Chapter 10: Two Inventions to Facilitate Care of Head and Neck Surgery Patients
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Description
In this chapter, Mr. Brewer discusses two devices he invented [and patented] to address the care of head and neck surgery patients. He began work on the first device, a “suction kit,” around 1980, when he identified problems in suctioning airways of post-surgical patients. He explains how this created risks of infection. He talks about the process of identifying the problem, proposing a solution, creating a pilot device to test, and the process of receiving a patent. He then talks about the second device that addressed oral care and open-wound care. He talks about the process of testing the value of these devices for patient care.
Next, Mr. Brewer describes the positive environment in which he was able to push his innovative ideas further, noting that he was able to inspire other nurses to present their ideas. He talks about the support he received from medical staff and the Patent Office, and describes in particular the collaborative and supportive environment of the Department of Head and Neck Surgery. He notes that he received licensures for other devices.
Identifier
BrewerCC_03_20190620_C10
Publication Date
6-20-2019
City
Houston, Texas
Interview Session
Cecil C. Brewer, RN, BSN, MS, Oral History Interview, June 20, 2019
Topics Covered
The Interview Subject's Story - The Researcher; The Researcher; Overview; Definitions, Explanations, Translations; Survivors, Survivorship; Patients, Treatment, Survivors; MD Anderson Product Development and IP; Discovery, Creativity and Innovation; Professional Practice; The Professional at Work; MD Anderson Culture; Working Environment
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
Well, I’ll say for the record, it is about 14 minutes of 3:00 on the 20th of June 2019. I’m Tacey Ann Rosolowski, and I am sitting in my office with Cecil Brewer for our third session together. So I wanted to thank you again for making the trek in on this hot day. (laughs)
Cecil C. Brewer, RN, BSN, MS:
Well, thank you for inviting me.
Tacey Ann Rosolowski, PhD:
Well, it’s a pleasure, a very interesting conversation. So we strategized a little ahead of time and decided we would start talking about your patents. So please tell me about that.
Cecil C. Brewer, RN, BSN, MS:
To talk about the patent, the patents are an innovation or an opportunity, I would call it, that presented itself starting back probably in 1980. As you know with all inventions, there’s a great need for something to occur or some type of problem that needs to be solved. So back in 1980 and probably before that when I was a clinical nurse at the bedside, I encountered several very difficult, very challenging patient care issues that I thought needed some adjustments or needed an improved way of being performed, the actual procedures for the patient.
Tacey Ann Rosolowski, PhD:
Now, this is when you were working with head-and-neck patients?
Cecil C. Brewer, RN, BSN, MS:
Yes. Two of the patents (inaudible) are derived from my work with head-and-neck patients. And the first patent has to do with patients who required, what we call, a suction where a tube is passed through a patient’s—either they’re an artificial windpipe called a tracheostomy, and if they’ve had a voice box removed, it’s called a laryngectomy. And the other way that you access a patient’s airway is through their nostrils or through their nose where a tube is passed from their nose into the trachea and various secretions are removed so the patient can breathe better. Well, there’s an issue that occur when you do that especially back in 1980, and you can easily inoculate the patient with bacteria if you’re not using a very clean process and or if you’re using say a say not so—if the instruments are not properly prepared or cleaned. As you may know or may not know, in 1980, institutions did not have what we call universal precautions as it’s done today. What are universal precautions? Universal precautions are what they call wearing protective patient attire like a gown, gloves, latex gloves, mask, hairnets, etc. to protect the patients from any type of artificial exposure. That was 1980; we’re not wearing gloves when we touch the patient.
Tacey Ann Rosolowski, PhD:
Yeah, you talked about that.
Cecil C. Brewer, RN, BSN, MS:
The only time we touched the patient with gloves is if you were doing a sterile procedure. And to suction a patient, it’s not—typically, it’s not a sterile procedure on an inpatient floor. In an intensive care unit, you would use a sterile procedure because the patient is probably on mechanical ventilation. The problem was the patients will be having these tremendous infections and we did not—had not come to the era of universal precautions, and I identified that there’s a problem. I didn’t identify universal precautions, but I said, “We needed to organize ourselves in a different way to be more efficient, effective.” And what happens when you’re doing a suction procedure, you need all of these different pieces of equipment, water and gloves and saline and catheters, and so forth. And you had to gather all of those things together, then you perform your procedure and then after that procedure, you started all over again. My idea was, well, let’s do this—let’s make this more efficient. So I started working on developing a—what we call a suction tray or a slash kit where the nurse or the provider would not have to gather all this equipment each time a suction occurred, but you would always—you could have it at your fingertips for a number of events. After much investigation, I feel like eight events would be enough in a kit or a tray for a nurse or a provider to have at their fingertips. Because typically by procedure, a patient probably would need suctioning on an average of about once—in an eight-hour nurse shift at that time, once an hour, and that would satisfy that nurse’s shift. And—
Tacey Ann Rosolowski, PhD:
So what was the process of getting all that approved and everything?
Cecil C. Brewer, RN, BSN, MS:
Oh, the process of getting an innovation or—approved at that time was quite challenging. MD Anderson had a patent committee and you would—my process was first, you have to document what you were trying to solve as though you’re writing a professional paper or a thesis and like you’re solving a problem. And you have to have all your citations and your references and what—and your background information to support what you’re doing. And you have to have a prototype of what you’re trying to accomplish, and then you have to have institutional support or practice support. So my process was, first, let me get—make sure that what I’m doing is—I have documentation to back up the claims for best practice. And then write it down and then present it to my peers, the nurses who performed these activities and to get their support and to do a trial and error but not—before you start trying to move forward to move—using these products on a patient.
Tacey Ann Rosolowski, PhD:
Now, was there support from your supervisors, your leaders, the people above you?
Cecil C. Brewer, RN, BSN, MS:
That’s a great question, was there support. There was a tremendous amount of support. As I may have mentioned earlier in my interview is that Joyce Alt Hall was my director, and Joyce Alt is—around the same time was inventing herself. She was inventing the Manifold tubing.
Tacey Ann Rosolowski, PhD:
That’s right.
Cecil C. Brewer, RN, BSN, MS:
So there was a tremendous amount of activity and innovation and encouragement for staff to do—to improve care. And so Joyce Alt all supported me, the quality department and nursing supported me. And with that backing, I was able to move forward to the higher administration, meaning the patent committee, and just to cut things short, move into the institution patent committee. I had an interview, got an interview with them, and presented my idea with the documentation. They voted on it, and they accepted the project, and it moved to the next step. The next step was how do we get this moved to—from a prototype setting to an actual product to be used on patients. And that was to identify outside partners to help shepherd the project, which is very—it’s very detailed where you have a contract. But the patent committee, the institution patent office is such a beautiful thing. That’s what they do. So they walked me through this process, they supported the project. There’s Arnold White & Durkee in Austin, Texas as the [institution’s] intellectual properties attorneys at the time and maybe still the attorneys for patents at MD Anderson. And I would communicate with them and then we got to contractual agreements with partners from the outside. We were able to then start developing—moving the prototype into an actual product line and writing and to get an FDA, Federal Drug Administration, approval in a product that’s going to be utilized on a patient, on a human subject has to get FDA approval.
Tacey Ann Rosolowski, PhD:
Approval, right.
Cecil C. Brewer, RN, BSN, MS:
So we went through that, and that took some time, years to go through that process because there’s more documentation, more trials and errors. And finally, we reached a point where we have to manufacture the product. And after you manufacture the product, now you still need more support in the area of how you’re going to sell it, who’s going to buy it, and who’s going to use it. So working with the institutions’ purchasing department, the materials management department, the nursing department, the education department because the staff have got to be trained on how to use the product. The product was finally—made it to the bedside probably in the mid-’80s. We went through a series of modifications based on the feedback from the user group, the nurses, and the respiratory therapists. So the product is a continuously improved product. And in 1990—well, first of all, an application for a patent because we thought it was so unique, no—we could—I could not find in the literature or in practice where this type of device was available throughout nursing in the country. We applied for a patent, and as you know, the patent process is very detailed. It’s like writing a paper first. They said 90 percent at that time, about 90 percent of all the applications were rejected. You get your rejection letter, and the rejection letter typically was like “Are you really serious about you’re saying? If you are, you will continue to investigate.” And I continued with that over a number of iterations. And finally in 1990, the US Patent Office issued a US patent on this [3C?] nasal suction—it was 3C tracheostomy and nasal suctioning tray and that was in 19—then, simultaneously with that, there was another issue occurring with head-and-neck patients as related to overall care and care of wounds, an open wound that patients had, and it had to relate how do we irrigate those very—various orifices in the body. And as you know, head-and-neck patients have a tremendous amount of this—of surgery, and those areas of surgery have to be maintained as clean as possible for the healing process to take place and to avoid infection. And the old process was an irrigation process that was not as deemed effective almost as though the same process for the—used for developing the suction tray. It was an assembly of supplies, and the supplies were not efficient as I thought they should be. I came up with an idea based on trying to solve a problem of how do we clean the wound, how do we reach the very deep small crevices within the human tissue whether it be a wound in the mouth, your nose, or your ear, or even on another part of your body, and deliver whatever the doctor wanted to be delivered whether it be an antibiotic or just a cleaning solution or a type of irrigation, so forth, and so on. And my thought was a water pistol. I said, “Take a water pistol, and you put water in it, and you can spray it.” And that’s where the atomizer device came, but I called it the [3C easy spray?], but it does it have a very long technical name of for the archives and patent. Because what differentiates your patent is your—is how—is the—it has a lot to do with what you call it and how does it work. And it wasn’t a water pistol, but it was an atomizer, and that atomizer was able to—well, you connect it to an air source, and you’re able to just create a spray, a very fine mist where the particles could be delivered to the exposed area, the wound if you will. Primarily, the focus on the oral cavity like post dental work or post dental surgery or oromaxillofacial surgery, jaw surgery, palate surgery. Sometimes, the patient had their—had to have what we call an exenteration of their eye and so you have a socket that has to be cleaned while it’s going through the healing process, ears, etc. Those were the issues I was dealing with. We were able to develop this atomizer, which if you looked at it, you can envision like a little water pistol, but it’s not. And you’re able to spray these—the patients’ orifices in any direction that you choose because of the—it has swivel on the end of the pipe—of the pistol—piston, and you’re able to regulate the flow of your solution as well as strength of the solution coming and going and so that was—and that was 10 years. Tacey Ann Rosolowski, Ph.D. Ten years, okay. I was going to ask you how long that took.
Cecil C. Brewer, RN, BSN, MS:
Yeah, both of these projects were 10-year projects. Tacey Ann Rosolowski, Ph.D. Right. What was the impact at the end? I mean for example with the atomizer, how did you document the value to patient care?
Cecil C. Brewer, RN, BSN, MS:
Same way, the same way. You have to—it’s literature research, looking at infection, looking at your infection control information, looking at infect—you know, what, I mean the patient had been—[usually?] comparing the patient in control group, uncontrolled group, infections. And also, there’s cleanliness and applicability to your user group, your nurses and your doctors as to how efficient it was making their job and the patient comfort. And you measure those to satisfaction surveys or oral discussions with the patient. A lot of it, it was all about improving the care for the patient. Tacey Ann Rosolowski, Ph.D. Now, these devices went into use here at MD Anderson and elsewhere as well?
Cecil C. Brewer, RN, BSN, MS:
Yes. Tacey Ann Rosolowski, Ph.D. That’s very cool. Congratulations.
Cecil C. Brewer, RN, BSN, MS:
Thank you, thank you. Prior to your patents being issued, your product has been used. After I’ve completed one application process, I became like the guru of patents here at MD Anderson, so people came to me with ideas on how can I get this patent, how can I take my invention forward. And then the word started getting around in the medical center and I got—so I’d get invitation from other hospitals to come speak to their nursing staff about innovations and things like that. Tacey Ann Rosolowski, Ph.D. Did you find that there were increasing numbers of nurses who were coming forward with ideas and moving ahead with this process because of your work on that?
Cecil C. Brewer, RN, BSN, MS:
I think the stimulus was there for nurses to come out of the shadow. For the longest, I always believed that nurses were too generous. They were giving away their ideas to these marketing groups. These marketing groups come into the medical center, they say, “Okay, we’re going to have a set—we need 30 nurses to come to this event tonight, and we’re going to give every $100, and we’re going to have a brainstorm about this issue.” And they sign all the disclo—nondisclosure agreements when you go in the door, and what they were doing, they were either trying to create a product or improve on a product, and they were picking the minds of the experts for $100. And what I saw come out of my process of getting a patent was that nurses would look for alternatives rather than going to these marketing groups. They want to say, “Why can’t I do this myself? I have all this information,” and the person who probably has the best idea for how a problem should be solved at the bedside with the patient is the provider. Tacey Ann Rosolowski, Ph.D. Absolutely.
Cecil C. Brewer, RN, BSN, MS:
And so I saw a lot of increase in activity with nurses and with coming forward with ideas and solutions, but not all solutions are patentable. Tacey Ann Rosolowski, Ph.D. I mean that sounds like a real strengthener for the role of nurses in oncology and kind of step forward, and it’s a real legitimization of their expertise.
Cecil C. Brewer, RN, BSN, MS:
Yes, it is, and it does show that you’re getting out of this box of just always providing, providing and taking for granted the level of the expertise that you have and that is—it has marketability. Real— Tacey Ann Rosolowski, Ph.D. I mean I’ve talked to a number of people in nursing who—I mean when I talk to Barbara Summers, when I talk to Joyce Alt both them emphasized this need to shift the perspective that the nurse is a doctor’s helper. And here, this is a very important moment there that no, nurses have a level of expertise, they can take credit forward, they can move forward with it in their own—in their own right.
Cecil C. Brewer, RN, BSN, MS:
At MD Anderson at the time, the partnerships that were created with the medical staff because we can’t be myopic about this and forget that you—some—when you’re doing a product that has to do with human subjects, you have to partner with the medical staff. And the partnership with the medical staff who believe in your product that it’s going to improve their practice with the patient, it’s going to number one, help the patient. It’s going to have some type of tremendous benefit for the patient. And I found that the physician group in the Head and Neck Department were more than supportive. They would review my writings. They would sit in when I want to have discussions about moving forward with this, and I was looked at as a partner and not as this handmaiden. And I think it legitimized that we had abilities beyond the bedside. Tacey Ann Rosolowski, Ph.D. Now, let me ask you this question, do you think it helped that you’re a guy?
Cecil C. Brewer, RN, BSN, MS:
I never thought of it that way. I thought it helped because I was a good nurse. I think all the nurses that I worked with who had ideas and had solutions, they were expert nurses, or they were expert providers. We never looked at it as—back in those days as male-female issue. We always looked at ourselves as being expert nurses. One of the things that was the philosophy in the nursing department back in those days was that we were developing nurse experts. That was the day of—when we had, what we’d call, clinical nurse specialist, and we were all specialists in our particular domain of oncology, leukemia, head and neck, general surgery, gynecology, lymphoma, you name it. And we were expert, and we could come to the table and have a high-level discussion with the medical staff and with other providers with a high level of respect. So I think that was an inherent philosophy that was developing there and as a core competence that I think, we had in a tremendous number of nurses. I happened to be in the patent and innovation or product side of nursing. That became my expertise. Others were writers, they’re researches, nurses at that time. They were writing in peer review journals, things like that. So this whole innovation of the ’80s with the nurses was just a tremendous amount of intellectual property at MD Anderson. Tacey Ann Rosolowski, Ph.D. Interesting.
Cecil C. Brewer, RN, BSN, MS:
And we could just talk about all of the nurses, those expert nurses who worked here, how they moved their careers to other places in the nursing domain throughout this country. And you see, I was surrounded by all of those expert nurses who are nurse scientists and are authors and administrator, and we were all immersed right here at MD Anderson. Tacey Ann Rosolowski, Ph.D. It sounds like a wonderful environment.
Cecil C. Brewer, RN, BSN, MS:
Oh, I think the environment was wonderful in the ’80s and in the early ’90s. We were challenged. The director was supportive, and the institution was supportive. But it’s not easy process. It’s a long process. You have to be patient, but if you believe, honestly believe that what you’re doing is for the best of the patient and you persevere through these obstacles and you find the appropriate resources that MD Anderson has, which is called the Intellectual Properties Department—you know. All hospitals don’t have that particular resource to their staff. Because if you’re trying to do a patent and you’re going external by yourself, you will probably be discouraged because of the amount of money it takes to get off the ground. Tacey Ann Rosolowski, Ph.D. Right, of course.
Cecil C. Brewer, RN, BSN, MS:
It takes a tremendous amount of money and, and... Tacey Ann Rosolowski, Ph.D. Well, that’s a great story.
Cecil C. Brewer, RN, BSN, MS:
But also from that, I was able to—once you get warmed up on a product and you get a name, you start doing other things. So I was able to get license agreements on two other, several other activities. I signed an agreement with Rice University—I mean I and MD Anderson collaborated with Rice University to work on developing an innovative process for disposal of sharp instruments. This in the ’9—in the early ’90s, and that was post the era of the problem that was occurring (inaudible) with AIDS and the need for proper disposal of needles and sharps. I started a project with Rice to come up with a way where we—when you handled a contaminated needle or a contaminated sharp object that you only handle it once, and you dispose of it. Because for every time you have to manipulate that that particular needle or sharp, you had a potential to increase your—exponentially, you increase your potential of injury. And we worked on that for a number of years, and it’s a very difficult pro—I don’t think we had the technology at the time to solve the issue that we were presented with. It got to be a little too—the expertise wasn’t there, I don’t think. I think we were before our times, before our times. Then, we worked on some other pro—some other license agreement with some other issues that were identified in patient care with some other pro—but no patents on those products. Tacey Ann Rosolowski, Ph.D. Well, that’s an amazing success record though and so congratulations on that. It’s wonderful.
Cecil C. Brewer, RN, BSN, MS:
Thank you.
Recommended Citation
Brewer, Cecil C. RN, BSN, MS and Rosolowksi, Tacey A. PhD, "Chapter 10: Two Inventions to Facilitate Care of Head and Neck Surgery Patients" (2019). Interview Chapters. 912.
https://openworks.mdanderson.org/mchv_interviewchapters/912
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