Focus: September 15, 2010 by ChristianaCare

FOCUS Support the United Way of Delaware

hristiana Care's United Way of Delaware campaign kicked off on Sept. 14 and runs through Dec. 10. By participating in the campaign, employees help the United Way of Delaware address some of our state’s most pressing social problems. Christiana Care's goal is for 4,100 employees to give to the campaign this year. With your generosity, we will meet and surpass our goal. Every gift is important, no matter what the size. As in previous campaigns, employees may designate to support:

Inside

The Community Impact Fund.

Transformation Rewards

Change to health care career proves satisfying

n Five specific focus areas within the Community Impact Fund.

Breast Center offers advanced technologies

n A specific 501 (c) 3 nonprofit organization of your choice.

NuMoM2b study focuses on 1st pregnancy outcomes 5 Seckel named to AACN national board of directors Tips for back-to-school organizing

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For example, you can designate Christiana Care's Visiting Nurse Association and/or other areas of Christiana Care. Use the agency search key at www.uwde.org to find organizations you want to support. To designate where your dollars go, the minimum gift is $25. All employees should have received an e-mail with your unique password and a link to United Way’s online E-Pledge System. If you’ve deleted

Supporting the United Way of Delaware helps keep agencies like Christiana Care VNA active in the community and caring for more of our neighbors. (For more more photos of patient Beau and the VNA home health care team, visit www.christianacare.org and click on Flickr.com.)

the e-mail, and forgotten your password, click on the link to get into the E-Pledge System and click on the "forgot password" button. Enter your badge number and e-mail address and the password will be e-mailed to you. Your User ID is your badge number. Thank you in advance for your generosity as we work together to reach our goal, and most importantly, support our neighbors. Christiana Care is again using the EPledge system on the United Way of Delaware's Web site. Go directly to the United Way E-Pledge System through the portals.

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

Transformation Rewards benefit Christiana Care and our community

he first year of our Transformation Rewards Program (TRP) has been a great success for Christiana Care and our community. Our operating gain exceeded budget for the 2010 Fiscal Year surpassing the maximum performance level of the program. Our patient satisfaction score also exceeded the minimum performance threshold. The results of the TRP are a benefit to our neighbors in the community. Our success owes in part to several transformational efforts across the spectrum of care that have improved dramatically the way we provide care, ultimately leading to safer and better outcomes and a higher quality of care. These efforts also reduce our costs and enhance the experience for our patients and their loved ones. Our efforts encompassed nonclinical initiatives that improve the way we do things. In addition, obtaining Magnet status is a result of our hard work and dedication. Our success benefits our community by enabling us to invest in new technologies and programs to provide even better care. We can all look forward to working together in the coming year to advance further our transformational efforts to benefit our patients and community.

Physicians give their all to launching CPOE

ittle more than six months after Computerized Provider Order Entry rolled out, patients are receiving care more safely and efficiently as doctors and other providers have embraced the electronic system for ordering medications and tests. “The physicians have been superstars,” says Terri Steinberg, M.D., MBA, chief medical information officer. “We asked them to make a dramatic change in giving up paper and they have stepped up and performed magnificently.” Several community doctors have opted to turn over care of their admitted patients to hospitalists. But all the physicians working in Wilmington Hospital and Christiana Hospital are using the system, she says. Input from doctors continues to be an 2

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essential element in continuing to refine the system to make it safer, more efficient and user friendly.

within the order sets for hydromorphone, a commonly prescribed pain medication.

For example, physicians have voiced concerns regarding the CPOE help desk, which is currently staffed by technicians and technical analysts, who are unable to answer clinical questions. Those questions are relayed to clinicians but the delay involved in getting the responses to doctors has been frustrating.

“Almost immediately, overdosing and underdosing of hydromorphone was extinguished, which is a big win,” Dr. Steinberg says, noting that the module has been submitted for several quality assurance awards.

“We listened to the physicians,” Dr. Steinberg says. “We are now looking into ways to virtually staff the help desk with clinicians.” The input of the Pharmacy and Therapeutics Committee played an important role in a significant improvement in the system, establishing standard modules with doses

Although the data is not yet in, she says it is clear medication is getting to patients more quickly because doctors and nurses can review orders for confirmation immediately. “CPOE is transforming patient care by dramatically reducing the risk of medication and order entry errors," Dr. Steinberg says. “In addition to improving patient safety, care is delivered more efficiently.”

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Former bankers find health care careers more satisfying

eslie McClendon and Nikesha Whye are phlebotomists, drawing blood from patients for testing.

ored strategy for people who are entering new fields, says Sean Ellsworth, Director of Recruiting Services in the Human Resources Department.

Before they entered the health care field, the Christiana Hospital workers were focused on a different type of withdrawal—transactions made at banks.

“There is no substitute for that front-line work, that clinical credibility,” he says. “But if you have a background in leadership in another field and transition into an entrylevel position in health care, the skills from a previous position can help you move up the ladder and advance your career.”

McClendon held a number of supervisory positions and was a paralegal at one major regional bank, and Whye was a credit analyst at another. Both women were laid off after bank mergers. And both viewed losing their jobs as an opportunity to retrain and embark on new careers. Glad to have been ‘downsized’ “It sounds strange, but I was ecstatic when I was downsized,” recalls McClendon. “It was the chance I had been waiting for to do something different.” She trained as a medical assistant and volunteered at Wilmington Hospital. She came to Christiana Care on a three-month assignment to assist with biometric screenings for employee Health Risk Assessments. That job led to another, with McClendon applying for a casual position as a phlebotomist. Barbara Roberts-Baker, Manager, Specimen Processing and Procurement, says she is hesitant to hire phlebotomists who do not have hospital experience. But McClendon’s maturity, enthusiasm and life experience won her over. “After meeting Leslie, I saw she exemplified our core values and I knew her phlebotomy skills could be groomed to meet our expectations,” she says. “I knew Leslie was a real

Training grant led to new skills After she was downsized, Whye took advantage of a government training grant to develop new skill sets. From left, phlebotomist Nikesha Whye, Barbara Roberts-Baker, manager, Specimen Processing and Procurement, and phlebotomist Leslie McLendon.

find, someone who is very patient focused and demonstrates a great work ethic and interpersonal skills.” Six months later, McClendon was offered a full-time job. “I showed to my managers that I was dependable, someone you can count on to be there at 5 a.m.,” she says. Future plans include nursing career Today, McClendon is taking a course in allied health management. She also is considering studying to become an LPN or RN.

“I always knew I wanted to go into health care but it was hard to even think about quitting my job because I was making money and had a certain lifestyle,” she recalls. “When I was laid off, all my excuses for not going to school went away.” It wasn’t long before Whye was certain she had taken the right turn on the career path. Working with patients fulfills her passion for helping others. “Nikesha is extremely caring and demonstrates compassion to those she encounters,” Roberts-Baker says. After several years in phlebotomy, Whye, decided to go to nursing school. She is now completing her clinical studies at Del Tech while she continues to work at Christiana Care.

Eventually, she would like to become a “Christiana Care invests in its employnurse practitioner. ees,” she says. “There’s no limit to “At Christiana Care, there are so many how far you can go if you are willing opportunities,” she says. “People ask to do the work.” me where I want to work after I graduWorking your way up is a time-honate—and the answer is obvious.”

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Breast Center offers patients newest diagnostic technology

he Christiana Care Breast Center in the Helen F. Graham Cancer Center is recognized as one of the best facilities for comprehensive breast care, not only because of its physicians, surgeons, nurses and staff, but for offering cutting edge technology as well.

“This type of image shows a total-volume view of a potential tumor so it can be more precisely measured for depth and further treatment can be planned,” says Darcy Burbage, MSN, CNS. “When physicians have more information with which to proceed, the overall quality of care improves.”

“Patients, visitors and physicians are pleased that we do breast biopsies right here where we do the diagnostic imaging, and that we provide experienced nurse navigators to guide our patients through the entire experience,” says Breast Center Director Renie Mullaney, MS. “We are proud to be a center which is able to offer our patients excellent service, along with the latest technology in breast imaging.”

New biopsy system Another advancement is a new biopsy system which provides greater and more consistent patient comfort by delivering lidocaine, a numbing medication, intermittently during a core breast biopsy, rather than just at the beginning. “These improvements are examples of the Breast Center’s ongoing effort to monitor and incorporate new technology, to ensure that we’re bringing the best experience and quality of care possible to our patients,” Mullaney adds.

3D ultrasound imaging One recent improvement in technology that Mullaney cites is three-dimensional ultrasound for more in-depth diagnosis when screening mammography indicates a need for closer inspection. Lead Technologist Terry Smith, RTR (M), says that “compared to a two-dimensional transducer, 3D ultrasound provides a superior picture enabling better assessment of the depth of the area of concern in suspicious areas seen on mammography.”

Dedicated breast MRI system The Christiana Care Breast Center is also the only facility in Delaware, and much of the surrounding region, with a dedicated MRI system designed for breast imaging. “Most breast MRIs are done using standard MRI equipment

that was intended for use on the whole body” says Wendi Rader, RTR (M), BS. “But that equipment was not designed for a patient to lie on her stomach for what can be an extended period, it is simply not very comfortable.” The dedicated breast MRI unit offers padding in locations appropriate for increased comfort. It also includes eight-channel coils, resulting in faster scan times and images of much higher resolution. In 2006 the Breast Center took a big step forward switching from analog film technology to a paperless, filmless digital system. Three things drove that change, according to Mullaney: n Christiana Care’s commitment to best-practice standards and patient safety. n The efficiency afforded by the new ability to share images more easily throughout the health system. n Our patients’ own interest in the newer technology, which demonstrates a good trend toward patients’ taking active roles in their health.

To contact the Christiana Care Breast Center call 623-4200.

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Study focuses on pregnancy outcomes for first-time mothers

hristiana Care has an important role in a groundbreaking study of first-time mothers that will ultimately result in identifying problems sooner, as well as new strategies and interventions to help moms and babies. Sponsored by the National Institute of Child Health and Human Development, the nuMoM2b Study focuses on understanding predictors and causes of adverse outcomes in women with their first pregnancies. The study will enroll 10,000 women across the United States, including 1,250 expectant moms at Christiana Care, one of the highest volume hospitals for deliveries in the Mid-Atlantic region. About 40 percent of the women who give birth in the United States are first-time mothers. That means doctors cannot rely on the medical history from past pregnancies to identify potential problems. “We will be focusing on spontaneous pre-term birth and preeclampsia, which are important outcomes in firsttime births,” says Matt Hoffman, M.D., director of OB/GYN Education & Research and principal investigator in the study. “Moreover, preeclampsia is more common in first time mothers.” Identifying associated genes “We hope to be able to identify the genes that may be associated with these conditions, as well as identify genes that may protect against them.” Occurring in about 7 percent of pregnancies, preeclampsia is marked by high blood pressure and excess protein in the urine after 20 weeks of pregnancy. Untreated, it can lead to serious — even fatal — complications for both mother and baby. The risk of developing preeclampsia escalates to 25-30 percent in women

The national nuMoM2b study will draw 1,250 maternity cases—12.5 percent of the total required for the trial—from Christiana Hospital.

who have a first-degree relative—a mother or a sister—who has had the condition.

well it is functioning,” she says. Emotional and environmental elements, including stress and lack of

“We hope to be able to identify the genes that may be associated with these conditions, as well as identify genes that may protect against them.” Matt Hoffman, M.D., Director of OB/GYN Education & Research Christiana Care will recruit women who are less than 14 weeks pregnant, working with community doctors, as well as with expectant mothers who are having their first trimester screening at Christiana Hospital, says Stephanie Lynch, OB/GYN research manager and the study coordinator. “In addition to genetics, we will be looking at other factors, such as the development of the placenta and how

sleep, also will be evaluated. “There’s a lot of folk wisdom about these issues, but not much data,” Dr. Hoffman says. The budget for the nuMoM2b study is more than $1 million, funded by the American Recovery and Reinvestment Act. For more information or to enroll in this study, call 302-733-3576.

Crisis Leave Program helps employees during life crises

ur Crisis Leave Program continues to be a great way for individuals to support their Christiana Care colleagues in a time of need.

Cindy McHugh Theresa Messick Karen Mohamed Elizabeth Motyka Lorraine Moye Robert Mulrooney Melani Murphy Clyde Painter Simin Parvizi Shawnae Phifer Barbara Roberts-Baker David Singley Allison Starr Peter Sullivan Deadra Sylvester Tina Smokovich Jennifer Tetrick

More than 80 donations have helped strengthen the three-year-old program since July 1, 2009. Those generously donated hours provided support to 22 recipients who were dealing with crises, such as a family member’s terminal illness, or other catastrophic life events. These generous Christiana Care employees deserve a sincere thank you for their support of the Crisis Leave program. Here’s a list of their names, excepting those who wish to remain anonymous: Felisha Alderson Linda Bakomenko Marianne Barrow Linda Bruzda Carmella Coates Donna Curtis Debbie Dibert Marykay Ennis Tina Favazza Beth Firzgerald Everett Fitzgerald Salena Giddings Cynthia Griffin Patrick Grusenmeyer Jennifer Haines Brian Humphrey Margaret Humphrey Paula Jackson Charles Jenkins Jonelle Jennings Sophia Johnson Mary Lagowski Stacy Lourie Dale Lowe Mary Alice Martelli

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Louise Thomas Robert Vagonis Martha Zazzarino How to donate Employees may make donations at any time throughout the year by completing the Web form located on HR Online. How to request CLB time Eligible employees may request Crisis Leave Bank time by completing the request form on HR Online. To learn more about this program, as well as other Great Place to Work benefits, visit the Finance section of HR Online, or call the HR Service Center at 327-5555.

Social Media Policy Reminder

and credibility by modeling our core values and mission.

Please review the employee handbook on Communication Media on HR Online along with a short video about social media.

Christiana Care’s guidelines on open communication support an individual’s right to privacy while ensuring that one's personal commentary does not adversely affect our mission to care for our community. All written and verbal communication, including electronic communication, reflect the value of the Christiana Care brand.

ith the rise of social interaction over the Internet, Christiana Care wants to ensure that you understand the do’s and don’ts of social networking and potential employment implications when identifying yourself as a Christiana Care employee.

As a health care organization, how individuals portray themselves has an affect on the trust and credibility our patients, their families, and our community place in Christiana Care. Christiana Care depends on your strong clinical and technical competencies and collaboration among co-workers to meet the needs of our patients. In turn, Christiana Care relies on you to maintain our communities’ trust

Social interactions over the Internet are becoming more frequent. You may be are unaware that every e-mail, text message, Blog or entry on Facebook, MySpace, MSN, or iChat, leaves an information footprint that can be picked up by third parties. When employees identify themselves as a part of an organization, the image they portray, even as private individuals, can have a profound impact on the Christiana Care brand.

Maureen Seckel named to AACN national board of directors Critical Care Medicine. “She brings boots on the ground experience as well as management and long range development skills to the table. I am sure her leadership and vision will be welcome additions to the board." Seckel’s term of service on the AACN board began on July 1. She previously chaired the organization's evidencebased practice resource work group and was a member of the research work group.

Maureen A. Seckel, APN, CCRN

aureen A. Seckel, APN, CCRN, has been appointed to a threeyear term on the board of directors of the American Association of CriticalCare Nurses (AACN).

Seckel earned a bachelor of science degree in nursing from Boston University and a master of science in nursing degree from the University of Delaware (UD). She holds national specialty certification in critical care nursing and CNS certification in acute and critical care. She won the AACN’s national Excellence in Caring Practices Award in 2002 .

“Maureen is a role model for CNS practice,” says Kathleen Schell, interim director of the UD School of Nursing. “She works with patients with complex health problems and is a teacher and mentor to staff, a partner and leader on interdisciplinary teams, and a researcher who implements evidence-based practice. Her work with AACN is a natural extension of her interests and ability to make things happen for the nursing profession.” "Maureen's clinical knowledge and insight will be of great value to the AACN Board,” says Joanne Matukaitis, MSN, RN, NE-BC, FABC director, Cardiovascular/Critical Care Patient Care Services. “We are very fortunate that she will be able to have a voice at a national level that will help to drive best practice for critical care nursing."

Seckel, a critical-care medicine/pulmonary clinical nurse specialist (CNS) in the MICU and 3D Pulmonary stepdown at Christiana Care, has been a member of multiple critical care initiatives, including team participation in the 2007 Codman award for the Sepsis Alert Program. She has been a co-investigator on multiple research studies, lectures locally and nationally on pulmonary and critical care topics, and has published multiple articles and book chapters in the nursing literature. She is also an adjunct faculty member in the University of Delaware's School of Nursing. “Maureen is a great choice for the AACN board,” says Marc Zubrow, M,.D., Christiana Care’s director of

Clinical Nurse Specialist Maureen A. Seckel, APN, CCRN, (second from right) conducts rounds on the 3D Pulmonary Stepdown Unit at Christiana Hospital.

Audrey Van Luven appointed Senior Vice President

udrey Van Luven has been appointed Senior Vice President and Chief Human Resources Officer for Christiana Care Health System. “During the past eight months, Audrey has served very effectively in an Acting capacity,” says Christiana Care President and CEO Robert J. Laskowski, M.D., MBA. “The new title Chief Human Resources Officer reflects the vital importance of Christiana Care's most important asset —our people.”

1986 and completed her master’s degree in human resources at Wilmington University in 1987. Van Luven is a member of the senior leadership team, responsible for strategic planning, design and execution of Human Resource services that support the achievement of our Mission, Vision, strategic and operating goals.

She serves on the board of trustees for Delaware Technical & Community College, the board of directors for the Delaware Center for Maternal Fetal Medicine of Christiana Care, and the Van Luven began her career at Development Council for Delaware Christiana Care in 1988 and has Technical and Community College, since served in various HR leaderWilmington/Stanton campuses. She is ship roles. She was promoted to also a member of the Society for Audrey Van Luven director of Human Resources in Human Resource Management, the 1998 and named vice president of American Society for Healthcare Human Resources in 2006. She received her bachelor’s Human Resources Administration and the Philadelphia degree in medical terminology from Wesley College in Human Resource Planning Group.

Formulary update

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Therapeutic notes

n February 2010, the Food and Drug Administration (FDA) issued a safety alert regarding the use of long-acting beta-agonists (LABAs) in the treatment of asthma (see table below). The FDA’s analyses of recent studies demonstrated that use of LABAs was associated with an increased risk of severe exacerbations of asthma symptoms as well as an increased risk of death in both pediatric and adult patients. The risk of increased asthma-related death associated with LABAs has been known for some time, and these products already contain a Black Box Warning relating to this risk. The revised labeling required by the FDA reinforces their continued concern about LABA safety.

LABAs are effective bronchodilator agents that help lessen asthma and chronic obstructive pulmonary disease (COPD) symptoms by relaxing muscles in the airway and lungs. The FDA deter-

mined that when LABAs are used appropriately with an asthma-controller medication their benefits for improvement of asthma symptoms outweigh the potential risks. However, due to safety concerns, the FDA is requiring manufacturers to make modifications to the product labels of LABAs. In order to ensure safe use of LABAs, the FDA is recommending the following new safety requirements: n LABAs used as a single-agent are contraindicated without the use of an asthma-controller medication such as an inhaled corticosteroid. n Pediatric and adolescent patients who need both LABA and an inhaled corticosteroid should use a combination product containing both an inhaled corticosteroid and a LABA to ensure medication compliance.

LABAs should be used for the shortest duration of time necessary to achieve control of asthma symptoms and discontinued if possible when asthma control is achieved. n

n LABAs should be used long-term only when patient’s symptoms are not adequately controlled on asthma-controller medications. n LABAs should not be used if patient’s asthma is adequately controlled on low or medium dose inhaled corticosteroids.

It is important to note that even though LABAs are approved for the treatment of asthma and COPD, the FDA’s new recommendations apply only to the use of LABAs in the treatment of asthma. The FDA is also requiring manufacturers to have a risk management program for these products, which includes a revised medication guide written specifically for patients and a plan to educate healthcare professionals about the appropriate use of LABAs. In addition, the FDA is requiring manufacturers to conduct additional clinical trials to further evaluate the safety of LABAs when used in combination with inhaled corticosteroids.

Tips to help your kids get organized for school

om, where’s my backpack?

Have you seen my homework, Dad? It’s back-to-school time. Those first few weeks of class offer a great opportunity to earn an A-plus in organization and establish good habits that will carry you and your children through the school year. Surprises can be fun—but save them for birthday parties. You can avoid unpleasant surprises by posting a big

calendar where everyone in the family can see it. Jot down all your appointments as soon as you make them.

If Madison will need a ride home from soccer practice on Tuesday, pencil her in. If Duane has a piano lesson on Thursday, make a note of it. You can take the mayhem out of mornings by planning ahead so that all your family’s tasks aren’t scrunched into a single chaotic hour. Here are a few ways you can take the stress out of your routine: Take showers at night to avoid bathroom gridlock in the morning, when kids are already busy competing for the sink to brush their teeth.

Pack lunches the night before. Stock up on fruit, low-fat yogurt, granola and other healthy foods you can assemble quickly.

After you clear away the dinner dishes, set the table for breakfast.

n Kids—and parents!—can save time by picking out the next day’s wardrobe when they arrive home from school or work instead of waiting until morning. That way, you know ahead of time if a button is loose or those khakis need pressing. For maximum time savings, choose five outfits or uniforms on the weekend to wear during the week. n Establish a launch pad, the place where kids keep their backpacks, completed homework, permission slips, jackets and anything else they need to take to school the next day.

Despite their protests, children thrive on structure. You can avoid struggles over such issues as homework by establishing a few ground rules. For example, no TV, video games or instant messaging until assignments are complete. Your kids might give you a hard time for a few weeks after you lay down the law. But soon, they will realize that organization has taken a lot of the stress out of getting ready for school.

Credit Union reps now available on site on Wednesdays

hestnut Run Federal Credit Union representatives are now available at Christiana Hospital on Wednesdays from 11 a.m.-2 p.m., by the West End Cafe. Wilmington employees can visit their representative in front of the cafeteria on the first Wednesday of each month from noon to 2 p.m. Employees can open new accounts, apply for loans, change payroll deduction, make deposits and even pick up 10

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a check from their account. Be sure to ask about new Holiday Loans with rates as low as 3.99 percent APR, first-time borrower loans for members with high school and college children and Visa promotions to help with holiday gift giving. Ask about discount Regal movie tickets too. Employees posted at other locations

may visit the credit union office at 926 Centre Road, open weekdays 8:30 a.m.-4 p.m., or the Glasgow office at 400 Technology Drive, Newark, open weekdays from 9 a.m.-5 p.m. For more information about Chestnut Run Federal Credit Union, visit www.chestnutrunfcu.org, call 302-9993193 or e-mail memberservices@chestnutrunfcu.org.

Presenting, Appointments, Awards Presenting

Appointments

Awards

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Christiana Care contributes to Pakistan relief efforts

hristiana Care recently made a $10,000 donation to support relief efforts for the devastating flooding in Pakistan. The crisis has not been officially designated as a Christiana Care supported event. (See Christiana Care Guidelines

for Humanitarian Support or Disaster Relief.) According to the U.S. Department of State, at this time the most effective way to assist relief efforts is by making cash contributions to humanitarian organizations conducting relief operations. The magnitude of the tragedy is staggering. After severe flooding from nearly a month of torrential monsoon rains—the worst in Pakistan’s history—a fifth of the country is flooded. The disaster has driven 15 to 20 million people

from their homes. Six million are in need of emergency assistance, such as food and clean water. Millions of acres of the country’s best cropland are underwater. Livestock drowned. Medical clinics washed away. Cholera threatens survivors. And, flooding is expected to worsen. Despite the enormity of the crisis, the world has been slow to respond. Enthusiasm for helping has been dampened due to a relatively low death toll (more than 1,600) and because the tragedy unfolded over a period of time, not with a sudden jolt like an earthquake. Add to this, many donors are fatigued from the challenge of rebuilding Haiti. Organizations listed on GuideStar.org, are providing relief efforts. To make an online donation, click on the organization's name, then click on the Donate Now button in its GuideStar report.