Focus: May 20, 2010

FOCUS Delaware Health Science Alliance powers bench to bedside medical research

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he 2nd annual Delaware Health Science Alliance (DHSA) research conference hosted by Christiana Care showcased new opportunities to enhance collaborations and reinvent health care.

The May 4 event at the John H. Ammon Medical Education Center featured Christiana Care President and CEO Bob Laskowski, M.D., Gov. Jack Markell, and other regional and national leaders in health care and research.

Transformation Nurse navigators guide heart-failure patients

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OB emergency response team 3 Nursing specialty certification 4 Nursing Excellence Awards

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News Delaware Marathon: A day to remember

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Gift of Life program wins honors

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State Trauma Symposium

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Proper disposal of pharmaceuticals

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DHSA leaders, from left, UD President Patrick Harker, Robert J. Laskowski, M.D., Delaware Gov. Jack Markell, DHSA Executive Director Kathleen Matt, Thomas Jefferson University President Robert Barchi, and Nemours CEO Tom Ferry.

The DHSA partner institutions—Christiana Care, Alfred I. duPont Hospital for Children, Thomas Jefferson Medical College and the University of Delaware— focus on developing world-class health care education, interdisciplinary research and quality health care delivery through the expertise and resources of its member organizations.

“In true Delaware fashion, we formed a partnership that has the creativity of four very different but complementary organizations to focus on caring for our neighbors. To do that effectively, we need to be well-educated and wellinformed. We also need creative ideas, and those are embedded in the fabric Driving medical research Christiana Care aims to help Delaware of the DHSA.” and the surrounding region drive Gov. Markell helped kick off the conmedical research from discovery to ference by pointing out the regional delivery and ensure innovation. economic impact of DHSA. Dr. Laskowski says he is repeatedly “When it comes to innovation, workasked when he is going to build a force development and science and medical school in Delaware. technology, this alliance just has it "I always reply, 'We already have one, nailed,” he says. “Efforts like this don't start with the government; they at Thomas Jefferson [University, start with people who have not only Philadelphia],'" he says. “In the past two years, that relationship has turned tremendous vision, but also the ability to execute.” into so much more.

Visit the Flickr Gallery on Christiana Care’s website for more conference photos.

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R A N S F O R M AT I O N

Heart failure nurse navigators guide patients through care After discharge, a clinical nurse navigator follows up with each patient by phone within 72 hours.

“This contact is important,” says Joanne Matukaitus, RN, MSN, director of Cardiovascular /Critical Care Patient Care Services.

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eart failure patients have a new ally. Clinical nurse navigators are joining the Christiana Care Heart Failure Program this spring.

Specially trained registered nurses now guide heart failure patients through the care and resources they need while in the hospital and follow up with them after discharge to avoid readmission.

No. 1 diagnosis in Medicare “Heart failure is the number one diagnosis among Medicareeligible patients admitted to the hospital for cardiovascular care,” says Heart Failure Program Medical Director Mitchell T. Saltzberg, M.D. Too often, patients who return home face readmission within 30 days.

“Heart failure is a complex illness that often requires specialized care, testing, procedures and multiple consults by a variety of health professionals,” Dr. Saltzberg says.

“Coordination of care and services by a clinical nurse navigator facilitates a shorter length of stay and a smoother transition to outpatient care. The nurse navigator is an advocate to ensure that patients’ needs are met in a timely and coordinated fashion.”

Upon admission, Heart Failure Clinical Leader Carolyn Moffa, FPN, MSN, pairs heart failure patients with a clinical nurse navigator to show them the ropes. “During the inpatient stay, we identify and assess the risks

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FOCUS May 20, 2010

Patti Christopher, RN, reviews heart failure education with a patient on 5E.

for readmission and work with each heart failure patient to address any barriers to a successful transition from hospital to home.”

Nurse navigators as liaisons In the hospital, clinical nurse navigators are liaisons between patients and their family members with physicians, therapists, case managers, social workers and other members of the health care team. They provide education and answer questions about medications, nutrition, activity, and weight and fluid monitoring, extending the opportunity for patients to learn to self-manage their chronic illness before discharge.

“We want to make sure patients have the right medications in compliance with doctor’s orders and that they schedule a follow-up appointment within one week of discharge at the Heart Failure Clinic or with their private physician,” she says.

Encourages outpatient follow-up This follow-up encourages patients to seek outpatient treatment early and as needed to maintain their independence and quality of life and to avoid readmission to the hospital.

“We recognized that the ability of patients to see their doctors quickly after a hospital discharge can significantly reduce the chances that the patient is readmitted to the hospital,” Dr. Saltzberg explains. “The Heart Failure Program is committed to ensuring that adequate services are available for heart failure patients to have the best hospital experience, a well-coordinated discharge and timely follow-up in the community.”

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Emergency response team acts quickly in obstetrical crises

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n obstetrics, a crisis can loom at any time.

At Christiana Care, expectant mothers in peril receive care within minutes, thanks to the Obstetrical Emergency Response Team (OBERT).

Instead of going through traditional escalation steps, OBERT brings immediate help to obstetricians and nurses responding to such conditions as shoulder dystocia, hemorrhage and fetal distress.

“Things can deteriorate quickly in obstetrics, and many problems can’t be predicted,” says Matt Hoffman, M.D., MPH, director of the Division of Education and Research. “With OBERT, we often are able to intervene before something becomes a full-blown emergency.”

Responds wherever needed The team has responded not only to cases in Labor and Delivery and maternity units, but also to the Emergency Department—and, on one occasion, the hospital parking lot.

“OBERT brings our expert personnel to the patient’s bedside for an obstetrical emergency within minutes,” says Dot Fowler, MSN, RNC, director, Patient Care Services, Women's and Children's. “It’s available 24 hours a day, seven days a week for any obstetrical patient at Christiana Hospital.”

Launched here in September 2009, the concept is based on a model developed at the University of Pittsburgh.

Developed presentation In March, the Christiana Care team was invited to present the OBERT story at the Quality Improvement Initiatives in Obstetrical Care Forum at the Obstetrical Society of Philadelphia, one of the oldest OB/GYN educational groups in the nation.

Christiana Care is one of the highest-volume health systems for births in the Mid-Atlantic region.

Currently, more than 7,000 babies a year come into the world at Christiana Hospital, born to a widely diverse population of parents.

“As a high-risk obstetrical referral in Delaware, we take care of very complex patients, and this is another part of our safety net,” Dr. Hoffman says.

OBERT team members Cynthia Fowser, RN, Gregory W. Demeo, D.O., Jill Mahone, RN, Adeyinka Reid, RN, Valerie Pappa Gray, RN, and Lori Smith, RN stand ready to intervene in obstetrical crises.

Delaware Marathon volunteer appreciates urgent care received Kerry Wilson, a pregnant volunteer at the Delaware Marathon May 16, started having contractions during the race and went to Christiana Hospital. She sent this note to Christiana Care Vice President, Emergency, Trauma & Aeromedical Services Linda Laskowski Jones.

Linda (and team), Hi. I was the pregnant volunteer at the race on Sunday. I just wanted to send a thank you to you and your team for all of their help on Sunday. I really am glad you made me stay put and go to the hospital. Your training, knowledge, and attentiveness really came through and I very much appreciated it! Turns out that I was indeed having contractions (low intensity but high frequency) 2-3 min apart. So they set me up with some IV fluids, a shot to stop the contractions, and a steroid for the baby’s lungs in case she did come early. I was not dilated luckily. Went to the regular ob yesterday morning and they sent me to our hospital in PA as well for monitoring. Was 1-2 min. apart contractions! YIKES! So now I’m on bed rest, no more volunteering or anything until this little one comes. So very happy to have caring and attentive people working the medical tents at races.

Thank you again so much for your care and support!

It’s Magnetic!

“Forces of Magnetism”

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hristiana Care invites all departments, units and teams to participate in the 2010 Annual Focus on Excellence Awards (FOE) program.

It’s time to share projects that demonstrate improvement in process or outcomes.

To get started, complete an online letter of intent on the portal

by June 4.

Key dates: n

June 15: DRAFT abstract due.

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Aug. 20: FINAL abstract and presentations due.

Oct. 17-22: FOE Exhibition in Room 1100, Christiana Hospital and outside the Wilmington Hospital cafeteria.

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Nov. 18: Awards celebration.

The FOE Awards: Provide an opportunity for formal team recognition. n

Foster departmental and subsidiary performance improvement efforts, teamwork and integration. n

n Encourage interdisciplinary, interdepartmental and inter-subsidiary participation on projects to enhance relationship-building, organizational learning and integration. n Reinforce use of PDCA (Plan-DoCheck-Act) as a performance improvement model. n Educate staff about ongoing efforts to improve clinical and service quality and safety. n

Position Christiana Care for external recognition as a quality leader.

4: Personnel Policies and Programs 5: Professional Models of Care 6: Quality of Care 14: Professional Development

Policy breaks down barriers to nursing specialty certification and renewal

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hether to pursue a speciality certification or not is a decision faced by many nurses in their path of professional development. Nurses achieve and maintain nationally recognized certification through hours of clinical practice and passing a rigorous exam. Certification validates a nurse’s knowledge in a speciality area.

Christiana Care is committed to helping nurses begin this journey.

We now offer more review courses on campus and prepayment options for courses and initial exams through Patient Care Services Education within the Department of Nursing, as well as certification renewal (as outlined in Patient Care Services Policy #300).

Eliminate barriers “We want to eliminate any barriers to obtaining nurse certification,” says Tamekia Thomas, MSN, RN, PCCN, critical care education coordinator.

“Achieving certification is an important step in a nurse’s commitment to higher standards and better patient outcomes.”

Earlier this year, Christiana Care achieved Magnet® recognition for excellence in nursing by the American

Nurses Credentialing Center (ANCC).

Only 6 percent of U.S. hospitals have earned this honor, the highest level of national recognition for sustained excellence in nursing care.

Goal is 25-percent increase As of March 2010, 934 nurses--fewer than one-third of the nurses at Christiana Care--were certified. Our goal is to increase the number of certified nurses by at least 25 percent during the next three years.

During May, nursing certification review courses in gerontology, medical-surgical and CCRN/PCCN/ CEN will be offered on campus, and more courses are planned.

Obtaining and maintaining a professional certification takes commitment and dedication.

“The preparation necessary to achieving certification is hard work, and we are trying to make the process seamless for our nurses by eliminating any perceived barriers,” Thomas says.

For more information about certification, visit the Nursing Certification website on the Nursing Portal under Education.

NATIONAL NURSES WEEK

2010 Annual Nursing Excellence Awards Direct Care Frances Baker, RN - Wilm ED Danyell Bishop, RN - 4D Catherine Bloss, RN - 5A Patty Bracken, RN - 7E Maria Brown, RN - TSU Sarah Burcham, RN - 6B Colleen Callahan, RN - 5A Lynda Cavanagh, RN - 3D Babin Chandran, RN - 5E/W Gabriella Collins, RN - Operating Room Heather Corrado, RN - 3W Terry Craig, RN - Wilm ACE Unit Janice Crispin, RN - Virtual ICU Barbara Dean, RN - NICU Tom Desper, RN - 2C Brenda DiSabatino, RN - 6A ACE Alana Downs, RN - 4C Sharon Ennis, LPN - 3B Tracie Farmer, RN - CDU Suzanne Fischer, RN - IV Barbara Foote, RN - 3B Angela Forese, RN - 3W Josh France, RN - 5E Mary Gallagher, RN - VNA Adeyoyin Gbadamosi, RN - 4E Shirley Gharbin, RN - 4E Ashley Gleber, RN - Wilm OR Jackie Grau, RN - MICU Barbara Griffin, RN Beth Gunther, RN - PACU Mary Harrington, RN - 5C Amanda Hill, RN - 4E/W Dianne Holleran, RN - Labor & Delivery Emily Joyner, RN - 4C Ann Kaiser, RN - CH EAU Jennifer Keith, RN - WH OR Kathleen King, RN - 6N/S Kim Manley, RN - HVIS Kristina McCarthy, RN - 6B Deborah McCracken, RN - HVIS Elizabeth Mitchell, RN - Surgicenter Daphne Mullett, RN - 3A

APNs

Non Direct Care

Marilyn Bartley Trauma Program

Mary Ciechanowski Helen Jackson Stroke Parent Education

PCC - MICU

Nurse Manager, 6E

Educator

Beth Donovan Gwen Ebbert Wound Ostomy SDS, 4D Continence

Partners of Nursing - Patient Escort Jaime Murray, RN - Hemodialysis Jolene O’Neill, RN - Per Diem Linda Papa, RN - SPU Geraldine Pelensky, RN - Wilm ED Susan Penta, RN - WH Surgical Service Brittany Powers, RN - 5D Dionne Price, RN - 4E/W Kim Proctor, RN - CVICU Lea Purcell, RN - WH ICU Alison Purner, RN - 5B Jaclyn Rehm, RN - 5B Susan Reynolds, RN - 4A Andrea Riley-Desgouttes, RN - 4S Olivia Ringer, RN - SCCC Linda Roderick, RN - CICU David Salati, RN - CHR ED Lindsay Sanderson, RN - 4D Eva Smith, RN - 6E Lori Smith, RN - Labor & Delivery Dreama Szutenbach, LPN - VNA, Camden Dawn Todd, RN - 3 Surgical Tracy Townsend, RN - GI Lab Judith Tozzoli, RN - CH Surgicenter Jennifer Vansant, RN - VNA, New Castle

Cheryl Wade, RN - MICU Loretta Walls, RN - VNA, Camden Kim Watson, RN - CVICU Deborah Willeford, RN - CHR ED Darla Winstead, RN - WH Post Anesthesia Jeanna Wood, RN - SCCC Advanced Practice Marilynn Bartley, RN, MSN - Trauma Program Mary Ciechanowski, RN, MSN - Stroke Educator Gwen Ebbert, BSN, RN-BC - SDS, 4D Kim Berl, RN - SDS, 5 E/W Non-Direct Care Beth Donovan, RN, MSN - Wound Ostomy Continence Helen Jackson, RN, BSN - Parent Education Leadership Eileen Evangelista, RN, BSN - PCC, MICU Connie Jordan, RN-BC- Nurse Manager, 6E Partners of Nursing Patient Escort

Brian Little, M.D., Match program fills all Ph.D., named residency programs openings chief academic officer hristiana Care had a very sucThomas Jefferson and Philadelphia

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rian W. Little, M.D., Ph.D., has been named Christiana Care’s chief academic officer.

Since joining Christiana Care in 2000 as vice president of Academic Affairs, Dr. Little has established a culture of excellence, helping Christiana Care Brian W. Little, M.D., Ph.D. achieve regional and national prominence in education and research.

Our thriving graduate medical education programs, now totalling more than 250 residents, bring doctors in training from throughout the nation to Delaware. With the help of his leadership, Christiana Care has: n Promoted interdisciplinary education. n new programs in cardiology, sports medicine and nephrology. n Launched Achieving Competency Today, an education program nationally recognized for innovation in hospital-based education. n Guided the transformation of the clinical and translational research activities of Christiana Care from a focused effort in clinical trials to a broad-based enterprise with numerous federal and private grants and contracts and international research—culminating in the establishment of the Delaware Health Sciences Alliance. n Helped numerous faculty members develop collaborative research projects with the University of Delaware/Delaware Biotechnology Institute, Thomas Jefferson University, A.I. DuPont Hospital for Children and other institutions.

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cessful residency match program this year.

“We have accepted 90 graduating students and residents into our allopathic residencies and fellowships, osteopathic residencies, pharmacy, podiatry, dentistry and oral maxillofacial surgery residencies,” says Brian Little, M.D., Ph.D., Chief Academic Officer.

College of Osteopathic Medicine head the list with eight and 10 new residents, respectively.

Drexel, Temple, Maryland and Virginia Commonwealth have sent us at least three new residents.

More than 40 other Universities from Florida to Vermont, and as far west as Iowa and Michigan are represented.

Roger B. Thomas Memorial Lecture Faith T. Fitzgerald, M.D., MACP, (above left, with Virginia U. Collier, M.D., Hugh R. Sharp, Jr. Chair of Medicine), delivered the 5th Annual Roger B. Thomas Memorial Lecture, sponsored by the Department of Medicine at Christiana Care. Dr. Fitzgerald, a professor of Medicine and associate dean of Humanities and Bioethics at University of California, Davis School of Medicine, presented a lecture, titled “The Virtual Patient.”

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Wound Care team earns Center of Distinction Award

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hristiana Care’s Center for Wound Care and Hyperbaric Medicine received a Center of Distinction Award from the nation’s leading wound care management company, Diversified Clinical Services.

The award recognizes high patient satisfaction rates, exceptional healing results, and outstanding clinical outcomes over the past twelve months.

For more details on the award, visit www.diversifiedcs.com.

Nada Raiser (left), area vice president Diversified Clinical Services, Jacksonville, Fla., presents Diversified Clinical Services’ Center of Distinction Award to Nicholas O. Biasotto, D.O., medical director of Christiana Care Wound Care Center, and Wound Care Center Director Adrienne Abner.

Focus on Excellence – Best Practice Review – May 2010 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.

SPECIMEN LABELING Q. What is the Best Practice for verifying the correct patient and collecting specimens for clinical testing?

A. . The best practice is to identify the individual as the correct patient and to MATCH the service or treatment to that patient. This includes collection for blood, urine, stool, sputum, and specimens from procedures.

BEFORE COLLECTION: Compare patient ID label with lab requisition/order using two unique identifiers.

Take specimen label and specimen container to bedside Compare patient ID band with the specimen label using two unique identifiers, and then collect the specimen AFTER COLLECTION and BEFORE LEAVING THE ROOM: Place your initials, date, and time of collection on the label In the presence of the patient, place the specimen label on the container If the patient collects the specimen himself (urine collection), it is to be handed to staff and labeled immediately in front of the patient BEFORE SENDING: Compare the labeled specimen with the lab requisition using two unique identifiers, and then bag the specimen and requisition.

To ask questions, contact the content expert: Kathleen Gorczyca - 733-3627. To reach the Safety Hotline, call SAFE (7233) from within Christiana or Wilmington hospitals. From outside the hospitals, call 302-623-SAFE. Further information is available on the portals in the Archives of Best Practices. From your portal, choose Focus on Excellence, Joint Commission Readiness, Ongoing Strategies, Educational Strategies, Monthly Q&A.

Strong home-health-care link to health system benefits all

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t the Visiting Nurse Associations of America annual meeting in April, Lynn C. Jones, FACHE, president of Christiana Care Visiting Nurse Association (VNA), said VNA nurses benefit greatly from being associated with a local health system.

His presentation centered on the advantages of working together, both for the organizations and for the communities they serve. Jones addressed historical drivers toward affiliation, differing mind sets of hospital and home health agencies, and how the two worlds are converging within today’s health care reform.

Lynn C. Jones, FACHE

Key benefits of collaboration include:

n Shared planning for health care reform challenges. n Reduced avoidable hospital readmissions. n

Enhanced clinical programming.

n Improved communication and transitions across the care continuum. n

Higher patient satisfaction.

n Increased opportunities for palliative care.

CEOs from VNAs in Rhode Island, Connecticut and Maine joined Jones in sharing their successful experiences.

Most VNAs operate independently, without benefit of health system affiliation.

GET HELP WITH TOBACCO CESSATION

National expert on autism lectures John B. Moeschler, M.D., director, Clinical Genetics, Division of Genetics and Child Development at Dartmouth-Hitchcock Medical Center, lectured on recent research into the genetics of autism at the John H. Ammon Medical Education Center in April.

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VNA shares transformational ideas at national gathering

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hristiana Care Visiting Nurse Association colleagues visited the annual meeting of the Visting Nurses Association of America in April, bringing some of their proudest accomplishments of the year to share.

One of the projects was an orientation and continuing education program developed to prepare private duty nurses to provide quality care for medically complex patients.

Education and preceptor support

“Private Duty Nursing: The Journey from Novice to Expert,” a presentation

by Suzanne Butler, RN, BSN, Cleveland Cartwright, RN, and JoEllen Workman, RN, MSN/HAS, detailed VNA’s ongoing education and preceptor support program to prepare private duty nurses for treating medically complex patients at home.

Typically, the patients are under age 21 and ventilator dependent, who require eight to 16 hours of skilled service every day.

VNA’s Private Duty Nurses have provided care to our community

At the annual Visiting Nurse Association of America meeting, from left, Andy Carter, president and CEO of the VNAA, Gale Bucher, RN, MSN, COS-C, VNA COO Rhonda Combs, Mary Nordenson (Delaware Physicians Care Insurance), Suzanne Butler, RN, BSN (VNA Private Duty), Cleveland Cartwright, RN, (VNA Private Duty), and Lynn C. Jones, president of Christiana Care Visiting Nurse Association.

(statewide) since 1988. However, a shortage of qualified nurses has led to significant discharge delays from acute care settings for these patients.

VNA’s new program offers:

It’s Magnetic!

n Classroom training and an assigned preceptor for each student n

“Forces of Magnetism” Force 10: Community and the Health Care Organization

Annual competency labs

n Ongoing support from a supervisor, clinical coordinator, case management and office staff.

Results of their endeavor include increased nurse satisfaction and retention, and staff expansion to accommodate additional patients.

The number of qualified private duty

nurses increased 28 percent with 76 newly hired nurses from July 2007 to July 2009.

“Partnering with a Managed Care Organization to Improve Heart Failure Patients” presented by Gale M. Bucher, RN, MSN, COS-C, Rhonda Combs, RN, MSN, Lynn C. Jones, MHA, FACHE, and Mary Nordenson, RN, BSN, MHM, illustrates how home telemonitoring improves outcomes in heart failure patients and reduces rehospitalization and emergency room encounters. Pre and postfinancial information showed significant cost savings to insurance companies (up to 85 percent) by aligning with home care agencies to deliver telehealth.

Celebrating our Magnet status n her comments announcing Magnet status for Christiana Care, Gail A. Wolf, DSN, RN, FAAN, chair, Commission on Magnet Recognition, summed up the magnitude of the accomplishment.

COMPLIMENTARY MEAL SCHEDULE

“People think Magnet is about nursing, but it is really totally about patient care,” Wolf said. “From [the boardroom] down through the CEO to everyone that lays hands on patients, to the security staff and volunteers who greet people at the door, every single person is a player.

Wilmington campus – June 3

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“I want to make sure that all of the people that contributed to this are recognized for the enormous gift that they brought to the table for patients.”

As part of our Magnet celebration, Christiana Care is offering a complimentary meal for all employees. The meal is way to thank the entire Christiana Care team for dedication and hard work for achieving Magnet recognition this year.

Christiana Hospital – June 2 Lunch - 10:30 a.m.-1:30 p.m.

Dinner - 4-7 p.m.

Midnight shift meal - midnight-3 a.m.

Lunch - 11 a.m.-1:30 p.m.

Dinner - 5-6:30 p.m.

Boxed meals for midnight shift at Wilmington campus may be picked up from the kitchen after 4:30 pm June 3.

Boxed take out requests for Christiana and Wilmington are available for staff who are unable to leave their post during the scheduled serving times.

Christiana) (cafeteria kitchen for Wilmington) the morning of the event.

Please e-mail Ann Marie Phillips for Wilmington or Mike Frawley for Christiana Hospital by May 25 with the number of boxed meals needed.

Selection will be Barbecue Chicken or Vegetarian.

The cafeterias at Wilmington and Christiana Hospital are closed for breakfast on the morning of the Magnet celebration (June 2 for Christiana and June 3 for Wilmington) so staff can prepare for the event.

The coffee shops open at 6:30 a.m. on June 2 (Triangle Room Christiana) and June 3 (Whirling Top Wilmington) to serve early breakfast.

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Delaware Marathon: A day to remember

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ny medical team volunteers who expected a hohum kind of day at the May 16 Delaware Marathon sponsored by Christiana Care were surprised by the 34 patients seeking aid in their medical tent.

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Christiana Care President and CEO Bob Laskowski, M.D., with Wilmington Mayor Jim Baker, speaks to neighbors at the race.

Equipped with event radios for emergency communication, the team rotated coverage of the medical tent, finish line and the relay race transition area.

“We had a truly amazing day,” says Linda Laskowski Jones, RN, ACNS-BC, CCRN, CEN, MS, Christiana Care vice president, Emergency, Trauma & Aeromedical Services.

2-way radios kept everyone informed.

The team, which included nine nurses from Christiana and Wilmington emergency departments, seven physicians and an EMT from Christiana Care’s Medical Reserve Corps, were supported by EMT's from the City of Wilmington nad New Castle County paramedics with their mobile command unit and bicycle patrol.

The most emergent care rendered was to a 50-year-old marathoner who went into cardiac arrest at the finish line.

Revived with CPR and a single shock from an Automatic External Defibrillator, the patient was accompanied by medics and Emergency Medicine Resident Julie Silverman, M.D., to Christiana Hospital, where he survived “fully intact,” Jones says.

Look in a near-future issue of Focus for a feature story on the patient who survived cardiac arrest at the finish line.

Jones says the team also managed: n A male marathon runner with chest pain who had ischemia and was sent to Christiana Emergency Department. n A pregnant event volunteer who was having severe abdominal pain (later confirmed to be contractions).

Linda Laskowski n Cases of severe respiratory distress, exhaustion/hypoJones treats a glycemia, leg cramping and agitation, knee abrasions, and one runner’s case of a missing relay race athlete whose disappearance skinned knees. n

A runner who broke a leg at the finish line.

distressed his three teammates.

“I received wonderful feedback from the marathon organizers regarding our overall set-up and operations,” Jones says. “It was exhilarating to be a part of the great teamwork that we shared. I especially want to thank Tony Reed, M.D., who has worked with me for the past few years in coordinating this medical team event.”

Overheated runners get help cooling off.

Professor turns homeward for Guillain-Barré syndrome care

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ometimes quick intervention and treatment make all the difference.

At least Professor Peter Caws thinks so.

body,” says Laura Michelsen, DPT. “He was an active participant in therapy and he questioned the value of every exercise we suggested. This ownership of his therapy regimen, combined with seeking medical treatment early, facilitated his quick recovery,” she says.

Caws, a professor at George Washington University, experienced a sudden onset of Guillain-Barré syndrome (GBS) last October while in Washington, D.C. It began with strange sensations in his feet one evening, and by morning he could hardly stand or use his hands. Double vision would follow. “I was completely helpless,” he says.

Guillain-Barré syndrome is a neurological disorder characterized by ascending paralysis. Loss of motor function begins in the peripheral nervous system and is marked by weakness in the legs, arms and upper body.

Without treatment, symptoms increase in intensity until muscles, including respiratory muscles, become paralyzed. Typical recovery from GBS can take up to a year.

Wanted to be close to home While colleagues recommended he seek medical attention in nearby Baltimore, Caws returned to Newark instead. “I did not want to be hospitalized far from my family, and hurried back to be admitted to Christiana Hospital,” he says. Decisive action by his neurologist rapidly brought Caws’ symptoms under control.

Aggressive therapy achieves big gains Following a seven-day stay at Christiana Hospital, Caws was transferred to the Center for Rehabilitation at Wilmington Hospital for physical

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“One doesn’t realize that just standing up employs visual, muscular, and neurological cues,” says Professor Caws.

“It was humbling to have to think ‘where are my feet’ before beginning to walk. I have great respect and admiration for the careful but challenging exercises my [therapy] team developed,” Peter Caws, Ph.D.

and occupational therapy. On arrival he was unable to walk. Repositioning and transferring required two-person assistance because he was so weak.

Even simple activities such as eating and dressing were difficult.

Caws received aggressive therapy three hours per day. Physical therapy treatment targeted his individual need for balance, gait and transfer training; as well as exercises to strengthen his core and upper and lower body. It also incorporated customized activities necessary for his commute to Washington and his return to teaching.

Occupational therapy focused on restoring fine motor coordination and independence with activities of daily living.

“Mr. Caws is very in tune with his

After one week of therapy, he was walking independently with a walker and able to go up and down a full flight of steps without assistance. His sitting and standing balance improved dramatically, and he regained self-sufficiency with daily activities. Caws was discharged and returned to teaching two weeks later.

No better place for treatment Today, Caws has resumed his active lifestyle. He teaches full-time, exercises with a personal trainer and maintains an active social life with his wife. “I was just amazed by the quality of care [at Christiana Care]. I count myself extraordinarily lucky to have been the object of such high level professional attention, prompt treatment and skillful therapy. I could not have received better care anywhere in the country,” he says.

Vigneau named senior Christiana Care honored for vice president, Heart leading role in Gift of Life program & Vascular Health

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he Philadelphia Chapter of the Gift of Life organ donor program presented a plaque to Christiana Care to recognize Christiana Care's leading role in the program.

More than 42 families have donated 100 organs for transplant through Christiana Care, which is the leading health care facility for transplant donations to Gift of Life's Philadelphia chapter.

Penny Vigneau, MSW, MBA

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enny Vigneau, MSW, MBA, has been appointed appointed senior vice president of the Center for Heart & Vascular Health.

Vigneau earned her masters degree in social work from West Virginia University and her MBA from the University of Chicago.

She joined Christiana Care as vice president in 2005. Since then, she has led the numerous transformative initiatives, such as:

Transitioning the cardiac surgery program from private practice to a hospital-employed physician group n

n Initiating the cardiac surgery program at Beebe Medical Center. n Facilitating the Christiana Care Vascular Specialists sub-corporation. n

Implementing the neurovascular

Accepting a plaque from Gift of Life from Philadelphia Chapter Gift of Life Director of Hospital Services Gwen O'Shaugnnessey (right) are, (from left) Christiana Care Chief Operating Officer Gary Ferguson, Veronica McCall of Gift of Life-Philadelphia, Joanne Matukaitis, RN, MSN, CNA, BC, director, Cardiovascular /Critical Care Patient Care, Critical Care Medicine, and Gerard Fulda, M.D., FACS, FCCM, FCCP, director of Christiana Care Surgical Critical Care.

interventional program for acute stroke rescue.

Electrophysiology labs, HVIS, noninvasive services, E-tower practice offices and nuclear medicine.

n Launching the cardiovascular specialty programs for screening and pre- Vigneau assumed executive responsivention, pulmonary hypertension and bility for the Kidney Transplant adult congenital.

Program in 2008 and is one of the three Christiana Care executives n Overseeing several construction leading our strategy in our southern projects, including new service area.

Annual symposium features state’s top trauma experts

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he 2010 Delaware Trauma Symposium April 30 at the Chase Center on the Wilmington Riverfront attracted some 480 people to the ninehour annual event.

Steven Johnson, M.D. (left) and Marilynn Bartley, RN, MSN, FNPBC, (right) gave a joint presentation about their medical mission to Haiti.

The popular symposium this year featured: n Keynote speaker University of Arizona Medical Center Trauma Medical Director Peter Rhee, M.D., who gave a presentation on Suspended Animation in Trauma. n From Haiti to Home: A Journey Unparalleled,” presented by Marilynn Bartley, RN, MSN, FNP-BC and Steven Johnson, M.D.

Extremity Compartment Syndrome and Fasciotomy, presented by Christiana Care Trauma Surgical Critical Care Attending Surgeon and General Surgery Residency Program Director Frederick Giberson, M.D., FACS. n

by Christiana Care Emergency Medicine physician Brian Levine, M.D., and lectures on beach surf injuries, pediatric sports-related injuries and forensic medicine case studies.

“The symposium is always a big success because the hospitals within our statewide trauma system work very well together,” says Christiana Care Trauma Program and TSU Manager Joan Pirrung, APRN, BC. The symposium draws people from Delaware and the surrounding states.”

Frederick Giberson, M.D.

n Marc Zubrow, M.D., Director of Critical Care Medicine, Christiana Care Health System, presenting on Telemedicine in Trauma. n Health Care: Right or Privilege? by Ehyal Shwieki, M.D., trauma surgical critical care attending surgeon.

Presentations on numerous other topics by Delaware’s top experts, such as a trauma-related drug abuse update n

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Medical tent volunteers had a busy day May 16 at the annual Delaware Marathon sponsored by Christiana Care Health System. See story, next page.

Trauma Center Publishing, Presenting redesignated Level I Appointments, Awards Mark Cipolle, M.D., named Delaware Committee on Trauma chair

Publishing Heather Bittner Fagan, M.D., FAAFP, Denise Taylor, MS, RD, Megan Laurent, et al., published an article titled “An obesity prevention program in a Delaware elementary school,” Delaware Medical Journal.

2010;82:133-136.

Nathan Merriman, M.D., et al., published an article titled “Hip Fracture Risk in Patients With a Diagnosis of Pernicious Anemia,” in Gastroenterology (Vol.138, Issue 4).

Mark D. Cipolle, M.D., Ph.D.

Presentations Denise Lyons, MSN, GCNS, BC and Patricia M. Curtin, M.D., FACP, CMD, presented a poster titled “The WISH Program: An Interdisciplinary Approach to Geriatric Education,” at The American Geriatrics Society 2010 Annual Meeting and at the Model Geriatric Programs: Materials and Methods Swap, in Orlando in May.

The following papers were presented hristiana Care’s Trauma Program by the Division of Neonatology, has been redesignated as a Level I Department of Pediatrics at the Trauma Center after verification by the Pediatric Academic Societies Meeting American College of Surgeons. in Vancouver, BC: Redesignation means that Christiana n “Immunoreactive trypsinogen (IRT) Care continues to offer the highest is elevated in very low birth weight level of trauma services. infants who die,” by Sarvin Gavham, Mark D. Cipolle, M.D., PhD., chief of M.D., Amy Mackley, RNC, Lou Trauma Surgery, has been appointed Bartoshesky, M.D., Aaron Chidekel, chair of the Delaware Committee on M.D., and David A. Paul, M.D. Trauma (COT). n “Does prolonged premature rupture Look for a full story on Christiana of membranes increase the odds of Care’s leadership role in Delaware trauma necrotizing enterocolitis?” by Raquel care and a profile of Dr. Cipolle in a near- Gomez, M.D., Robert G. Locke, D.O., future issue of Focus.

Amy Mackley, RNC, and David A. Paul , M.D.

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n “A pilot study of antibiotic usage across four NICUs for early and late onset sepsis,” by Haritha Vellanki,

M.D., Pamela Douglas-Fontello, RN, and David A. Paul, M.D. “Correlation of proton magnetic resonance spectroscopy (MRS) and volumetric MRI of the preterm white matter,” by Erlita Gadin, M.D., David A. Paul, M.D., Amy Mackley, RNC, Kert Anzilotti, M.D., Karl Steiner, M.D., and Cole Galloway, M.D. n

n Use of antenatal steroids in very low birth weight infants between 1994 and 2006,” by Celina Sindall, M.D., David A. Paul, M.D., Robert Locke, D.O., Amy Mackley, RNC, and Deborah Ehrenthal, M.D.

Mitchell T. Saltzberg, M.D., presented "Implanted Cardiac Rhythm Management Devices in Heart Failure: Who, What, Where?” at the Thirteenth Congress of Chest Pain Centers in Las Vegas, Nevada.

At the Med-Peds Program Director’s Association Annual Meeting in April: n Allen Friedland, M.D., et al., presented ”Med-Peds Program Directors Professional Activities. n Allen Friedland, M.D., Jennifer Packard, M.D., and Daniel Elliott, M.D., presented “Impact of a Regional Med-Peds Meeting on Student Interest in Med-Peds.” n Ellen Justice, MLIS, AHIP, Roy Kao, M.D., Tony Bianchetta, M.D., and Allen Friedland, M.D., presented “Librarian and Med-Peds Teaching Resident Collaboration: Library Informatics and Evidence-Based Pediatrics Showcased.” n Allen Friedland, M.D., et al, presented “Do Med-Peds Graduates Maintain Dual Board Certification?”

VP Linda Laskowski Jones’ article wins silver award

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n article cowritten by Linda Laskowski Jones, RN, ACNS-BC, CCRN, CEN, MS, and her husband Lawrence J. Jones, III, NREMTB, BA, for the magazine Nursing2009 won a silver award" in the “How To” category from the American Linda Laskowski Jones Society of Healthcare Publication Editors (ASHPE).

Laskowski-Jones, Christiana Care vice president, Emergency, Trauma & Aeromedical Services, and her husband are members of the Blue Mountain Ski Patrol in Palmerton, Pa. To read the full article, check News & Events on your portal.

Christiana Care advertising wins national acclaim

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wo Christiana Care advertising campaigns won national healthcare advertising awards this spring. Our community benefit campaign won a silver Aster Award for a newspaper advertising series. Our heart arrhythmia ad won a silver in the Healthcare Advertising Awards.

The Aster Awards, which received more than 3,000 entries this year, are hosted by Marketing Healthcare Today Magazine and Creative Images, Inc. The Healthcare Advertising Awards, sponsored

by Healthcare Marketing Report, is the nation’s oldest, largest health care advertising awards competition. Approximately 4,000 entries were considered this year.

An ad for Christiana Care’s Healthy Beginnings Program for young moms-to-be promotes prenatal education, medical care and peer support to help give babies their best chance starting out in life.

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Teach children about nutrition for a healthy start in life

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ids need to eat right to grow up strong and healthy.

As babies and toddlers, Mom and Dad are in charge of what their little ones eat.

But in a world of fast food and snacks filled with salt, sugar and fat, how do you keep your children on the path toward nutrition as they become more independent?

Teach your children how to eat well You can start by giving your child an education in eating well. For example, read the labels together when you are grocery shopping, comparing not only price but how much sodium and fat is in that frozen pizza. What is the calorie count for a serving of applesauce?

Are there many vitamins in it? Or is sugar the primary ingredient?

Compare two similar products from a nutritional standpoint. Then ask your child to decide which will go into the shopping cart.

You can extend that learning curve to eating out. When you and the kids grab a quick bite, steer them away from the fries and toward the salad.

Instead of a double dip of ice cream, indulge in a refreshing scoop of water ice.

Say no to fried foods Make certain your children know that preparation makes a huge difference in the calorie count of foods. Say “no” to chicken that is breaded and fried; say “yes” to chicken that is grilled and skinless.

More important, keep in mind that parents are ultimately the greatest influence on what their kids eat. It doesn’t make much of an impact on a daughter whose parents caution her to avoid sweets as mom is going back for a second helping of lemon meringue pie.

Be a good role model. Lead by example.

Parents can give the whole family a leg up on success with a few simple steps that will boost the healthy quotient on their daily diet without sacrificing good taste.

First, switch from whole milk to lowfat milk and nonfat milk, also known as skim milk. (If you are currently drinking whole milk, it might be easier to take it in stages, as you and your kids will have to adjust to a slight difference in taste.)

Get more mileage out of meats Cut back on high-fat cuts of meat, such as beef and pork. You can make these meats go further by thinking of them as ingredients you add to rice, beans or pasta, rather than the main course.

Also, banish soda and other sugary soft drinks from your home. If you don’t buy it, your kids are much less likely to drink it.

Free skin screening detects cancers early

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hristiana Care’s Community Health Outreach & Education Program, partnering with the Delaware Chapter of the American Academy of Dermatology screened 278 people at the Helen F. Graham Cancer Center.

Many abnormal skin conditions were detected and referred for follow up.

Dermatologists and physician assistants, nurses, clerks and others volunteer to staff the free early detection program each year in May. For information on skin cancer screening and early detection, call 623-4661.

Physician Assistant Megan Bovero, PA-C, examines patient Ternoski for signs of skin cancer at a screening at the Helen F. Graham Cancer Center.

THERAPEUTIC NOTES

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n 2007 the Joint Commission (JC) introduced the Anticoagulation National Patient Safety Goal (NPSG) to “reduce the likelihood of patient harm associated with the use of anticoagulant therapy.”

n Implementing an anticoagulant management program.

Approved protocols are used: l For the initiation and maintenance of therapy l Are appropriate to the medication used, and condition treated. n

The requirements of the NPSG introduced broad sweeping changes for all n Warfarin specific elements: JC accredited health care organizations l Warfarin is dispensed for each and the patients “under their umbrelpatient in accordance with established la,” both inpatient and outpatient. monitoring.

Several elements of performance are:

INR A baseline INR is established for all patients started on warfarin therapy.

A current INR is available and is used to monitor and adjust therapy. l

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Christiana Care gathered representatives from physician groups, Nursing, Pharmacy, Nutrition, the Clinical Laboratory, Administration, Data Acquisition, and Performance Improvement and formed a team dedicated to meeting the requirements of the NPSG. The team has accomplished many things, such as reviewing patient education and associated materials, implementing an anticoagulation monitoring service, revising heparin preprinted order sheets and MAR and developing a new warfarin preprinted order sheet.

With the advent of CPOE there is less need for preprinted sheets, however structure is still necessary to maintain established protocol ordering. Fortunately, CPOE has a solution.

Ordering heparin infusions and warfarin via a Power Plan (PP) or Care Set (CS) provides the necessary structure by grouping required orders and CCHS dosing and monitoring guidelines together.

The chart below shows available CPOE ordering methods for heparin infusion and warfarin, how to access the Christiana Care DVT/VTE prophylaxis protocol, as well as stand alone enoxaparin and dalteparin.

PARE program cuts pharmaceutical waste

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hristiana Care’s Pharmaceutical Waste Reduction Effort (PARE) is a cooperative endeavor involving Occupational Safety, Pharmacy, Nursing, Environmental Services and other departments to improve regulatory compliance, staff safety and environmental stewardship.

Guidelines for PARE factor in wherever we create pharmaceutical waste, such as nursing units, pharmacies, laboratories and other clinical areas, as well as in the soiled utility room and designated areas.

By providing methods to properly dispose of unused pharmaceuticals, we comply with regulations and help ensure that untreated waste does not enter our water supplies or landfills.

FAQs When do PARE guidelines apply?

PARE applies whenever we dispose of an unused quantity/portion of any Environmental Protection Agency-regulated substances or pharmaceuticals we have determined should be treated similarly, or expired pharmaceuticals that cannot be returned for credit.

Why are we doing this?

Once disposed, many pharmaceuticals meet the definition of hazardous waste, the handling and disposal of which are subject to requirements of

the EPA and the Joint Commission.

Compliance with the regulations and standards helps prevent pharmaceutical waste from damaging the environment while ensuring we do not incur fines, penalties or administrative actions.

In addition to proper segregation and disposal, PARE includes analysis and tracking to learn how to reduce waste from unused pharmaceuticals, samples, expired pharmaceuticals and items that are used infrequently by finding less hazardous alternatives.

What is our education strategy?

PARE training will include information regarding which pharmaceuticals require special disposal methods.

Some current disposal practices will not change, including the pouring of IV nutrition and unmodified saline solutions down the drain and placing empty sharps in sharps containers.

However, some changes are already being implemented. For example, white/yellow chemotherapy receptacles are being removed from nursing units, replaced with black waste containers. Empty chemotherapy containers should be placed in the black containers. Staff can check pharmaceuticals to verify disposal methods on the profile list located near the black containers.

Gift stores offer convenient shopping

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eed a gift but don’t have time to go shopping?

The Glass Box gift shop at Christiana Hospital and the Window Box gift shop at Wilmington Hospital may have just what you are looking for, whether it’s flowers, balloons, refreshments, reading materials, or a special gift for a loved one, co-worker or baby.

The gifts shops are run by the Junior Board of Christiana Care and feature a great selection of reasonably-priced merchandise. The gift shops also have convenient hours for Christiana Care employees on the go. Profits from both gifts shops benefit Christiana Care programs.

Glass Box Christiana Hospital 302-733-1100 Monday – Friday 9 a.m. to 7 p.m.

Saturday and Sunday 11 a.m. to 4 p.m.

Window Box Wilmington Hospital 302-428-2246 Monday – Friday 9 a.m. to 4 p.m.

Saturday and Sunday 11 a.m. to 2 p.m.

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C-A-R-T: Cancer awareness resources to go

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new project to increase access to materials at the Junior Board Cancer Resource Library will begin making its rounds throughout the Helen F. Graham Cancer Center in June 2010.

Volunteers from the Junior Board will provide cancer patients expanded access to educational materials. Booklets and pamphlets will be available on a mobile cart which will visit waiting areas and infusion suites in the Cancer Center.

Materials are free and are aimed to meet the general needs of patients across the continuum of cancer care, as well as materials for caregivers and family members.

Junior Board Member, Zita Aquino shows a brochure to patient Brenda Selby at the Helen F. Graham Cancer Center.