Saving limbs, saving lives

Nicki Vedenoja has been a registered nurse for 13 years — caring for patients in oncology, orthopedics, general surgery and other hospital units. The Alaskan native now serves as the nurse navigator for Sharp Grossmont Hospital’s Limb Preservation Program.

In her role, she combines her clinical skills with her knack for writing and organization to raise awareness about the program. She also connects patients to resources to help them manage their diabetes or peripheral vascular disease in order to decrease their risk of losing a limb.

Nicki shares how she plans to make an impact on improving patient care and outcomes through the program.

How would you describe the Limb Preservation Program?
The goal of the Limb Preservation Program at Sharp Grossmont is to identity patients earlier in the process who may be at risk for amputation, such as those with non-healing, lower-extremity wounds with a history of diabetes or peripheral vascular disease.

The aim is to decrease amputation rates by providing a patient-centered program with a multidisciplinary team consisting of wound care, dietary, vascular, podiatry, diabetic education, infectious disease and case management services. The overall goal is to reduce the risk of amputation and improve healing and function.

What does a limb preservation nurse navigator do?
The nurse navigator wears many hats. I follow patients along their journey from inpatient to outpatient. I try to introduce them to resources such as support groups or giving pep talks on the importance of smoking cessation.

I intend to be the go-between for doctors and patients, encouraging my patients to advocate for themselves and be proactive in their health management. My goal is to also improve communication between care providers.

There’s also a large data component of tracking patients to follow their outcomes. So I’ve created a database where I document their hospital stay course, but also if they’ve been on blood thinners, whether they have diabetes or have family support at home.

And lastly, I’ve really been working to get the word out to clinicians that our program exists. We want more doctors and nurses to be aware of this program because we know that, unfortunately, there are so many patients with chronic, lower-extremity ischemia who will be at risk for amputations if we don’t improve blood flow, get control of blood glucose, and get their wounds treated.

Which patients would benefit from this program, and how would they benefit?
Our patients will typically have an active, lower-extremity wound; diminished or no palpable pedal pulses; foot or leg discoloration; or chronic infection. These patients will likely have a history of diabetes and/or peripheral vascular disease or smoking.

Almost 50% of patients who have had an amputation have not had any diagnostic testing to determine if blood flow to that leg could’ve been improved. But in places where a limb preservation program is in place, the rate of amputations decreases anywhere from 36% to 86%.

What are your hopes for the Limb Preservation Program?
I know realistically we can’t prevent every amputation, but I have high hopes that identifying patients earlier on and getting them access to the proper interventions and an established multidisciplinary care team, we can have great success.

Many people don’t realize that having a major lower extremity amputation greatly increases their chance of mortality, so this isn’t just about loss of function or independence — it’s literally life or death. Saving limbs saves lives.

What do you like to do outside of work?
I’m a busybody. I always have a project going on, whether it’s remodeling our 1950s home or flipping a used travel trailer I bought online. I am married with two little kids, and we love beach days, camping trips, and can’t wait to travel internationally again.