RDs In Practice – Supporting the Pediatric Intensive Care Patient

Infant with cap being fed a bottle

RDs In Practice is an educational program aimed at advancing clinical knowledge and ideas in specialty areas of pediatric nutrition. Didactic lectures, question/answer sessions, and networking opportunities will allow time for attendees to discuss emerging topics, evidence based practice and solutions to practice dilemmas.

Date: August 12, 2015

More Information: Shonda Brown, RD at rdsinpractice@choc.org or 714-509-7829.

This event was made possible by an unrestricted educational grant from Nutricia North America.

Program Objectives:

Upon completion of this program, participants should be able to:

  1. Understand the complex physiology and metabolic sequelae of critically ill patients in the intensive care unit.
  2. Describe the advancements of respiratory support in the critical care setting.
  3. Recognize the barriers and unique challenges in providing optimal nutritional care in the PICU setting.
  4. List key components in establishing a standardized approach to nutrition support in the PICU.

Target Audience:

The program is intended for registered dietitians and clinicians who specialize in the acute care setting.

Program Faculty

Dr. Nick Anas, Director Pediatric Intensive CareNick Anas, MD
Director Pediatric Intensive Care, CHOC Hospital
A recognized expert in pediatric critical care medicine with more than 25 years of experience, Dr. Nick Anas has served as director of CHOC pediatric intensive care unit (PICU) since 1991 and as the pediatrician-in-chief since 2009. He is board certified in Pediatric Critical Care and Pediatric Pulmonology. He is on the Editorial Board of Pediatric Critical Care Medicine and is the Associate Director, Pediatric Critical Care Fellowship Harbor UCLA-CHOC. Dr. Anas is a nationally recognized expert in the treatment of acute respiratory failure in children and an active member in the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI), an international research consortium. The PICU at CHOC is a research center for a number of clinical trials addressing issues pertinent to critical illness and injury. On the forefront of critical care education and research, Dr. Anas has more than 80 publications in prestigious medical journals and is the author and editor of several textbooks devoted to pediatric critical care.

Roy Ramirez, Respiratory TherapistRoy Ramirez, RCP, RRT-NPS, RPFT
Respiratory Therapist, CHOC Hospital
Roy Ramirez is a Respiratory Care Practitioner, Registered Respiratory Therapist with Neonatal Pediatric Specialty (RRT-NPS) and a Registered Pulmonary Function Technologist (RPFT). Roy has been at CHOC since 1989 and in the last 8 years has fulfilled the role of ECMO Coordinator. He is a board member of the California Society Respiratory Care Southern California Chapter (CSRC) and Chair of the Annual Neo-Peds conference for the last four years. Under his watch, The ECMO team has cared for many critically ill patients. Most recently CHOC has earned the coveted designation of Extracorporeal Life Support Organization (ELSO) Center of Excellence. Roy is also the CHOC’s study Coordinator for Nutritional Adequacy and Outcome in Neonates and Children on Extracoporeal life support in collaboration with Washington University School of Medicine in St. Louis/St. Louis Children’s Hospital.

Jan Skaar, Clinical DietitianJan Skaar, RD, CSP, CNSC, CLE
Clinical Dietitian III, CHOC Hospital
Jan received her BA in Food and Nutrition from the University of Iowa and completed her Dietetic Internship at the University of Iowa Hospitals and Clinics. She has credentials in Nutrition Support (CNSC) and Pediatric Nutrition (CSP). She has worked at CHOC Hospital for over 12 years in the NICU, OICU and PICU. Jan was a core CHOC NICU team member in the Vermont Oxford Network Nutrition Project and participated in the development and implementation of the NICU feeding guidelines.  Since becoming the primary dietitian for the PICU, she enrolled CHOC in the Pediatric International Nutrition Survey (PINS), collecting PICU patient nutrition data and outcomes. She collaborated with our nursing Clinical Practice Council (CPC) to develop and implement the PICU Enteral Feeding Guidelines and order set. She is currently leading a follow up nutrition study to evaluate CHOC’s nutrition practices and outcomes.

Amanda Legro, Clinical DietitianAmanda Legro, MS, RD
Clinical Dietitian II, Miller Children’s Hospital, Long Beach
Amanda graduated with her BS in Nutrition and Dietetics followed by her Masters in Nutrition Science from California State University Long Beach (CSULB). She completed her dietetic internship with CSULB and has been practicing as a Registered Dietitian at Miller Children’s and Women’s Hospital Long Beach (MCWHLB) since 2012. Amanda has worked as the Pediatric Intensive Care Unit (PICU) dietitian and outpatient for Pediatric Cardiology and Pediatric HIV clinics for three years. Her interests include pediatric critical care nutrition support, congenital heart defects, indirect calorimetry, and early enteral feeding in the ICU setting. Amanda wrote her thesis on Early Enteral Feeding in the PICU using data collected from her patients at MCWHLB. She has since focused the majority of her work on promoting and implementing the feeding algorithm in the PICU to improve clinical outcomes and shorten length of stay. She is active with ASPEN and serves as a member of the Malnutrition Committee. Amanda has been influential in teaching and performing indirect calorimetry testing in the ICU setting, developing and implementing a nutrition curriculum for medical residents, incorporating the new malnutrition definition and standardizing diagnosis in physician and dietitian practice at MCWHLB, and recently, leading a team of clinicians to build upon the feeding algorithm for general pediatric patients from admission to discharge.

Grace Lee, Pharmacy EducatorGrace J. Lee, PHARM. D., BCPS
Pharmacy Educator, CHOC Hospital
Dr. Grace Lee obtained her Doctorate of Pharmacy from the University of California San Francisco and completed a general pharmacy practice residency at the University of Washington Medical Center. She served as a clinical pharmacist in the pediatric intensive care unit at CHOC for over 9 years and is currently the clinical educator for the department of pharmacy. Her clinical interests are intensive care and epilepsy.


Janyce Cunnane, MSW, LCSW
Clinical Social Worker, CHOC Hospital
Janyce is a Licensed Clinical Social Worker serving children and their families at CHOC for the last 34 years. She earned her Master of Social Work from CSU, San Diego and her Bachelor of Arts in Social Welfare from CSU, Chico. Janyce covers the Pediatric Intensive Care Unit and previously her coverage included Cardiology and the general medical and surgical units. In the PICU, she provides psychosocial assessments, crisis intervention, supportive counseling, guidance with critical decision making and referrals to community resources. Janyce is a member of CHOC’s Family Centered Care, Bereavement and Palliative Committees. She has presented talks in the area of critical debriefing, child abuse and neglect, parental support, coping with death and dying of children and the importance of self-care.

Jennifer Hayakawa, Clinical Nurse SpecialistJennifer Hayakawa DNP, PCNS-BC, RN, CNRN, CCRN
Clinical Nurse Specialist, CHOC Hospital
Jennifer received her MSN as a Parent-Child Clinical Nurse Specialist (CNS) at California State University, Dominguez Hills and her Doctor of Nursing Practice at the University of San Francisco. She is a board certified pediatric CNS as well as a certified critical care registered nurse (CCRN) and neuroscience nurse (CNRN). Jennifer has worked in the Pediatric Intensive Care Unit at CHOC Hospital for over 13 years. She recently collaborated with the CHOC PICU dietitian and unit-based practice council to develop a PICU Enteral Nutrition Protocol and presented a poster, Ensuring the Provision of Optimal Nutritional Therapy in Pediatric Critical Care, at the American Association of Critical Care Nurses 2015 National Teaching Institute in San Diego.

Leigh Hammerstein, Clinical NurseLeigh Hammerstein, BSN, RN, CCRN
Clinical Nurse, CHOC Hospital
Leigh received her BS in nursing from Azusa Pacific University and is completing her studies for her MS in nursing in December 2015. She has worked in the Pediatric Intensive Care Unit (PICU) at CHOC since 2010 and is active in championing new initiatives to improve patient care including implementation of nutrition guidelines for critically-ill pediatric patients. Currently she is the chair for CHOC Nursing Research and Innovation Council that oversees evidence-based practice and nursing research throughout the organization. In 2012, she participated as an Evidence-Based Practice Scholar and explored the significance of gastric residual volumes in the critically-ill pediatric population.

Kim Clemens, Physical TherapistKim Clemens PT, CWS
Physical Therapist III, CHOC Hospital
Kim received her Master of Physical Therapy (MPT) at Chapman University in 1993.
She has worked as a Pediatric Physical Therapist at CHOC for the past 13 years and provides wound care in all departments, both inpatient and outpatient and has focused much of her care in the NICU. Kim has worked continuously on the development of the Rehab Wound Care Team here at CHOC, which includes the implementation of the program, ongoing development and creating a wound care training program for physical therapists new to our Rehab department. In 2010, Kim took the national exam to become a Certified Wound Specialist (CWS) from the American Board of Wound Management. She taught for two years in the Master of Physical Therapy program at CSULB, instructing the Wound and Burn Management lectures. Kim is an active member of the California Chapter of the APTA as well as the Wound Management special interest group.


Round Table Discussions

Challenges of the Obese Pediatric Patient
Jan Skaar, RD, CSP, CNSC, CLE

Indirect Calorimetry
Amanda Legro, MS, RD

Families in Crisi (no handout available)
Janyce Cunnane, MSW, LCSW

Nursing Care of the Tube Fed Patient
Jennifer Hayakawa DNP, PCNS-BC, CNRN, CCRN & Leigh Hammerstein, BSN, RN, CCRN

Medication Management
Grace J. Lee, PHARM. D., BCPS

Wound Care
Kim Clemens PT, CWS

Podium Presentations

Fundamentals of Pediatric Intensive Care
Nick Anas, MD, Director-Pediatric Intensive Care

Advances in Respiratory Management (no handout available)
Roy Ramirez, RCP, RRT-NPS, RPFT

Overcoming Barriers and Optimizing Nutrition Support in the Critically Ill Child
Jan Skaar, RD, CSP, CNSC, CLE

Implementing Nutrition Support Protocols in the PICU
Amanda Legro, MS, RD