Catholic Health World - February 15, 2023

New president at Ascension 7 Serene retreats for staff 8

Robots wheel their way into staff support roles at hospitals

By LISA EISENHAUER

The robots maneuvering through the corridors of Mercy Hospital Jefferson don’t even turn many heads anymore.

For five years, the 3-foot-tall autonomous devices have been beeping their way down the halls at the 251-bed hospital in Festus, Missouri. They deliver meals to units, pick up and drop off laundry, tow trash to an out door dumpster, and shuttle medications and supplies. The hospital’s six robots together logged 5,500 miles last year.

In January, Chesterfield, Missouri-based Mercy began a phased expan sion of the robots to seven of its other acute care hospitals in Missouri, Arkansas and Oklahoma. The TUG robots are made by Pittsburgh-based Aethon. The company does the mapping and programing required before the robots go live and it monitors their operation remotely once they are in service.

3D prints let visually impaired mom-to-be ‘see’ son’s ultrasound

By JULIE MINDA

It’s a much anticipated pregnancy milestone for countless expectant moms: seeing their baby for the first time — on a video monitor — when they have their second trimester ultrasound.

But for Ashton Johnson, a visually impaired woman pregnant with her first child, her 20-week ultrasound at an Omaha, Nebraska, clinic late last year was a bit frustrating. She has a genetic condition that prevents her from seeing images that lack sharp contrast, so it was impossible for her to discern as a baby the ill-defined black, gray and white pixels that she saw on the ultrasound monitor.

Her husband, Logan Johnson, narrated what he saw on the screen — the baby

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Head start on health equity

A boy learns about oral health from a dental student at an event at Meharry Medical College in Nashville, Tennessee. The historically Black academic health sciences college is one of a trio of initial recipients of grants from the new Ascension Foundation. All three grant recipients are training upcoming generations to tackle health disparities. Story on PAGE 3

Life abounds in multigenerational apartment complex on college campus

By PATRICIA CORRIGAN

Local retirees, single mothers and their children and retired members of the School Sisters of Notre Dame Central Pacific Province all are making a home together at Trinity Woods, a four-story apartment complex on the verdant 80-acre campus of Mount Mary University in Milwaukee. From all accounts, the intergenerational living arrangements are a grand success.

Trinity Woods opened in December 2021 as a three-way partnership between Milwaukee Catholic Home, a retirement community that offers independent living, assisted living and skilled nursing care on its Milwaukee campus; the School Sisters of Notre Dame Central Pacific Province; and Mount Mary University, a private Catholic university for women sponsored by the Notre Dame order.

Milwaukee Catholic Home manages Trinity Woods.

“Our board, which includes some School Sisters of Notre Dame, is very intentional about honoring our ministry of service to others in the Roman Catholic faith tradition,” said David Fulcher, chief executive of Milwaukee Catholic Home. “The genesis of Trinity Woods was to provide housing for some of

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‘Tranq,’ a street drug fanning out across the U.S., is fresh horror of opioid abuse syndrome

By LISA EISENHAUER

Dr. Zachary Risler can count on treating at least one patient every shift in the emergency room at Nazareth Hospital in Philadelphia who is either in the midst of an acute drug overdose, in need of care for recalcitrant wounds caused by injecting street drugs or dealing with another medical condition that has been spawned or worsened by substance abuse.

Most likely, he says, many of the patients have injected opioids cut with xylazine, a drug known on the street as tranq. Xylazine is a veterinary tranquilizer and painkiller with no approved uses in humans. It is widely present in opiates sold on the street in Philadelphia.

Routine toxicology tests done by hospitals don’t screen for xylazine, so Risler and his colleagues look for the clues that point

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XYLAZINE INFILTRATES STREET DRUG SUPPLY

WHAT IS XYLAZINE? Xylazine has federal approval for use in animals as a sedative and pain reliever.

Known on the street as “tranq.”

PHILADELPHIA: THE EPICENTER OF TRANQ

From 2015 to 2020, the percentage of all drug overdose deaths involving xylazine increased from 2% to 26% in Pennsylvania.

Repeated exposure to xylazine may lead to severe, necrotic skin ulcerations.

In 2021, 90% of street opioid samples in Philadelphia contained xylazine.

A WAVE OF WOUNDS Xylazine is not safe for use in humans and may result in serious and life-threatening side effects that appear to be similar to those commonly associated with opioid use.

SIGNS OF GROWTH ELSEWHERE Xylazine was involved in 19% of all drug overdose deaths in Maryland in 2021 and 10% in Connecticut in 2020.

From left, expectant mother Ashton Johnson and her husband Logan Johnson view a 3D print of their baby’s ultrasound from their obstetrician Dr. Katie Sekpe, who looks on. Sekpe practices with CHI Health Clinic Women’s Health, part of CommonSpirit Health.

Risler

Fulcher Bailey Nielsen

Two Trinity Health hospitals are piloting the use of Moxi robots like this one for deliveries.

3D baby images

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rolling, the baby appearing to sleep — but Ashton craved details.

Life hacks

Prior to that imaging appointment at the CHI Health Clinic Women’s Health, Ashton and her husband had done research about best practices and life hacks for visually impaired parents. They came across articles about physicians in Brazil who were making three-dimensional models of ultrasound images for patients who couldn’t see traditional ultrasounds.

The Johnsons casually talked about the value of those models during the fetal ultrasound. The technician made a mental note and related that conversation to Dr. Katie Sekpe, Ashton’s obstetrician. A colleague at CHI Health Clinic Women’s Health, Dr. John Coté, had printed 3D models of Sekpe’s own twins from fetal ultrasound images.

Sekpe approached Coté about creating the 3D models for Ashton, her first patient with a serious visual impairment.

Molding better outcomes

Coté is a clinical obstetrician-gynecologist with CHI Health and an assistant professor at Creighton University who has been researching, among many other subjects, the use of 3D printing for better patient outcomes.

He says his interest in 3D printing began when his family got a home 3D printer for Christmas several years ago. At first, he was mainly printing Star Wars figures and other toys for his kids but then the self-described “tech nerd” started experimenting with sending medical images — including computerized tomography and magnetic resonance imaging scans and ultrasounds — to the printer.

When Sekpe approached him, he was eager to help. He printed one of the several 3D models Ashton received in December. His is an FDM printer, short for fused deposition modeling. The printer extrudes and layers plastic filaments to replicate in three dimensions the flat two-dimensional image that it is interpreting. Coté says he’s learned over time how to refine electronic files like ultrasounds to remove the image distortions that can translate to physical shapes on a 3D model.

At Coté’s suggestion, Sekpe also enlisted a technician at the hospital to create additional models of Ashton’s ultrasound on the Stratasys brand PolyJet 3D printer used to create medical models at CHI Health Creighton University Medical Center — Bergan Mercy. The polymer it uses in printing has a different hardness when it is cured than the materials Coté’s printer uses. Coté says the colleagues wanted to give Ashton models of varying pliability so she could experience the contours of the baby’s face

3D modeling has applications in obstetrics care, says CHI Health obstetrician

Research that Dr. John Coté has been reviewing and adding to on his own indicates that there are many potential benefits of using three-dimensional models of fetal ultrasound, computerized tomography and magnetic resonance imaging scans.

Coté is a clinical obstetriciangynecologist with CHI Health in Omaha, Nebraska, and an assistant professor at Omaha’s Creighton University. He says that while the application of 3D printing is still in early use in medical modeling, obstetricians and gynecologists have been able to use 3D printing to educate their surgical teams, medical students and patients.

in different ways.

Based on what he’s learned about application for 3D printing in maternalfetal medicine from his own and others’ research, he views it as a very effective tool to promote bonding prior to a baby’s birth, among many other benefits.

Patient-specific anatomical models are used to preplan hysterectomies and for a fuller understanding of tissue damage from endometriosis, Coté says.

Research also has shown that having models of their baby in utero can motivate pregnant women to quit smoking, Coté says. Smoking during pregnancy raises the risk of birth defects.

amaurosis. According to a medical information website from the University of California San Francisco, LCA is a rare inherited eye disorder that causes severe vision loss at birth. LCA is the most common cause of inherited blindness in childhood and is found in two to three out of every 100,000 babies, according to the site.

In early December, the clinicians surprised Ashton by inviting her and her husband to CHI Health Creighton University Medical Center — Bergan Mercy. The expectant mother knew as she headed over that she’d be receiving a 3D print made from her baby’s ultrasound but did not know she’d be getting multiple models. At the hospital, Sekpe and Coté and a hospital staffer presented her with the 3D ultrasound models. She says running her fingertips over the models to feel the shape of her baby’s face and features “was very emotional — I couldn’t stop crying.”

The Johnsons display the models in the nursery and have taken them along to baby showers. As Catholic Health World went to press, Ashton was due to deliver her son in early February. The couple planned to name him Quinton.

Extra preparations

Ashton was born with leber congenital

Ashton says she’s always been determined not to let her visual impairment define or limit her. “I set really high goals for myself,” she says. She earned her doctorate in physical therapy at Creighton University and did her clinical rotation at CHI Health Creighton University Medical Center — Bergan Mercy. The medical center is part of CommonSpirit Health.

In preparing for bringing home baby Quinton, Ashton and Logan are applying some of the tips from their research.

Ashton bought a breastpump with raised buttons that are easy to locate. The pump has fewer small parts than other models, which simplifies cleaning. The baby’s bottles have raised numbers and letters, so Ashton can know how many ounces of milk she’s giving Quinton.

The couple is using a black Sharpie to label items in the kitchen and nursery with large lettering — a hack that will help a sleep-deprived dad too.

jminda@chausa.org

Coté says his research shows that 3D models of fetal ultrasound images have had a measurable impact on bonding for pregnant women who have suffered from past birth trauma or miscarriage. Seeing the model allows them to emotionally process the new pregnancy.

The lifelike modeling can help a woman whose baby has a visible birth defect in utero to emotionally prepare for the baby’s appearance. Coté says he once made a model for an expectant mother whose baby would be born with a cleft palate. She brought the model to her baby showers to prepare relatives and friends too.

Coté’s research also has shown that 3D fetal modeling helps fathers-to-be. Normally, fathers do not bond as closely with their unborn babies as mothers do because of the physical connection between mother and child, Coté says, adding his research shows that having a model of their baby in utero allows fathers to bond with their child more closely before birth.

— JULIE MINDA

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Coté

By touching 3D prints made from her 20-week pregnancy ultrasound, Ashton Johnson explores the contours of her baby’s face. A visual impairment prevents Johnson from seeing the low contrast screen image of a 2D ultrasound. A team at CHI’s Health Clinic Women’s Health and CHI Health Creighton University Medical Center — Bergan Mercy created the models for Johnson.

Dr. John Coté says the colleagues wanted to give Ashton models of varying pliability so she could experience the contours of the baby’s face in different ways.

Bailey Nielsen

New Ascension Foundation to invest in organizations addressing health disparities

By JULIE MINDA

Ascension has launched its first national philanthropy. The Ascension Foundation is funding organizations and initiatives that address the root causes of health disparities and that promote health equity. Three academic institutions are the inaugural fund recipients.

Ascension did not disclose the dollar figures for the foundation’s allocations.

In a press release, the system said the foundation aims to support programs that have the potential to disrupt generational poverty, create pathways to economic stability for individuals and families and build a health care workforce that better reflects the diversity of the U.S. population.

In the announcement, Ascension Chief Executive Joseph Impicciche said the impetus for the foundation’s creation was Ascension’s recognition during the throes of the pandemic “that our nation’s health care disparities are wider and deeper than ever, and it will require largescale, national solutions if we are to truly improve the health of communities, particularly communities that have long been underserved.”

Impicciche said a hope is that the Ascension Foundation will “catalyze other health systems and organizations to also make long-term investments in eliminating health disparities and strengthening our communities.”

Leading the work is Robyn Kress, senior vice president of Ascension Foundation. There are six dedicated foundation staff including Kress. The foundation is governed by a three-member board and has six advisers including Impicciche to provide input on the collaborations the foundation is considering.

Gene Ford, senior director of public relations, marketing and communications at Ascension, said the foundation selected the trio of academic institutions as its first funding recipients based on how successful they’ve been to date in developing, supporting and promoting health equity.

Ascension is allotting the three initial grants for a three-year term.

Girls’ middle school

Recipient Marian Middle School is in St. Louis, where Ascension is based. Seven communities of Catholic sisters founded the school in 1999. Marian President Mary Elizabeth Grimes said the school provides faith-based education to adolescent girls who have a high academic potential and come from families of limited means.

According to Ascension’s release, Marian has helped disrupt poverty by guiding its students to career success. Some Ascension employees are Marian alumnae.

The school has what Ascension describes as a rigorous academic program that incorporates science, technology, engineering and math as well as an enrichment program promoting leadership and self-discovery.

The students’ families pay tuition on a sliding scale based on family income. Grimes said Ascension Foundation’s grant will support a fund that subsidizes tuition costs for students. The foundation also is providing funds for Marian’s graduate support program. That program offers students academic, social and financial support during high school and college and as they pursue a career. Marian’s graduate support directors provide students with mentoring and resources through high school and college, and into career success.

Ascension Foundation also is enabling students and their families to purchase lowcost prescription drugs through the Ascension Rx program, which offers medications, often at discounted rates, through a partnership between Ascension and Walgreens. Ford said that while many Marian families have drug coverage through Medicaid, not all do.

Medical college in Nashville

The second fund recipient is Meharry Medical College in Nashville, Tennessee, where Ascension has a network of health care facilities. Meharry is one of the oldest historically Black academic health sciences centers in the U.S. and is a leading educator of Black medical doctors, dentists and biomedical scientists. According to information from the college, Meharry has trained 14% of all Black physicians and 27% of all Black dentists practicing in the U.S. Meharry also is a top educator of Black biomedical doctors of philosophy in the U.S.

Affiliated with the United Methodist Church, Meharry is “particularly well known for its uniquely nurturing, highly effective education programs; emerging prominence in health disparities research; culturally sensitive, evidence-based health services; and significant contribution to the diversity of the nation’s health profes-

sions workforce,” according to Ascension’s release.

Ford said Meharry focuses on service to communities of color and low-income communities. According to information from Meharry, many of the school’s medical and dental students work in a clinic for the medically underserved and many dental students take part in a day of free oral health care for low-income people. The college provides about $29 million in uncompensated medical and dental care to low-income people annually. And about 83% of alumni physicians and dentists practice in underserved areas.

Ascension Foundation funds will help to cover stipends for lodging, travel and equipment for Meharry students undertaking clinical rotations at Ascension hospitals. This includes surgery rotations in Indianapolis. Ascension also is providing medical education scholarships for four Meharry students each year. And the foundation is investing in Meharry’s middle school pipeline programs.

School of medicine in Detroit

Ascension Foundation’s grant to Wayne State University School of Medicine in Detroit will provide tuition support for students of the school’s Med-Direct and post baccalaureate programs.

Med-Direct is for high-performing high school students who wish to pursue medical careers in a program that addresses health disparities. The students are accepted into the program as undergraduates and are guaranteed acceptance to the

medical school if certain baseline measures are met, according to information from the medical school.

Ascension has an extensive presence in Detroit. The Ascension Foundation may facilitate clinical rotations at Ascension facilities for students in the Med-Direct program.

Wayne State’s post baccalaureate program provides students who have completed an undergraduate degree with academic support and wraparound services that enable them to prepare for medical school and a career in medicine. According to Ascension, a goal of the post baccalaureate program is to build a pipeline of physicians dedicated to caring for medically underserved populations and communities.

Ascension plans to measure the impact of the foundation’s investments by gauging to what degree the diversity of the health care workforce increases and to what extent social determinants of health are addressed among high-risk populations in the communities Ascension serves.

For future grant allocations, Ascension Foundation said it plans to identify additional organizations that are well established and have had success addressing disparities in their communities, align well with the foundation’s focus areas, and share Ascension’s values. Ascension wants to invest in organizations or initiatives that can be scaled for greater impact. Recipients do not have to be located in Ascension service areas.

jminda@chausa.org

Among the recipients of funds from the Ascension Foundation are Marian Middle School, a private Catholic girls’ school in St. Louis; and Meharry Medical College, a historically Black medical, dental and science institute in Nashville, Tennessee. Clockwise from top, a Marian student completes schoolwork, a Meharry medical graduate attends her hooding and degree conferral ceremony, and a Meharry medical student examines a mock patient.

Joseph Impicciche said a hope is that the Ascension Foundation will “catalyze other health systems and organizations to also make long-term investments in eliminating health disparities and strengthening our communities.”

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the aging sisters, but we also realized that some students at Mount Mary University may be single moms who don’t have a lot of resources available.”

Fulcher added that as his board considered an intergenerational living arrangement, they recognized that “a tight-knit community with mentoring and a shared sense of purpose” could benefit single mothers, older adults including couples and singles, and the sisters.

“In our research though, we were hardpressed to find a truly intergenerational retirement community that is doing what we’re doing,” he said. “It would be great if Trinity Woods could serve as model.”

Comfort in community

The $45 million complex was a design challenge for the architects, Fulcher said. “We’ve got a chapel, a fitness center, an outdoor courtyard, a day care center, a beauty salon and a community dining room that accommodates high chairs for babies and seating for adults. We made sure the residential living areas for the students and their children are secure, and now we’re working on ways to engage everyone — music concerts, art classes, happy hours and Sunday night movies for kids.”

Trinity Woods has 52 independent living and assisted living units for the Sisters of Notre Dame, 90 market-rate independent living apartments for individuals and couples 55 and older and 24 furnished units for single mothers enrolled at Mount Mary University and their children under the age of 12.

The units for students and children measure 656 square feet, with two bedrooms, a living room, a bathroom and a small kitchenette with a refrigerator and microwave oven. Each floor has a laundry room and a lounge with a television and a stove. The students pay $1,200 a month, which includes meal plans for moms and their children, utilities and parking. As of late January, eight single mothers were in residence, with 11 children among them. Five graduate students who live at Trinity Woods do not have children.

Miya D. Rogers, 35, is one of the moms. A doctoral student at Mount Mary, she is in her second year working toward a degree in counselor education and supervision. A licensed professional counselor who previously worked in South Carolina, Rogers also teaches part time at the university. She moved in with her two young boys in January 2022.

“When I toured Trinity Woods, I determined it was a good fit for me and my sons. I wanted some stability, a place to call our own, a safe and loving environment,” she said. “I love living here among people who have so much wisdom and so much life experience — it’s a total blessing. We all can learn from one another, and I hope more communities become more open to this kind of opportunity.”

Diana Fontanez, 28, and her daughter moved in in August. She is a junior at Mount Mary, studying communications. “We are so blessed to live here,” she said. “I’ve had time to talk with some of the sisters at lunch, and that’s had a big impact on me. One told me she used to be a first grade teacher, and I was able to ask her questions about my daughter and my fears about doing the right thing. The sister was able to ground me, and reminded me my daughter is so lucky to have a mom like me. A weight lifted off me that day.”

Fontanez’s daughter also gets support from the other residents. “She is close to another child here, and has a bond with a mom and her son, who is 2. The sisters all

praise her for helping him,” she said. “And when we see some of the senior residents, it’s wonderful the way they greet us and chitchat with us, ask us how it’s going.”

Marguerite Guy, 78, and Katie Lisa, 77, are two of the seniors who moved to Trinity Woods because of its intergenerational component. Together with residents June McClain and Carol Fibich, the women come up with ways to mix the generations and brighten the days of the single mothers and their children.

“The mission here appealed to me,” said Guy, a retired schoolteacher and principal who moved in almost a year ago. “This seemed like a perfect place for me, and I decided I wanted to be a part of this wonderful ministry,” she said. “I’m already like a grandma in the lives of many moms, and I also work with young adults in my church.”

Guy said the residents’ committee she

is active on is planning to provide welcome baskets for the moms with cleaning products, toiletries and other essentials. The committee set up an “angel tree” for Christmas. “The moms put their names on it and listed whatever gifts they or their children would like,” she said. All of the mothers received a few small gifts as well as a handmade quilt, which had been donated by residents and people from the area who heard about the angel tree.

Trinity Woods seniors bought toys and knit blankets for all the children. There were hand knitted hats and scarves for moms and kids.

Last month the residents committee hosted its first tea to give the seniors and their young neighbors an opportunity to socialize. This month it will host a tea at the university that is open to all students.

Lisa and Guy both said they look forward to learning about the students’ career choices and goals in life and sharing some things about themselves.

“I wanted to live in a community where I would find purpose and meaning in the last chapter of my life,” said Lisa, a retired social worker. “I’m healthy, I’m active and I’m interested in people, interested in making connections. We have so much to offer each other.”

Residents enjoy a summer concert at Trinity Woods on the grounds of Mount Mary University in Milwaukee. The four-story apartment complex combines independent and assisted living units for members of a School Sisters of Notre Dame congregation with market-rate independent living apartments for seniors and apartments for university students including single mothers.

Rogers

Fontanez

Guy

Lisa

Tranq dope

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to the drug. One clue is if the patient is in the midst of an acute overdose and unresponsive to the opiate reversal medication naloxone. Black wounds are another.

“I think the big thing that we’re seeing are people that show up with these really bad wounds, something called eschar, which is necrotic or black wounds,” Risler says. The wounds, much like those from thermal or chemical burns, pose risks for infection and disfigurement. The wounds can require intense and long-term medical care.

Worsening epidemic

The spike in prevalence of xylazine in street drug supplies of opiates is exacerbating an unchecked epidemic that already claims an alarming number of lives. The Centers for Disease Control and Prevention says 80,816 fatal overdoses — 75% of all overdose deaths — in 2021 involved opioids. The number of opioid-related fatal overdoses in 2010 was 21,088.

A report published in April 2022 in the journal Drug and Alcohol Dependence says xylazine is increasingly present in overdose deaths. In 10 jurisdictions across the nation that were studied, detection of the drug in overdose deaths went from 0.36% in 2015 to 6.7% in 2020. The highest xylazine prevalence was in Philadelphia (25.8% of overdose deaths), followed by Maryland (19.3%) and Connecticut (10.2%).

The National Institute on Drug Abuse says the number of opioid overdose deaths involving xylazine is unknown. “Most overdose deaths linked to both xylazine and fentanyl also involved additional substances, including cocaine, heroin, benzodiazepines, alcohol, gabapentin, methadone, and prescription opioids,” according to a research brief from the agency.

The brief describes xylazine as a central nervous system depressant that can cause drowsiness and amnesia. It says the drug can “slow breathing, heart rate, and blood pressure to dangerously low levels.”

Repeated use of xylazine, the institute says, is associated with skin ulcers, abscesses, infections that can extend into bones and related complications. The institute says people report injecting, snorting, swallowing and inhaling drugs containing xylazine.

Labs can use additional analytical processes to detect xylazine in blood. Toxicology results from patients who fatally overdosed in Philadelphia and other drug hotspots across the nation show increasing evidence of xylazine abuse, the institute says. And deaths involving xylazine have been spreading westward from an epicenter in Northeastern states.

Research suggests that people suffering from substance use disorder began using xylazine in Puerto Rico in the early 2000s. Then the drug found its way into the opiates being sold illicitly in cities with large Puerto Rican populations. Users report that xylazine prolongs the euphoric effects of fentanyl, the synthetic opioid that is largely blamed for the widening overdose epidemic.

Philadelphia’s Department of Public Health says xylazine was first detected in the street drug supply there in 2006. By 2021, the agency reports, 90% of street opioid samples contained xylazine. The number of fatal overdoses in Philadelphia in which xylazine was detected spiked from 15 in 2015 to 434 in 2021.

FDA issues alert

Still, xylazine remained largely under the national radar until last November, when the Food and Drug Administration issued a warning to health care professionals. The warning says the agency is aware “of increasing reports of serious side effects from individuals exposed to fentanyl, heroin, and other illicit drugs contaminated with xylazine.”

The warning notes that naloxone may

not reverse the effects of opioid overdose when xylazine is present. In such cases, the FDA says clinicians “should provide appropriate supportive measures.”

Risler says that’s what he and his colleagues do at Nazareth, a Trinity Health hospital in a working-class section of north Philadelphia. Supplemental oxygen to counter suppressed breathing is one of the supportive measures Nazareth clinicians provide to patients. Some patients with life-threatening respiratory suppression require intubation.

Because patients who have taken xylazine along with an opioid usually have been unconscious for a while when they are brought into the ER, Risler says when they regain consciousness the rush of the opioid has most likely worn off or been reversed by naloxone. That can leave them in what he describes as withdrawal with intense drug cravings.

“It’s just this tough balance between making sure that they survive an acute overdose and then convincing them that we’re here to help them and try to get them the care they need,” Risler says.

Nazareth has social workers in the ER who can provide warm handoffs to rehab programs. It sends kits with two doses of naloxone home with patients who are abusing opioids.

On the alert

In St. Louis, Drs. Steven Lorber and Mick Kilkelly haven’t seen evidence of xylazine use in patients being treated for drug overdose at SSM Health Saint Louis University Hospital.

“It’s probably here,” says Lorber, SSM Health Saint Louis University Hospital’s chief of emergency medicine. “It’s just that we’re not seeing it because we’re not looking for it.”

Given the uptick in xylazine’s presence in street drugs elsewhere, Lorber and Kilkelly are on the alert.

Kilkelly, division chief of adult anesthesiology and medical director of SSM Health Saint Louis University Hospital’s operating rooms, points out that heroin and methamphetamine have long been cut with baking soda, baby powder and other substances that don’t have much of an impact on users.

“But this stuff (xylazine) does create these devastating wounds that take a tremendous amount of time, energy and effort and health care resources to heal,” he says.

Demand and supply Lorber and Kilkelly say xylazine’s spread

in the street drug supply is to be expected for several reasons. One is that there seems to be demand for the drug. Another is that xylazine is currently not classified as a controlled substance. Even if drug enforcement agents or police find a trafficker with a stash of xylazine, the possession will not prompt charges.

“It’s not illegal to possess xylazine,” Kilkelly says. “You can have cases of this stuff in your trunk and get pulled over, and the officer has no legal authority to do anything.”

The doctors also say that much like fentanyl, xylazine apparently can be easily manufactured in a lab. “The purity is probably very, very high and it’s highly concentrated,” Lorber says. “So, it’s this very small amount of chemical that you need that you can then cut to make a great deal of product to sell.”

The SSM Health Saint Louis University Hospital doctors note that in the U.S., drug trends tend to start on the nation’s coasts or southern border and then move inland. They are hoping that before xylazine becomes more prevalent in the Midwest they and other care providers have time to educate themselves about how to detect the drug’s presence and treat patients who have developed dependencies to it. They also hope to get a jump start on informing the public and the substance-abusing community on xylazine’s risks.

As to how to curtail the supply of xylazine, Kilkelly and Lorber expect that federal regulators will eventually add the drug to the list of controlled substances and policymakers will make its unauthorized manufacture and possession illegal. That, they say, will spur the development and use of simple tests that can detect xylazine in drug supplies and in toxicology tests of patients being treated for overdose.

Compassionate care

In the meantime, the St. Louis doctors are looking toward the East Coast to see what best practices their peers identify for treating patients harmed by xylazine use.

Nazareth is the third hospital in Philadelphia where Risler has worked. At each one he has helped treat a population of patients with substance dependency disorders and related comorbidities.

“I think you quickly realize that none of them want to be in the position that they’re in,” he says. “It’s just these drugs are so addictive, it’s hard to get over that. We are just treating them with the most compassionate care that we can and kind of meeting them where they are and just doing everything we can to help.”

leisenhauer@chausa.org

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COMMUNITY HEALTH INVESTMENT CERTIFICATE

COMMUNITY HEALTH INVESTMENT CERTIFICATE

A street scene in Philadelphia, a center of xylazine abuse. The animal tranquilizer, which has no approved human uses, was found in 90% of street drugs tested by the Philadelphia Department of Public Health in 2021. The number of fatal overdoses in Philadelphia in which xylazine was detected rose from 15 in 2015 to 434 in 2021.

Lorber

Kilkelly

Sipa USA/Alamy Stock photo

Robots

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Jackee Bauch, executive director of support services at Mercy Jefferson and Mercy Hospital South in St. Louis County, Missouri, has helped oversee the robot pilot project. She says while patients and visitors still sometimes do a double take when the machines roll past, co-workers have become accustomed to the robotic couriers.

Bauch says the machines have improved the work environment by unburdening co-workers of some tasks in order to open up more time for other duties. The robots push meal carts to patient floors where nonmedical aides pass out the food trays to patients. Robots cart medications and supplies to medical units to recapture time pharmacy and clinical staff can devote to patient care. They assist housekeeping staff by hauling loads of dirty linen to the laundry.

Bauch says robots have not replaced any co-workers, just taken over some of the more mundane tasks. “We want to treat our co-workers with dignity and this is one way to do it because it allows them to spend more time with patient care,” she says. “That’s why they come here to work, to take care of patients and serve them.”

Rise of robotic technology

Robotic technology factors into clinical care too. Many surgeons use robotic tools to increase surgical precision. Rehabilitation robots assist in reconditioning patients. Robotic exoskeletons allow wheelchair users to stand and walk.

Saint Joseph Hospital in Denver, part of Intermountain Health, opened in 2014 with what it called the nation’s first robotic pharmacy.

In 2020, the American Nurses Association published an 84-page case study on the use of autonomous service robots in hospitals. The white paper notes that the technology appears to be on the rise and is likely to have profound impacts on the profession.

“Regardless of the speed with which this transition will occur, robotics associated with patient care will very likely transform and revolutionize the way we support, augment, and deliver care,” the case study says.

Two hospitals within Trinity Health are piloting the use of Moxis made by Diligent Robotics for the hospital system. One is MacNeal Hospital in suburban Chicago, part of Loyola Medicine. The other is Trinity Health Oakland Hospital in Pontiac, Michigan.

Diligent Robotics, an Austin, Texas-

based company founded in 2017, designs robots specifically for use in health care settings. Diligent says the number of hospitals using its Moxi robots increased from two at the start of 2022 to 14 by year’s end. Moxis logged a total of 160,000 deliveries in those facilities last year.

Jennifer Moore, nurse manager of cardiac telemetry at MacNeal Hospital, calls the two Moxis that began making rounds there in August “a great addition to our staff.”

In her unit, Moore says the Moxis cart the cardiac telemetry boxes between patient rooms and the central telemetry hub. The robots also ferry goods from central supply and medications from the pharmacy. Moore says Moxis usually deliver requested supplies within 10 minutes.

“This is a solution to a problem I don’t think we realized we had,” she says. “I think it has been great for our staff overall because they appreciate the time Moxi has

given them to stay at the bedside.”

No replacement for the human touch

Unlike TUG robots, which from the front resemble a washing machine-sized appliance, Moxi robots have a more humanlike appearance. They are 4½ feet in height and weigh in at about 300 pounds. They have what looks like a torso with a bendable arm

attached. They are topped with a rounded block about the size of a human head, complete with eye-like lights that can flash red hearts when people are around.

MacNeal staff summon and direct the Moxis via iPad kiosks at central locations in the hospital. The robots are programed for routes within and between the hospital’s two towers. Each robot has three secure drawers in its base. Access to the drawers is programed into individual workers’ electronic ID badges.

While they can’t carry on a conversation, Moxis can announce themselves with simple statements like “I’m here for a pickup.” When they’re not on a task, the devices park themselves at recharging stations.

Diligent Robotics contracts out the Moxis in packages that include programing and service. Gregg Springan, head of clinical informatics at Diligent Robotics, says the company is continually updating the Moxi software. The programing incorporates machine-learning algorithms that fine-tune the robots’ ability to navigate in their environments.

Springan says while the Moxis somewhat resemble humans, the company’s intent is not to replace flesh and blood workers. “In fact, I would argue that robots can’t replace the human touch,” Springan says.

What they can do is give workers more time to do essential tasks and bolster the efficiency of a workforce that is increasingly spread thin, he says.

Optimism and concern

The American Nurses Association case study includes input from Diligent and three hospitals piloting service robot use. The white paper reflects optimism that the devices will in the long run prove to be a blessing for nurses, as well as concerns.

“If nursing is to remain relevant, we must use our superpower of innovation and become proactively involved in charting the path for the adoption of this emerging technology, provide direction into what skills robots provide and help determine how robots are incorporated into the patient care ecosystem,” the paper says.

Springan is onboard with the notion that nurses should have input into how Moxis and other robots impact their profession. He’s a former intensive care nurse and part of a team of clinicians at Diligent who he says are “representing the voice of the medical profession” as the company continues to evolve its technology.

Proof of concept

At Mercy Hospital Jefferson, pharmacist Rachel Handrahan had reservations when the TUG robots were introduced. “I was kind of like, eh, I don’t know how that’s actually gonna work,” she recalls.

Now her pharmacy keeps two of the robots busy with deliveries day and night. One of the TUGs has multiple drawers. Handrahan can schedule a specific drop spot for each drawer. Staff at the receiving end have to use a unique ID and their fingerprints to open the drawer. At each scheduled stop, the robot will wait up to 10 minutes before automatically moving on to the next stop and then returning to their base. The robot’s runs can take more than an hour.

The other pharmacy robot has one large locked cabinet. Handrahan sends it out with deliveries that require more space, such as bags of intravenous fluids.

When the TUGs are on the units, Handrahan can monitor from her desktop their whereabouts and progress as well as who has accessed each compartment. She can even switch to a view from the cameras on the robots to see their surroundings.

Now that she’s had the robotic helpers for several years, Handrahan admits, “I do like them way more than I ever thought I would.”

leisenhauer@chausa.org

Springan

Moore

Pharmacist Rachel Handrahan uses a TUG robot for deliveries at Mercy Hospital Jefferson in Festus, Missouri. The robot has several compartments for medications and supplies. Opening a compartment requires a unique ID and fingerprint. The TUG can be programed for several stops on various floors each time it is sent out to the units.

A TUG robot hauls a meal cart out of the nutrition services department at Mercy Hospital Jefferson. The hospital has six TUGS. Two of them are specially built for pharmacy deliveries. The other four, including this one, deliver meals, cart soiled linens to the laundry and haul trash to a dumpster. When not use, they return to their bases to recharge.

“This is a solution to a problem I don’t think we realized we had. I think it has been great for our staff overall because they appreciate the time Moxi has given them to stay at the bedside.”

— Jennifer Moore

Bauch

Lisa Eisenhauer/@CHA

Lisa Eisenhauer/@CHA

SSM Health hospital funds education navigator for former inmates

By JULIE MINDA

When people are released from incarceration and rejoin society, it can be very difficult for them to gain stability, and this is especially true for individuals who lack a high school diploma, job skills and a path to employment.

In Sauk County, Wisconsin, SSM Health St. Clare Hospital — Baraboo is investing community benefit dollars to break the cycle of revolving door incarceration. The hospital provides the financial support that enables the Sauk County Department of Human Services to employ an education navigator. In that post Sasha Ripley provides resources and tutoring for returning citizens who want to earn their high school general equivalency diploma, or otherwise pursue further education.

Ripley also directs formerly incarcerated individuals to job training programs and social services.

Amanda Hanson, justice, diversion and support programs manager for the Sauk County Administration department, says education is fundamental to well-being and independence. “Not having an education greatly impacts people’s finances, health,” their

ability to support themselves and their family and many other aspects of their lives, she explains.

Sauk County in south central Wisconsin has a population of nearly 66,000. Baraboo is the county seat and the county’s largest city.

According to information from SSM Health, around 2017, Sauk County’s health department set out to better understand the socioeconomic problems, trauma and stress that were occurring among people who had been jailed and their families. The cycle of repeated incarceration and the economic upheaval it engendered produced food and housing instability.

The Sauk County Sheriff’s Office and departments within the University of Wisconsin-Platteville Baraboo Sauk County got involved in the study. A significant percentage of former inmates lacked high school diplomas and many had been telling the sheriff’s department that they wanted education, training and credentials.

The research group enlisted SSM Health St. Clare Hospital — Baraboo’s support to fund the education navigator program. The hospital has been providing $71,000 annually since 2020. It covers the navigator’s salary as well as the costs of textbooks and testing fees for program participants. So far, three people have earned their GED. Two of them have applied to go to college in the fall. Eight students are working their way through the program now.

Ripley assists with the paperwork and other process steps to pursue the GED and she provides virtual tutoring. She works with program participants on practice tests and arranges transportation to the GED testing site where a civics test is administered. It is the only one of a series of tests that has to be completed in person. Candidates also must pass tests in language arts, social studies, science and math.

The students can opt to pursue the High School Equivalency Diploma, or HSED, which adds some introductory health coursework on top of the GED requirements. Students pursuing an HSED also receive instruction on job searching skills, workplace etiquette and cover letter and resume writing.

Ripley says students may study and prepare for several months before each test, so it usually takes at least a year to complete her program and earn a GED, and it would take a few additional months to earn an HSED.

She also can help those who have gotten their GED to register for college placement and complete financial aid forms.

Ripley can connect her students with a Sauk County job center for job training, resume writing assistance and other services.

Jennifer MacDonald is an employee of the justice, diversion and support division of the county administration department. She held the education navigator

position temporarily last fall while Ripley was on leave. MacDonald says one student in the program wants to be a peer mentor and needs a high school diploma to qualify. Another student wants to be an addiction counselor, and the diploma is the first step to pursuing higher education toward that goal.

Another man, who is nearly 60 years old, wants to show his kids he can learn to read. He’s spent many years in prison, MacDonald says, and is determined to be a role model to his kids, who are in elementary and middle school.

Nikeya Bramlett, community health manager for SSM Health St. Clare Hospital — Baraboo and SSM Health St. Mary’s Hospital — Madison, says while the education navigator program is still relatively small and slowly gaining momentum, SSM Health expects it will come to have a lasting positive impact for participants and their families.

She says, “We at SSM Health are investing in this because it’s related to our mission, which includes serving vulnerable populations. This population of formerly incarcerated people is extra vulnerable, and they often don’t have the resources they need to thrive.”

YEAR R E NEW

Eduardo Conrado became president of Ascension Feb. 1. The change was announced by Joseph Impicciche. Impicciche preceded Conrado as Ascension’s president and continues as the St. Louis-based system’s chief executive officer.

Conrado was most recently Ascension’s executive vice president and chief strategy innovation officer, a post he’s held since July 2019. In announcing his promotion, Ascension credited him with leading the development and implementation of the system’s strategic plan.

Conrado was a member of the Ascension Board of Directors from 2014 to 2018 before becoming the system’s executive vice president and chief digital officer in September 2018. Prior to that, he was executive vice president and chief strategy and innovation officer for Motorola Solutions Inc.

Ascension also announced Jan. 31 that Craig Cordola has been named executive vice president of Ascension Capital, the system’s independent investment management and comprehensive planning firm. He will transition from his responsibilities as executive vice president and chief operating officer of the system.

Ascension credited Cordola’s leadership in the system’s pandemic response as essential to ensuring caregivers had resources to safely and effectively care for patients and their families. Cordola, the statement said, has played a pivotal role in Ascension’s environmental stewardship and he oversaw the launch of Ascension’s consumer experience efforts.

St. Louis-based Ascension operates more than 2,600 sites of care — including 139 hospitals and more than 40 senior living facilities — in 19 states and the District of Columbia.

➲ Join us as we renew our rhythms of well-being — intentionally, mindfully, prayerfully and communally. chausa.org/renewyear

came so they might have life and have it more abundantly.

Ripley

Hanson

MacDonald

Bramlett

Conrado

Conrado named president of Ascension; Impicciche continues as chief executive

Cordola

SERENITY SPACES

HOSPITALS GIVE WORKERS ROOM TO DE-STRESS

By LISA EISENHAUER

Catholic health ministries across the country are not only encouraging their staffs to tend to their own well-being as the COVID-19 pandemic and work exhaustion lingers, many of them also are creating special spaces on their campuses for workers to kick back and recharge.

Holy Cross Health, a 557-bed hospital in Fort Lauderdale, Florida, that is part of Trinity Health, set up three serenity rooms on different floors and a resiliency garden in an outdoor courtyard for staff to catch their breath. The spaces opened in March 2021.

Mark Doyle, president and chief executive, says the idea behind the relaxation spaces is to help staff de-stress so they “can get back to work and do what we do best, which is take care of patients.”

The largest of the serenity rooms replaced the hospital’s gift shop on the ground floor. Its decompression tools include eight massage chairs. Even with that many (and three more in another room), Doyle says there is sometimes a line of staffers outside the door waiting for their turn.

The garden has a sail-like cover for shade, a section with butterflyattracting plants and more than two dozen tables with chairs. In the temperate months “a lot of times, there’s not one chair available,” Doyle says.

‘A great resource’

Mercy Health — Lourdes Hospital in Paducah, Kentucky, part of Bon Secours Mercy Health, also has three recharge and renew rooms. It opened the first one in the emergency department in November; the other two are on upper floors and, while awaiting finishing touches, are available for staff to slip in for a brief break.

IMPACT Lourdes, Mercy Health Foundation — Paducah’s women’s philanthropy group, provided a grant to cover the rooms’ renovations and furnishings. Lori Meredith, a member of the group, says when the proposal for the rooms came in “we jumped on it.”

“We know (staff are) really busy

and they may not be able to go in there but for a couple three minutes at a time,” Meredith says, “but anything that we can do to help them to recharge and go back out there and give that great care that they give every day, we are glad to have a hand in it.”

ministry of the Sisters of Mercy — South Central Community. Fifty workers won a day of their choice of off-site relaxation, reflection and tranquility.

Support for self-care

for their patients, colleagues and families. The hospital is part of the Catholic Health system.

Jennifer N. Simon, nurse manager of the unit where Laugeman works, makes use of the den. “It’s very relaxing and helps me center myself so I can focus and get back to the task at hand,” she says.

‘The world was crazy’

All of the hospitals that are part of Springfield, Illinois-based Hospital Sisters Health System have a serenity room for staff. The rooms are for the exclusive use of staff except for the one at the flagship HSHS St. John’s Hospital in Springfield, which is also open to visitors.

The room at HSHS St. Mary’s Hospital in Decatur, Illinois, opened last July. It’s just outside of the hospital’s intensive care unit across from the elevators. “It’s easy for staff at the hospital to get to it,” says Valerie Jordan, St. Mary’s director of oncology services, who partnered with Karla Thornton, a spiritual care minister, to get the space set up.

Sullivan

Sherece Sullivan, an emergency room nurse at Lourdes, says the heated zero-gravity massage chair is the big attraction in the fully finished room. The décor includes wall hangings with inspirational messages. There are fidget spinners and other toys to release some nervous energy and a selection of adult coloring books and pencils to inspire creativity.

“I think it’s amazing,” Sullivan says of the room near the ER. “I think it’s a great resource to have.”

More fun and games

Rebecca Inman, ER nurse manager, collected ideas for the rooms at Lourdes and has overseen purchases of furnishings. She and two colleagues hung the waterfall mural that covers one wall.

“It was not easy,” Inman says of the installation, which involved aligning long sticky strips of wallpaper. “I understand why the maintenance department didn’t really want to do it.”

Inman says even with the pandemic’s impact easing and a sense of normalcy returning to the hospital, the relaxation spaces are much appreciated by staff. “What we do is a really difficult job and it’s nice that someone has noticed and provided us with something to be able to manage our ups and downs,” she says.

At Mercy Hospital South in suburban St. Louis a rejuvenation station that opened in January 2022 has massage chairs, a treadmill, a Pac-Man video game system, and iPads with preloaded relaxation apps and inspirational reading material. Occasionally, giveaways, such as munchies and soothing facial mask products, are available there.

The hospital is part of Chesterfield, Missouri-based Mercy. The relaxation space there is part of a systemwide effort to bolster co-worker well-being. Another piece was a drawing in the fall that was open to frontline workers for a respite day at the Mercy Conference and Retreat Center in suburban St. Louis, a sponsored

Sisters of Charity Hospital in Buffalo, New York, opened a Zen den last spring in a repurposed office space across from a nurses’ station on the third floor of the six-story hospital. A grant from the American Holistic Nurses Association paid for the furniture. The space is a complement to the peace garden on the hospital’s campus. The garden has a waterfall, benches and a heart-shaped path.

Laurie Laugeman, an RN who works in the unit for cardiac and neurology patients, says the nurse practice council in her unit wrote the grant request. “We felt strongly that we wanted to find ways to support each other in the self-care area,” Laugeman says.

Jordan says the pandemic brought many new worries — staff furloughs, uncertainty about the virus, the shortage of personal protective equipment for frontline caregivers, patient visitation restrictions and more — that added to an already stressful workplace. “The world was crazy,” she recalls, and even with the worst of the pandemic surges over, staff stress levels stayed high and the need for a space to decompress remained.

A cabinet in the serenity room at HSHS St. Mary’s Hospital has baskets with scripture reflections, inspirational reading material and meditation aids as well as a drop box for prayer requests.

— Jennifer N. Simon

The room has a massage chair, recliner, a desk and chair, inspirational pictures, soft lighting and relaxing music. Its walls are light gray. Each month the room has special features around a theme created by the hospital’s spiritual care team. One month the theme was gratitude and visitors to the space could note what they were grateful for in a communal journal.

Laugeman says the hospital’s philosophy is that if staff care for themselves they can better care

The serenity room has a sofa and reading chair, a small fountain and a mosaic artwork with the message “Called to care.” It also has a prayer box for staff to drop requests. Spiritual care ministers check that box and share the requests with the rest of their team. Those requests also are shared with the Hospital Sisters congregation and with a lay group that has a perpetual prayer presence in the hospital’s chapel.

Of the relaxation room that she and Thornton created, Jordan says: “I think it’s our way of telling our colleagues ‘We care about you. We want you to take care of you so you can take care of others.’”

leisenhauer@chausa.org

Laurie Laugeman, an RN who works in the cardiac-neuro unit at Sisters of Charity Hospital in Buffalo, New York, kicks back for a few minutes in the massage chair in the hospital’s Zen den. The space also has a recliner, a desk and chair, inspirational pictures, soft lighting and relaxing music.

Water pours from a fountain in the serenity room at HSHS St. Mary’s Hospital in Decatur, Illinois.

“ It’s very relaxing and helps me center myself so I can focus and get back to the task at hand.”

Hospital staffers get some fresh air in the resiliency garden at Holy Cross Health in Fort Lauderdale, Florida. The garden and three serenity rooms where staff are invited to take a break and de-stress opened in March 2021.