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New technology improves patient safety cally reducing the risk of medication and order entry errors,” says Terri Steinberg, M.D., MBA, Christiana Care’s chief medical information officer.
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hristiana Care Health System has achieved an important milestone in its ongoing quest to transform the delivery of health care services. On Jan. 28, we launched the Computerized Physician / Provider Order Entry (CPOE) system at Wilmington Hospital. Safer, easier The new technology, which makes it safer, easier and more efficient for doctors to order tests and medications, launches at Christiana Hospital in several weeks.
Clinical News Primary Stroke Center Certification
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Virtual hospital serves medical education
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Christiana Care’s customized CPOE program represents the most extensive use of the technology in Delaware and is one of only a handful in the region. Reduces risk of errors
Introducing new treatment for severe depression New Medical Genetics Program
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General News Delaware Medical Relief Team’s Haiti Mission
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IHI Open School
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“CPOE transforms the way we provide care to our patients because it emphasizes patient safety by dramati-
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Christiana marks 25 years as one of the mid Atlantic regions’ greatest hospitals S T O R Y,
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“It also helps doctors to be more efficient in patient care.” With bar-coded wristbands and an electronic medication administration record (eMAR) system already in place, Christiana Care joins an elite group of providers beginning to rely exclusively on a computerized health record. According to Healthcare Information and Management Systems Society (HIMSS) standards, the addition of CPOE puts Christiana Care in the top 3.6 percent of U.S. hospitals
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Closer to ultimate goal More important, that means Christiana Care is nearing its ultimate goal of establishing a comprehensive electronic health record (EHR) system. The federal government’s mandate is for hospitals to increase use of EHR from 10 percent in 2009 to 55 percent by 2014 in order to make health care safer and less expensive. Hospitals that do not meet federal guidelines by 2015 face reductions in Medicare reimbursement. CPOE reduces repeat tests and turn-
around times for results, as well as glitches associated with paper, such as incomplete charts. Because health care providers enter orders electronically, the system eliminates errors in deciphering doctors’ handwriting. CPOE also provides such conveniences as “smart med” pick lists, with usual doses and methods of delivery. It is equipped with several hundred order sets for the most common diagnoses. Dr. Steinberg notes that physicians provided invaluable insights throughout the planning process and will continue to have input as Christiana Care refines the system.
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Primary Stroke Center achieves certification
“Joint Commission advanced certification means our patients can be sure they will receive the best possible care.” Anthony Munson, M.D., medical director, Christiana Care Stroke Program
"It recognizes the hard work and dedication of our colleagues at Christiana Care to provide the best possible care to our patients.” Virginia U. Collier, M.D., Hugh R. Sharp, Jr. Chair of Medicine
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fter an on-site review at Christiana Care by the Joint Commission in November 2009, Christiana Care Health System has earned the Gold Seal of Approval™ for Primary Stroke Centers. Certification demonstrates that our stroke care program meets all national guidelines and recommendations that can significantly improve outcomes in patients with acute stroke. Primary Stroke Center certification is the Joint Commission’s first advanced certification program. Programs applying must meet the requirements for disease-specific care certification plus additional, clinically specific requirements and expectations. The Joint Commission’s Primary Stroke Center Certification Program, launched in December 2003, was developed in collaboration with the
“It is the best signal to our neighbors that the quality care we provide is effectively managed to meet the unique and specialized needs of stroke patients.” Timothy J. Gardner, M.D., medical director, Center for Heart & Vascular Health
“This distinction recognizes the exceptional process measures and clinical outcomes for Stroke patients we strive for, from the moment they arrive at the ED, through diagnostic imaging, treatment, recovery and rehab.” Penny Vigneau, MSW, MBA, vice president,Center for Heart & Vascular Health.
“It would have been impossible to earn this important certification and accreditation without the hard work, dedication and teamwork of Stroke Program Medical Director, Anthony Munson, M.D., Stroke Advanced Practice Nurse Mary Ciechanowski, and members of the Performance Improvement team led by Rosemary Ellis and Michele Kane." - Virginia U. Collier, M.D., Hugh R. Sharp Jr. Chair of Medicine
American Heart Association/ American Stroke Association. As of Oct. 1, 2009, there were more than 600 certified primary stroke centers in 49 states. Certification is available only to
stroke programs in Joint Commissionaccredited acute care hospitals.
Virtual Education and Simulation Training Center transforms approach to teaching and learning
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magine a seven-room hospital where doctors gain a firm foundation in surgical techniques, hand-toeye coordination and repetitive skills exercises—before they pick up a scalpel to operate on a real patient.
patient rooms.
The center in the lower level of the John H. Ammon Medical Education Center is one of only 106 member medical simulation centers in the U.S., according to the Society for Simulation At Christiana Care’s Virtual Education in Health Care. and Simulation Training Center, babies High-fidelity patient simulators are born every day, just as they are in a real hospital. Injured adults and chil- But the patients are mannequins, adult and pediatric high-fidelity human dren rush to the Emergency patient simulators that breathe, speak, Department. Patient are intubated, blink their eyes and respond to stimhave blood drawn and get IV drips. uli. Controlled by computers to simuExcept for the real flesh-and-blood late various conditions, the manikins aspects, the VEST Center functions produce heartbeats, bowel sounds and just like a hospital, complete with a blood pressure readings. trauma bay, an intensive care unit, “We have an obligation to our comoperating room and standardized munity, our families and ourselves to provide a training environment that does not compromise patient safety,” says Glen Tinkoff, M.D., medical director, VEST Center. “Previously, the only way we could teach these skills was at the bedside.” Doctors gain crucial experience dealing with high-risk conditions that rarely occur so they can provide the best care when those situations do arise. Audio and visual recordings enable learners to review and analyze their work. Glenn Tinkoff, M.D., Associate Vice Chair of Surgery and VEST Center medical director, and Staff Development Specialist Pamela Woods, RN, demonstrate resuscitation on a human patient simulator. 4
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Up-to-date education facilities “The VEST Center provides the most up-to-
Birthing mannequin “Noelle,” in the VEST Center’s Labor & Delivery Room is an invaluable teaching tool for pediatrics, OB/Gyn and neonatal medicine specialties.
date education facilities for physicians, as well as residents, medical students, nurses and allied health care personnel and staff,” says Brian Little, M.D., Ph.D., vice president for Academic Affairs and Research. “Medical schools, postgraduate training programs, credentialing committees, and licensing and specialty boards are all placing greater emphasis on using simulation modalities to evaluate competence.” Certified as Level II The facility has received certification as a Level II Educational Institute by the American College of Surgery, a designation for providers of basic education in enhancing patient safety through simulation. The 9,000-square-foot center is equipped with a working laparoscopy station with simulated tissues, an endoscopy/bronchoscopy simulator, and 3D visualization software and display, with more than 100 task trainers.
New outpatient treament for severe depression coming soon
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ome spring, Christiana Care’s Center for Comprehensive Behavioral Health will become the first center in Delaware to offer Transcranial Magnetic Stimulation (TMS) therapy for treating severe depression. TMS therapy is a 40-minute outpatient procedure prescribed by a psychiatrist for patients who have not responded to a trial of antidepressant medications. The therapy is non-systemic, meaning it doesn’t circulate in the bloodstream and does not involve surgery or anesthesia. Since it is noninvasive, patients can drive themselves to and from treatments. The system, the only device of its kind approved by the U.S. Food and Drug Administration, brings new hope to people suffering from depression without the side effects associated with current treatments. Magnetic impulses stimulate nerve cells “Until now, TMS has been available only at major academic medical centers,” says Harold Rosen, M.D., chair, Department of Psychiatry. “It is based on the use of magnetic impulses to stimulate the firing of nerve cells in the brain with the resulting release of neurotransmitters in the cerebral cortex. which help relieve the symptoms of depression.” How TMS works The patient reclines in a chair while magnetic field pulses are aimed at the left prefrontal cortex, an area of the brain that functions abnormally in patients with depression. The pulses are the same strength as those used in magnetic resonance imaging (MRI)
machines. Patients cannot feel the small amount of electricity generated by TMS. But the charges cause the neurons in the brain to release neurotransmitters in the form of chemicals, such as serotonin and dopamine, which relieve symptoms of depression. The treatment is administered daily for four to six weeks. In clinical trials, more than 10,000 treatments were performed. TMS did not produce systemic side effects, such as weight gain, sexual dysfunction, sedation, nausea or dry mouth. Nor did patients report memory loss or problems concentrating. The most frequent side effect was mild to moderate scalp pain.
Transcranial magnetic stimulation brings new hope to people suffering from depression.
New Women’s Health podcast goes live
TMS is not yet covered by all insurance plans, says Stephen L. Smith, MA, administrative director and program manager, Department of Psychiatry. Coverage must be determined on a case-by-case basis, but the Center will help patients seek reimbursement whenever possible, he says. Installation at the new Center for Comprehensive Behavioral Health at 201 W. 14th St. in Wilmington should be complete by early spring. To view the podcast, visit www.christianacarepodcasts.com/
Medical Genetics Program points the way to the future of medicine
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hristiana Care’s new Medical Genetics Program builds on scientific advances and helps transform the way many diseases are diagnosed, treated and even prevented. “Genetics classically has focused on prenatal, pediatric and cancer,” says Bruce Boman, M.D., Ph.D., director, Cancer Genetics and Stem Cell Biology at the Helen F. Graham
to develop an infrastructure to diagnose inherited disorders and to tailor treatments based on a patient’s unique genetic profile. “We have tremendous enthusiasm and support for moving forward into adult genetics,” says Louis Bartoshesky, M.D., MPH, chair, Department of Pediatrics. Dr. Bartoshesky is a specialist in medical genetics and also medical director of Genetics and Newborn Screening for the Delaware Division of Public Health. “The future of genetic medicine is looking at such common and etiologically complex disorders as hypertension, coronary artery disease and depression,” he says. For example,
Zohra Ali-Khan Catts, MS, CGC
Delaware. Until now, adults in need of genetic testing had to go to Philadelphia or Baltimore. All cancers result from genetic changes in cells. In about 5 to 10 percent of cancers, including “The future of medicine is genetics.” breast, ovarian, colorectal, pancreatic, - Louis Bartoshesky, M.D., MPH prostate, and Chair, Department of Pediatrics melanoma, the genetic changes are Louis Bartoshesky, M.D., MPH inherited from one or both parents. “We expect in the relatively near “When we know about a person’s risk Cancer Center. “But many diseases future to be able to draw blood, send factors, we can tailor prevention have genetic components.” it to the lab and learn that strategies to help lessen the likelihood Today, medical genetics is helping to Antidepressant A would work better that cancer will develop,” says Zohra save the lives of people who are at than Antidepressant B.” Ali-Khan Catts, MS, CGC, director of high risk for developing cancer. But the Cancer Genetic Counseling at As this new area of science, known as Dr. Boman says genetics programs Graham Cancer Center. “We can pharmacogenomics, matures, it will also can save people who have other screen to catch cancer early when it is use new molecular genetics technolodiseases. most curable.” gies to identify which drugs are most “The future of medicine is genetics,” likely to help patients and least likely For years, doctors have known that a he says. to cause a bad reaction, so that drugs number of diseases result from a Christiana Care’s Medical Genetics can be prescribed based on each change or changes (known as mutaProgram encompasses pediatrics, patient’s genetic profile. tions) in a gene or pair of genes. These maternal-fetal medicine, cardiology include some forms of muscular dysThe program also will provide the and cancer. The goal of the program is only clinical genetic services in trophy, as well as Huntington’s
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GENETICS
PROGRAM, CONTINUED
disease, a degenerative neurological disease, and Marfan syndrome, a disorder of the connective tissues that can affect the heart, lungs and eyes. But researchers are discovering genetic links to many more conditions and will learn much more through a collaboration between the Center for Heart & Vascular Health and the Helen F. Graham Cancer Center. “We will have a combined database that offers unparalleled opportunities for research,” says William Weintraub, M.D., FACC, John H. Ammon Chair of Cardiology and director of the Christiana Center for Outcomes Research. Genetic testing can help to confirm such heart disorders as Brugada syndrome, which causes sudden cardiac arrest when the walls of the heart are abnormally thick. Identifying inherited conditions also is important in preventing disease through medications and healthy habits. “Lifestyle and environment interact with genetics in ways that are still not very well understood,” Dr. Weintraub says. “But we are learning more every day.” Nicholas Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center at Christiana Care, says “The genetics field is moving forward rapidly and Christiana Care needs to stay on the cutting edge of clinical care and research. The Medical Genetics Program will help us achieve these goals.”
Genetics counselors earn board certification
Chandra Somerman
Marcie Parker
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wo Christiana Care genetics counselors at the Helen F. Graham Cancer Center recently earned board certification from the American Board of Genetics Counseling. Chandra Somerman and Marcie Parker both joined the Helen F. Graham Cancer Center in June 2007. Somerman holds a master’s degree in genetic counseling from Boston University School of Medicine. She is a 2004 graduate of Penn State University. Parker received her master’s degree in genetic counseling from Arcadia University and her bachelor’s degree from Syracuse University in 2005.
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egistration for children of Christiana Care employees for the 2010 Summer VolunTEEN Program is Feb.15-26. On March 1, registration will be open to everyone. The nine-week Summer VolunTEEN Program runs June 14 through Aug.
13. Students must be available for at least six weeks and donate 50 or more hours of service. Students must be at least 14 by June 14. If you would like your son or daughter to participate, please call the Volunteer Office at 302-428-2206.
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Christiana Hospital marks 25 years of serving our neighbors
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any Christiana Care employees who were here 25 years ago still refer to Sunday, Jan. 27, 1985 as Moving Day, or just “M-Day.” They started moving patients, key clinical equipment and provisions from Wilmington Hospital and the Wilmington General Division at midnight. The well-rehearsed plan was executed swiftly and carefully with the grit and discipline of a seasoned, invading army. Most of the 70 patients transferred from Wilmington Hospital were children who rode on buses and were carried on stretchers by Air Force medical corps personnel, or escorted one-ata-time by a third-year resident and a pediatric ICU-trained nurse. Other patients transferred or admitted on the first day included several dialysis patients, some seriously ill patients who arrived at Wilmington’s Emergency Department in the middle of the move or who came in through Christiana’s new ED, and about 15 non-emergency patients. The first surgical patient had an emergency appendectomy.
The lead story on p. 1 of the News Journal on Jan. 28, 1985 gave extensive coverage to the challenges and success of opening day at Christiana Hospital.
“I was recently out shopping, still in my uniform wearing my badge, and a cashier who was checking me out said she recently had a baby at Christiana Hospital. She couldn’t say enough good things about the care she received, from the time she hit the door to the time she left the hospital. I don’t work in labor and delivery, but she saw me as a representative of Christiana Care and wanted to take the time to say thanks. That was awesome.”
“I remember riding by the empty field where the hospital was going to be. I couldn’t imagine what a big hospital would look like out there in the middle of nowhere! Today, it looks so much different than when the four original towers opened. I don’t use the front entrance very often, but when I drive by in front of the hospital, I still look over and am impressed and proud of where I work, and wonder how it can be that many areas still need more space!”
Toni Allen Medical Assistant II
Ken Love Blood Bank Manager
“I worked in the ED when Christiana Hospital opened. The biggest challenge was finding our way around. We had maps that we used to find our way to whatever room the patient was admitted to, which felt very strange at the time. Some of our patients would actually read the map and direct us as we drove the stretcher.” Arlene Bincsik, RN, MS, CCRC, ACRN, Director, HIV Program
“ We m ove d a l m o s t 1 0 0 b a b i e s a n d c h i l d r e n t h a t d ay. I t w a s a n u n f o r g e t t a b l e ex p e r i e n c e .”
“I was an ambulance driver at that time and helped move some of the first patients into the new hospital. It was an exciting time for all of us. We were all excited; every department was proud of their area and wanted to show it off to everyone.” Walter (Buck) Jones Telecommunications analyst
Today there are 899 Christiana Care employees with 25 or more years of service.
“I remember showing up at NICU at Wilmington General. Every nurse was assigned a preemie. We were told to get everything we would need for the next 24 hours. The ambulance crew started arriving, and the first infant and nurse were on their way, starting a caravan of emergency vehicles down I95 in a snowstorm. Everything just fell into place. We went from two separate nurseries to one large nursery.”
“The biggest challenge I faced coming here from the Wilmington General Division was getting supplies. Transportation was overwhelmed, so I made several trips back and forth with my best friend, Rose Holt, RN. We loaded my Chevy wagon and brought everything we could stuff in there back down here. Plus, if you waited for transportation and your supplies were left at the loading dock, they had a tendency to disappear. There were many times when I was the only person on the whole third floor. I miss that quiet!” Denise Scales MS RNC Nurse Manager 3B-3C
Barbara Marconi RN, BSN, OCN
Joan Phillips of New Castle, the first of our neighbors to give birth at Christiana Hospital, and baby Jared Phillips, leave the Labor & Delivery Unit with an entourage of volunteers and staff at discharge. Jared was a breach delivery performed at 11:11 a.m. by George P. Liarokos, M.D., who also delivered the last baby at Wilmington General 12 hours earlier. 10
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Diane McGovern, RN Christiana Surgical & Procedural Unit Olga Ward, RN Radiology Nursing Tom Kendle Supervisor, Patient Escort
Center for Heart & Vascular Health John H. Ammon Medical Education Center
Emergency & Trauma Center
Original hospital towers
Women’s & Children’s Health Services
Delaware Medical Relief Team brings help and hope to Haiti
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Medical Relief Team from Delaware, including many Christiana Care physicians, surgeons, registered nurses, physician’s assistants an emergency medical technician and administrative professionals, departed for Jacmel, Haiti on January 20. The team brought with them desperately needed medical supplies and have cared for many in dire need of medical attention. Delaware surgeons performed a range of operations, and their efforts were complemented by a team representing pediatrics, cardiology, neurology, internal medicine and mental health. Doctors without Borders, which has a long history of helping the people of Haiti, has made special note of the Delaware Team’s work. In a letter to Christiana Care President and CEO Robert J. Laskowski, M.D., the organization’s executive director, Sophie Delaunay, stated: “I wanted to recognize the tireless work your team on the ground has done in the past 10 days under incredibly difficult conditions. Undoubtedly, they have provided critical lifesaving care in the face of tremendous needs.”
Members of the medical/surgical team from Delaware (in blue t-shirts) load supplies aboard a Dominican Navy boat bound for Jacmel, Haiti.
Delaunay further expressed her belief that the Christiana Care staff and Doctors Without Borders “share the same ambition of ensuring the best possible medical care for the patients at St. Michel Hospital in the days, weeks, and months ahead.”
The News Journal/ Suchat Pederson
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Kamar Adeleke, M.D., and Lanny Edelsohn, M.D., tend to the uncle of Delaware team member Jean Baptiste.
The Delaware Medical Relief Team
Christiana Care Reynold Agard, M.D., internal medicine. Lester Horrell, M.D. pediatrician. Nadiv Shapira, M.D., thoracic surgeon. Steven Johnson, M.D., general surgeon. Lanny Edelsohn, M.D., neurologist. Scott Stevenson, surgical physician's assistant. David Brayfield, nurse technician. Erin Meyer, M.D., internal medicine and pediatrics. Susan Kaye, RN. Rose Valmond, nursing student (native of Jacmel). Denise Sanchez, RN. Richard Agard, prospective medical student. Joshua Wallace, MHA, mental health associate at Christiana Care.
Delaware Medical Relief Team members work with Haitian medical colleagues on one of their first patients.
Kamar Adeleke, cardiologist, (Christiana Care and St. Francis Hospital). John Brebbia, M.D., trauma surgeon (Christiana Care and Bay Health). Other members Ingrid Agard, medical administrator. Kern Agard, Philadelphia, emergency medical technician. Ava Horrell, medical stenographer. Cliford Francois, U.S. Army, Jacmel. native and brother of Rose Valmond. Jean Baptiste, native of Jacmel, cousin of Rose Valmond. Source: www.delawareonline.com
Lester Horrell, M.D., treats an injured two-month old baby.
IHI Open School places latest quality and safety resources at your fingertips
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hristiana Care health professionals have at their fingertips free access to the latest resources developed by national leaders in quality and patient safety. The Institute for Healthcare Improvement (IHI) Open School, an online curriculum, offers those at the patient bedside the tools to improve care and patient safety. ‘Taking a leadership role’ According to Brian Little, M.D., Ph.D., vice president, Academic Affairs and Research, “Nationally, Christiana Care has taken a leadership role in patient safety and quality improvement education. As an IHI Open School chapter, at the grassroots level, we have opened a forum for interested healthcare professionals to interact and help each other develop and improve their patient care skills.” System wide, the IHI Open School is a foundation for other ongoing educational programs, including Achieving Competency Today (ACT): Issues in Health Care Cost, Quality, Systems and Safety curriculum designed for nurses, residents and other health care
learners. Reinforces quality and safety culture “The IHI Open School is a unique interprofessional educational opportunity to reinforce our culture of quality care and patient safety,” explains
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Key personnel The chapter leader is Matthew Judd,
“The IHI Open School is a unique, interprofessional educational opportunity to reinforce our culture of quality care and patient safety. ”
Sharon Anderson, RN, BSN, MS, FACHE, senior vice president, Quality and Patient Safety. “The resources cater to a variety of learning styles and anyone can take the courses.” Current IHI resources include online modules covering leadership, quality improvement and patient safety. Additional offerings include case studies, activities and exercises, podcasts, videos, faculty-developed resources, discussion groups, peer networks, literature reviews and links to relevant web sites. A kick-off event held last October at Christiana Care featured national health policy expert David Nash, M.D., MBA, FACP. Since then, all ACT course facilitators and the Departments of Performance Improvement, Patient
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Safety and Accreditation, and Medical Libraries have committed their professional staff to completing the IHI modules.
D.O., an Emergency Department attending and administrative fellow. Dr. Judd iand chapter faculty advocate for chapter needs and provide input into the development of future curricula and networking opportunities. “For all of us here at Christiana Care, job 1 is to improve patient health. Job 2 is to improve how we do job 1,” Dr. Judd says. “The IHI Open School is a vehicle for us to continue to educate ourselves and build the skills necessary to do these jobs well.” IHI Open School chapter faculty advisors are Charles L. Reese, IV, M.D., FACEP, Patty Resnik, MBA, RRT, CPUR, Loretta Consiglio-Ward, RN, MSN, and Lee Ann Riesenberg, Ph.D., RN. For more information about the IHI Open School, contact Dr. Judd at mjudd@christianacare.org or log on to www.ihi.org/ihi.
Upcoming events Celebrate Wear Red Day Feb. 5. Wear red when you go out to a participating area restaurant and receive a free hearthealthy menu item. Fordetails, visit www.christianacare.org/wearredday. Organizers for National Nurses Week in May are challenging all creative, interested nurses to answer the fifth annual Critiquing A Research Article, Tell It In A Poster! contest, an opportunity for nurses to practice essential research skills while showcasing evidence in support of our science. Register now for workshops on mentoring nursses in research critique skills and professional visual presentation. Open to all nurses. Participation in one of the workshops not required. Registration for the workshops is available now via the Ed Center. Eighth Annual Delaware Sports Medicine Symposium at the John H. Ammon Medical Education Center, Saturday, Feb. 13. Features local sports medicine physicians lecturing on preventing and treating sports injuries and how to upgrade the level of care they provide to the athletes. Contact 302479-5515 or e-maildelfamdoc@comcast.net. Physician Relations workshops (all at the John H. Ammon Medical Education Center): n Feb. 22, “The Role of Hyperbaric Oxygen in Treating Dental Patients,” with presenter Joseph Spera, D.M.D., and “Head & Neck Sequelae of Childhood Cancer Treatment,” with Kendra S. Schaeffer, D.M.D. n Feb. 26, “Bloodborne Pathogens,” required annual training for all workers with reasonably anticipated occupational exposure to blood or other potentially infectious materials. Fee $20
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per person, $35 per office. Bagged lunch provided. Registration available through the Education Center. Call Physician Relations at 302-733-1961 email cklecko@christianacare.org to request additional information. The 7th Annual Clinical Pearls Day at Medical Grand Rounds is Thursday, March 4, at 8 a.m. in the John H. Ammon Medical Education Center auditorium, with video transmission to Room 8119, Wilmington Hospital.
Biometric health screenings reminder
The 2010 Christiana Care Delaware Marathon Running Festival Sunday, May 16, Tubman Garrett Riverfront Park, Wilmington, includes Delaware’s oldest and largest certified road-running marathon, a certified half-marathon, and a four-person team relay marathon. If you are interested in participating or would like more information, see www.delawaremarathon.org. A portion of the proceeds benefits the Center for Heart & Vascular Health. New this year
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Congressman Castle tours our world-class imaging facilities
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embers of Christiana Care's Inpatient Imaging team gave Congressman Mike Castle a comprehensive tour of our imaging facilities. Staff updated the lawmaker on the latest technologies and equipment, integration of the different imaging modalities, and our technologically advanced Picture Archival System, which enables specialists to remotely view images taken anywhere across the health system. Kert Anzilotti, M.D., chair of Radiology and medical director of Imaging Services (left), Senior VP, Cancer and Imaging Services Patrick Grusenmeyer (center), and Congressman Castle tour imaging facilities at Christiana Hospital.
From left, CT Tech Assistant, Sameerah Payne, Kert Anzilotti, M.D., Congressman Castle and Radiology Section Supervisor Cathy Brady discuss magnetic resonance imaging equipment.
Congressman Castle views high-resolution medical images with Radiology Program Director Michael Sneider, M.D., in the reading room at Christiana Hospital.
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Therapeutic notes
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roper medication ordering is the critical first step in the chain of events that lead to a patient receiving the appropriate medication. Medication orders include complete and accurate information to minimize the risk of a medication error and to avoid delays in initiating therapy. Over the past three months, omission of key elements of orders has been the number one reason for clarification of high-alert medication orders. Commonly seen errors include omission of the type of insulin within correction scale orders and omission of a frequency within opioid orders. Please review the following information and follow it in your daily practice of writing medication orders. A complete medication order for a Christiana Care Health System patient must be legible and include the following:
Medication name. Specific dose in metric system units whenever possible (there are appropriate exceptions such as Opthalmic solutions dosed in drops, or Heparin dosed in Units). n Dosage form, including the concentration, when appropriate frequency and route of administration. n n
n Purpose or indication for all as needed orders (recommended for all medication orders). Instructions for administration n Prescriber’s signature and printed full name and/or identification number. n Prescriber’s contact information, telephone or pager number. n Date and time order written. The need for clarifying incomplete medication orders can result in significant delays in medication use. A number of steps are involved when an order is identified as requiring clarification. If the signature is not familiar or legible to the pharmacist, then he/she must contact the nurse to assess who wrote the order and then page or call the prescriber. At times, the original prescriber is not available (nights and weekends especially). In this situation, the covering physician would be contacted, who may not be familiar with the patient’s condition(s) and orders. The outcome is often a delay in the delivery of the intended medication(s). Remember to avoid using unacceptable abbreviations, some of which are listed below.
Following these processes can help ensure patient medication safety and timely medication administration.
A strategy for quitting tobacco without gaining weight
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ne of the biggest concerns expressed by smokers who want to quit is the fear that they will pack on the pounds when they toss their cigarettes. In truth, gaining weight is a possibility. But, hey, extra poundage is not always a side effect of quitting. So don’t let that deter you from giving Try sweet and crunchy baby carrots and plain popcorn as snack substitutes. up tobacco and gaining a healthier life. And even if an ex-smoker does put on That’s OK, as long as the snack is a frozen fruit bar weight, the benefits of a smoke-free life still outinstead of rocky road ice cream. weigh putting on a few pounds. Set yourself up for success by stocking the fridge Why the weight gain? with healthy choices. Go to the grocery store and buy a big bag of baby carrots. They are crunchy Several scientific reasons explain why some people and sweet—and good for you. gain weight after kicking the habit. First and foremost, your senses of taste and smell are no longer muted by tobacco. So you can taste your mom’s wonderful spaghetti sauce again. You can smell the bacon frying. Also, many smokers who are in the process of quitting eat to excess in an attempt to suppress their craving for nicotine. Giving up smoking is a stressful process—and lots of folks munch when they feel anxious or overwhelmed. Still, the fact is that giving up tobacco does not cause weight gain. Extra pounds are the result of extra calories. It’s that simple. Although different people have different metabolisms and exercise regimes, the general rule is that women should consume about 1,200 calories per day if they are interested in losing weight. Men should eat about 1,500 calories per day. But don’t focus on counting calories. Your priority is to not smoke. Pick the right snacks Lots of people who are in the process of quitting reach for a snack when they get the urge to reach for a cigarette.
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So, orange isn’t your color? Buy apples, celery or other fruits or veggies you enjoy. Other snacks you might want to add to your shopping list: wholewheat crackers, low-fat cheese, sugarless candy and gum. Potato chips? No! But plain popcorn is a low-fat, low-calorie alternative. Exercise helps to keep cravings for both tobacco and food at bay. It’s hard to ride a bike and light a cigarette, right? Ditto for pedaling while munching a burger. Down the road, many former smokers say they crave exercise and healthy foods—even more than they craved smoking. We’re here to help Christiana Care is here to help smokers quit, every step of the way. Employees can receive free, one-on-one counseling and medications at no charge through Employee Health. To learn more, call the Tobacco Cessation hotline at 302-733-1878. You also can contact the toll-free Delaware Quitline at 866-409-1858.
Virginia U. Collier, M.D., FACP honored for service to Medical Society of Delaware
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force behind continuing medical education in Delaware, Virginia U. Collier, M.D., FACP, Hugh R. Sharp Jr. Chair of Medicine at Christiana Care, is leaving her post as chair of the Public and Professional Education and Advocacy Committee of the Medical Society of Delaware. She has held the post for nearly two decades. Radiologist Martin Begley, M.D., is nominated to succeed her as chair. When the Medical Society of Delaware became a nationally accredited sponsor of Continuing Medical Education (CME) in the late 1980s, the organization chose Dr. Collier to lead them through the arduous application process with the Accreditation Council (ACCME). “We were successfully awarded this status in the early ‘90s,” recalls Executive Director Mark A. Meister Sr. “We have been fully reaccredited every four years since. We owe a great debt of gratitude for all Dr. Collier has done over the years to make it possible for the Society to provide quality, timely and affordable continuing medical education in Delaware.” Brian Little, M.D., Ph.D., Christiana Care vice president of Academic Affairs and Research, has worked closely with Dr. Collier for many years as vice chair of the Committee. “Dr. Collier’s dedication to all the hospitals and physicians was remarkable as she developed the down-state lecture series, always ensuring that every program in the state received adequate attention,” he recalls. “The continuing professional development of physicians is critical to improving the health of Delawareans. While physicians have multiple methods of continuing their medical education, the importance of accredited CME in Delaware cannot be underestimated.”
Recently, Dr. Collier took time out to share some reflections on her service to the Public and Professional Education and Advocacy Committee, 1990-2010.
Q. What is the committee’s role? A. The committee’s main responsibility is to run the Continuing Medical Education (CME) program of the Medical Society of Delaware. This program exists to ensure that the CME activities offered to physicians in the state meet the highest standards of the ACCME. The committee accredits these activities on behalf of the ACCME, and physicians who attend are able to earn CME credits, which are required for renewal of licenses in the state of Delaware.
Q. Your most significant contribution? A. Working to ensure that the Medical Society has the resources to adequately evaluate and accredit the majority of the CME activities in the state and to meet the ever-increasing requirements and standards of the ACCME.
ment by a broader group of members from New Castle County as well as southern Delaware.
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Recommendations?
Expand staff and infrastructure at the Medical Society to meet the increasingly stringent requirements of the ACCME, particularly with respect to demonstrating that accredited CME programs positively impact patient outcomes.
Q. Do you plan to continue serving in some capacity? A. I will always be available as a resource and will continue to be an active member of the Medical Society. I think it is important, however, for other Medical Society members with an interest in CME to become involved in the work of the Committee and other Medical Society activities.
Q. Important milestones? A. After rigorous reviews, earning ACCME accreditation in 1992 and then reaccreditations in 1996, 2000, Dr. Virginia Collier receives a plaque commem2004 and most recently in 2008. orating her service to the Public and Q. Has the committee changed Professional Education and Advocacy Committee, presented by Medical Society of or evolved during your tenure? Delaware President Nicholas O. Biasotto, D.O. A. We are seeking greater involve- (left) and Executive Director Mark A. Meister Sr.
Cafeterias switch to ecofriendly dinnerware
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hristiana Care Health System’s Waste Management team is partnering with Peninsula Compost Group in Delaware, which has built a state-of-the-art compost site in Wilmington.
means our products will break down in 45 days. Peninsula Compost Group soon will start accepting our food waste, too, so we’ll be composting at 100 percent.”
“Anything that can’t be eaten will end up as incredibly organic soil,” says Food and Nutrition Services Corporate Director Maureen Simpson-White. "We are not throwing anything away.”
Cafeterias adjust pricing
Styrofoam and plastic items are being replaced by items made of material that breaks down at the same rate as paper. Although many companies refer to their products as “biodegradable,” it’s not the same as the new material we’re using, Simpson-White explains.
“Our new point-of-sale system allows us to adopt a two-tier price structure that reflects the true cost of the food— the visitor’s price—and an employee price that will be about the same as what exists today,” says Maureen Simpson-White, corporate director, Food and Nutrition Services.
“Biodegradable products might take 100 years to break down,” she says. "We want to adhere to a more rigid standard, which
Wilmington and Christiana Care cafeterias have implemented two pricing levels: one for visitors and one for employees.
Did you know? The cafeterias now accept credit cards.
Christiana Care Executive Chef Andy Snapp and Corporate Director of Food &Nutrition Services Maureen Simpson-White display examples of new plates, bowls, containers and plastic wares that break down to compost 45 days after disposal.