Submitted by kmcochran on
On January 7th PQCNC held its Annual Meeting and I was most grateful that WRAL expressed great interest in covering the event. My intention was that WRAL would have an opportunity to showcase for the state the tremendous work we all have done and will be doing to improve perinatal care in North Carolina. I thought it most appropriate, given our commitment to partnering with families and patients, and the recent publication of PQCNC's CLABSI initiative, that we include Jean Paul Dame on the WRAL interview list. Gabby Dame is the face of that CLABSI effort, the Dame family has inspired all of us, and Jean Paul's determination to help us eliminate CLABSIs has been a critical factor in the success of that work.
As I watched most of Jean Paul's interview with WRAL I was surprised to hear him recount events that proceeded Gabby's death. His vivid recollection of these events was something he had never shared with me but these are the intense memories that led to Jean Paul advocating so fiercely for our efforts to reduce CLABSIs in the NICU.
The narration which accompanied the introduction of the PQCNC segment was a surprise to both me and Jean Paul. Dr. Allen Mask’s introductory comments specifically assigned Gabby's death to the actions of a single provider. While Jean Paul recounting events surrounding Gabby's death is vital for those whose mission is to reduce and maybe eliminate CLABSIs, the definitive nature of Dr. Mask’s narration was a shocking comment.
Several core principles form the foundation of PQCNC’s CLABSI work. First, we recognize that CLABSIs are complex events which will only be reduced in frequency by recognizing that multiple causative factors need to be addressed. Second, we will only improve when we work together as teams, whether it is in the NICU, Labor and Delivery or the Nursery. Nurses, doctors, practitioners, RTs, techs, ward clerks, infection control experts and families all have an equally important role to play as we strive to eliminate CLABSIs. While some have taken Dr. Mask’s interview comments as targeting nurses, my initial reaction when Dr. Mask commented on the role of a “nurse”, I heard my name. The painful fact is that while every one of us has a role in reducing CLABSI, every one of us who works with patients in the NICU has the potential to contribute to CLABSI. None of us would ever intentionally do so, and we all come to work every day hoping to heal, but we all also possess the ability to harm. We know this but we also know blaming well intentioned individuals will not create the culture of transparency, communication and teamwork we require in order to, hopefully, someday, eliminate CLABSI and NICU infections. While I was initially angered by Dr. Mask’s commentary, evaluating this anger and considering the journey we have been on with the Dames and CLABSI reduction led to something very different for me.
I contacted Rick Armstrong at WRAL, who conducted the interviews, and much to his credit Dr. Mask called me. I am absolutely convinced he intended no offense to anyone, most especially nurses and specifically NICU nurses. Dr. Mask felt he was simply summarizing the comments made by Jean Paul and had no intention of impugning NICU nurses, a specialty group for whom he made it very clear he has outstanding respect. He emphatically stated that it is his belief that in order for healthcare delivery and processes to improve, nurses will be our leaders. He suggested that I might have made WRAL staff aware of potential sensitivities on this issue. I take full responsibility for that but was hearing Jean Paul's recollection for the first time and had no idea the narration would include the comments it did. Dr. Mask stated he was sorry for any problems this might have caused, strongly reasserted he had no intention of offending nurses, applauded our team efforts and expressed he would do anything necessary to limit the unintended damage of the report. Based on our conversation he stated WRAL would re-edit the PQCNC report. True to their word WRAL did so very expeditiously and removed what many of us viewed as inflammatory commentary. I am grateful to Dr. Mask and Rick Armstrong for their diligent attention to this matter and their sincere determination to rectify any damage that may have been caused by the presentation of the PQCNC report.
I cannot erase the injury or pain any of these comments might have caused providers who work tirelessly at bedsides to care for the most delicate patients. I hope all will accept that while I did not know exactly how an otherwise powerful tribute to PQCNC work would be framed, I accept full responsibility for it. I am sincerely sorry for any distress this piece may have caused laborers in the field committed to making North Carolina the best place to give birth and be born. I hope NICU nurses, and all members of PQCNC teams across the state, know how I feel about them. You are the drivers of the reduction in CLABSI we have seen in NC. You are a major reason that 17 babies are now alive every year in North Carolina. These are babies who would have previously died. You are the reason that North Carolina now routinely leads the nation as the state with the lowest rates of NICU CLABSI.
I have to close by saying this has been an incredible learning experience for me, one which I might have chosen to avoid, but one which has been invaluable. It is a reminder to me of why CLABSI and infection prevention is so important. Jean Paul told us in “Gabby” that in the NICU we are taking care of much more than fragile infants, we are taking care of a family’s dream. I had not previously heard Jean Paul report the events that he recounted in the WRAL interview. I have worked with Jean Paul for five years and have never known the torment he bears for feeling that, whether true or not, as he sat at his beloved Gabby’s bedside he might have done something to prevent her death. This is a pain which he will always bear. The only thing that will mitigate it is our commitment to continue daily our efforts to prevent NICU infections.
One cannot be a healthcare provider in this business for any period of time and not have a Gabby. I do. I have several. There is not much we can do to bring back the babies that we think we might have done things differently for, but we can commit to honor their memories and secure as best we can the dreams of the families we care for today and in the future. Seventeen lifetimes a year is not a bad start. My hope is that it is a good start in comforting Jean Paul and Lisa Dame. My prayer is that the future work we do, together, as teams, will be comfort enough for Jean Paul and Lisa.
I look forward to continue working with you all to fulfill the dream that Gabby was sent here to inspire us to fulfill.
Marty McCaffrey
PQCNC Clinical Director