A child in the Pediatric Intensive Care Unit (PICU) needed a mode of ventilation that had not yet been utilized at Monroe Carell Jr. Children’s Hospital at Vanderbilt. The patient had been put on multiple ventilation modes without improvement and was requiring several months of paralytic medications in order to ventilate. Without this new mode, the family was having to consider end-of-life care.
Melanie Walker, a clinical educator in Pediatric Respiratory Care, was asked to help implement Neurally-adjusted ventilatory assist (NAVA), a relatively newer mode of ventilation in which a ventilator utilizes the electrical activity of the diaphragm to generate appropriate breaths and assist ventilated patients. It would be a bridge until they could send the patient home on a home ventilator.
When Walker was asked for a timeframe for its implementation, she initially said four weeks. “But to really help this child and save her life we were given four days,” she remembers.
Walker sprang into action, as did her team, and they were able to obtain the necessary resources from other hospitals, hold several in-service trainings on the front end, and implement the new mode of ventilation quickly.
The patient has been successfully transitioned to a home ventilator and is scheduled to be discharged soon in hopes of spending her birthday at home.
For her dedication to that patient and for her work ethic in providing quality and safe respiratory care for pediatric patients, Walker received Vanderbilt University Medical Center’s Credo Award, presented at the May 2024 virtual Leadership Assembly.
“Melanie went way above and beyond for the patient in the PICU,” a nominator wrote. “She ordered the necessary equipment, gained institutional approval, communicated with all of the necessary disciplines, worked with the ventilator clinical specialist and even canceled a portion of her vacation to ensure it all went smoothly. Because of Melanie’s contributions, this patient has already begun to show progress and is drastically improved from a clinical perspective. I am entirely convinced that this patient’s clinical status is a direct reflection of Melanie’s efforts and initiatives.”
Walker joined the Medical Center 12 years ago as a respiratory therapist. She became a clinical educator in Pediatric Respiratory Care in 2019.
In her role as clinical educator, she leads quality improvement projects in the PICU and the Pediatric Cardiac Care Intensive Care Unit. She also leads training, education and onboarding for respiratory therapists. Over the past year she has trained and provided orientation for 45 new hires, following up with them for equipment reviews and skills assessments and making sure they can work independently.
Over the past two years, Walker has also worked with her team in reducing unnecessary airway clearance therapies.
“I have worked side-by-side with Melanie for several years and have yet to have a single interaction where she was not active, helpful and insightful,” one nominator wrote. “As a member of the tracheostomy and ventilator team, I often find it difficult to remain up to date with the latest ventilator modes and devices, as these change with frequent regularity. Melanie has been instrumental in keeping our team … up to date. She has been able to procure educational ventilators for our team, which includes learners, and has spent significant time outside of her clinical duties to ensure that our team is properly educated. Her dedication to respiratory care at Monroe Carell has improved how we care for our patients in innumerable ways.”
Walker was told about the Award at a small gathering.
“I thought I was going upstairs for coffee. When I turned the corner, I saw a big picture of my face on the wall. I was just thinking, ‘That’s a really big picture of my face;’ I didn’t even see the little sign at the bottom of the photo saying I had won the Credo Award,” she said.
Walker’s husband, Todd, and 17-year-old daughter, Olivia, attended the celebration. The two kept the secret for a week.
“When I saw pictures afterward, my face was really, really red. It was a combination of embarrassment, high blood pressure and shock.”
View Melanie Walker’s video from Leadership Assembly here.
If you are a VUMC employee, you can nominate a colleague for an Elevate Credo Award, Five Pillar Leader Award, or Team Award. Visit the Elevate website to fill out a nomination form. Employees demonstrate credo behaviors when: they make those they serve the highest priority; respect privacy and confidentiality; communicate effectively; conduct themselves professionally; have a sense of ownership; and are committed to their colleagues. Elevate award nominations are accepted year-round. If a nomination is received after the cut off for an award selection period, the nomination will be considered for the next period. VUMC VOICE will post stories on each of the award winners in the weeks following their announcement.
