Innovation in Healthcare: Gabriel Mokwuah and Joel Brito

Patient Safety Associates, Holyoke Medical Center

Their Lifesaving Actions Shine a Light on a New Position at HMC

When Gabe Mokwuah came to this country from Nigeria when he was 12 and heard people talking about ‘football,’ he thought about the sport played with a round ball that athletes try to kick into a net.

The other football, the one that is much more popular in this country? He didn’t know anything about it, and didn’t really want to know anything about it.

But that didn’t stop the football coach at his New York City high school from trying to convince the large, fast, and very athletic Mokwuah to try out for the team. Eventually, and we’re simplifying things here, he succeeded in those efforts. But even then, Mokwuah wasn’t really interested in the sport.

It wasn’t until he started hearing the word ‘scholarship’ and came to understand that football could be a means to an end — a college education and a ticket out of a high-crime area on Staten Island — that he began to really take it seriously.

Fast-forwarding through the next several years, Mokwuah did attend and graduate from American International College, while also playing defensive end and linebacker — so well, in fact, that he was drafted by the Green Bay Packers in the 11th round in 1992 (they only have seven rounds today).

He played in two exhibition games, was cut, tried to catch on with a few other teams, didn’t, and wound up working as a court officer at the Hampden County Jail and House of Correction, a job from which he retired several years ago.

All that adds up to just one of the intriguing backstories that can be told by those now working as patient safety associates (PSAs), or, in his case, patient safety coordinator, at Holyoke Medical Center (HMC).

Joel Brito has one of his own.

He was working for Hulmes Transportation, taking individuals to medical appointments and daily programs while also volunteering his time to help those with substance-abuse issues when he saw an ad posted on Indeed — Holyoke Medical Center was looking for patient safety associates.

“As soon as I saw it, I jumped on it, and here I am. This has always been my dream — I always wanted to be in the healthcare field,” he said, adding that his ambition is to become a certified nursing assistant.

Others now working as PSAs at HMC have backstories as well. Some are retired or semi-retired CNAs who succeeded in finding work that is rewarding on many levels. Others are getting started down the road to careers in healthcare and have taken this entry-level position to explore options and find out if healthcare is for them. Some are in pharmacy programs. One is studying for her MBA.

The PSA position is relatively new to HMC, and healthcare in general, and it represents an imaginative and innovative step forward from the ‘sitter’ or ‘patient observer’ role seen in most hospitals, said Margaret-Ann Azzaro, vice president of Patient Care Services and chief Nursing officer at HMC.

“As soon as I saw it, I jumped on it, and here I am. This has always been my dream — I always wanted to be in the healthcare field.”

Elaborating, she said the role involves not merely sitting with an at-risk patient, but engaging with them as a well, a position that brings more value to the patients and the hospital, but also those who assume that role.

“We thought, ‘let’s come up with a safety role to empower people to not only keep these patients safe, but engage with them as well,” she said. “We don’t have sitters here; we don’t have observers here — we have patient safety associates, and the idea is to give them some education and tools to enrich the experience while they’re sitting with a patient.”

Mokwuah and Brito embody the motivations behind the PSA position and also just how vital these individuals are — to a hospital, to the patients they serve, to initiatives to reduce falls and improve overall patient safety, and, sometimes, much more.

Indeed, both have been credited with saving lives in recent months — Mokwuah in April, by seeing something while in the virtual monitoring room and immediately calling for a team member to check on the patient, and Brito in July for performing the Heimlich maneuver on a patient he heard making sounds of distress while he was sitting with another patient. (More on both episodes later).

Both men were named employee of the month for their respective actions. That’s certainly an honor, and in October, they’ll be receiving another one: Healthcare Hero.

 

Not on Their Watch

There are actually three distinct roles within the PSA position, and individuals with that title handle all three on a rotating basis, noted Brian Toia, Nursing director of the ICU, RN float pool, and patient safety associates, adding that teamwork is what makes this innovative program so effective.

The first role involves one-on-one direct care — staying within arm’s length of a patient with a high safety risk, including those susceptible to falls, patients with dementia, and those who might be suicide risks. The second involves virtual monitoring. Utilizing a camera system placed in rooms of patients with potential safety risks, PSAs working in the virtual monitoring room can keep tabs on up to 12 patients at once.

The third role is what those at HMC call a ‘rounder,’ one person dedicated to a unit who will frequently check on patients, respond to virtual monitoring calls, and also answer patient calls for assistance.

When asked which role he liked the most, Brito didn’t hesitate. “I like being a rounder. I love that it’s a non-stop job.”

But all these roles are vital to the overall mission of keeping at-risk patients safe, said Mokwuah, who coordinates the department and makes the daily assignments.

Before he talked about the PSAs and what they do, he put matters in their proper perspective. “The real heroes are the nurses, the doctors, and the administrators. And they have given us support for this program to take off. Our job is to keep people safe, and our program saves lives — we’ve proven that over and over again.”

“We thought, ‘let’s come up with a safety role to empower people to not only keep these patients safe, but engage with them as well.’”

Azzaro agreed, emphasizing, again, that PSAs are far more than the ‘sitters’ of years ago. These are individuals who can, and do, watch over patients. But they also engage them and help “enrich the experience,” as she put it, while offering some examples.

“We gave them dementia and Alzheimer’s education,” she explained, noting that this, like other aspects of the program, is fairly unique within the industry. “There are certain ways in which we can engage with patients that have dementia, that have Alzheimer’s. One thing that doesn’t help them is to not be stimulated. So the PSAs can read to them, they can play games with them, they can have conversations with them, they can read a book to them, they can put something on the TV or iPad and have the patient watch it with them.”

And while engaging with these patients, or watching them on the monitor, or coming to their assistance as a rounder, the PSAs are ultimately keeping them safe, said Azzaro, noting that there has been a measurable decrease in the number of falls recorded at HMC since the start of the program.

 

Changing Lives, Saving Lives

As he talked with BusinessWest outside the monitoring room, Mokwuah said the facility boasts a split screen showing more than a half-dozen patients in their beds. At this moment in time, all was quiet and normal.

That was not the case one afternoon back in April, when, while watching that same monitor, he noticed a patient that did not appear well, was acting differently, and had a noticeable status change.

He called for a rounder to immediately check on the patient, who, as it turned out, was experiencing a significant medical event, was unresponsive, and had no pulse. Staff quickly began performing basic life support, followed by advanced cardiovascular life support. After two rounds of CPR and cardiac medications, the patient’s own breathing and heartbeat returned.

Joel Rivas, director of Nursing Medical-Telemetry, who nominated Mokwuah for employee of the month, said at the time, “it is my professional opinion that, had the patient’s change in condition not been identified as early as it was, by Gabriel, we would not have had the positive outcome that we had.”

Similar things were said after another incident in early July, when Brito again showed the importance of HMC’s innovative PSA program.

He was serving as a rounder and sitting with a patient when another team member came in to provide patient care. During that time, Brito overheard a patient from another room making sounds of distress. Confirming that his one-on-one patient was safe and in the care of another team member, he stepped into the next room to check on what he’d heard.

“In the beginning, I didn’t pay too much attention to it, but something told me to get up and check that room, and when I did, I was really surprised because the lady was essentially purple,” he said, adding that he quickly positioned himself to perform the Heimlich maneuver and helped to dislodge the obstruction in the patient’s airway.

“This is a job where you have to be humble, you need to have some empathy, and you have to love people. That’s something my mom and my family instilled in me growing up, so I try to live my life that way and help people. This job gives me the opportunity to do that.”

Like Mokwuah, Brito was credited with saving a patient’s life, said Toia, adding that, had it not been for establishment of the rounder’s role within the PSA program, it’s unlikely that someone would have been able to respond as quickly to the situation as he did.

Looking back, Brito said he relied on his instincts and his training, and was thankful to be in a position where he could help people and make a difference in their lives — the most gratifying aspects of the PSA position.

Mokwuah said essentially the same thing.

“This is a job where you have to be humble, you need to have some empathy, and you have to love people,” he said. “That’s something my mom and my family instilled in me growing up, so I try to live my life that way and help people. This job gives me the opportunity to do that.”

 

Big-game Players

Gabe Mokwuah didn’t get to be a hero on the gridiron, at least at the pro level. But his life and career, especially this latest chapter, show that our heroes come from all walks of life. And they take all kinds of titles.

Patient safety associate is a relatively new one at Holyoke Medical Center, an innovative initiative that is helping to prevent falls, improve overall safety, and, as these cases show, save lives.

Mokwuah was right when he said that doctors, nurses, and administrators are heroes. But so are those with badges that read ‘patient safety associate,’ especially these two lifesavers and Healthcare Heroes.