Focus: July 21, 2010

FOCUS Christiana Care earns value award

To determine which organizations earn awards, Cleverley + A s s o c i a t e s considers financial viability and plant reinvestment, hospital cost and charge structure, and quality performance.

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hristiana Care has been recognized as one of the top 100 hospitals for community value in the nation by Cleverley + Associates® as part of its "Community Value Leadership Awards."

Inside Addictions outreach helps save lives

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Quick response revived marathoner

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Zohra Ali-Khan Catts promotes state professional standards 4 Volunteers help ensure that ‘no one dies alone’

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Publishing, Presentations, Appointments, Awards

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VNA offers private duty nurse training program

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People in national spotlight

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New OB/GYNs in Greenville

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Cleverley ranks the top 100 hospitals each year based on its Community Value Index (CVI), which considers financial viability and plant reinvestment, hospital cost and charge structure and quality performance.

Christiana Care also earned recognition as one of Cleverley’s

“Community Value Five-Star Hospitals” for 2010 for placing in the top 20 percent of all hospitals nationwide based on the CVI. Cleverley+ Associates is a Columbus, Ohiobased health care data and consulting services firm specializing in custom data analyses and reporting for healthcare providers, consultants, and vendors.

Learn more about the Community Value Index and Community Value Five-Star Hospital awards online at www.cleverleyassociates.com.

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Addictions outreach counseling helps save lives

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ore patients with substance abuse issues are receiving potentially life-saving treatment for addictions thanks to an innovative peer-to-peer counseling program.

An embedded, on-site outreach counselor at Wilmington Hospital is engaging patients with drug and alcohol problems at times when studies show intervention efforts most often find success.

Christiana Care launched the program Sept. 1, 2008 in partnership with

Force 14: Community and the health care organization

The program’s impressive success rate attracted the attention of Delaware Physicians Care, an Aetna Medicaid plan. In tracking 18 patients who received peer-to-peer counseling, the group found that individuals were taking better care of their health and relying less on emergency care.

Hospital admissions declined by a third and there were 38 percent fewer visits to the Emergency Department.

Meanwhile, visits to primary care providers increased 88 percent.

“ I t ’s a l ow - t e c h m e t h o d t h a t i s h av i n g a p o s i t i ve i m p a c t o n h e a l t h c a r e c o s t s .”

Patients who receive treatment for their addictions and routine care from their primary care physicians are less likely to develop more serious diseases.

“Care for substance abusers can be exceedingly expensive,” Dr. Horton says. “By getting them treatment, we can reduce their suffering and benefit society as well.”

Terry Horton, M.D.

Brandywine Counseling Inc. Since then the program has produced dramatic results that could ultimately reduce serious illnesses associated with addiction, such as pancreatitis, heart disease, kidney failure, cirrhosis and pneumonia.

More than a third enter treatment As of June 10, 2010, 35 percent of the 313 individuals who received peer-topeer counseling have participated in a licensed inpatient or outpatient treatment program, says Terry Horton, M.D., an internist on the faculty of the Department of Medicine.

“These numbers are exceedingly robust,” Dr. Horton says. “Before, the only option available to engage patients in community-based drug treatment was to hand them a phone number and a few, if any, would follow through.”

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FOCUS July 21, 2010

Brandywine Counseling’s Bobbie Dillard works directly and intensely with patients at Wilmington Hospital who have been identified as being addicted to drugs or alcohol.

Outreach for patients at bedside “Bobbie comes to the bedside or the clinic or the Emergency Department and talks with the patients,” Dr. Horton says. “It’s a low-tech method that is having a positive impact on health care costs.”

Finding ways to channel people into treatment for their addictions could have a sweeping effect on the health care system. Currently, 7 percent of the adults in Delaware are considered problem drinkers, according to the state Department of Health and Social Services, Division of Public Health.

Brandywine Counseling, Inc. counselor Bobbie Dillard meets with patients with alcohol and drug abuse problems after they arrive at Wilmington Hospital.

“When you include drug abuse, the number is even higher,” Dr. Horton says.

Bolstered by the success of the program at Wilmington Hospital, Christiana Care hopes to expand the initiative to Christiana Hospital.

“We’re working with the state to try to secure federal funding,” Dr. Horton says. “We think we have come up with an effective method that saves both lives and money.”

Quick response revived marathoner flow through the artery and insert a stent to keep the blood vessel open.

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n an annual foot race that was all about endurance and individual finish times, the most important result at the May 16 Delaware Marathon was the speedy response of a medical team.

Less than a month later, he was back at his law practice and playing kickball with his son.

“It was very fortunate that skilled people at the scene began to treat him immediately,” Dr. Rahman says.

“Their timely and professional response made all the difference. After his resuscitation in the field and even before he arrived in the hospital, the highly efficient, hospital-wide multidisciplinary system was in full swing to get the patient to the cardiac cath lab as expeditiously as possible.”

Seconds after crossing the finish line, Scott Stanley, a 50-year-old father of three from Drexel Hill, Pa., collapsed.

Fortuitously, Julie Sullivan, M.D., a PGY-3 Emergency Medicine resident, two visiting residents from Abington Family Medicine, several Emergency Department nurses and a paramedic were monitoring the event and responded within seconds.

Drexel Hill attorney Scott Stanley, 50, sur-

He had no pulse vived a sudden death experience at the Delaware Marathon finish line thanks to Stanley had no pulse. The team immediately began CPR and called quick action by emergency responders. Wth him, from left, are his wife, Rebecca, and for an ambulance, which is equipped with an automated exter- children Ellie and Olivia, and Nathan. nal defibrillator or AED, a portable ruptures and immediately forms a electronic device that automatically clot, completely blocking the artery diagnoses cardiac arrhythmias and and causing a heart attack. delivers an electric shock to the heart so that it can reestablish its rhythm.

“Without that shock to get the heart back on track, the patient dies,” says “I woke up in the ambulance,” he Ehsanur Rahman, M.D., FACC, associrecalls. “Before that, all I remember is ate chief of Cardiology, the intervencrossing the finish line and feeling tional cardiologist who treated him. faint.

Stanley had finished his marathon. But “I probably wouldn’t have made it if the race to the cardiac cath lab was in this had happened to me on a lonely full stride. street at 6 o’clock in the morning or driving in my car,” he says. “Hats off Every second counts to all the people at Christiana Care “When a patient has a blocked artery who took such wonderful care of me.” in the early stages of a heart attack, No history of heart disease heart muscle damage continues and every second counts,” Dr. Rahman says.

Stanley, who had no history of heart disease, had suffered sudden death, Stanley was rushed to the hospital for which occurs when plaque, already emergency cardiac catheterization to built up inside the artery, suddenly remove the blood clot, restore blood

A day to remember Throughout the day, nurses responded to a variety of conditions, including a marathoner with chest pains, a volunteer with labor pains and a runner who broke his leg as he crossed the finish line.

“I can't say enough about how well it all worked out with our team,” says Linda Laskowski Jones, RN, MS, ACNS-BC, CCRN, CEN, Vice President: Emergency, Trauma & Aeromedical Services. “They truly performed with the highest possible standards.”

Robert Laskowski, M.D., MBA, Christiana Care CEO and a participant in the day’s races, commended the volunteers.

“They showed their commitment to caring for our neighbors every step of the way,” he says. “They did a magnificent job taking care of the athletes and race volunteers.”

For Delaware Marathon photos, visit www.flickr.com/photos/christianacare

Genetic counselor helps establish state standards for licenses genetic counseling. It also set up a genetic counseling council under the Board of Medical Practice.

Why have licensing standards?

As genetics and regular screening becomes more integrated in health care, patients need access to those who have proper training in assessing family history and discussing genetic test results.

Whether you are being tested for a certain cancer, pediatric Zohra Ali-Khan Catts (left) joins Delaware Gov. genetic condition, or undergoJack Markell in announcing new laws governing ing prenatal screenings, you licensing of genetics counselors. need a consultation with a ven before she came to the Helen genetic counselor or medical geneticist F. Graham Cancer Center in 2002, to best understand the results of your certified genetic counselor Zohra Alispecific test as it pertains to your famiKhan Catts, MS, was motivated to get ly history. involved.

Whether you are being tested for a

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New to the state, she saw a great opportunity to establish the licensing requirements in Delaware as a way to contribute to her profession.

Genetic counselors work at major hospital and facilities throughout Delaware helping patients understand information and results from screening tests.

In a meeting with the other 13 genetic counselors in Delaware, Ali-Khan Catts introduced the idea of licensing laws for genetic counseling in Delaware. The counselors, along with medical geneticists, discussed the pros and cons of licensure and decided to pursue legislation.

Their proposal outlined standards for education and set the regulations for licensure of genetic counselors as well as penalties for failure to comply. It protects the public by identifying health care providers who have the appropriate training and expertise in 4

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FOCUS July 21, 2010

certain cancer or undergoing prenatal screenings, you need a consultation with a genetic counselor or medical geneticist to best understand the results of your specific test.

The coalition needed a legislative champion and Senator Bethany HallLong was a natural choice. As a nurse and educator, Senator Hall-Long quickly recognized the benefit this would provide to the public and was very motivated to introduce licensure legislation.

Ali-Khan Catts and the other genetic counselors worked closely with Senator Hall-Long to get the bill to circulate to the Board of Professional Regulations, Board of Medical Practice, and the National Society of Genetic Counselors for review before it was introduced in the state Senate on May 6, 2010 and passed by the Senate and House on June 3 and 23, respectively.

On June 30th, Ali-Khan Catts and her fellow genetic counselors joined Gov. Jack Markell in a bill signing ceremony in Dover at Legislative Hall.

In Delaware, screening for cancer has lead to a significant drop in state cancer rates and the work of genetic counselors, including Ali-Khan Catts, has been instrumental in the leadership and patient care demonstrated by the Helen F. Graham Cancer Center.

CCOP is cancer trials accrual champion

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linical trials play an essential role in cancer research.

The Cancer and Leukemia Group B, known as CALGB, places Christiana Care’s Community Clinical Oncology Program (CCOP) at the top for recruiting patients for clinical trials for the period May 1, 2009 to April 30, 2010.

Christiana Care was fifth overall out of 45 participating organizations, with an accrual rate of 26 percent, far above the national average of 4 percent.

That is due, in part, to recruiting community physicians to CCOP and making nurses readily available to enroll patients in the offices of oncology practices at the Helen F. Graham Cancer Center.

Top five accrual rankings for the year, in number of patients, include: Ohio State University - 518 University of North Carolina - 454 Washington University - 437 University of California at San Francisco - 374 Christiana Care’s Helen F. Graham Cancer Center - 341.

Volunteers help patients through final hours

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sabel Hendrixson had never met the elderly man at Christiana Hospital who was near death.

But she knew it was important to be with him at the end, so she hurried to his bedside. She held his hand and read him poetry.

“I hope that when my time comes someone is there for me if my family cannot be there,” she says.

Offering comfort to dying patients Hendrixson is one of more than 20 Vigil Volunteers in a program that offers comfort and compassion to dying patients who do not have a loved one nearby. It’s called No One Dies Alone.

“We did a lot of research into best practices to come up with what we think is an excellent system to help patients who are near the end die with dignity,” says Lily Tanverdi, Volunteer Coordinator at Wilmington Hospital.

Program established systemwide The pilot program was introduced at Christiana Care in March 2009, based on a group founded by a nurse at Sacred Heart Medical Center in Eugene, Ore. After a year of testing at several units at Christiana Hospital and Wilmington Hospital, No One Dies Alone has been launched systemwide.

Although precise statistics are not available, patients at Christiana Care die each year who do not have loved ones at their side, says Margarita Rodriguez-Duffy, MSW CAVS, Manager, Volunteer & Student Administration.

“Perhaps they may not have family in the area or no family at all,” she says.

“Volunteers are willing to serve as

Thirteen Christiana Care Vigil Volunteers assembled above include (standing, from left) David Hayward, Andrew DelGenio, Darren Cowgill, Isabel Hendrixson, Theresa Brainard, Charles White, Elayne Tomb, Andrew Fairchild, Laura Lagana, Sandra Krett, Mariana Oratorio. Seated from left are Shirley Williams and Mary Frederick.

surrogate family members during this last journey.”

Years ago, when she was a volunteer in the Medical Intensive Care Unit, Sandy Krett sat with a dying patient.

“His family could not bear to be with him when he died, so I volunteered,” she recalls.

Now a Vigil Volunteer, she is grateful to see a system in place for patients who are alone.

Volunteers are trained and equipped Each volunteer carries a bag equipped with reading materials, recordings of soothing music and a journal. If the patient is dying from an infectious disease, the volunteers are outfitted with masks, gloves and protective clothing.

During her vigil with a patient, volun-

teer Bonnie Haines read psalms from various religions and spoke to the man as if he were an old friend.

“He wasn’t conscious but I talked with him as if he was,” she recalls. “I told him about my family and my grandchildren.”

Soon after, Haines sat with her 93year-old father, who was in hospice care.

“As my father died, Andrea Bocelli was singing in the background, which was quite beautiful,” she recalls.

“Being with someone at the end is a real privilege.”

Volunteers undergo training sessions before they begin their work. To learn more, call 302 733-1284 or go to www.christianacare.org/volunteer.

Focus on Excellence - Best Practice Review Consistent with our strategies for engaging staff in continuous improvement and best practices, we regularly review important topics in Focus to help reinforce safe-practice behaviors. These tips reinforce information and enable staff to better articulate our safety practices during an unannounced survey.

Look Alike/Sound Alike Medications Q.

What Actions should be taken to avoid confusion of Look-Alike / Sound-Alike Medications (LASAs)?

Actions: Along with the 5 Rights and 2 Patient Identifiers

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Look up all Medications in Formulary, Drug Reference Book, Micromedix or call the pharmacist.

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Always check the brand name and generic name of medications.

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List both names on the MAR for redundancy and communication to all team members.

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Be knowledgeable of the purpose/indication for use of each medication. (In most cases LASA medications are used for different purposes.)

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How does Christiana Care Health System help prevent confusion of LASA medications?

Pharmacy: n Assesses each new Formulary addition for LASA potential. n Separates LASA medications within the Acudose cabinets. n Utilizes alert stickers, labels and tall man lettering. n Includes individual LASA reminders within the drug information monographs of the Christiana Care Health System formulary.

Systemwide: n Implemented Bar Coded Medication Administration to assist in checking the 5 –Rights. n Posted the LASA list on the Nursing portal in the Staff References section. n Placed viewable product notes in EMAR/CPOE to alert a LASA potential.

Well-informed Caregivers and Patients are the Vital Link in the Safety Chain to Prevent Errors

Next ACT course starts Sept. 8

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cademic Affairs, in partnership with Quality and Patient Safety, offers the next Achieving Competency Today (ACT) course, Issues in Health Care Cost, Quality, Systems and Safety, for physicians, residents, nurses, pharmacists and allied health professionals.

The ACT course takes place on Wednesday evenings Sept. 8 through 6

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FOCUS July 21, 2010

Dec. 1, from 4-7:30 p.m. Enrollment is limited to 28. Applications, due by Aug. 6, are available through the Academic Affairs Office, Christiana Hospital, MAP 2, Suite 2114, or by emailing Theresa Fields, administrative assistant, at tfields@christianacare.org.

Course description Achieving Competency Today (ACT) is a graduate level, interdisciplinary 12-

week course that includes modules on performance improvement, patient safety, measurement and outcomes analysis in quality improvement, interdisciplinary team concepts, the U.S. health care system, a brief history and comparison with other models, health care economics and legislation, change theory, and budgets and approval processes as they relate to conducting a performance improvement project.

Events

Publishing, Presenting, Appointments, Awards

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D U C AT I O N

VNA launches private duty nursing career path

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he Visiting Nurse Association’s (VNA) career path for private duty nurses (PDNs) supports Christiana Care’s Magnet designation.

It also enhances VNA’s education and preceptor support program, “The Journey From Novice to Expert” created in 2007 to increase the number of qualified PDNs caring for medically complex patients, including those with tracheostomy and ventilator dependency.

“This career path recognizes nurses for their experience, skill level, education, and leadership behaviors; and provides clearly defined steps for advancement from LPN I to RN II within the private duty specialty,” says program director Cleveland Cartwright, RN. Statewide private duty nursing services grew by 18 percent at VNA from 2007 to 2009 as a result of the program, which serves adult and pediatric patients in the home and school environment.

Creates career growth potential VNA is the first home care agency in Delaware to offer this type of advancement opportunity for private duty nurses, according to Case Management Supervisor JoEllen Workman, RN, MSN/HSA. “VNA can continue

Qualified VNA private duty nurses care for medically complex patients, including those with tracheostomy and ventilator dependency.

hiring new graduates, while also offering growth potential for current staff and experienced nurses joining the agency,” she says.

Career paths are available for licensed practical nurses and registered nurses.

Designations include LPN I, LPN II, LPN III, RN I and RN II. VNA places all new hires in the PDN career path according to their skills and experience. Current VNA LPNs who meet the required qualifications

are considered LPN IIs. Current registered nurses are now categorized as RN I. VNA will begin accepting applications for LPN II and LPN III this October to enable nurses to meet criteria requirements. RN II designations begin June 2011.

To learn more about the PDN career path or to request an application contact a case management supervisor at 1-800322-4428, visit the VNA homepage via the employee portal or visit www.christianacare.org/vna/privatedutynursing.

There will be two cohorts during the fall semester:

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mmaculata University is starting new accelerated RN to BSN classes at Christiana Hospital in the fall.

Students attend class once a week onsite and are able to complete degree requirements within a reasonable time frame. Courses have been designed to

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FOCUS July 21, 2010

Monday evenings, starting Sept. 27.

Thursday evenings, starting Sept. 23. be relevant to the world of work and to prepare registered nurses for positions of leadership in the multi-faceted modern health-care industry.

For more information, contact Madeleine Keyes at mkeyes@immaculata.edu or call 610-6474400, ext. 3173.

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Gerard Fulda, M.D., to lead task force

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E C O G N I T I O N

Albert Rizzo, M.D., named chairmanelect of American Lung Association

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elaware pulmonologist Albert A. Rizzo, M.D., was elected chair of the National Board of Directors for the American Lung Association. He just completed serving a two-year term as the Association’s highly visible Nationwide Assembly Speaker.

Gerard Fulda, M.D.

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erard Fulda, M.D., has been appointed by the U.S. Department of Health & Human Services (HHS) to serve as chair of the Scientific Knowledge Subcommittee (task force) for the Organ Donor Management Task Force.

Sponsored by HHS, the Health Resources and Services Administration (HRSA) and the Organ Donation and Transplantation Alliance, the task force addresses opportunities to improve outcomes of and decrease variation in donor management practices.

The task force will advise the sponsoring agencies about:

n Gaps between what is known and what needs to be known about hemodynamic management of the deceased organ donor.

The assets or capabilities needed to improve the quality/quantity of research to better identify optimal organ donor management procedures or protocols. n

In March of 2010, Dr. Rizzo testified on Capitol Hill, at the request of Sen. Tom Carper, in support of SB 2995, the Clean Air Act Amendments of 2010, which aimed to strengthen the Clean Air Act by cleaning up sulfur dioxide, nitrogen oxides and mercury from power plants.

Dr. Rizzo has served as a volunteer for the American Lung Association in Delaware for more than 20 years, including two terms as the state chapter Chairman of the Board of Directors.

He was responsible for starting the Delaware Asthma Consortium, which now includes more than 60 members from the community,

Albert A. Rizzo, M.D.

pharmaceutical companies and businesses, to address management and care of individuals with asthma.

Dr. Rizzo is chief of the Pulmonary and Critical Care Medicine section at Christiana Care and a managing partner of Pulmonary Associates, PA.

Mullenix receives top coordinator award

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herrill Mullenix won the Emergency Medicine Residency Association's 2010 Residency Coordinator of the Year Award, presented in June in Phoenix, Ariz.

Fifth-year EM/IM resident Christian Research studies that should be considered Coletti, M.D., now an attending physician that would have the greatest impact on organ with Doctors for Emergency Services, predonation outcomes. sented the award. n Research studies that can be conducted at the DSA level, regional level and/or national level. n

Sherrill Mullenix

Greenville Medical Office welcomes Dr. Smith and Dr. Powell, OB/Gyns

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he Department of Obstetrics & Gynecology and the Medical Group of Christiana Care announced the opening of a new OB/GYN practice at the Greenville Medical Office - Center for Women's Health, at 3706 Kennett Pike in Greenville.

Kirsten Smith, M.D., and Julia Powell, M.D., are now accepting obstetrics and gynecology patients at their new women’s health practice. Each offers experienced care for women, from family planning, obstetrical care and contraception to treatment of the symptoms of menopause and more.

To learn more about our women's health services or to find a doctor, call 302-623-2273.

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retchen Makai, M.D., now sees patients at her office in MAP 2 on Christiana Hospital campus, in addition to her Greenville Medical Center office hours. Her practice is in Suite 2103.

Dr. Makai performs minimally invasive gynecologic surgical procedures that address a variety of women's health concerns, including irregular bleeding, fibroids, pelvic pain, endometriosis and ovarian cysts.

These minimally invasive procedures require very small incisions or no incisions at all. They often can provide an alternative to a hysterectomy.

A new, state-of-the-science OR was installed this year in MAP 2, providing patients with access to a high-tech facility equipped with miniature cameras, fiber optics and high-definition monitors.

She also has regular hours at the Christiana Care Center for Women's Health, 3706 Kennett Pike in Greenville.

For an appointment, call 302-6234410.

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Therapeutic Notes

Welcome New Medical-Dental Staff Emergency Medicine

Some of the challenges faced when prescribing for the elderly population include avoiding overuse of medications and avoiding the use of medications that may be poorly tolerated.

Suboptimal use of medications, including the omission of indicated medications may also be a concern.

These can be associated with an increased risk of adverse drug events, morbidity and mortality. Screening tools are available to help guide prescribers in selecting medications that may be safer options for elderly patients. Beers’ criteria, which have been widely cited, contains two lists of medications that are recommended to avoid in adults over 65 years of age, one independent of and one dependent of disease state.

A newer screening tool, STOPP (Screening Tool of Older Persons’ Potentially inappropriate Prescriptions) has been developed according to physiological systems. Examples of potentially inappropriate prescriptions as determined by STOPP criteria include digoxin dosed at >125 mcg/day in patients with impaired renal function, or the use of tricyclic anti-depressants in patients with dementia. Others include NSAID use along with warfarin, proton pump inhibitors for peptic ulcer disease at full dose for >8 weeks, and drugs that adversely affect those prone to falls such as benzodiazepines or vasodilator use with postural hypotension.

STOPP criteria should be used in conjunction with START (Screening Tool to Alert doctors to Right Treatment) to evaluate errors of omission, which is failing to prescribe drugs with an indication that could benefit a patient.

Barry et al. evaluated 600 community dwelling patients (>65 years of age)

Pediatrics/Pediatric Nephrology

Surgery - General Emergency Medicine/ Internal Medicine Surgery - Neurologic

Obstetrics/Gynecology

admitted to a hospital with acute illness, and found one or more appropriate medications were omitted in 57.8% of the patients.

The most frequently omitted include statins for atherosclerotic cardiovascular disease, warfarin in chronic atrial fibrillation, ACE inhibitors for congestive cardiac failure, aspirin for stenotic arterial disease, and calcium supplementation for osteoporosis. Some reasons may include the attempt to avoid polypharmacy or focusing on palliation of symptoms rather than secondary disease prevention.

Overall, STOPP and START may be useful tools to help guide prescribing, although randomized controlled trials

would be required to determine if use of these can significantly reduce morbidity and mortality.

Ensuring safe prescribing practices for our patients is a key factor in providing optimal patient care. Using available tools can offer guidance for prescribers facing challenges when choosing medications for their elderly patients. Along with these tools, evaluating a patient’s medication history combined with the medication reconciliation process provides an opportunity to match each medication with an appropriate indication. These efforts combined can help us provide high quality patient care.

Pianist fills main lobby with soothing melodies

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ntonio Valle, Jr., a nurse assistant in PACU, says it feels natural to play the grand piano at Christiana Hospital for the people sitting in or traversing the main lobby.

“I have had so many people say such nice things and even leave notes thanking me for giving them a time of peace in such a hard time in their lives … I’m so happy that I could give back a little by doing something that I hadn't put too much thought into.”

Valle, who has been playing the piano in the lobby since May 2010, started learning music at age 4.

Listeners can often find Valle playing in the main lobby Tuesdays and Fridays from 12:30-1 p.m.