EDITOR'S NOTE:
This article was updated in November 2020 with new developments from nurse innovators Debbie and Chao Hsing. See the below for more details of their journey this past year as awardees of the Johnson & Johnson Nurses Innovate QuickFire Challenge in Perioperative Care.

Debbie Kantor, APRN, founder of Hero Medical which is developing a cap-shaped smart bandages to stop bleeding and start monitoring sooner, has had a busy year since being awarded the Johnson & Johnson Nurses Innovate QuickFire Challenge in Perioperative Care. Debbie was recently selected as a Semifinalist for NSAiTech’s Cycle II for medical breakthroughs. In addition, she recently published a poster with the Mayo Clinic for their House of Surgery Annual Symposium 2020 that highlights Hero Medical’s pre-clinical study results, showing how their bandage is on average nearly three times faster to apply than standard of care dressing. Now, with a pitch accepted by the National Science Foundation and in collaboration with the Mayo Clinic, Hero Medical is turning their attention to machine learning, working to develop a proprietary algorithm and mobile app for the sensor-portion of the bandage, having already evaluated over 87,000 first responder visits for head injuries.

Chao Hsing Yeh, PhD, RN, Associate Professor at Johns Hopkins School of Nursing, developed Wireless Auricular Point Stimulation (APS)^© 2019, JHU, a treatment based on traditional Chinese medicine acupuncture that aims to provide a non-invasive, self-administered and nonpharmacological treatment for pre-, intra- and postoperative pain. Since being named an awardee in the Johnson & Johnson Nurses Innovate QuickFire Challenge in Perioperative Care, she has developed the APS prototype, which is controlled by a smartphone app, and filed for a patent. A clinical trial is now underway* to evaluate the optimal parameters of APS on pain outcomes as well as the safety, tolerability, usability, and adherence of patients. Results are expected by June 30, 2021.

+++

In spring 2019, Johnson & Johnson, in collaboration with the Association of periOperative Registered Nurses (AORN), launched the Johnson & Johnson Nurses Innovate QuickFire Challenge in Perioperative Care from the floor of the 2019 AORN Global Surgical Conference & Expo. This Challenge invited nurses to submit their novel concepts, protocols, screenings, treatment approaches and device ideas with the potential to improve perioperative care. In the spirit of Perioperative Nurses Week, we’re excited to announce that the awardees of this Challenge are Debbie Kantor, APRN, Co-Founder at HERO Medical, and Chao Hsing Yeh, PhD, RN, Associate Professor at Johns Hopkins School of Nursing.

Debbie’s and Chao Hsing’s innovative ideas were selected from over a hundred applications and were chosen based on the thoroughness of their approach, feasibility and uniqueness of their idea, identification of key resources, plan to further the idea and the solution’s potential to improve perioperative (pre-, intra- and post) care and health outcomes.

The Johnson & Johnson Notes on Nursing team recently spoke with Debbie and Chao Hsing to learn more about their innovative potential solutions and how being named awardees in the Johnson & Johnson Nurses Innovate QuickFire Challenge in Perioperative Care can help them advance their promising ideas.

Debbie Kantor, APRN, Co-Founder at HERO Medical Technologies, created the HERO Bandage, a simple one-piece wound care dressing for the head or limbs designed to improve the self-care and monitoring of chronic wounds.

J&J: What was the inspiration behind the HERO Bandage?

Debbie: The HERO Bandage is a combination of my experiences as both a nurse and a mother. My real “Aha!” moment came when I was working in home health care in Jacksonville, Florida conducting health risk assessments for older adults. One day a patient’s wound care nurse cancelled a visit, and while I was helping the patient bandage her infected stump leg wound, I struggled to find the right bandages to dress her wound. The bag of wound care supplies was a mess of gauze squares, rectangles and wraps, and I realized there needed to be a better way.

After this experience, my inventing wheels started turning and I thought back to when my daughter needed a ventriculoperitoneal (VP) shunt placed in her head and she needed to return to the hospital soon after surgery. Around the same time, there was also a school shooting in our area, after which several kids were airlifted to the same hospital to receive emergency and neurosurgical care. I couldn’t stop thinking about how there should be a quicker, easier way to stop bleeding more efficiently for both head and leg wounds, and that’s when the idea for the one-piece HERO Bandage came to me. And the name came from my love of Superman, and my belief that this solution can have a super impact on wound care.

J&J: What was your innovation journey like from ideation to development?

Debbie: Even though the idea for the HERO Bandage came to me in 2013, I spent a few years continuing to think about and develop the product. I wanted a design that could be applied for not just head wounds, but amputations above the knee, below the knee, fingers, toes, limbs and other appendages. I spent a lot of time tweaking and refining the design, sitting on my sofa with a needle and thread, experimenting with materials that I cut up and stitched together and continuing to work with woven and gauze materials for the multilayer cap-shaped bandage.

Originally, my team was small but mighty. My son, Elliot, played an incredible role by creating digital renderings of what the product could look like. My best friend’s mother helped me sew a few of the prototypes and would call me to discuss different materials we could use. My wife has a background in human resources and logistics, so she offered guidance on what our manufacturing and supply chain could look like, and I also used her in a home video demonstrating how the bandage would work. The HERO Bandage project has been self-funded, so we’re thrilled that Johnson & Johnson is our first true funding. Right now, our prototype is for a medium sized head, but funding from Johnson & Johnson will help us go to product development and expand.

My idea evolved through a few phases after speaking with various wound care companies and healthcare invention organizations. HERO Medical Technologies was the first company to join the Mayo Clinic Life Sciences Incubator in Jacksonville, Florida. Now I am ever thankful for a wonderful mentor, Tom Dugan, a partner at 360 Life Sciences Advisors, who has encouraged me along the way and sees my vision for the HERO bandage. After I filed for a patent in 2015, it was the first time I felt comfortable talking about my idea. I engaged The Patent Professor®, John Rizvi, Esq., who was wonderful in walking me through the steps of filing a successful first patent, and it was an incredible relief when my patent was granted in 2018.

J&J: How can the HERO Bandage help improve surgical outcomes?

Debbie: There are over two million traumatic brain injuries a year, for which over 20,000 ventriculostomies, or devices that help drain excess fluid from the head, are placed. [1] Head wounds post- neurosurgical procedures can carry considerably high rates of infection, as can knee amputations with an infection rate as high as 70%. [2] There currently is an incredible need for a standard bandage that can influence wound care protocols. Research has shown that implementing better neurosurgical protocols, which include wound care, could reduce surgical site infections by 36%, which would transform perioperative care. [3]

I believe for dressing a head or stump, not much has changed in wound care for centuries. Nurses are told to “change the dressing as needed” for certain protocols, but what exactly does this mean? When you watch training videos from around the world on how to wrap a head, it often has the patient sitting up and helping hold up the bandage, which is very unrealistic. Nurses are constantly debating how tight should they wrap a wound, how should they wrap it and how much gauze should they use. And having to grab and open multiple wound care supplies with gloved hands in a high stress environment is incredibly difficult.

The HERO Bandage is a single, sterile package that has the potential to help health systems be more efficient and lessen the burden for frontline healthcare workers. With fewer pieces and skills required, it provides an easy-to-use bandage that can cover a larger part of a wound in less time than a normal dressing would take. And I think what really makes our product unique is that it can eventually be used for the head, an amputation, a limb or other appendages. Also, current bandages only cover a part of the head while ours provides full coverage, so there really isn’t anything like it currently available.

J&J: What role can the HERO Bandage play in the pre, intra or post perioperative stages?

Debbie: I think this solution could potentially have the greatest impact in the pre-hospital, ambulance setting, when saving time and blood is incredibly vital. We did our own market research with paramedics, who shared how something like the HERO Bandage could help them treat victims of car accidents and older patients on blood thinners who have fallen. Our goal would be to have every ambulance in America and every military medical team carrying this bandage. Preventing blood loss, even an extra unit of blood, before the patient gets to the hospital can have implications for a whole cascade of events throughout their care.

This potential solution has versatility for multi-trauma and high-bleeding events, such that our bandage could prevent the need to apply yet another bandage in the emergency room before transport to the operating room. And in the long term, we think the HERO Bandage can have a home in every glove compartment, with patients being able to take the products home or buy in retail stores. There is an incredible need outside the hospital setting for wound care supplies that are easy and efficient, as well as visually pleasing.

J&J: If you were writing a letter to yourself years ago, would you say or do anything different to get to where you are in your nursing journey today?

Debbie: I actually had another idea for a nonhealthcare solution 20 years ago but didn’t have the funding. I had no idea what I was doing and wrote the patent paperwork myself. They basically laughed me out of the room and told me I needed a professional. After watching that idea eventually get to market by someone else, I was motivated to bring a healthcare solution to market that I knew could have a greater positive impact. This experience taught me a lot, but most importantly it taught me the significance of finding the right resources. Many people with great ideas end up dropping them or watching others carry them over the finish line because of the expenses and not knowing what to do.

I would also tell myself, and younger nurses just beginning their innovation path, that it’s okay to be scared. Innovation is a journey different for everyone. Keep a journal and write down the good, the bad and the ugly. Fellow nurses of all stages can be a great resource. Find a champion who believes in you and the potential impact of your idea.

J&J: How does it feel to be awarded the Johnson & Johnson Nurses Innovate QuickFire Challenge? What does this mean for your invention?

Debbie: I’m incredibly excited! I’ve been waiting for a moment like this and for a company like Johnson & Johnson to recognize that my solution can be lifesaving and improve perioperative care. My innovation journey has been a long ride- thrilling and scary- but a lot of fun. Having people believe in me and my idea is amazing, and to have won this Challenge is a tremendous validation. I grew up with Johnson & Johnson as a household name, so to have such a company backing my idea is amazing.

J&J: What does being a “Nurse Innovator” mean to you?

Debbie: Every nurse is a problem solver. At some point throughout their nursing career they have had to “jimmy rig” something to get a product to work. Nurses often get the short end of innovation, being asked to just follow orders instead of having a role in developing the protocols. After successfully developing my idea, I feel like I now get to join an incredible club of nurse innovators!

(Digital rendering of the HERO Bandage courtesy of Elliot Kantor)

Chao Hsing Yeh, PhD, RN, Associate Professor at Johns Hopkins School of Nursing, developed Wireless Auricular Point Stimulation (APS)© 2019, JHU, a treatment based on traditional Chinese medicine acupuncture that aims to provide a non-invasive, self-administered and nonpharmacological treatment for pre-, intra- and postoperative pain.

J&J: What was the inspiration behind Wireless Auricular Point Stimulation© 2019, JHU, and can you speak to your journey in developing the invention?

Chao Hsing: As a nurse, I have often felt powerless to better manage patients’ pain and suffering. This drove me to reflect on my cultural background and draw from it. I was born and raised in Taiwan and was cultivated in traditional Chinese medicine, and I feel like the concept of auricular point acupressure (APA) is built into my genetic makeup.

The inspiration for my idea to treat pain came after incorporating APA into my nursing practice. In lieu of needles, I taped seeds to specific ear points and had patients use their index finger and thumb to press the seed to stimulate ear points to treat their pain. After listening to the great responses from my patients, I thought about the growing opioid crisis and the limited availability of nonpharmacological treatments to treat pain. I also thought about the times that patients are unable to press their own ear points – for example, during the perioperative periods as they prepare for, undergo and recover from surgery. I knew there had to be a better way to administer APA and Wireless APS was born.

J&J: In your perspective, what are some of the challenges in perioperative pain management?

Chao Hsing: Opioids are considered a primary treatment for some intraoperative and most postoperative pain management. Research has shown that some patients still experience moderate to severe pain after being discharged from the hospital and being prescribed a medication to help them manage their pain[4], and that there can also be a link between receiving an opioid prescription and potentially becoming a long-term user.[5] Today acupuncture has been suggested as a possible alternative method of treatment for pain management, including for postoperative pain.[6] However, the use of acupuncture is limited by insurance coverage and availability of acupuncture resources.[7][8]I believe there has been pressure to encourage nonpharmacological treatments for postoperative pain, but this has created challenges for many, especially post-surgical patients who are trying to manage their pain effectively.

J&J: How does your invention leverage Auricular Point Acupressure (APA), and how did you and your team decide on this specific design?

Chao Hsing: APA is based on traditional Chinese medicine practices dating back more than 3000 years. The belief was that since the ear is shaped like an inverted fetus, it is a microsystem in which specific points on the ear correspond to specific organs and areas of the body.[9] By stimulating the points on the ear that correspond to the area of the body where the pain is located, a patient’s pain can be relieved. Despite APA’s long use in Asia and Europe, it is relatively new in the United States and has not been used, made available or researched as extensively as other pain treatments.

We chose the smartphone app to deliver the APA educational video because of its wide availability in the U.S. and the ability online technologies have in scaling to wider populations and gathering end-user data. The development of Wireless APS is based on the many lessons we learned from the patients that have been treated in our clinical studies, which have been funded by the American Cancer Society, the National Health Institute, University of Pittsburgh and Johns Hopkins University.[10] Our study findings show that APA can be a powerful self-management method for providing immediate and lasting pain relief.

J&J: What role can Wireless Auricular Point Stimulation play in the pre-, intra- or post-perioperative stage?

Chao Hsing: I hope that the Wireless APS will provide improved pain relief for perioperative patients, so they don’t have to use as many pharmacological options. My team imagines patients and healthcare staff first being introduced and instructed on how to use Wireless APS before surgery, so that post-operation patients will be able to operate the device themselves whenever pain relief is needed instead of relying only on opioids. We believe this solution has the potential to improve the entire pain management experience for patients, not only decreasing a patient’s pain intensity, but also increasing their self-efficacy to help manage their own pain.

J&J: What impact can this invention have on hospitals and healthcare professionals, especially on systems battling the opioid crisis?

Chao Hsing: I believe opioid use has taken an incredible toll on not just patients, but entire health systems. I believe this toll has been physical, emotional and financial. Wireless APS has the potential to broaden the options of pain management and provide an adjunctive option for perioperative care. Moreover, APA could be more widely disseminated than acupuncture, allowing patients to focus on self-care by engaging the therapy daily, anywhere and anytime as a practical tool for pain control. The availability of APA as method of care offers the potential to improve patients’ quality of life in a cost-effective manner.

J&J: Do you have any advice for nurses seeking support to develop their idea?

Chao Hsing: As a nurse and scientist, I never thought of myself becoming a nurse innovator. I would tell nurses you have to believe and love what you are doing. I often told myself, if I cannot do this, my patient won’t be able to do it. Be passionate to what you do. Find a positive environment and surround with people who will encourage, motivate and support you endlessly. Once you set up your goal, it may need to take a little detour, but your persistence will pay off. Keep trying, do not give up and do not settle.

J&J: How does it feel to be awarded the Johnson & Johnson Nurses Innovate QuickFire Challenge? What does this mean for your invention?

Chao Hsing: I am humbled and proud of my team to receive this award. The award not only recognizes my team’s efforts and our potential solution for pain management, but also gives patients who are suffering from pain an opportunity to know this powerful and effective treatment which is not currently available in the mainstream healthcare system. With the help of Johnson & Johnson, I am confident I will be closer to reaching my ultimate goal of providing an inexpensive, novel, non-pharmacological, non-opioid method that has the potential to revolutionize pain management in both high and low resource settings.

(Pictured above is a patient receiving APA on his ear)

Being selected as the awardees of the Johnson & Johnson Nurses Innovate QuickFire Challenge means nurse innovators Debbie and Chao Hsing and their teams will gain access to funding and support to help move their innovations forward, including grant funding of $50,000 each, mentoring and training opportunities from the Johnson & Johnson Family of Companies, and access to the Johnson & Johnson Innovation—JLABS ecosystem, which helps innovators accelerate discovery and get operational support to bring their healthcare solutions to life.

Learn more about the Johnson & Johnson Nurses Innovate QuickFire Challenge series and meet past awardees here and follow @JNJNursing on Facebook and Twitter to stay up-to-date on upcoming Challenge opportunities.

[1] Sorinola, A., Buki, A., Sandor, J., & Czeiter, E. (2019). Risk Factors of External Ventricular Drain Infection: Proposing a Model for Future Studies. Frontiers in Neurology, 10. doi: 10.3389/fneur.2019.00226
[2] Sumpio BE, Thakor P, Mahler D, Blume PA. Negative pressure wound therapy as postoperative dressing in below knee amputation stump closure of patients with chronic venous insufficiency. Wounds. 2011;23(10):301–8.
[3] Kestle, J. R. W., Riva-Cambrin, J., Wellons, J. C., Kulkarni, A. V., Whitehead, W. E., Walker, M. L., … Holubkov, R. (2011). A standardized protocol to reduce cerebrospinal fluid shunt infection: The Hydrocephalus Clinical Research Network Quality Improvement Initiative. Journal of Neurosurgery: Pediatrics, 8(1), 22–29. doi: 10.3171/2011.4.peds10551
[4] Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. The Journal of Pain. 2016;17(2):131-157.
[5] Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use - United States, 2006-2015. MMWR Morbidity and Mortality Weekly Report. 2017;66(10):265-269.
[6] Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. The Journal of Pain. 2016;17(2):131-157.
[7] Bonakdar R, Palanker D, Sweeney MM. Analysis of state insurance coverage for nonpharmacologic treatment of low back pain as recommended by the American College of Physicians Guidelines. Global Advances in Health and Medicine. 2019;8:2164956119855629.
[8] Harrison JD, Reddy S, Liu R, Adler SR, Chao MT. Implementing an inpatient acupuncture service for pain and symptom management: Identifying opportunities and challenges. Journal of Alternative and Complementary Medicine. 2019;25(5):503-508
[9] Nogier P. Handbook to Auriculotherapy. 1st ed. Moulins-les-Metz: Maisonneuve; 1981.
[10] Chao Hsing Yeh: Faculty Directory. (n.d.). Retrieved from https://nursing.jhu.edu/faculty_research/faculty/faculty-directory/chao-hsing-yeh.

*Not under the auspices of Johnson & Johnson or any of its affiliates.