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Diabetes – Summer 2012
Future of Nursing Initiative
Heart Failure - Fall 2011
Influenza - Winter 2011
Nursing Ethics - Fall 2011
Trauma - Fall 2010
Traumatic Brain Injury - Fall 2010
Fluids & Electrolytes
Carrie Adams, RN, CGRN
Ellen Fern, BSN, RN
Janet King, BSN, RN, CGRN
Deborah Palmer, MSN, RN, CGRN
This session will provide hands on experience in the motility room setting. Contents will include review of the swallowing process (anatomy and physiology and motility images [both contour and wave forms]), ergonomic setup of the motility equipment, techniques used for successful catheter placement, the use of a patient education video pre-procedure, and a live demonstration of an esophageal motility procedure using high resolution.
Jane Allaire, RN, CGRN
James Collins, BS, RN, CNOR
Michelle E. Day, BSN, RN, CGRN
Cynthia M. Friis, MEd, BSN, RN, BC
Patricia Maher, RN, CGRN
Joan Metze, BSN, RN
The process as outlined by the Society of Gastroenterology Nurses and Associates (SGNA) for reprocessing flexible gastrointestinal endoscopes will be thoroughly reviewed. Participants will have the opportunity to practice their skills with guidance from our knowledgeable trainers. Tips on how to develop, manage, and deliver the reprocessing competency will be discussed as well.
Kanoe Allen, MSN, RN, PHN, OCN
This relaxed and interactive session will include a look at the real life challenges and opportunities for making the leap from staff to management, and offer tips and tools to make it easier. The course will offer the advanced beginner/competent individual tools and structure for development of staff, physician relationships, regulatory compliance-infection control, life safety, CMS/JC, bringing in new technology, budgeting, benchmarking, and quality and program development/marketing.
Phea Anderson, MS, RN, CGRN
Karen Laing, MA, RN, CGRN
Throughout the past four years, numerous hospitals and ambulatory facilities have boarded the bandwagon utilizing Lean Principles to improve the efficiency of work flow, patient care, and supply management. Reduction of/or eliminating waste and redundancy in workplace processes has improved patient, physician, and staff satisfaction. Frequently, the focus is on the operating room and emergency department because of the perceived financial impact. However, the work processes of endoscopy lend itself well to improvement using lean methods; resulting improved financial, patient satisfaction and safety performance. Dont know where to begin? Well teach you the basics and get you started. Volunteer registrants will have an opportunity to submit data and photos which will be analyzed prior to the course, then shared with participants during the session. Based upon past comments a section on the change management process has been added. This session provides the basics in lecture format, demonstration of sample data, photos and high level of discussion. In the past, this session has been popular enough to require waiting lists and additional session. Registrants this year said this course provided more information than our expensive consultant. Efficiency improvement is the beginning of a lifelong journey, join us you can make a difference.
Michele Bachman, MSNc, BSN, RN
Gastrointestinal screening and surveillance impacts gastrointestinal health care staff daily. Endoscopic procedure rationale provides the gastrointestinal staff with supporting evidence as to why procedures are being performed. This process encompasses resource utilization, which is inclusive of patient safety and cost effectiveness. Gastrointestinal screening and surveillance covers many different aspects of the gastrointestinal system. The focus of this presentation will be esophageal screening and surveillance for Barrett's, gastric cancer screening and helicobacter pylori, colorectal cancer screening and surveillance for both average risk and increased risk populations, and lastly colorectal cancer surveillance for inflammatory bowel disease. Objectives for this presentation will include increased knowledge of current Gastrointestinal guidelines pertinent to above stated gastrointestinal disease processes.
Kathy A. Baker, PhD, RN, ACNS-BC, CGRN
This presentation by Gastroenterology Nursing Editor Kathy Baker will discuss the "how-to" of writing for publication including tips for increasing the success of being published. Gastroenterology nurse authors and members of the editorial board will be present to talk one-on-one with workshop attendees. Participants will leave with the beginnings of a publishable manuscript.
This workshop, facilitated by the Gastroenterology Nursing Editor and Editorial Board, will offer experienced authors and manuscript reviewers (or those who want to be) insight into what a peer-reviewer looks for in a quality manuscript. The reviewer perspective of how to critique a manuscript will assist experienced manuscript reviewers to refine their review skills as well as promote more successful outcomes for experienced authors submitting manuscripts for peer review.
Dorothy Berry, RN
Angela Burnett, BSN, RN, CGRN
Darlene Gassoway, BSN, RN, CGRN
A well-planned program with clearly defined goals supports the endoscopy technician's abilities to grow and realize their potential. Areas to consider include a thorough pre-assessment of knowledge and skills, a structured timeline for weekly/monthly achievements, and provision of routine educational resources. In addition, required unit specific competencies encourage the endoscopy technician's development and accountablility as a valuable member of the endoscopy team. Skills specific to each endoscopic procedure are addressed. Too, the concept of encouraging the endoscopy technicians to participate in developing competency feedback is discussed. Presentation methods incorporate power point, lecture, and hand-outs representing an actual orientation program with competencies. In conclusion, a strong orientation foundation fosters the endoscopy technician's desire to truly expand their horizons, understanding how important their role can be.
The pregnant patient presents special considerations for the endoscopy unit. Primarily, the focus concentrates on the safety concerns for the mother and fetus during procedures. To maintain such safety, the Endoscopy nurse's awareness must encompass particular moderate sedation guidelines, monitoring techniques, side effects of other medications on mother and fetus, positioning, electrocautery, use of fluoroscopy, and coordination of multidisciplinary efforts. As well, an institutional policy in place provides a standard of care for the endoscopy nurse to refer to. In addition, highlights of individual endoscopic procedures are addressed. Procedures included are endoscopic retrograde cholangiopancreatography (ERCP), esophagogastroduodenoscopy (EGD), colonoscopy, bronchoscopy, and gastrointestinal bleeds. Presentation methods utilized for this program include power point, lecture, and case studies. In conclusion, although the pregnant patient is not a frequent client to the endoscopy suite, she provides the endoscopy nurse with a challenge to expand her/his horizons so the best quality of care is given with utmost consistency.
Patricia A. Bierly, MSN, RN, CPNP
The presentation will discuss the pediatric patient with reflux and the role of impedance and current treatment options. Case studies will be utilized.
This presentation will discuss the unique need of the pediatric patient with inflammatory bowel disease (IBD) compared to the adult IBD patient. There will be discussion of current treatment options in the child with IBD and omplications throughout the life span.
Joseph Brasco, MD
We would be looking at the role of the human gut flora and its role in health and disease. The lecture will also explore how certain drugs, antibiotics in particular, diet and probiotics can restore an imbalanced gut flora and how this can impact certain common gastrointestinal conditions such as constipation, chronic diarrhea, irritable bowel syndrome (IBS), and inflammabory bowel disease (IBD).
Debra Brendley, BSN, RN, CGRN
Endoscopy in a normal setting presents many challenges. However, endoscopy on the United States Naval Ship Mercy multiples and magnifies these challenges. Some of these challenges included untrained staff, limited supplies, no technological support, lack of disinfecting machines, language barriers and cultural differences. One Naval Reserve Nurse was chosen to support Pacific Partnership 2008 on a naval hospital ship as a medical-surgical nurse and found her self in the middle of an unusually complex situation. The space for a unit, a gastroenterologist, $250,000 worth of state of the art equipment and her expertize is all she had to work 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 from Southeast Asia.
Jan Brooks, BSN, RN, CGRN
In the current field of gastroenterology, cardiac monitoring is recommended for specific patient populations. At my facility, we monitor all patients. It is important that all nurses have a basic understanding of cardiac rhythms for safe administration of sedation. This course is intended to augment the basic knowledge of nurses. It will cover normal conduction of the heart, rate determination, specific steps utilized to determine and identify a cardiac rhythm. Rhythms included are sinus rhythm, sinus bradycardia, sinus tach, atrial fib, atrial flutter, narrow complex tachycardias, premature ventricular contractions, ventricular tachycardia, ventricular fibrillation, AV blocks and asystole. It is not intended as a substitute for a basic EKG class.
Sandra Brubaker, BS, MT, ASCP
Linda Knight, BSN, RN
Corinne Pavesic, RN, CGRN
The most current esophageal manometry technology is high resolution impedance manometry. This allows pressure sensors to span the pharynx, upper esophageal sphincter (UES), esophagus, and lower esophageal sphincter (LES) to see the entire dynamics of a swallow and bolus clearance. This session will provide comprehensive information about esophageal anatomy and physiology, manometry, protocol, and contour waveform understanding to improve their procedures. Manometry plots will be discuss in detail to better comprehend the study and improve the data acquisition and analysis. New information (data) obtained from impedance and multiple pressure channels will be discussed and how it is used in the patient evaluation. A manometry and impedance overview, protocol, an actual patient procedure, and break out sessions will be included in the session. Break out sessions will include hands-on with the volunteer patient, abnormal waveforms, and trouble shooting discussion.
Dariele Burchfield, RN, CGRN
Kevin Cooper, BS
The efficiency of an endoscopy unit is critical to its overall success. A patient's satisfaction can directly be impacted by their experience as they flow throughout the process. Also, with the double digit increases in costs and decreasing reimbursement rates, there is an overwhelming need to drive change and impact operational efficiencies in order to be fiscally responsible. To successfully accomplish this, you have to not only understand your processes, but also be able to quantify them to know where the true areas of opportunity lie. At the conclusion of this presentation, the participants will be able to: (1) describe a structured performance improvement methodology; (2) understand the definition of benchmarking and how it can impact and drive performance improvement; (3) verbalize tools available to point to areas of operational efficiency (4) discuss importance of buy in from administration, physician, and nursing staff; (5) discuss the Duke Six Sigma patient satisfaction project to improve operational efficiency and decrease wait times for patients; and (6) verbalize take away strategies for performance improvement. The efficiency of an endoscopy unit depends on smooth and efficient patient flow from the time of their arrival at the front desk to their discharge after the procedure. Understanding the processes along with measuring and monitoring their performance provides feedback to help the management and physicians make appropriate changes and improve the operational efficiency of the unit.
Dianna Burns, BS, RN, CGRN
Philip R. Fileri, Esq
Peggy Gauthier, MS, BSN, RN, CGRN
Mary Beth Hepp, MBA
Meg La Brecque, BA, RN, CGRN
Diane Moore, RN, CGRN
Cheryl Phillips, ADN, RN, CGRN
Barbara Schwant, BSN, RN, CGRN
Leslie Stewart, BA, RN, CGRN
Theresa Vos, MS, BSN, RN, CGRN
This condensed version of the Society of Gastroenterology Nurses and Associates (SGNA) Regional Society Leadership Conference summarizes expectations, responsibilites and resources available to local leaders. The meeting will provide abundant opportunities for you to network, learn and exchange information and ideas with local leaders. Anyone who is currently an SGNA Regional Leader or considering becoming a Regional Leader should attend.
Bradley J. Catalone, PhD, MBA
Lawrence F. Muscarella, PhD
Wallace Puckett, PhD
This session will discuss current infection control issues surrounding the reprocessing of flexible gastrointestinal endoscopes. This distinguished panel will discuss topics such as reprocessing equipment after use on patients with specific infectious diseases, updates related to biofilms, barriers to consistent infection control in the gastrointestinal (GI)/endoscopy unit, shelf life of reprocessed endoscopes and recent reported breaches in reprocessing.
Catherine Collins, BSN, RN, CGRN
Deborah Gates, MS, BS, RN, CGRN
Michelle Hendricks, BSN, RN
Charlotte Michniewicz, ADN, RN, CGRN
Christopher Robbins, BSN, RN, CGRN
Sandra Schneider, CGRN, RN
This workshop will center on a hands-on equipment demonstration focusing on advanced endoscopic retrograde cholangiopancreatography (ERCP) and its accessories, using a step-by-step approach discussing equipment use and potential complications. The therapeutic components associated with ERCP can be both complex and challegning. Return demonstration and discussion will center on mechanical lithotripsy, entrapped stones, Spyglass, short-wire systems and metal stents.
Benign and malignant strictures from an array of diverse etiologies may occur in any portion of the gastrointestinal tract. Dilation of these strictures is indicated whenever there are clinically significant symptoms. This presentation will offer the participant an introduction to the various conditions necessitating stricture management and the accessories which are utilized to maintain patency within the lumen of the gastrointestinal tract.
Jennifer Cook, MS, BSN RN
Nancy Schlossberg, BA, BSN, RN, CGRN
This session offers nurses and associates timely gastrointestinal-specific information and practical tips for optimizing the reimbursement process in the hospital outpatient department or ambulatory surgical center (ASC) setting. The presentation summarizes key reimbursement principles, the impact of 2009 and 2010 reimbursement payment changes, and offers practical recommendations for implementing optimal charge capture and denial appeal processes.
Deborah Copeland, BSN, RN-BC, CGRN
Janet Hannah, RN, CGRN
Georgette Knoebel, BSN, RN, CGRN
Sandra Thomas, RN, CGRN
Kendall Yoshisato, RN, CGRN
The American Board of Certification for Gastroenterology Nurses (ABCGN) Audit Committee will present an overview of the recerification qualifications and contact hour requirements. Gastrointestinal-specific requirements will be covered, as well as the "submit per year" recertification option.
Glenda Daniels, PhD, RN, CGRN
Marilee Schmelzer, PhD, RN
Kathleen Foote, BSN, RN, CGRN
Ann Hayes, BSN, RN, CGRN
Nancy Nardelli, RN, CCRC
Sharon Dudley-Brown, PhD, RN, CRNP
Colorectal cancer is the 2nd leading cause of cancer-related deaths in the United States. About 90% of colorectal cancer deaths are potentially preventable if the disease is detected early, but only 30 to 40% of Americans older than 50 have the recommended screening colonoscopy. Many avoid them because the colon must be clean and the cleansing procedure is difficult. Even when patients are willing, cleansing is often inadequate and the colon cannot be clearly visualized. The purpose of the study was to (1) describe bowel cleansing preparations being used across the country, (2) compare their cleansing effectiveness and tolerability, and (3) compare effectiveness in elderly patients and those with decreased bowel motility. Data were collected from five sites (Maryland, Washington, California, and 2 in Texas). A comparative, descriptive design with convenience sampling was used to collect data from 500 adult patients scheduled for colonoscopy (100 subjects/site). As of June 1, 2009, 315 subjects had completed the study, and data collection should be completed by December 2009. The researchers also learned important lessons about coordinating data collection at distant geographical sites and will offer suggestions for conducting multi-site research studies. The study was partially funded by a research grant from Society of Gastroenterology Nurses and Associates (SGNA).
Rhonda DelCampo, RN, CGRN
Esophageal strictures causing complete obstruction are often difficult to treat using standard dilation techniques. Completely occlusive strictures may develop after head and neck radiation therapy or esophgectomy. Lumen restoration may be achieved endoscopically via antegrade-retrograde techniques. In some cases, however, patients may need to undergo a collaborative effort by the gastroenterologist and the ear, nose, and throat (ENT) surgeon in the operating room for lumen restoration. We will explore the antegrade-retrograde dilation in the gastrointesitnal lab as well as the surgical procedure to facilitate alimentary tract patentcy.
Alida C. Dempsey, ADN, RN, CGRN
This presentation will discuss how auto immune diseases and the medications used to treat them affect the gastrointestinal tract. Included in this discussion will be new and existing treatments and medications. The topic will conclude with ways to assist patients in coping with and choosing treatment options that will help them manage their auto immune disease.
Nancy DeNiro, RN, CGRN
Cathy Dykes, MS, RN, CCRC, CCRP, CGRN
Do you have good information to share with your colleagues? Are you passionate about something specific in gastroenterology? Are you involved in research? Are you struggling for the best way to present your story? In this session, you will learn some techniques to help you deliver a successful program. This session will include advice on writing an abstract, preparing your talk, using humor, eye contact, timing, voice inflection, use of PowerPoint and more!!
It is a known fact that customer service expectations in healthcare are high, which creates a new challenge for health care workers. We must be dedicated to improving customer service in order to make an exceptional impression on every healthcare customer, every time. Providing meaningful customer service in healthcare creates an environment where patients want to be treated, where physicians want to practice, and where employees want to work. Healthcare in GI is 10% product and 90% customer service. This session will explain why customer service is so important, describe what healthcare quality of service should look like, and discuss first impressions and perplexing perceptions by the healthcare customer, Attendees will be reminded of what customer service can, should, and will do.
Teri Derimanoczy, MSN, RN, FNP-BC
Civility in the workplace comes im many forms. It consists of two parts: (1) behavior that a reasonable person would find hostile or offensive and unrelated to an employer's legitimate business interests and/or (2) it causes physical or psychological harm to the employee. Why is this so suddenly important? Because patient care and safety are greatly impacted when this behavior is allowed to perpetuate. Effective in 2009, The Joint Commission (TJC) now has a new standard that mandates disruptive behavior be addressed on all levels of the organization.
Judy Lindsay, MA, BSN, RN, CCRN, CGRN
Endoscopic ultrasonography (EUS) programs are on the rise as the demand for this service in the community continues to grow. Put aside your worries and join us for a practical, hands-on, packed-with-good-tips course to learn EUS set-up and handling of fine needle aspiration (FNA) needles. Get off to a good start with confidence and ease and in no time you can be like an experienced pro!! This presentation will include a review of linear and radial echoendoscopes, the set-up for EUS including catheter based mini-probe, balloon application/removal, handling standard and specialized FNA needles, demonstration of team members performing FNA, scope care and processing, and set-up for slide preparation
Starting an wndoscopic ultrasonography (EUS) program is a daunting, yet exciting, task. Join us in this informative session for a step-by-step approach of what it takes to expand present day endoscopy capability into the world of EUS. This presentation will include: purpose and role of EUS and fine needle aspiration (FNA), risks and complications, equipment inventory, staff training, multi-discipline collaboration, procedure and cart set-up, cost and benefits of program, impact on gastrointestinal practice, ultrasound terminology, endoscopic visualization, and specimen management.
Thomas DeSimio, RN, CGRN
Diseases of the biliary and pancratic systems are becoming more common. In the past, cholangioscopy has been a difficult procedure from many points of view. The procedure required two endoscopisits to control the scopes, while at least one associate was assisting the procecess. A new product from Boston Scientific allows a single operator platform the for manipulation of the scope system. This development will put cholangioscopy in the hands of more endoscopists, creating the need for more highly trained assistants. The system has many key compoments, among them the fiber optic cable. The fiber optic cable is fragile and needs to be handled with extreme care to avoid damage. Other componenets are very small and are not always easy to use. This lecture will identify the indications for use, operation and setup of the system, and share eperiences to promote successful cholagionscopy
This session will discuss new treatment options utilizing endoscopic ultrasound (EUS) as an alternative to surgical solutions.
Deborah Dlugose, RN, CCRN, CRNA
Providing safe and effective sedation for patients undergoing gastrointestinal procedures is a challenging part of our practice. Changes in sedation practice are driven by the rising number of such cases done each year and the increasing level of responsibilities of nursing roles in these procedures. New definitions and standards are being promulgated by various groups while pharmacology and technology for sedation are advancing. This full-day workshop will focus on topics including strategies for patient selection, assessment and planning; planning for clinical safety; making sense of monitoring; rational titration of medication; rapid response to emergency events; effective documentation; and risk management strategies from bedside to manager levels. Critical thinking and problem-solving skills will be emphasized as the course content is presented. Case illustrations from the instructor's long experience in sedation and legal nurse consulting will also sharpen participants' abilities to provide sedation which is both safe and effective. Is your practice ready to evolve?
Kate Donovan, BS, GTS
Many of us working in the healthcare profession have witnessed firsthand how just one small breakdown in communication can affect patient care. Difficult conversations take both skill and courage and can be increasingly challenging when there are high stakes. Being able to openly and directly address conflict and safely express opinions will increase your satisfaction at work. This interactive session will explore how to transform a culture of silence.
Motility studies are useful tool in the diagnosis and evaluation of a variety of functional gastroenterology issues. With many functional gastrointestinal disorders manifesting at a young age, it is critical that we have the tools to perform the necessary testing as needed. This session will review intestinal manometry studies and tracings, focus on the challenges in performing pediatric manometry studies as well as the advances in new technology.
Barbara Dossey, PhD, RN, AHN-BC, FAAN
Integral and holistic nursing weaves together our Florence Nightingale (1820-1910) legacy, our science, and our art to increase our understanding of being a nurse and a citizen activist at our deepest and highest expression of self, nature, and culture. It focuses on the individual and the collective, the inner and outer, and human and nonhuman concerns. An integral, holistic process and approach has wholeness as it goaldynamic, interdependent, open, fluid, and continuously interacting with changing variables that can lead to greater complexity and order. It more effectively links and binds nursing practice, education, research and policy to interface and position nurses and nursing in transdisciplinary dialogues that asist them in lcearly articulating their mission and work. This comprehensive integral and holistic understanding of the complexity of human nature challenges us to strengthen and to engage ourselves fully at individual, shared and collective levels to heal earth and its people.
Colon preparation is one of the most important elements of colorectal cancer screening. A good preparation optimizes the discovery of polyps and enables their safe removal. In real estate, its LOCATION, LOCATION, LOCATION!! In colonoscopy preparation its HYDRATION, HYDRATION, HYDRATION!! The history, importance, and current use of preparations will be discussed. The role a good nursing assessment and pre-procedure teaching plays will be emphasized. Helpful hints to set up the colon preparation process for success for the patient will be shared.
Nancy Eisemon, MPH, RN, CNS, CGRN
The session will provide an overview of the American Board of Certification for Gastroenterology Nurses (ABCGN) test development process, eligibility requirements for certification, and recertification. It will discuss the four content domains of the test plan and make suggestions on test preparation.
Kimberly Foley, BSN, RN, CGRN
Margie Lanza, BSN, RN, CGRN
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 parlimentary procedure will be reviewed and attendees will participate in mock session of both a House of Delegates and a Reference Hearing. Find out what happens and how you can participate.
This presentation will focus on the fundamental elements of completing the Application for Nursing contact hours through the Society of Gastroenterology Nurses and Associates (SGNA) Approver Unit. Participants will receive helpful hints on how to best meet the criteria for approval and tips on creating an effective educational experience.
Agnes Gaber, MSN, RN, ANP-BC, CGRN
The effects of tobacco use on the gastrointestinal tract start at the mouth, nose, throat, larynx, esophagus, pancreas and worsening symptoms of Crohn's and irritable bowel disease. Tobacco use has been cited as the chief avoidable cause of illness and death in the world. Tobacco use exacts a heavy cost to society as to individuals and health care expenditures. Given the health dangers it presents, and because of nurses' numbers, class status political capital, and moral authority in society, they are the group of health care providers whose voices are needed to help avert the global tobacco epidemic. No one starts smoking to become addicted to nicotine. It is not known how much nicotine may be consumed before a habit becomes an addition. The smoker faces a lifetime of health risks associated with one of the strongest addictions known to humans. Epidemiological data suggests that more than 70 percent of the 45 million smokers in the United States today report that they want to quit, and approximately 44 percent report that they try to quit each year. Nurses should promote tobacco cessation as a standard of nursing practice. Evidence shows that even brief intervention can be effective.
Yvonne Garcia, MSN, MBA, ND
Patricia Benner's Stages of Clinical Competence: From Novice to Expert, formed the framework for this research. The investigator, a novice in research, was assigned a project to broaden her knowledge and experience in this area. Self evaluation revealed skill acquisition to be competent. The project assigned was to research a complaint which was generated by the medicine service regarding in-patient procedural delays. The service complained that Endoscopic procedure delays were occurring due to 1) conflicts in the consultants clinic schedule and 2) factors associated with the in-patient services. The secondary purpose was to identify the economic impact to the hospital associated with procedure delays. A descriptive correlation study was conducted, collecting data for one month on existing records. The focus was on adult in-patients posted or scheduled for gastroenterology procedures. It was hypothesized that a significant correlation would be realized between procedure delays and patient preoperative readiness. The delays identified in this study correlated 100% with a lack of preoperative preparedness (r = 1, p < .001?). Lack of preoperative readiness increased patient hospital days by 20%. Increased hospital days warrant implementation of subspecialty related guidelines to decrease hospital length of stay, minimize diversions, and improve patient satisfaction.
Sandra Schneider, RN, CGRN
This workshop will center on a hands-on equipment demonstration focusing on basic endoscopic retrograde cholangiopancreatography (ERCP) and its accessories. The diagnostic and therapeutic components associatesd with ERCP will be broken down using a step-by-step approach. The goal of this workship is to develop-through return demonstration-an understanding of the equipment used and its effects. Demonistrations will include initial cannulation, catheter and guidewire exchanges, guidewire manipulations, plastic stent placement, speciment collection, sphincterotomy, occlusion retrieval balloons and balloon and catheter dialtions.
The newly inducted Society of Gastroenterology Nurses and Associates (SGNA) President will present the 2010-2011 SGNA theme to the members. The focus of this presentation will be to define the strategic direction of SGNA. Attendees will gain insight not only into the heart of SGNA as an organization but into their own professional journey in gastroenterology. Membership as well as active participation in SGNA will be encouraged.
Joseph E. Geenen, MD
This discussion will include: Acute pancreatitis, idiopathic acute recurrent pancreatitis, chronic pancreatitis, sphincter of Oddi dysfunction, pnacrease divisum and the value of pancreatic stents in pancreatic diseases.
Theresa Geil, RN, CGRN
Pleuroscopy is the inspection of the pleural cavity through an incision in the thorax. This procedure has historically be done in the operating room. With the expansion of pulmonary practice Endoscopy units are now doing these types of procedures. This course is intended to provide an overview of pleuroscopy and its importance in the evaluation and management of pleural disorders. The focus will include staff education, role delineation, room preparation, specialized equipment, and the success of team collaboration. We will discuss the difficulties in making sure the rooms were appropriately set up for sterile procedures. Scheduling of these cases and times suggestions. Case presentations with photographs and video clips will be shown. All information will be presented in a power point format.
This presentation is designed to provide introductory information and to reinforce skills already implemented by pulmonary endoscopy nurses. Areas to be discussed include the flow of the patient from preparation to recovery with the primary focus on assessment and procedural techniques. We will discuss the set up of the bronchoscopy suite to facilitate the flow of the procedure. We will cover indication for bronchoscopy assessment of the patient, essential monitors and emergency equipment. Delineation of the primary and sedation nurses and the communication pathway.
Julie Gorski, RN, BSN
A preliminary survey of primary care physcians indicated a need for nurses to participate in collaborative practice efforts to increase colorectal screening. Communication skilss, such as motivational interviewing (MI), can help patients work though the ambivalent feelings when referred for a colonoscopy. The purpose of this project is to evaluate use of face to face MI to promote scheduling colonoscopy immediately following a patient's wellness check up. Design: This is an evidence-based practice pilot project. Training in MI was completed by family practice nursing staff. Patients were referred to registered nurses (RN) by the physician following patient's wellness exam. Registered nurses documented education and MI strategies/skills used during their interaction. Data was collected for a 4 month period. The sample (n = 94) had 61% males. Ages ranged from 50 to 78 years of age. The most frequently used MI strategies were: elicit-provide-elicit (60%), summarization (51%), open eneded questions (34%), and affirmation (27%). Primary patient concern was prep issues (61%). Completed colonoscopies totaled 76 (83%). Of those, 39 (51%) had polyps, 102 polyps were removed, 18 were hyperplastic, and 41 adenomatous. Face-to-face nurse-patient interactions using MI is an effective and feasible intervention for increasing colonosopy screenings in ambulatory settings.
Claudia Guilbeau-Brand, BSN, RN, CGRN
Bile duct visualization has been around for at least 30 years; these older prototypes were cumbersome and required the use of two operators, were very fragile and had limited maneuverability. In the past several years there has been an emergence of new technologies, which enhance diagnostic and therapeutic applications of the endoscopic retrograde cholangiopancreatography (ERCP). This includes video and semidisposable cholangioscopes, which have increased the availability and utilization of single-operator peroral cholangiopancreatoscopy for the patient with a standard ERCP to that fail to make a diagnosis or provide a therapeutic intervention, due to technical difficulties or poor x-ray. The direct visualization of the pancreatico-biliary system and therapeutic options available, make this procedure an alternative choice in targeting and treating bile duct stones, strictures, hemobilia, and could lead to an expanded next generation of intraductal diagnosis and therapy indications in the future. The nurse must remain competent with these new technologies and be able to assist the physician as well as educate the patient undergoing these new procedures.
Lisa K. Hardee, MAHS, RN, CGRN
Gastrointestinal procedures in a physicians office setting can present a different set of challenges than a hospital or ambulatory surgical center (ASC). The physical layout of the building may hinder your process. Don't have enough sinks? Big basins will do. The consultation and office visits slow the process down, so the schedule needs a running start in the morning and constant vigilance thereafter. The staff needs to be consistent with patient education, set-ups, documentation, and assisting with procedures. Different assignments within the department make the schedule both versatile and challenging. Supply systems need to be such that any staff member can carry on regardless of who is on vacation. Presentation areas include adapting to a fixed physical area for procedures, office visits, and consultations; nurse schedules and helping with the internal medicine physicians when needed; additional fixed assignments for specific duties (restocking exam rooms, education packets, procedure supplies, etc.); patient teaching and documentation in the in the electronic medical record; meeting accreditation standards; having fixed assets including staff; office duties; appointment scheduling; ICD-9, CPT, HCPCS, and other topics that you need to know in an office.
Jane D. Harker, MS, BSN, RN, CGRN
Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most tecnically challenging, but rewarding procedures performed in many endoscopys units today. It is important for the nurse and/or technician assisting the physician to be knowledgable about all aspects of this procedure. This presentation will take an alphabetical look at all aspects of ERCP, including indications, treatment options, equipment and complications. PowerPoint, pictures, and videos will be utilized during the presentation.
Barbara Ann Harmer, MHA, BSN, RN
The Accreditation Association for Ambulatory Health Care (AAAHC) Survey Process: From Application to Decision is an in-depth, interactive program designed to give you the knowledge and skills you need to prepare for the AAAHC survey process. Whether you are applying for accreditation for the first time or preparing for re-accreditation, this seminar can help you understand applicable AAAHC standards, policies and procedures to get your organization ready for its survey. This course will look at all AAAHC chapters and standards relevant to the gastroenterology field.
The aim of this study was to evaluate possible differences in bowel preparation for colonoscopy between diabetics who receive an experimental preparation (20 oz Mg citrate/4L PEG) and diabetics who receive a standard preparation(10 oz Mg citrate/4L PEG). Adequacy of bowel preparation is critical for good bowel visualization. Diabetics are prone to slowed: gastric emptying, colonic transit, and colon evacuation. Inadequate preparations may lead to sub-optimal colonoscopy resulting in overlooked pathology or repeated examinations. Repeated colonoscopy exposes the patient to potential cardiac and respiratory risks, because of sedation. The endoscopy itself may cause perforation and bleeding. Avoiding repeated colonoscopies maximizes patient safety and organizational efficiency. Using a double blind experimental design, 198 diabetics scheduled for colonoscopy were randomly assigned to either the experimental group or standard group. There was a significant difference between the groups. Patients in the experimental group had significantly cleaner colons than the standard group; chi-square = 5.14, p = 0.02. We now use this diabetic colon preparation in our GI unit and others may confidently implement this preparation for diabetics. This safe and inexpensive intervention may also be used for patients who have constipation or a history of prior poor colon preparation.
Lisa Heard, BSN, RN, CGRN
Assuring patient safety during gastrointestinal procedures requires constant communication between nurses, technicians and endoscopists. This session will present steps in developing a gastrointestinal (GI) endoscopy team based, high fidelity, simulation training program. Basic principles of crisis resource management (CRM) and course development will be presented and discussed. The goal of this session is to provide the manager, educator and team with tools to develop a CRM program that enables staff to respond effectively to GI endoscopy emergencies.
Children undergoing gastrointestinal procedures require specialized care. The inherent differences in the pediatric patient require the nurse to be skilled in the area of sedation, fluid and airway management, intravenous access and specific procedural instrumentation. Many of these areas differ from that of the adult population. This session will focus on the care and management of the pediatric patient undergoing endoscopic procedures. Intravenous placement, sedation, airway management, parental involvement, physiologic monitoring and endoscopic equipment needs will be addressed. Developmental needs of pediatric patients and interventions to assist in positive procedural experiences will be discussed. Age specific case studies following patients through the process of an endoscopy will also be presented. The goal will be to assist the gastroenterology nurse to feel more comfortable and confident in the management of the pediatric endoscopy patient.
LeaRae J. Herron-Rice, MSM, BSN, RN, CGRN
As health professionals we have an obligation to our patients, employers and most importantly to ourselves to take steps to expand our professional growth. For the new GI nurse just learning the skills can be overwhelming. As gastrointesitnal (GI) nurses we are fortunate to have a professional organization that encourages us to be the best we can be. The Society of Gastroenterology Nurses and Associates (SGNA) is your professional organization that can be your guide to expanding your GI horizon. During this session the novice GI nurse will be learn about the benefits of SGNA resources, both at the regional and national levels. Learn about volunteering opportunities and how you can take steps to get involved and join your peers in the journey for professional growth.
Tammy Hogue, MS, RN, CGRN
A basic review of cardiac rhythms and interpretation. Session will include quick review of cardiac anatomy and physiology and common cardiac rhythms. Attendees will have opportunity for hands on practice of rhythm interpretation.
Rey Hondrade, BSN, RN, CGRN
Javier L. Parra, MD
In ther general field of a gastrointestinal practice, patients are usually diagnosed with either an upper endoscopy or colonoscopy. On occasion, patients with gastrointestinal bleeding need further diagnostic modalities. In 2000, capsule endoscopy was introduced and is useful in the diagnosis but not in the treatment of several small bowel diseases. Balloon assisted and spiral enteroscopy are newer procedures that not only allow accurate diagnosis, but also help in treating small bowel diseases. Coagulation, clipping, injection and tattooing are several of these treatment modalities. In this presentation, nursing care before, during and after the procedure will be addressed, as well as setting up of the different devices. Medical evidence based data will be presented, including comparison of small bowel depth of insertion and time of balloon versus spiral enteroscopy. The audience will also learn of possible complications and precautionary measures associated with these procedures. Video clips of findings and therapeutics of small bowel diseases will also be presented.
Raymond Hucke, MPH, OTR
James Prechel, GTS
Sara San Miguel, GIA
This 4 hour class will incorporate a formal one hour lecture along with three hours of hands on. The lecture will cover the theory behind the hands on application, and will provide informative, visual guidance to achieve the objective of each technique. In the hands on portion of the class the attendees will get a chance to demonstrate up to (time permitting) 12 techniques. The lecture and hands on portion of the course will offer the attendee proper ergonomics with focus on safety and comfort for the patient as well as the caregiver. The goal of this course is that all attendees will learn and perform each technique and be able to take the skill back to their department to perfect and share with coworkers. It is our suggestion that each attendee wear comfortable clothing as we will be performing the techniques on each other.
Sharon Iden, RN
Denise Schield, BSN, RN, CGRN
There are continually many legislative changes that affect the delivery of healthcare and especially our practice in the endosocpy setting. Recent changes in Medicare guidelines were effective May 18, 2009. These changes required endoscopy centers that are classified as ambulatory surgical centers to develop, initiate, change and implement new policies and procedures and forms to comply with new regulations. In this ever changing healthcare environment, endoscopy centers have to keep abreast of the legislation and adapt their practices to comply. This can be a challenging and daunting task for those responsible at the endoscopy center to ensure the center is up to date and in continual compliance. We would be presenting recent and any new legislative changes that have impacted the endoscopy setting. Information would be provided to participants on specific ways to comply, such as policy and procedure formation and adaptation. Interpretation and understanding of the legislative changes would be addressed also. Any forms or policies and procedures that would be helpful would be shared with participants. This will be a lecture with powerpoint presentation.
Rie-Ann Jansen, BSN, RN
As a gastrointesitnal (GI) nurse recently diagnosed with celiac disease and also having 2 teenage children diagnosed, I realized how little I knew about the disease and the gluten-free diet. The implications of the disease, its treatment (gluten-free diet), and possible long term complications are also not very well understood by health care workers including GI nurses, dieticians, and doctors. The information provided in this presentation was obtained by doing personal research: web searches, reading medical literature, attending dietician counseling, and attending support group meetings. Personal perspectives are based on life experiences. Celiac disease and the gluten free diet are becoming more significant in the GI nursing practice as more people are being diagnosed with the disease. Purpose: provide an overview of celiac disease and describe the challenges of a family diagnosed with celiac disease that health care professionals may not be aware of. This includes a description of the disease process: symptoms, diagnoses, treatment, and long-term issues. The personal perspective includes explaining the challenges that a family diagnosed with celiac disease faces. The presentation is intended to acquaint the GI nurse/associate with more information about celiac disease and its challenges so they can provide more knowledgeable care to their patients.
Michelle Juan, MSN, RN, ACNS-BC, CGRN
Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is used to treat pancreatic cancer-related pain. The efficacy of an increased dose is unknown. The purpose of this study was to compare the effect of an increased dose of alcohol on the outcome of pain and quality of life in patients with painful unresectable pancreatic cancer. Subjects were randomized to receive 10mL vs. 20mL of 98% alcohol during EUS-CPN. Pain was assessed at 24 hours and weekly thereafter by a blinded interviewer. Quality of life was assessed at baseline, and weeks 2, 4, and monthly. Twenty subjects were enrolled. An increased dose of 20 ml of 98% alcohol provided longer duration of pain relief. Median (range) onset of pain relief for this subgroup was 1 (1-14) days. Subjects who received 20 ml alcohol had fewer problems with pancreatic pain, digestive symptoms, nausea, and vomiting. Quality of life scores directly correlated with pain relief on multiple measures. An increased dose of alcohol may result in better pain relief and quality of life. Improvements in EUS-CPN will lead to better outcomes for patients with pancreatic cancer-related pain and will particularly impact patient care in gastroenterology nursing.
Greg C. Kaiser, MD
This session will include a review of the various types of polyps and associated syndromes or disease states that define them.
Linda L. Kelly, RN, CGRN
There are numerous published standards for processing endoscopes which are often complex and vary depending upon the type of scope. These standards are critical given what we know about harm caused from breaches in reprocessing. Staff need to be welltrained on the correct use of equipment and demonstrate understanding of the reprocessing steps. But what happens when the best equipment and staff training are not enough? This session is a case presentation of a hospital based endoscopy unit that experienced a breach in high level disinfection (HLD). This course includes the fail proof process developed to assure HLD occured from the processor to the bedside. In additon to the process it includes guidelines for managing an exposure. It will be presented in lecture format with powerpoint presentation. This program may apply to learners from novice to expert professionals.
This session will address the use of an ambulatory pH study to effectively document abnormal esophageal acid exposure, duration and frequency of reflux events and correlation of stated symptoms and reflux. This will be accomplished by reviewing case studies of patients pH studies. Nursing care and procedure steps used during a catheter less (Bravo) placement and a catheter probe placement will be identified. Clinical pictures and a video clip will be used to assist in this learning process. Identification of the advantages and limitations of both the catheter less (Bravo) and the catheter probe pH studies will be addressed. Findings of clinical studies will also be discussed.
This session will present information on an innovative method to evaluate motility within the gastrointestinal tract. The Smart Pill monitoring system uses sensor technology to collect information regarding pressure, pH and temperature within the gastrointestinal tract. Through data analysis the Smart Pill assists in providing diagnostic information of motility disorders such as gastroporesis. Indications and contraindications for this procedure will be discussed. To assist in learning, explanations of the procedural process will be reviewed using clinical pictures and patient examples.
Timothy Kinney, MD
Natural orifice translumenal endoscopic surgery (NOTES) involves passing a flexible endoscope through a pre-existing natural orifice such as the mouth, the vagina, or the rectum to access the abdominal or chest cavity in order to perform basic surgical procedures. This session will provide an overview of natural orifice surgery, review some of the potential benefits and risks of NOTES, and discuss the future directions of this technology.
Michael Kost, DNP, CRNA
This presentaiton will feature medical legal, presedation, procedural, and postprocedural considerations associated with the safe and competent care of the sedation patient. This topic would be appropriate for sedation nurses at various clinical experience levels.
Benchmarking is a performance improvement method that has been around for hundreds of years. Recently, it has been used in healthcare as a standard on which to initiate efforts to improve efficiency, cost-effectiveness and quality of health care delivery. Accrediting bodies, insurance payers and Medicare require that facilities demonstrate measures of performance improvement but the greatest value may be in the process of comparing data. Data collected for Benchmarking may also be used to determine the financial health of a facility and support purchasing decisions. Collecting the data is just the beginning, what you do with that data is what is important. Finding and closing competitive gaps as the industry faces healthcare reform facilities cannot remain immune to the need to collect pertinent data, find solutions that improve the efficiency of delivery, decrease costs and satisfy patients This session seeks to simplify the process by establishing common definitions, scrutinize a smaller sample of benchmarking and develop a greater understanding of the importance and urgency of the process.
This session will review and discuss a case presentation of a USS Indianapolis survivor and gastrointestinal (GI) patient for 60+ years. This fascinating case review subject is a walking 60-year histroy of gastroenterology issues and GI techniques, developments and advancements. Review this amazing history and see how far we have come.
Edward Leigh, MA
Learn what to say to patients and what NEVER to say to patients!! This high-energy interactive program will empower gastroenterology professionals with skills to dramatically improve the quality of interactions with patients. This will lead to highly satisfied patients and improved compliance. This workshop covers: opening/closing patient interviews, listening skills, empathic responding, questioning techniques and top tips to educate patients with impact!! Communicate your way to success!!
Barbara Levin, BSN, RN, ONC, LNCC
Mary Ann Shea, JD, BS, RN
One woman's experience resulted in profound changes within a hospital system and has affected patients throughout the country, including the development of The Joint Commission's National Patient Safety Goals. This case study will describe how a series of errors culminated in a cardiac arrest. This program will use slides, video clips and photos to tell the story of how nursing, laboratory and physicians contributed to her arrest. The session will have an impact on those regarding the aftermath of errors.
This session will focus on documentation errors that put you and your patient at risk. Prompt recognition of and response to treatment errors are imperative to optimize the patient's potential for a positive outcome, minimze patient injury and decrease the risk of litigation. Timely documentation not only maximizes quality care and defends you in the event of a lawsuit; it can also prevent a lawsuit. Attend this session to learn ways to protect your patients and yourself.
John C. Lipham II, MD
Gastroesophageal reflux disease (GERD) is a serious medical condition that produces a wide variety of symptoms and complications. Left untreated, GERD can progress to esophageal cancer which has seen a dramatic upswing in the last twenty five years. In this presentation, learn more about GERD and the latest in treatment options. 1. Prevalence 2. Definition of GERD 3. Etiology of sphincter weakness 4. Diagnostic tests for GERD 5. Symptoms 6. Complications associated with GERD 7. Treatment options for GERD a. Modify diet b. Maintain upright position c. Medication 8. Complications of medication response 9. Overview of endoscopic and surgical approaches to fix the LES a. NIssen b. Stretta c. Endocinch d. Enteryx e. Esophyx f. Medigus (Clinical Trial) g. Linx Sphincter Augmentation 10. Summary
Georgia Lynch, BSN, RN
Paracentesis is a procedure done to diagnose the cause of ascites, to diagnose spontaneous bacterial peritonitis and to relieve tense ascites. In the endoscopy unit, patients are treated palliatively to relieve their symptoms that develop from tense ascites by performing large volume paracentesis. It is important for the nurse caring for this patient to understand the implications of liver failure and complications that can develop when removing large amounts of ascitic fluid. This session will review the anatomy of the liver. The functions of the liver. This presentaion will also discuss the morbidity and mortality associated with liver failure and the causes of liver disease. We will discuss the the paracentesis procedure and review the benefits and contraindications. The procedure, equipment and materials used, as well as nursing care of the patient pre, intra, and post with identification of possible complications will be reviewed. The importance of using plasma volume expanders will be discussed. Finally, a case study presentaion of complications of large volume paracentesis will be reviewed.
Isabelle Lynch, MBA, BSN, RN
Inflammatory bowel disease (IBD), a chronic condition with episodic periods of remission and relapses, afflicts over one million people in the United States. IBD often begins in adolescence or early adulthood, and its chronic course requires long-term, often expensive healthcare. Patient support and education are essential to improved compliance with treatment. Improved compliance equates with improved quality of life and IBD nurses can be crucial to the care and optimization of treatment by providing information on diagnosis, therapies, continuity of care and support during flares. Symptoms of IBD vary according to the disease site along the GI tract and disease severity. Accurate diagnosis is made through a combination of signs and symptoms review along with a combination of laboratory, endoscopic, radiological and histological tests. Treatment strategies focus on resolving symptoms as well as improving quality of life. Medical treatment options available include: 5-ASAs, corticosteroids, antibiotics, immunomodulator and biological therapies. Ongoing research into new drugs and established therapeutic agents may contribute to the design of a more optimal regimen for IBD patients.
Raul Magadia, MD
This session will review the epidemiology and pathogenesis of C. difficile infection, identify current treatment strategies for C. difficile infection and explain C. difficle evidence-based guideline recommendations for clinical practice.
Shannonlee Maialetti, BSDI, RT(R), RDMS
Participants will be able to understand the basics of endobronchial ultrasound (EBUS), as well as how it realted to alternative studies, such as transbronchial needle aspiration (TBNA) and mediastrinoscopy. Discussed will be anatomy and physiology, physics, ultrasound imaging and TBNA, mediastinoscopy and EBUS procedures.
Cheree D. Marshall, GTS
This session will cover team work and the work relation between licensed and non-licensed professionals. It will also discuss how the SNA is growing and who is growing with it.
Theresa Menacol, MS
This presentation is designed to address these issues, providing participants with an understanding of the cancer risks associated with the most common hereditary colorectal cancer syndromes, the features and clinical management of these syndromes, and relevant health insurance issues.
Christine Milne, BSN, RN, CGRN
In today's stressful economic environment, gastrointestinal departments are challenged with providing highly technical and costly endoscopic procedures while coping with declining re-imbursement. The manager and supply coordinators are faced with the daunting task of identifying ways to cut costs without impacting quality patient care. The manager and supply coordinators will learn ways to identify and implement opportunities to manage current inventory with limited budgets. This presentation will offer effective methods for the management team to incorporate physician involvement in product selection and cost saving opportunities. Advantages of consolidating product inventory will be discussed. The learner will be able to identify techniques for collaboration with vendors to acquire best pricing for disposables and capital purchases. In addition the importance of promoting staff awareness and accountability for their part in cost containment efforts will be explored. Time will be allotted for interactive discussion of ideas and success stories.
Denise S. Morin, MSN, RN
Although liver transplantation (LT) is the best treatment for patients with liver failure, the scarcity of deceased donor organs has resulted in a surgical innovation, living donor liver transplantation (LDLT). This surgical alternative is possible because of the liver's ability to regenerate and advances in imaging technology. Priority concerns regarding LDLT include ensuring donor safety and selecting appropriate LDLT recipients. While LDLT will not replace LT from deceased donors, it does increase the number of patients who may benefit from LT.
Daniel Ng, MD, FACS, FASCRS
This presentation will begin with a brief introduction to the role of laparoscopic surgery in the field of colorectal surgery. This session will then discuss the evolving techniques of robotic surgery and its current application in colorectal surgery. After providing the audience with details of the actual procedure, video demonstrations will help to further the understanding of this elegant new operation. Participatns will then learn aout the benefits as well as the limitations of robotic surgery. The discussion will conclude with the current robotic experience as well as future applications and enhancements for this technique.
Cori L. Ofstead, MSPH
Alycea Snyder, BA
Harry Wetzler, MD, MSPH
To develop interventions that will improve adherence with disinfection guidelines, more information is needed about factors affecting compliance. The purpose of this study is to evaluate employee perceptions, occupational health, and reprocessing practices in diverse settings. This was a prospective, multi-site, observational study utilizing interviews, surveys, and direct observation of reprocessing procedures. Endoscope reprocessing guidelines were in place at five sites, and 97% of reprocessing employees affirmed the importance of recommended steps. Most employees (54%) disliked some reprocessing tasks, 71% felt pressure to work quickly, and 53% observed procedural delays due to a lack of clean endoscopes. Leak tests, cleaning, disinfection, and alcohol flushes were consistently done when enhanced automated systems were used to reprocess 114 gastrointestinal endoscopes. With manual cleaning and high-level disinfection, zero of 69 gastrointestinal endoscopes were reprocessed according to guidelines. Symptoms attributed to reprocessing were reported by 53% of employees. Physical discomfort occurred more frequently with manual cleaning and high-level disinfection (90%) than with enhanced automated systems (21%; p < 0.001). This study identified several factors that may contribute to nonadherence with reprocessing guidelines. Strategies for educating employees, monitoring compliance, and alleviating time pressures and symptoms associated with reprocessing may improve employee satisfaction and health while ensuring patient safety.
Elaine V. Parker, BSN, BA, RN
Cindy Tiemann, BA, BSN, RN, CGRN
Despite our best efforts, some patients experience and/or recall significant discomfort during colonoscopy. Endoscopy nurses have questioned whether a relationship exists between the time interval from start of sedation administration to the start of procedure (referred to hereafter as time interval) and the level of procedural pain perceived by the patient. The purpose of this descriptive study was to determine if such a relationship existed, and to identify related factors. Among the data collected were the patients pre-procedure anxiety and pain levels, amount and timing of medications administered, procedure duration, and the patient, nurse and physician perception of procedural pain. Using non-experimental design, variation in pre-procedure timing occurred naturally, based upon physician practice. Analysis revealed that the percentage of patients who reported a pain-free procedure rose as the time interval increased, reaching 86% after 4-5 minutes. This time interval also correlated to a shorter procedure time and less dosing of additional Demerol. Nurse and physician perceptions of patient pain were positively correlated with the patients own perceptions. This research found that waiting 4-5 minutes for optimal medication effect increases safety and satisfaction for the patient, nurse and physician.
Jeanine Penberthy, MSN, RN, CGRN
This lecture will include a basic overview of the anatomy and physiology of the biliary system. The pathophysiology related to biliary diseases will be discussed including: Stone disease, strictures and tumors. Treatment options will be discussed in detail from traditional endoscopic retrograde cholangiopancreatography (ERCP) using standard technology such as sphincterotomy, dilation, stenting both plastic and metal to cholidochoscopy using advanced technology such as electrohydraulic lithotripsy and photodynamic therapy. Endoscopic Ultrasound (EUS) will also be discussed and different applications such as intraductal exams. Difficult cases will be presented with a combination of both ERCP and EUS. Video clips of actual procedures will also be utilized to demonstrate these techniques.
Vince Poscente, CSP, CPAE
Renowned business strategist on accelerating business through speed and change and New York Times bestselling author, Vince Poscente is a master communicator. He knows how to get an audience's attention with practical information made sustainable with his unforgettable story. Give your audience an invigorating perspective that reveals leadership strategies for aligning employees with a common mission.
Mike Rayburn, CSP
This hilarious, musical keynote will motivate and energize you. You will learn: three simple, powerful tools you can use immediately and forever to access the gold mine of unrealized potential inside you; the most powerful motivational forcde on this planet (hint...it is not power, sex, money or fame); the most basic human brain function and how to harness it for powerful change; that managing change is not only stupid, it's dangerous. The only way to manage change is to create change...to define the curve rather than follow it. You'll learn how to do that; how to set goals that take you or your organization beyond what you've imagined is possible; the power of a sense of purpose and how to determine if your purposed in life is over; a simple, powerful 10-minute exercise that will show you how to become a virtuoso, a master of the things that truly matter.
Patricia Raymond, MD, FACP, FACG
IBS is tough to diagnose. And you dont commonly get to watch the process from initial presentation to successful management. In this highly interactive session, teams will assist in history, physical exam, lab and endoscopic evaluation, and management of a typical IBS patient.
We have handled helicobacter and were conquering colon cancer. The next growth area in gastroenterology will be shrinking the obesity epidemic. Overweight and obesity have reached epidemic proportions in the United States. Over 61 percent of Americans are overweight and one-fourth of American adults are obese (an estimated 97 million), putting them at serious risk for poor health (DHHS, 2001). We have an expansion in our knowledge of obesity physiology, based on studies of rats with genetic variations. This knowledge of leptin, leptin receptor, and melanocortin-4 (MC4) receptors is driving research into new obesity medications. And surprising studies show that the intestinal bacteria in fat mice differ from those in lean individuals. Might bacteria regulate body weight? Although this presentation will focus on the studies of rat physiology which are leading to our understanding of obesity and drug development, the presentation will include a brief review of endoscopic bariatric procedures currently under development.
Jay A. Redan, MD, FACS, ASCRS
GI endoscopy has long been a separate area of expertise freom operating room (OR) nursing. As we move forward with natural orifice and endoluminal surgery, the OR nurse will now have to learn this specialty. This session will teach you how to incorporate this "new area" of OR nursing into your operating rooms.
Erik Reilly, MEd, BS, RN, CHES
Denise Wilson, RN
In today's endoscopy units, gastrointesitnal (GI) associates perform a vast array of roles that directly affect patient care. Currently, unlike other members of the healthcare team, GI associates do not have a formalized training program. Furthermore, many GI associates come in to their role in endoscopy with minimal, if any, experience within a clinical setting. Education and a process to assist the GI associate to demonstrate their competence in the key areas of infection control, reprocessing of endoscopes, equipment utilization, safety, chemicals, and regulations is necessary to assure the associate has the appropriate level of knowledge to perform their role. This presentation will present one units approach to educating and creating competencies for GI associates. It will outline and describe the process taken to create competency based educational initiatives and assist their GI associates to prepare for the Certification Board for Sterile Processing and Distribution (CBSPD) flexible endoscope reprocessor certification exam.
Alisha Richins, BSN, RN
Rebecca Siirola, RN
Every generation of nurses has its own set of strengths and weaknesses. Mixed together your Endoscopy Lab can wind up with a nursing staff with vast talent and abilities but also a tendency to occasionally clash, especially with regard to their diverse approaches to work However, while nurses are of generally different ages, there is no gap in our basic interests: more input with patient care decisions, better pay and improved working conditions. The good news is that it is possible to help nurses from different generations learn to understand each other better and to work together as a cohesive unit. The first step is for nurses and nurse managers to realize that there will always be some small differences that distinguish each generation and to not let them get in the way of working together. This presentation will be an anecdotal and informative look into various solutions for this emerging problem using role playing, demonstrations and audience participation. This presentation will be given by two gastrointesditnal nurses: a new graduate registered nurse (RN) and a seasoned RN with 23 years experience.
Laryl Riley, MSN, RN, RNP, CGRN
Michele Rubin, CNS, RN, CGRN
This presentation is designed for the healthcare provider learning to talk with patients, to examine them and then to understand and assess their problems. It is assumed the learners have had basic courses in human anatomy and physiology. Symptoms identified by taking a history provide some of the most important items of information used in the process of diagnosing a disease state. Participants will learn to take the symptoms patients recognize and report and translate them into technical terms, group them, analyze them and make tenative hypotheses about the abdomen and the processes most likely causing them. This workshop will also concentrate on the examination of the abdomen using the techniques of inspection, auscultation, percussion and palpation. Common or important problems as well as the infrequent or esoteric will be identified.
Abnormal liver function tests is a frequent reason for gastroenterology consult. Although fatty liver is becoming a common cause in the "enlarging" population in more than twenty five percent of the cases other causes must be ruled out. Differential diagnosis includes but not limited to: hepatitis both viral and autoimmune, hereditary hemochromatosis, alpha 1 antitrypsin, gallstone disease, wilsons disease or liver cancer. Careful history taking, specialized blood tests and imaging are required to make the proper diagnosis.
This class will provide a didactic component covering topics of interventional endoscopic ultrasound (EUS) procedures. Pancreatic/biliary and pulmonary anatomy will be discussed. This hands-on session will cover use of the ultrasound processor keyboard during the EUS procedure, ultrasound balloon application, endo bronchial ultrasound guided trans bronchial needle aspiration (EBUS-TBNA) and proper scope handling during the procedure, as well as throughout reprocessing. A phantom model will be available to simulate an actual fine-needle aspiration (FNA).
The ileoanal pouch anastomosis procedure is completed in 1, 2, or 3 stages depending on patients acuity level, indeterminate diagnosis of ulcerative colitis or if obese. Staging the ileoanal pouch procedure is increasingly more common and can be confusing to the patient and the care providers. Close patient follow up within the first 12 months is key to a patients adjustment and satisfaction with the ileoanal pouch. In addition, early complications of dehydration, perianal dermatitis, ileoanal dehiscense, ileoanal stenosis, irritable pouch and anal stenosis as well as late complications of pouchitis, Crohns disaese, anal or pouch fistulas etc. can develop. Early recognition and treatment is key to successful management. Often fine tuning of the patients dietary and bowel habits provides better patient outcomes. Over time, patients forget some of the management strategies that help to maintain good functional results. As an advanced practice nurse, I manage the post operative and follow up maintenance management of the ileoanal pouch patients. This presentation will give the nurse a better understanding of the ileoanal pouch procedure, the possible stages as well as expected functional results. The nurse will develop an awareness of pouch complications, issues in patient management and treatment that is evidenced based.
Phyllis Russo, BSN, RN, CGRN
The Endoscopy Assistant/Technician Update Education & Certification Preparation Course is a presentation for the experienced EA/ET looking to complete a nationally recognized competency program. This program reflects 2010 standards and practices to attest to maintained competency and also to prepare an individual for national certification offered by the Certification Board for Sterile Processing and Distribution (CBSPD). This presentation reviews the theoretical knowledge supported by clinical skills of the newest technology available. It is also helpful to nurse educators looking to establish study programs for the EA/ET within their own region. This program includes focus on: role delineation and regulatory standards; gastrointestinal anatomy, physiology and pathophysiology; patient safety in endoscopy; infection control; the handling and maintence of endoscopy equipment; and, performance improvement and endoscopy research.
Basic gastrointestinal (GI) reimbursement economic changes continue to impact the GI and endoscopy landscape. This one-hour session introduces GI nurses and associates to the basic elements of how and why GI facilities and physicians get paid for their delivery of endoscopic patient care and services. The presentation defines reimbursement vocabulary and concepts such as current procedural terminology (CPT) code, relative value units (RVU), and modifier and payer mix. The session then applies these fundamentals to reading and understanding a fee schedule. Learning these ABCs better equips all GI nurses and associates to expand their horizons and add to their armament of tools to work smarter, not harder without compromising staff, physician and customer satisfaction.
Nurses must expand their professional horizons and become involved in research activity. Knowledge development through research is necessary for the growth and survival of gastroenterology nursing. Also, many health care facilities are encouraging nurses to conduct research so that they can seek magnet designation. A research proposal must be written and approved by an institutional review board before any research project can be started. Proposals include a logical, workable research plan, explain how research subjects rights will be protected, and demonstrate how the project contributes to nursing knowledge. The presenter is a doctorally prepared nurse researcher, who has received several research grants, and teaches university courses about proposal writing. She has been a member of the Society of Gastroenterology Nurses and Associates (SGNA) research committee for many years and is currently the research committee chair. She will introduce the participants to the process of writing a research proposal and will emphasize strategies for convincing reviewers that the research project is important and practical.
David Smith, BSN, RN, CGRN
Known for its aggressive and devastating progression, pancreatic cancer can catapult patients into a whirlwind of tests, consults, options, and emotions. Endoscopy nurses can find themselves in a unique situation dealing with a patient who has pancreatic cancer. How can he or she provide the most beneficial care and support in such a limited window of opportunity? The purpose of this presentation will be to give the endoscopy nurse the tools to provide the best care for patients facing pancreatic cancer. This will include the 1) the basic understanding of the anatomy and physiology of the pancreas; 2) the physiology and disease progression of pancreatic cancer; 3) the knowledge and technical skills surrounding endoscopic procedures involved with pancreatic cancer (i.e. endoscopic retrograde cholangiopancreatography [ERCP] and endoscopic ultrasonography [EUS]); 4) the potential situations, treatments, and outcomes facing the patient; and 5) the emotional aspects surrounding the diagnosis and treatment of pancreatic cancer. The intent of the presentation is to blend the science of endoscopy and the art of nursing into a holistic approach to help these patients. By offering knowledge, technical expertise, and emotional support, the endoscopy nurse can empower the patient and offer the greatest impact in, what is often, a limited interaction.
Paulette Smith, BSN, RN, CGRN
First done over a century ago, and in the early stages, fraught with technical difficulty, esophageal manometry is now widely accepted in gastroenterology practice. This presentation will review the historical progression of esophageal and pH testing into the 21st century. The physiology of swallowing and gastroesophageal reflux as well as bolus transit will be explained. Examples of high resolution impedance manometry and impedance pH testing showing both normal and abnormal tracings will be presented.
Shari L. Taylor, MD
The most accurate and specific histologic diagnoses for gastrointestinal diseases occurs when pathologists and clinicians partner together. This session discusses how biopsy sampling and submission of relevant clinical and endoscopic findings can affect a pathologist's ability to render the most accurate and specific diagnosis. Optimal biopsy sampling and necessary accompanying information for several major gastrointestinal diseases, including eosinophilic esophagitis, Barrett's esophagus, and various types of colitis, will be discussed.
Diane K. Theisen, BSN, RN
Open access continues to grow. We have over 45,000 referrals since 2006. We are currently using this patient population base to do studies on improving no show rates, different preps with better compliance and results. The process continues to evolve and change as it grows. The developement of an online form, increasing data base and lean events to assess progress continues. Will describe process, change and at least two studies being done on the data base. One is in progress on the prep and the other is in the planning stage; looking to fill up the cracks so that patients have their colonoscopy done in a timely manner. Currently our success rate for screening is around 30%. We are looking to significantly improve this. I am looking at every patient who is a no show and trying differenct methods to have them complete their studies. Once again as this process grows the challenges are to continue our standardardization of the process while expanding and maintaining our patient first approach.
This program will take a participant from the esophagus to the stomach and the upper part of the duodenum. I will discuss anatomy and physiology and function. Once this is covered I will discuss different diseases and emergencies and show how the patient presents and what is present during endoscopy along with how the disease can change the muscles and function of the esopahgus. I will also discuss manometry in some of these disease processes including accahlasia and Barrett's. We will discuss argon, snares, clips, and dilating equipment and stents. Knowing what was done and what and its impact will be improves your nursing care by making you proactive and a more knowledgable member of the team.
Lynne A. Thomas, BSN, RN, CGRN
Eco-friendly products and processes are gaining importance in industry and lifestyle. This session will explore the use of environmentally conscious practices in gastroenterology and endoscopy. We will discuss the effect of green technologies on patient safety, equipment, practice settings, and staff morale. Earth-friendly choices are increasing in every facet of health care delivery and this session will provide food for thought regarding the options available to endoscopy practitioners.
Ergonomics is an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely. The goal of this session is for the participant to recognize endoscopy related activities impacted by ergonomic practice habits and consider alternatives to those that may be considered injurious to self, patients, and/or equipment.
Doris Thornhill, MSN, RN, CCRN, ACNP-BC
As clinicians, patient safety is our primary focus and concern. By monitoring EtCO2 during moderate sedation, an accurate picture of the patients ventilation status can be obtained. Knowing the patients ventilation status is essential for safe provision of moderate sedation. Capnography (EtCO2) is the earliest indicator of respiratory compromise such as hypoventilation, airway obstruction or no breath. Evidenced based research strongly supports usage of EtCO2 to monitor ventilation during moderate sedation. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines notes that capnography is a superior way to evaluate ventilation, compared with pulse oximetry. The Joint Commission standard (PC 03.01.05) on moderate sedation states that patients oxygenation, circulation and ventilation are monitored continuously. Ventilation can be monitored by actively watching the patients chest rise and fall, however this method does not always accurately indicate if ventilation is effective. Many clinicians have a false sense of security in monitoring a patients respiratory status. Many have indicated that pulse oximetry monitors ventilation, which is not true. Pulse oximetry only assesses oxygenation. During this presentation, supporting literature will be reviewed that recommends usage of EtCO2 during moderate sedation.
Betsy Tyler, BSN, RN
Rita Walters-Peyton, BSN, RN, CGRN
Effective precepting is the key for a solid foundation in creating exceptional gastrointestinal nurses and associates. Strong preceptors use knowledge, vision and experience to guide preceptees toward their fullest potential. We intend to provide a fun, humorous and knowledge-packed presentation encompassing all types of learning styles. We will offer exciting combinations of educational and interactive demonstrations regarding the layered approach to precepting. The challenges of diverse generations, personalities and physicalities among preceptees will be addressed.
Jon A. Vanderhoof, MD
This session will review the pathophysiology and therapy of short bowel syndrome - applicable to all ages.
Laura Whitlock, BSN, RN, PHN, CGRN
Anemia can be caused from disease processes ocurring in the gastrointestinal tract. This session will cover - from head to toe - some of the important diseases that cause anemia, their etiology, presentation and treatment.
Kathleen A. Wilson, BSN, RN, CGRN
The purpose of esophageal banding is to reduce the overall surface area of varices to decrease possibility of spontaneous rupture. Portal hypertension is caused by decreased liver function resulting in a back up of venous blood flow into the mesenteric system. Pooling of blood in this area will present as dilated veins, or varices, throughout the gastro-intestinal system. Varices are graded according to size. Patients who present with liver disease and decreased liver function are at risk to develop these dilated veins. Esophageal gastro duodenoscopy is performed to check these patients regularly to assess and treat varices. Treatment options include the ligation of varices, sclerosing agents, use of medication, balloon tamponade, placement of a shunt, or liver transplant. A nurse or technician will assist the Doctor in preparing the patient for procedure and providing education for aftercare and follow-up.
Karen Zervopoulos, CMA, CSPDT, CFER, GTS, AGTS
This presentation by an associate will focus on the importance of certified personel in reprocessing of endoscopes.
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