For Clinical Practice

New Jersey Nurse, May/Jun 2004

2004 C.A.R.E. Awards

Susan Torres, RN

After many years in a successful business career, Susan pursued her lifelong dream of entering the nursing profession. She received her nursing diploma from Englewood Hospital in 1990 and her Bachelor's degree in Nursing from Seton Hall in 1995. She graduated with honors from both institutions and gave the graduation speech at pinning at Seton Hall.

In 2001, Jersey Shore Medical Center received a competitive Certificate of Need from the New Jersey Department of Health and Senior Services to establish a Center for Bloodless Care. Shortly thereafter, Susan was selected to lead this important initiative. In only two years, she has taken the vision proposed in the certificate application and has built the Center for Bloodless Care into a prominent center with a statewide and national reputation for excellence. After attending the Bloodless Medicine and Surgery Institute in Cleveland, Ohio, Susan initiated the program by building an interdisciplinary team and developing medical and surgical policies and procedures related to rendering health care without the use of blood products. She designed and now delivers formal education programs that reach audiences of physicians, nurses, medical residents and ancillary staff. These programs not only increase knowledge levels, but also change long-standing practice patterns, beliefs, attitudes and prejudices to this revolutionary and little understood therapy. She considers her most important work the coordination of medical, surgical, nursing and ancillary services to meet the comprehensive needs of patients who request bloodless or blood conservation therapy and to act as an advocate for these patients.

Currently, Ms. Torres coordinates multidisciplinary efforts to promote blood conservation for in-patients and out-patients at JSMC. She collaboratively facilitates patient care and discharge activities. Susan has built up a significant client base for the Center from referrals. Her sources of referrals to the Center include primary care physicians, surgeons, and patient self-referral. Additionally, she set up a computerized consultation service by which physicians may contact her for appropriateness of patient referral to the Center. This service processes 4 to 5 consultations weekly.

Susan works closely with the Jehovah's Witness community to assure them access to culturally sensitive state-of-the-art health care. This has had important implications for all patient populations. Using research findings based on data from the Center, Susan has written new therapy protocols that changed the standard of practice, increased the quality of care and improved outcomes related to blood use for all patients at JSMC. For example, recently Sue received an urgent request for consultation regarding a patient whose postoperative hemoglobin was 4.5. The patient was a Jehovah's Witness and refused to receive a transfusion. Susan started an aggressive regimen based on past successful results and accompanying data from the Center. By discharge, ten days post-surgery, the patient's hemoglobin was 6.8.

Susan frequently is consulted prior to patient admission for surgery. After reviewing pre-admission test results, she makes recommendations regarding diet and medication supplementation to both the patient and the physician to help the patient build up their internal iron resources and decrease the likelihood of need for a transfusion. An example of the fruits of this preoperative counseling was seen recently when a patient who was a Jehovah's Witness was placed on a preoperative regimen three weeks prior to a hip replacement. The patient experienced a significant preoperative increase in her hemoglobin, decreasing her projected length of stay by three days. Upon discharge, this patient called Susan to speak with her personally to express her gratitude and appreciation for exceeding her expectations about her hospital treatment. Occasionally Susan is consulted on an emergency basis, such as when a 12-year old child was brought into the emergency room as a severely injured trauma patient. The trauma physicians were desperately trying to honor the parents' wishes for the child not to receive blood. Susan, again following data results collected from the Center, her experience, and newly written protocols, treated the child and monitored his progress closely for seven days. The child experienced a significant increase in hemoglobin, avoided the need for a transfusion and was discharged.

Susan's impact on the Jehovah's Witness community is wide-spread. Last year, she was contacted by a physician in Jamaica regarding a patient who required cardiac surgery. The young woman, a Jehovah's Witness, was experiencing signs of congestive heart failure and needed a valve replacement. The ability to perform this type of surgery without the use of blood products was beyond the capabilities of the local hospitals. Susan met with the Chief of Cardiac Surgery and the administrative team at JSMC, who agreed to provide pro bono services. Susan coordinated the logistics of transportation, lodging and preadmission testing, and personally saw to it that the patient received all necessary treatment to prolong her life and to return home safely and in a much healthier state.