RICHMOND, VA—When Jennifer Farrell, RN, arrived at the Richmond VAMC in February 2015, the interventional radiology department was in its infancy. The hospital’s IR department essentially began with the hiring of the first interventional radiologist, Dr. Jonathan Ha, in August 2012, with a second, Dr. Mack Hendrix, hired on in November 2014. The ribbon wasn’t cut on a dedicated IR suite until November 2016.

When Farrell was hired, she became one of only three nurses tasked to IR and one of the few people in the radiology department with IR experience. A critical care nurse since 1996, Farrell had taken four years off after her last child was born in 2004. When she went back to work, it was at Chippenham Hospital—a for-profit hospital in Richmond. There she was introduced to IR.

“I immediately fell in love with it,” Farrell said. “IR is helping patients by doing minimally invasive procedures that otherwise would require surgery. No one day is the same. Adult critical care can be that way when you’re in the ICU or at a Step Down unit, but in IR you’re taking care of inpatients, outpatients, emergencies. It’s very exciting and fast-paced.”

She also likes being able to see the sometimes-immediate results of her work in the patients.

“One of the procedures we do is kyphoplasty. People have compression fractures in their spine, and we go into their back and place cement. It’s kind of like an internal cast. It goes in like toothpaste and in 15 minutes there’s a chemical reaction and it hardens up,” Farrell explained. “It’s one of my favorite procedures. Patients walk in with a 10 out of 10 on the pain scale so they can’t even get on the table by themselves. And then when they get up, there’s no pain. In IR you get to see a lot of what you fix. It’s tangible.”

When she was hired by Richmond VA, she was asked to take that love and excitement along with the knowledge she’d gathered at Chippenham and use it to help build their nascent IR department. Because few other employees had IR experience, the department needed someone to help educate nurses and technicians.

“Since my arrival in February 2015, only 4 out of 12 employees had previous IR experience,” she explained. “And because we do so many procedures, it’s possible to do something today and not do it against for six months.” That means that nurses and techs working in the IR department are constantly facing new procedures, each coming with different protocols, medication needs, technical requirements and post-procedure care.

Farrell’s solution was to create a manual that can act as a one-stop reference for interventions, equipment used, medications administered and lab management in the IR department at Richmond. “An Interventional Radiology Guide For Nurses And Technologists” currently stands at 109 pages and includes details on dozens of IR procedures.

Farrell collaborated with Mary Beatty-Brooks, a medical illustrator at the Richmond VAMC, who formatted the book and illustrated it using photos taken from local patient procedures. “I collaborated with her a lot—hours and hours and hours and multiple edits,” Farrell said. “Everyone in the department teases me. A year ago, I spent my own money to get it bound and then brought everyone copies. And then next thing they know, I’m telling them, ‘No, that’s not the last draft.’ We kept adding more procedures and revising things.”

Farrell has also helped oversee the inevitable culture shift a growing IR department brings to radiology. Before, the procedures in radiology were less complicated and required little in the way of nurse presence. Now there’s a staff of nine nurses who care for the patients, do medication review and look at the patient holistically. “Now the nurses and techs are working as a team,” Farrell said.

The manual—available in print and as a PDF—will likely have a life beyond the Richmond IR department. It’s already being used as training for the department’s residents from Virginia Commonwealth University’s School of Medicine. And Farrell is happy to share the PDF with anyone who emails her at [email protected]

“This edition is only the beginning,” she said. “I’m sure there will be more procedures. We’re always expanding.”