I am nominating Amy Pyo-Twist, RN, nurse coordinator of the Fecal Microbiome Transplant (FMT) Team, to recognize her outstanding contribution to the care of children with chronic c. diff infections. Chronic c. diff causes chronic, often bloody diarrhea, abdominal pain and may lead to toxic mega colon if non-responsive to treatment. The current cost to treat c diff is $1,500 to $4,000 per treatment (medications are costly) and has a high mortality risk if unresponsive.
About 5 years ago, a team was put together from Infectious Disease (ID), Digestive Health Institute (DHI), and Child Life to investigate the use of FMT for the treatment of chronic c. diff. Amy did not have experience building a program, nor did she have experience with FMT, yet she embraced the idea of developing a new program to help improve the lives of children experiencing the symptoms of chronic c. diff, when conventional antibiotic treatment was unsuccessful. Amy navigated the organization and utilized resources from the DHI, ID, clinic, child life, pharmacy, EPIC, insurance negotiators and an outside vendor (Open Biome), who provides the fecal material, to develop an FMT program that would be cost and medically effective. The group focused on a cost-effective, safe alternative to colonoscopy thus a decision to use a nurse-driven nasogastric (NG) tube placement procedure for FMT blossomed.
Amy met challenges during the development and implementation of this program, such as location, dedicated time, equipment/sample procurement and storage, but she was determined to make this program successful. Other areas of growth for Amy included: guideline and policy/procedure development including assent and consent, FDA approval and oversight, EPIC build for nurse-driven orders, working with the pharmacy to procure and order samples and nurse education regarding protocols, data collection and placement of NG tubes.
During the last 5 years, Amy has provided care, guidance, and education to families who are at their wits end trying to procure a treatment that resolves the horrible symptoms of chronic c diff. In addition, Amy has provided mentorship to staff and faculty (inpatient, outpatient, and networks of care) and has provided leadership for the FMT program evaluation, which includes data collection and analysis. Given this program has been so successful, Amy has provided nursing leadership on how to build a nurse-driven FMT program to other organizations both nationally and internationally.
To date, the FMT program has treated over 116 children with chronic c. diff. The success rate for non-Inflammatory Bowel Disease Patients is 95-97% at 3 and 6 months respectfully. The success rate for children with IBD is 83-88% at 3 and 6-month intervals post-procedure. No untoward events have been described using this FMT procedure except for 10 patients experiencing emesis.
Since the cost of the nurse-driven NG procedures is 85% less than a colonoscopy and safer given the child does not experience anesthesia, the outcome of the FMT program has been well recognized and received locally, nationally and internationally. Amy Pyo-Twist shares the success of this program at many conferences such as QI and Qdoba, NASPGHAN (2015), the World Congress of NASPGHAN (2016) where she received the Poster of Distinction Award. In 2016, she also presented at CHCO Nursing Grand Rounds and the Pediatric O'Neil Conference and this year she was asked to provide a 1-hour oral presentation at SPN. Within the last year, an FMT publication has occurred, demonstrating the success of a nurse-driven NG FMT procedure. A reviewer informed the team this is the biggest cohort of FMT patients/procedures submitted on this topic.
Amy leads nursing creativity and innovation with the FMT program which provides patients and families with a novel model of care. Her success is recognized and celebrated nationally and internationally. Amy demonstrates why we are different!