastinoscopy. Discussed will be anatomy and physiology, physics, ultrasound imaging, TBNA, mediastinoscopy, and EBUS Learn what to say to patients and what never to say procedures. to patients! This high-energy interactive program will empower gastroenterology professionals with skills to dramatically improve the quality of interactions with

Abstracts | SGNA’s 38th Annual Course

FLORENCE NIGHTINGALE: APPRECIATING INTESTINAL TRANSPLANTATION IN THE OUR LEGACY, ENVISIONING OUR FUTURE, CURRENT ERA CONNECTING OUR WORLD Richard S. Mangus, MD, MS, FACS Phyllis Malpas, MA, RN, CGRN Gayle Mullins, BA, RN The indications for intestinal transplantation (IT) continue to broaden and include intestinal failure, certain Florence Nightingale is the gold standard for the his- non-resectable tumors, and portomesenteric thrombo- torical role of nursing as a profession. She is credited sis. This study reviews the changing indications for IT with the origination of its art and science. Her vision, and current outcomes including an update regarding however, went far beyond the well known traditional the current status of intestinal transplantation. Nurses role. Nightingale’s dedication and determination will be able to identify patients that may benefit from encompassed holistic care from the individual to the intestinal transplantation following a review of indica- community, then out to the world. Through a dialogue tions and outcomes for intestinal transplant patients between Nightingale and a modern nurse, the link at a single center over a 7-year time period. Study between Nightengale’s purpose and each of us in the results demonstrate continued improvement in IT out- healthcare community becomes clear. The topic leads comes for both adult and pediatric patients. An the attendees to an understanding of their historic but increasing number of patients can benefit from this holistic role and its current application in healthcare. option. Intestinal transplantation is a viable option for many patients with otherwise terminal diseases including short gut, certain non-resectable tumors and INTESTINAL TRANSPLANTATION IN INFANTS portomesenteric thrombosis. YOUNGER THAN ONE YEAR OF AGE Richard S. Mangus, MD, MS, FACS LONG-TERM LIVING WITH A A. Joseph Tector, PhD, MD PERCUTANEOUS ENDOSCOPIC Rodrigo Vianna, MD GASTROSTOMY (PEG) TUBE Terry Markiewicz, MS, RN, CGRN Parenteral nutrition (PN)-dependent infants with short gut are at high risk of cholestatic liver disease, cirrho- Gastrointestinal nurses routinely assist in the place- sis, and death. Intestinal transplantation may be indi- ment of PEG feeding tubes. Many of the recipients cated for these children if they develop PN-related are no longer functional in their activities of daily liv- complications. This presentation reports study results ing and received a PEG as a result of stroke or other for infants undergoing intestinal transplantation. debilitating entity. What happens, however, to the Management options for infants with short gut syn- patient who is highly functional but cannot eat? This drome who are candidates for or who undergo intes- presentation will focus on one woman’s journey after tinal transplantation will be highlighted. Review of multiple surgeries for oral carcinomas, dealing with outcomes for intestinal transplant patients less than 1- the multitudes of complications that can and do arise year of age will be reviewied along with the primary as the result of artificial feeding methods. Lessons study outcomes including PN-independence and learned can be applied to persons of any age with a patient survival. Results demonstrated that infants less PEG. Many of the complications necessitate a team than 1-year of age can successfully undergo intestine approach (collaboration) in developing a resolution. transplantation with good outcomes. Intestinal transplantation is a viable alternative for young infants with life-threatening complications of intestinal failure. COURAGEOUSLY NAVIGATING REGULATIONS FOR AN EFFECTIVE INFECTION CONTROL PROGRAM Rhonda Maze-Buckley, RN, CGRN

This presentation will discuss current guidelines and regulations as they pertain to an effective infection control program. The speaker will discuss current

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practices as required by Medicare, The Joint COURAGE AND COMMITMENT TO COLLABORATE WITH CLIENTS Commission (TJC), and the Accreditation Associaiton REGARDING THEIR CELIAC CONDITION of Ambulatory Health Care (AAAHC). Lea Anne Myers, BS, RN, CGRN

PEDIATRIC SEDATION AND ANALGESIA This session will provide you with a general under- Michael Mazurek, MD standing of celiac disease and provide you with additional knowledge to use when educating your clients with celiac disease. We will also review tips and This presentation will address the requirements for resources to use to collaborate with your clients to providing safe pediatric sedation including pre- help them manage their celiac condition more effec- sedation, intra-procedure sedation, and post-sedation tively while maintaining a “close to normal” lifestyle. requirements. Included in this presentation will be definitions of various levels of sedation, appropriate monitoring techniques, and specific case discussions. WHAT IS THE EVIDENCE BEHIND OUR SEDATION PRACTICE? Susan Nuccio, MSN, RN, ACNS-BC, CGRN GASTROINTESTINAL AND LIVER DISEASE IN CHILDREN This presentation will take a look at present moder- Jean Pappas Molleston, MD ate sedation nursing practices. Evidence-based nursing practice concepts will be discussed along with the This session will provide an overview of pediatric evidence we have in support of our sedation pratices. gastroenterology disorders including abdominal pain, The presentation will include professional, regulatory, gastro-esophageal reflux, liver disease, and non-bleed- research, and best-practice resources. Areas of pre- ing gastrointestinal emergencies in children. assesment, intra-procedure monitoring, and post- procedure care will be addressed.

WHEN TWO HALVES ARE GREATER THAN ONE WHOLE: LIVING LIVER DONATION THE BEGINNING LINKS OF ENDOSCOPIC RETROGRADE Denise S. Morin, MSN, RN CHOLANGIOPANCREATOGRAPHY (ERCP) Jeanine Penberthy, MSN, RN, CGRN Although liver transplantation (LT) is the best treatment for patients with liver failure, the scarcity of deceased donor organs has resulted in a surgical inno- This session will start at the very beginning—the vation: living donor liver transplantation (LDLT). This why’s, how come’s, and what are we looking at will surgical alternative is possible because of the liver’s be covered including basic biliary anatomy, physiolo- ability to regenerate and advances in imaging technology, and pathophysiology. The equipment commonly gy. Priority concerns regarding LDLT include ensuring used during ERCP will be discussed, and fluoroscopic donor safety and selecting appropriate LDLT recipi- images of biliary anatomy and common biliary ents. This presentation will build on previously pre- diseases will be reviewed. sented content and includes discussion of donor quality of life, identified medical conditions in the “healthy” living liver donor, and variations on living liver dona- ENDOSCOPIC ULTRASOUND: BACK TO tion including the urgent living liver donor evaluation BASICS and simultaneous living liver and kidney donation. Jeanine Penberthy, MSN, RN, CGRN

The use of endoscopic ultrasound (EUS) has become more and more common over the last few years. This lecture will cover endoscopic ultrasound from its humble beginnings (i.e. basic EUS anatomy, the

Abstracts | SGNA’s 38th Annual Course

functions of the ultrasound scopes and processors) Colorectal Cancer Screening Saves Lives campaign. to the current treatments modalities (i.e. fine needle Relief is the emotion experienced by the patient who aspiration, fine needle injections, celiac plexus blocks, can get his tumor removed; dismay is the emotion and neuorolysis, along with pseudocyst drainage. We when follow-up care or symptoms reveal that the can- will also review how the technology of EUS has cer has metastasized to the liver. Evidence demon- evolved, making it a very effective means of evalua- strates that treatment options can appreciably prolong tion of the gastrointestinal tract and treatment. a satisfying, productive life. How and when does colon cancer progress so that the patient succumbs to the disease? The purpose of this presentation is to ADVANCING NURSING: SHARED outline the evolution of colon cancer, treatment GOVERNANCE AND PROFESSIONAL options, management, and prognosis. The role of the PRACTICE GI nurse in the interdisciplinary care of the patient to achieve optimal outcomes will be presented. Tim Porter-O’Grady, DM, EdD, ScD(h), GCNS-BC, NEA-BC, FAAN BOWELS GONE WILD: DIARRHEA This session will specifically focus on the transforma- DILEMMAS tion of the clinical provider’s and manager’s role Patricia Raymond, MD, FACP, FACG within an effective shared governance system. The focus will reflect the principles and protocols related to effective and sustainable shared decision-making Loose watery stools: there’s a lot more to the diagno- models. Implications are included for the provider sis and management of this process than just a with regard to shifting shared governance structures colonoscopy and biopsy. We’ll talk about the differ- to support a continuum of care. ential diagnosis of diarrhea; clinical clues that you might be dealing with a diarrheal syndrome such as glucagonoma, pancreatic insufficiency, or carcinoid COMPLEXITY AND NURSING PRACTICE: syndrome; and symptom management including the NEW RULES FOR LEADERSHIP proper selection and use of probiotics. Tim Porter-O’Grady, DM, EdD, ScD(h), GCNS-BC, NEA-BC, FAAN COMMIT TO QUALITY ENDOSCOPY: THE LINK BETWEEN PRACTICE AND CARE

This session will specifically focus on the transforma- Patricia Raymond, MD, FACP, FACG tion of the healthcare leader’s role with a new set of leadership expectations. The focus will reflect the Studies have shown that a cecal withdrawal of Ͼ6 min- introduction of healthcare transformation realities utes leads to finding twice the number of polyps than and post reform concerns confronting leadership in withdrawals under 6 minutes. A study at a teaching hos- healthcare. Implications will be discussed for these pital revealed that one attending had a cecal intubation organizations with regard to shifting post-reform of an appalling 63% You want to do good endoscopy in social economic and technical forces, as well as the your suite; in fact, you are pretty sure you do—or are accountability of the role in a complex environment. you? Do you insist on photodocumentation of the cecum? Measurement of withdrawal time? Can’t get your physicians on board? This presentation will arm COLON CANCER METASTASIZED TO THE you with ammunition to address these issues and more. LIVER: NOW WHAT? Janice A. Provenzano, MSNED, RN, CGRN ENDO MANAGEMENT SKILLS: FORGING THE LINKS/BREAKING THE CHAINS According to the American Cancer Society, nearly Patricia Raymond, MD, FACP, FACG 50,000 people died of colorectal cancer in 2009. Endoscopy and gastrointestinal (GI) nurses and associates participating in screening and diagnostic colono- In this collaborative session, Dr. Patricia Raymond scopies believe in the American Cancer Society’s facilitates a roundtable discussion with both

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experienced endoscopy managers and those new to BASIC GI REIMBURSEMENT the position, mining your colleagues years of experi- Nancy Schlossberg, BA, BSN, RN, CGRN ence for time-tested ideas to forge your own amazing suite. Get your management questions answered, or offer your expertise to your colleagues, or both! Economic changes continue to impact gastrointestinal (GI) and endoscopy practice for physicians, nurses, associates, and patients. This session introduces GI WHATS NEW IN INFLAMMATORY BOWEL nurses and associates to basic elements of how and DISEASE (IBD)? INCREASED why GI facilities and physicians get paid to deliver UNDERSTANDING: IDENTIFICATION OF endoscopic patient care and services. The presenta- BIOLOGIC TARGETS AND EMERGING tion defines basic reimbursement vocabulary and THERAPIES concepts including Current Procedural Terminology Laryl Riley, MSN, RN, RNP, CGRN (CPT), International Classification of Diseases (9th ed.), Clinical Modification (ICD-9)-CM), relative value unit (RVU), and modifier and payer mix. The IBD is a chronic, lifelong disease with no medical session then applies these fundamentals to reading cure. Multiple modalities are required to aid in treat- and interpreting a fee schedule. Learning these ment. Newer therapies have now been shown to alter “ABCs” equips all GI nurses and associates with the natural history of the diseases or to maintain sta- another tool to enhance commitment and collabora- ble remission. We will discuss emerging biologic tion with staff, physicians, and patients. agents, their potential targets, and the supporting data justifying their use including the clinical precau- tions that should be taken for patients receiving bio- NEW FRONTIERS IN INTERVENTIONAL EUS logics and safety monitoring concerns. Janak N. Shah, MD

WHAT DOES ELEVATED LIVER ENZYMES MEAN? A FUN APPROACH TO THE The session will focus on cutting edge advances in DIAGNOSIS AND MANAGEMENT OF THE interventional endoscopic ultrasound (EUS). Specific PATIENT WITH ELEVATED LIVER topics that will be covered will include: EUS-guided ENZYMES endoscopic retrograde cholangiopancreatography Laryl Riley, MSN, RN, RNP, CGRN (ERCP), EUS-guided treatment of tumors, EUS-guided therapy of varices, and new EUS technology.

An elevation in the amount of enzymes released by the liver is a symptom with a myriad of causes. When IBD FROM A TO Z the liver is inflamed or damaged, it secretes an exces- sive amount of these enzymes. Most cases of elevated Shamita B. Shah, MD liver enzymes are merely temporary and not something to be overly concerned about, but there are instances when an elevation in liver enzymes needs to An overview of inflammatory bowel disease (IBD) will be treated as a serious problem. Eliminate the feeling be given to the audience including definitions of the of uneasiness the next time your patient presents with disease, proposed etiologies, triggers, diagnostic studies elevated liver enzymes or any form of liver disease. including endoscopy, and overview of management. This session will review the normal function of the liver and most causes of elevated liver enzymes, including examination tools, current management, as FROM THE OFFICE TO THE ENDO LAB well as incorporating memory aides and helpful AND BACK: WHAT YOU AND YOUR pearls. Attendees will be able to use newly acquired PATIENT NEED TO KNOW skills to manage case studies. Jo Sienknecht, RN, CGRN

This presentaiton will address various aspects of nursing assessment and patient education that takes

Abstracts | SGNA’s 38th Annual Course

place in the office and endoscopic setting. Basic phar- will review the history, transmission, and risk factors macology, laboratory, and radiological tests; for C. diff infection and key reprocessing steps which endoscopy procedures; and other diagnostic tests will reduce the risk of cross contamination from the be discussed along with common disease processes endoscope when using high level disinfection. and how they relate to the plan of care. The value of collaboration between the provider office staff and the endoscopic staff is essential. The presentation will FINDING THE LEADER IN YOU: MAKING include ways to foster the team approach between THE CHOICE TO LEAD these entities. Leslie E. Stewart, BA, RN, CGRN

CLUES FOR UNDERSTANDING Leadership is both a role and “life changing” person- GASTROINTESTINAL MANIFESTATIONS al decision. You need no title to be a leader, for it has OF INBORN ERRORS OF METABOLISM less to do with the size of your professional position and more to do with your commitment to excellence. Megan M. Skinner, MGC, CGC Leadership is about your impact and the choices you face in order to influence others by doing your best This session will focus on different metablism disor- work each and every day, regardless of where you are ders and their presentations, emphasizing their GI planted. Leadership is the recognition of a desire not symptoms. found in a name or a position. It is the ability to see opportunity amid crisis and guide a situation towards a positive outcome. Distributed leadership, or leader PULMONARY MEDICINE: AROUND THE democratization, is a powerful idea that calls upon WORLD IN ONE HOUR personal empowerment to lead with the authority of knowledge founded in experience and evidence. As Jason T. Smith, MD we face the demands of change in the coming years, identify your potential and the difference you make. We will take a tour of pulmonary medicine, highlight- Step into SGNA leadership! Commit to the variety of ing disease processes, diagnosis, and management. challenges that face our organization and help SGNA add value through your extraordinary contribution to our future growth. “Find the Leader in You and BRONCHOSCOPY CSI Make the Choice to Lead!” Jason T. Smith, MD TELEPHONE LEGAL SAVVY: LINKING TELEPHONE PRACTICE WITH BETTER We will cover emerging technology of diagnosing dis- PATIENT CARE ease by bronchoscopy. Also addressed is the prepara- Carol Stock, JD, MN, RN tion of samples for pathology and microbiology.

This session will explore the use of the telephone, COMMITMENT TO SAFETY: PROTECTING email, and other communication technologies in gas- PATIENTS FROM CLOSTRIDIUM DIFFICILE trointestinal (GI) practice with a special emphasis on DURING ENDOSCOPY legal ramifications in regard to proper patient care. How much information can you share via non face- Paulette Smith, BSN, RN, CGRN to-face communications? Pre/post procedure telephone calls, leaving messages, follow-up calls, and Clostridium difficile (C. diff), a spore forming bacte- emails, in the era of the Health Insurance and ria, is carried by 15–53% of asymptomatic people. Portability Accountability Act (HIPAA) will be dis- Its ability to cause diarrhea has been known for over cussed. What can you do to reduce communications 30 years, yet recently this organism has emerged as a liability exposure in practice, yet safely prepare serious health threat. The current standard for endo- patients for procedures? This interactive session will scope reprocessing is high level disinfection, which review actual GI telephone calls pre and post proce- does not kill all bacterial spores. This presentation dure and analyze scenarios for legal compliance.

VOLUME 34 | NUMBER 2 | MARCH/APRIL 2011 175 Copyright © 2011 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited SGA200171.qxp 3/24/11 1:50 PM Page 176

Abstracts | SGNA’s 38th Annual Course

Communication practice guidelines will be suggested COLLABORATING WITH THE CHIEF FINANCIAL OFFICER (CFO) FOR CAPITAL for implementation into GI practice. At the conclu- EQUIPMENT sion of the session, you will be able to identify telephone practice risks and be equipped with several Lynne A. Thomas, BSN, RN, CGRN communication guidelines to assist you in creating a more legally defensible telephone GI practice. This program is designed to increase the knowledge base of endoscopy nurses with a responsibility for, or KEEPING CURRENT ON PATIENT SAFETY an interest in, the use or purchase of capital equip- IN ELECTROSURGERY ment. It will provide elements of a capital equipment proposal, the importance of due diligence when pur- Susan Teague, BS, RN, CGRN chasing, and collaborative ways to impact the CFO or corporate executive committee’s purchasing decisions. The technology of electrosurgery has become an indispensible component of interventional and therapeutic gastroenterology procedures in the 21st centu- PRACTICAL TOOLS TO HIGHLIGHT YOUR ry. Safe clinical use of electrosurgery requires much CARE OF PATIENTS more than turning the electrosurgical unit on and Lynne A. Thomas, BSN, RN, CGRN connecting the accessories. The history of electrosurgery, its evolving significance, its current uses, and Mela Tucker, MBA, BSN, RN how to apply it safely will be discussed. This presen- Bunny Twiford, RN tation will focus on the fundamental elements of electrosurgery and the best electrosurgery practices for assuring patient and staff safety during its use, as well This session is designed to guide participants through as exploring the challenges of electrosurgical use the elements of Centers for Medicare and Medicaid often seen in patients with implanted electronic Services (CMS) survey preparation, benchmarking, devices. This session is designed to empower the and risk management. healthcare provider in the role of patient advocate by acquainting them with essential electrosurgery knowledge, emphasizing the importance of nursing compe- BARRETT’S ESOPHAGUS HANDS-ON tency in electrosurgery, and reinforcing the necessary critical skills for safe electrosurgical patient care dur- Ada Turner, BSN, RN, CGRN ing clinical applications. Ingrid K. Watkins, MSN, RN, CGRN

ELEMENTS OF THE ALIMENTARY TRACT This presentation will provide an overview of the pathophysiology, diagnosis, statistics, and evidence-based Diane K. Theisen, BSN, RN management of Barrett’s esophagus. The audience will be provided with procedural skills needed in the management of Barrett’s as it relates to ground breaking Let’s take a journey. Start at the mouth and travel technological advances pertaining to the disease. through the gastrointestinal (GI) tract. For the first part of the presentation, anatomy and physiology of the upper GI tract and small intestine will be THE LINK BETWEEN ORIENTATION AND explored. Then we discuss the most common diseases SGNA STANDARDS AND RESOURCES seen in our department, how they change function, Kimberly F. Venturella, RN, CGRN and current treatment options. This session provides a strong base for a better understanding of these common GI diseases. Have you struggled with creating an orientation program for new registered nurses (RNs) or Associates? Have you suddenly found yourself responsible for your staff’s orientation and not had much to work with? We have a wealth of resources at our fingertips as SGNA members. Find out how to incorporate

Abstracts | SGNA’s 38th Annual Course

SGNA standards, procedures, and training modules plan for pediatric constipation will be explored. The into your orientation program. Design an orientation management plan is multimodal to include behav- program that is specific for your center or facility. ioral modification, medications, and physical therpy What about your preceptors? Do they see orientation intervention. Nurses play a key role in the treatment through your eyes? How do you keep them on your of chronic constipation through education and page. What about continuity in preceptors? That’s the patient/family support. ideal, but what if it’s just not possible. How do you keep all your preceptors on the same page? Principals of adult learning and orientation development will be ALLERGY IN THE GASTROINTESTINAL discussed, expained, and demonstrated in this timely TRACT: EOSINOPHILIC ESOPHAGITIS presentation. LeAnne Vitito, MS, RN, FNP-BC, CGRN

RADIOFREQUENCY ABLATION: THE LINK Eosinophilic esophagitis (EE) is an emerging disease BETWEEN TREATMENT AND BARRETT’S in both pediatric and adult populations related to ESOPHAGUS food ingestion or aeroallergens. It is characterized by inflammation of the esophagus that is caused by Kimberly F. Venturella, RN, CGRN eosinophils. Recent data suggests the that this disease occurs in 1 in 10,000 people; however, it is speculat- Esophageal cancer is on the rise. Barrette’s esophagus ed that the number of affected individuals is higher occurs in about 15% of gastro-esophageal reflux dis- due to increasing incidence and improved awareness. ease patients. That equals about 3.3 million people in Often, the clinical symptoms of EE mimic gastroe- America. Gastro esophageal reflux disease patients sophageal reflux disease (GERD) and thus patients are at risk for developing intestinal metaplasia in the are not appropriately treated. Clinical symptoms esophagus as a protective reaction to the exposure to include dysphagia, heartburn, food impaction, vomit- gastric acid in the esophagus. The problem with this ing, food refusal, and abdominal pain. Diagnosis of sort of cellular proliferation is that this metaplasia EE is made by endoscopy and esophageal biopsy that can turn into cancer. Historically, treatments have had confirms greater than 15 eosinophils per high power risk and side effects that compromised quality of life. field. Characteristic endoscopic features (pictures) of Radio frequency ablation has had demonstrated suc- EE will be presented. Because management of EE is a cess as a treatment method to eradicate the presence multifacorial process, options for treatment will be of metaplasia and the risk of developing cancer. This explored along with the controversy surrounding dis- one hour presentation will explain Barrett’s esopha- ease management. gus, historical treatment options, and focus on radio frequency ablation as a safe and effective treatment for all types of Barrett’s tissue. INFLAMMATORY BOWEL DISEASE MEDICATION UPDATE LeAnne Vitito, MS, RN, FNP-BC, CGRN “MOMMY, I CAN’T GO:” PEDIATRIC CONSTIPATION Inflammatory bowel disease (IBD) is a complex dis- LeAnne Vitito, MS, RN, FNP-BC, CGRN ease often requiring multiple medications to induce and maintain remission. The goal is to effectively Constipation is a decrease in the frquency of stools or treat the disease, but avoid complications that can be the painful passage of stools.This is a common pedi- associated with medications, and improve the quality atric problem that about one-third of 4 to 7 year olds of life. This lecture will address the indication, side experience at any given time. Approximately 5% of effects, and expected outcomes while using these IBD primary school children get constipation for more medications. It will also look closely at the nurse’s than a six months. At least 25% of visits to the gas- role in monitoring patients while on therapy. Content trointestinal (GI) clinic are due to problems with con- will include information regarding mesalamine, corti- stipation. This problem often requires frequent follow costeroids, immunomodulators, biologic agents, and up visits and extensive patient/parent education in antibiotics. order to overcome this issue. The pathophysiology, symptoms, diagnostic work-up, and management

VOLUME 34 | NUMBER 2 | MARCH/APRIL 2011 177 Copyright © 2011 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited SGA200171.qxp 3/24/11 1:50 PM Page 178

Abstracts | SGNA’s 38th Annual Course

ADVANCED THERAPEUTIC ENDOSCOPY BARRETT’S ESOPHAGUS HANDS-ON Theresa Vos, MS, BSN, RN, CGRN Ingrid K. Watkins, MSN, RN, CGRN

This presentation highlights the advancements in This presentation will provide an overview of the endoscopy as it addresses each organ of digestion. pathophysiology, diagnosis, statistics, and evidence- Through the use of schematics, videos, and didactic based management of Barrett’s esophagus. lecture, an update of what’s new in therapeutic Furthermore, the audience will be provided with pro- modalities will be presented. Topics to be discussed cedural skills needed in the management of Barrett’s include Barrett’s esophagus, hiatal hernia, small as it relates to ground breaking technological bowel therapy, biliary and pancreatic disease, and the advances pertaining to the disease. treatment of a colonic bleed.

DUCTOSCOPY: BEYOND THE BREAD AND ERCP: FROM START TO FINISH BUTTER ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) Theresa Vos, MS, BSN, RN, CGRN Frank Weilert, FRACP, MBBCh, BSc

This newly revised optional session will address endo- This session will review the visualization of the com- scopic retrograde cholangiopancreatography (ERCP) mon bile duct (CBD) with standard ERCP techniques focusing on normal anatomy and physiology, abnor- and direct cholangioscopy including Spyglass, moth- malities of the biliary system, abnormalities of the er-baby cholangioscopy, and cholangioscopy using pancreatic system, and a review of normal versus standard endoscopes. We will also discuss intra-duc- abnormal anatomical structures as viewed through tal interventions including electro-hydraulic lithotrip- radiological imaging. The use of procedural videos, sy and intra-ductal ultrasound. equipment discussion, and didactic presentation will address ERCP from the very basic to the advanced level. Audience participation is encouraged as part of ABDOMINAL PRESSURE ASSISTANCE: THE the learning process. LINK TO SUCCESSFUL COLONOSCOPY Dorie Werner, BSN, RN, CGRN OPTIMAL CARE FOR INFLAMMATORY BOWEL DISEASE PATIENTS: A This lecture will include the presentation of studies to MULTIDISCIPLINARY TEAM MODEL help understand why loops form during colonoscopy and how to manage them. Discussion will include Julianne H. Wagnon, JD, RN, FNP-BC why colonoscopy is more difficult in women, factors affecting insertion time and patient discomfort, and a This lecture examines the etiology, epidemiology, description and demonstration of techniques that will diagnosis, and treatment of inflammatory bowel dis- facilitate successful, efficient, complete colonoscopy. ease. Within the treatment section of the lecture, in This presentation is directed to those who are ready addition to current medical options and investigation- to understand the relationship between proper appli- al agents, there will be an in depth discussion of the cation of abdominal pressure during colonoscopy and multi-disciplinary model in place at the Vanderbilt the practice and care of the patient. Inflammatory Bowel Disease Center. The five key elements of the model are: (1) Psychology, (2) Dietary, (3) Education, (4) Medication, and (5) Adherence. WHAT YOU ALWAYS WANTED TO KNOW Attendees understanding and application of informa- ABOUT PULMONARY PROCEDURES...BUT tion covered in the lecture will be reviewed by inter- WERE AFRAID TO ASK active case studies. Keri White, BSN, RN

This presentation focuses on pulmonary procedures including bronchoscopies, thoracenteses, and chest

Abstracts | SGNA’s 38th Annual Course

tube placements. The presentation goes through the researchable projects. Many excellent clinical ques- typical preparation of a pulmonary patient including tions go unanswered for a variety of reasons. acceptable lab values and medications. Additionally, Facilitators and barriers to this process need to be it discusses anesthesizing a patient’s airway, sedating understood to be successful. In order to develop a the patient, and different therapies utilized during good research idea, the following questions will be bronchoscopy including bronchalveolar lavage, trans- addressed: What is the topic or issue? Is the topic bronchial and endobronchial biopsies, fine needle researchable? Is your question too broad/too nar- aspirations, and brushings. The presentation explains row? Has it been done before? Review of the litera- what these therapies entail and the nurse’s role. ture will be emphasized with the aim of making this Additionally, bronchoscopy recovery and possible a standard activity in evidence based practice. complications during recovery (pneumothorax, stridor, Interactive opportunities for the audience will bleeding, intubation) will be addressed. The presenta- include coming up with a problem statement and tion also talks about specific newer interventions such exploring the steps to overcome in their agency/insti- as endobronchial ultrasound, electromagnetic naviga- tution to bring their idea to reality. Issues to be ana- tion, pleuroscopy, and pleurx catheters. lyzed include the passion for the topic, availability of project mentors, and requirements of institutional review boards. Team work, as an exemplar, will be FROM IDEA TO RESEARCH discussed as a prescription for success. Evidence based research is an important nursing activity Donna Zucker, PhD, RN, FAAN requiring knowledge, accuracy, and team work. Continued interest in nursing research will build our knowledge base and provide excellence in clinical The purpose of this presentation is to share strategies practice. that will help generate nursing ideas resulting in