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Program brings perinatal training to hospitals by Dick Peterson Public Relations If there's no one else around to rely on for the care of a desperately ill infant, a small, rural hospital can be a scary workplace for a nurse.   “Here you have an enormous number of people around you,” said Kathy Ray, R.N. But not so in many of the hospitals Ray and her colleagues in the MUSC Perinatal Outreach Program visit regularly. Their job is to provide nurses at eight Lowcountry hospitals with the training they need to stay professionally current in their fields.   And help lessen the scariness.   Completing the team with Ray, the regional systems developer, is Mary Ernst, R.N., obstetrics, and Kim Thayer, R.N., in neonatal education. Combined, they represent more than 50 years’ experience in perinatal nursing. Backed by their experience and equipped with a wealth of knowledge, they teach courses, conduct seminars and update nursing staffs in new techniques in level-one and level-two hospitals throughout the Lowcountry region.   The statewide program began in the mid-70s by dividing South Carolina into the Piedmont, Midlands, Pee Dee and Lowcountry perinatal regions with a level-three hospital in each providing the outreach education.    With funding from DHEC, the state's Department of Health and Environmental Control, “The perinatal regional program helps nurses professionally at their place, at their pace,” said neonatology director Dilip Purohit, M.D. He said that the program also teaches nurses how to evaluate their patients to know what care is appropriate for the risk and to know when the risk is so great the patient needs to be transported to a level-three facility.   The relationships that Ray, Ernst and Thayer maintain with Lowcountry hospital staffs keep the lines of communication open and enhance the effectiveness of their training, Ray said. While what they call PCEP, an acronym for Perinatal Continuing Education Program, is the foundation of their work with the hospitals, the three make it a point to keep contact with perinatal nursing staffs and visit when they are in the area.   “We return to each hospital to conduct the PCEP courses every three-to-four years,” Ray said. “But it's these relationships we establish that encourage them to pick up the phone and ask questions when they have a special case.”    Maybe they had an incident that didn't go as well as it should have. Maybe a baby was transported here and they need to know what to do when the baby returns, or the mother recovering back at the hospital is asking what's being done.    “We can help them with the answers they need.”  Maternal-Fetal Medicine director Roger Newman, M.D., said that the Perinatal Outreach Program's work in Lowcountry hospitals also has helped obstetrics nurses and physicians recognize high-risk pregnancies as opportunities to care for both mother and baby before birth.    “It's better when mothers can be transported before their babies are born,” Newman said. “That puts them in better proximity to our neonatal nursery and to the subspecialty care available here for both the mother and infant. We're able to present the neonatal nursery with a healthier infant than if the baby were transported after birth.”   Newman said that MUSC has a high percentage of complicated births. From 50 to 60 percent, he estimates, have high risk factors, such as multiple and premature births, and pre-mature labor. This makes MUSC much more experienced in not only managing high-risk births and caring for very low birthweight and desperately sick infants, but in teaching other hospitals how to recognize which births they can handle and which need to be transported.   “In fact, our students see too many complicated births here to offer them a realistic obstetric experience,” Newman quipped.   In addition to PCEP, which teaches and refreshes the basic skills of perinatal care, they provide free courses that teach nursing and medical staff and teach teachers in neonatal resuscitation and electronic fetal monitoring. “Many hospitals aren't willing to pay for off-site education,” Ray said, “and few nurses can pay it out of pocket, so we come to them.”   They also schedule conferences and workshops as requested and work to improve their own skills.   “They do most of the work, and periodically we (physicians) go,” Purohit said. “In all, the full range of educational services is available to the hospitals. The hospital staffs can be credentialed, stay certified and update their CEUs (continuing education units) and it doesn't cost them much of anything. The hospitals really appreciate the service.” The MUSC Medical Center is well staffed and highly experienced to treat desperately ill infants. It is MUSC’s team of caregivers at that assures neonates the very best of care and is the foundation upon which the Perinatal Outreach Program is built. The numbers speak for themselves: Board Certified Neonatologists -- 6 full time, 2 part time Neonatal Nurse Practitioners -- 14 RNs highly experienced in the care of sick neonates -- 90 Clinical Pharmacist for the Neonatal Intensive Care Unit only -- 1 Nutritionist for NICU only -- 1 Pediatric Surgeons -- 4 Pediatric Cardiologists -- 7 Pediatric Subspecialties (blood, kidney, lungs, radiology, etc.) included? -- Yes Maternal Fetal Medicine (specialist for delivering high risk pregnancy) -- 6 Patient Care Days <1,500 grams birth weight -- 9,216/year