Pediatric nurse practitioners (PNPs) play integral roles in the development and implementation of programs to optimize care coordination and delivery in complex pediatric patients. We describe the development of an interdisciplinary program for young children with heart failure requiring a Berlin Heart ventricular assist device (VAD) and the contributions of a PNP in the intensive care setting.

Young children supported on VADs often have prolonged hospitalizations while awaiting heart transplantation. Providing critical care specifically oriented toward long-term stays requires a significant culture shift in the ICU. A PNP-led interdisciplinary group evaluated our ICU practices and identified areas for improvement. The work group introduced specific interventions to optimize interdisciplinary care coordination and enhance practice standards. These included: 1) interdisciplinary care guidelines for chronic patients, 2) assigning a primary physician and PNP to each patient, 3) psychological interventions for families to reduce the impact of extended stays, 4) early jejunal feedings to optimize nutritional status, growth and healing, 5) a protocol for developmental and rehabilitative services, 6) a strategy to minimize blood draws and transfusions, 7) increased structure for interdisciplinary rounds to optimize team and family communication, 8) comprehensive nursing education for VAD patients that included wound care, anticoagulation, and blood drawing practices, and 9) a protocol for off-unit rehabilitative/developmental interventions. Our team found that comprehensive, interdisciplinary care coordination and standardized practice was achieved. Overall care for our Berlin Heart patients was improved, and the ICU PNP was integral to the initiation and implementation of the interdisciplinary care process we developed.