FOCUS Focusing on the people and initiatives that distinguish Christiana Care Health System
Christiana Care embraces CMS campaign to improve patient safety
VOLUME 22, NUMBER 11
A publication from Christiana Care Health System External Affairs P.O. Box 1668 Wilmington, DE 19899-1668 www.christianacare.org
Accepting certificates of excellence from Quality Insights of Delaware representative Kathy Rivard (center) are, from left: Janet Cunningham, Michelle Kane, Sharon Anderson, Beth Donovan, Carol Briody, Patty Resnik and Michelle Collins.
C Inside Christiana Care ranks among state’s Top Work Places
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Christiana Care nurses earn statewide honors
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Transforming Leadership Forum
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Surgeon Jay Luft, M.D.,’s mission to Ethiopia
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New CPR guidelines
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Community Clinical Onclogy Program leads patient accruals
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Caring for Yourself - See your dentist regularly - Get help controlling asthma
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hristiana Care Health System received Certificates of Excellence from the Centers for Medicare & Medicaid Services (CMS) for collaborating in hospital-acquired infection and pressure ulcer prevention projects conducted by Quality Insights of Delaware (QID) in the CMS 9th Scope of Work period. A Scope of Work refers to a three-year period during which CMS enters contracts with quality improvement organizations such as QID across the nation to conduct quality improvement projects. The 9th scope pertains to the contract that started July 1, 2008 and ended June 30, 2011. The theme was patient safety. As part of a larger group encompassing West Virginia, Pennsylvania and Delaware, QID won CMS’ approval for two project proposals to gather data and measure results in health
care provider collaborative efforts to reduce transmission of hospitalacquired Methicillin resistant staphylococcus aureus (MRSA) and to reduce the occurrence of pressure ulcers. Our participation in the CMS 9th Scope of Work is a great example of how we learn as a system to improve patient care in a collaborative strategy with other providers throughout the State of Delaware and our region. MRSA safety initiative The QID-run, statewide collaborative project to reduce MRSA took place from August 2008 to July 2011. Wilmington Hospital Intensive Care, or WICU, became the chosen battleground for implementing MRSA prevention strategies. “WICU submitted MRSA data from the Infection Prevention department to the Center's for Disease Control's CONTINUED,
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CMS patient safety theme empowers quality improvement PAT I E N T
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National Healthcare Safety Network,” says Kathleen Wroten, RN, Infection Prevention manager. Infection Prevention and the WICU collaborated on various initiatives to reduce the risk of MRSA transmission, such as hand hygiene education and monitoring, educational sessions with staff and new isolation signs, she explains. Educational seminars and statewide sharing sessions allowed hospitals to share successful strategies and barriers statewide. “At Christiana Care, WICU reported no MRSA transmissions during several months of the project,” Wroten says. Preventing pressure ulcers Pressure ulcers occur when pressure against the skin reduces blood supply to that area and the affected tissue dies. This can happen when you stay in one position for too long without shifting your weight. You might get a pressure ulcer if you use a wheelchair or are confined to a bed, even for a short period of time (for example, after surgery or an injury). Christiana Care participated in the CMS Pressure Ulcer Reduction Project, joining a community of practice organized by QID that included nursing homes and other stakeholders to share tools, successes and learnings. The project timeframe was August 2008 to January 2010. To begin, Christiana Care completed a hospital baseline self-assessment survey for pressure ulcers reduction. Initial project strategies consisted of: n Organizational commitment, reflected by the interdisciplinary
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teams, policies and protocols, accountability and staff education.
Christiana Care ranked best in state for career opportunities
n Risk assessment of patients upon admission and daily. n Pressure ulcer prevention through daily skin inspection, moisture management, optimal nutrition and hydration and minimizing pressure. n
Treatment and documentation.
Participating hospitals administered patient safety surveys at baseline and remeasurement. These survey instruments included the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture and the Hospital Leadership and Quality Assessment Tool (HLQAT).* Focused on managing incontinence Beth Donovan, MSN, RN, CWOCN, wound ostomy continence nurse, says QID’s data collection tool helped Christiana Care define an opportunity for improvement in moisture management. Moisture is a significant cause of pressure ulcers in patients whose condition includes incontinence. The pressure ulcer prevention project team focused on improving moisture management on one unit (4 E/W at Wilmington Hospital) with a view to improve systemwide learning based on the results. Systemwide learning after the 4 E/W experience helped improve pressure ulcer prevention throughout the health system. * The HLQAT is the result of a public-private collaboration of national organizations interested in helping hospitals maximize their reimbursement on value-based purchasing quality measure sets.
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or the eighth consecutive year, the News Journal has named Christiana Care a Top Workplace employer, ranking the health system 6th in the large workplace category and best in career opportunities. The newspaper bases the honor on employee surveys from 100 companies in the Delaware region. More than 700 Christiana Care employees completed a survey in May, voting Christiana Care the top workplace for career opportunities. Only 50 companies made the best place to work list this year. The publication featured the rankings in Top Workplaces 2011 insert in the News Journal on Sunday, Aug 14.
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Heart Failure Program called ‘one of the best’ in U.S. Center for Heart & Vascular Health and across the entire Christiana Care Health System,” added Mitchell Saltzberg, M.D., medical director of the Heart Failure Program.
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hristiana Care Health System’s Center for Heart & Vascular Health has earned the Joint Commission’s Gold Seal of Approval. Christiana Care is the only hospital in Delaware and one of just 33 in the United States to demonstrate compliance with The Joint Commission’s national standards for health care quality and safety in disease-specific care. The award recognizes Christiana Care’s dedication to continuous adherence to The Joint Commission’s stateof-the-art standards. High-quality treatment “This certification is a testament to the high-quality treatment we provide to patients with heart failure,” says Timothy J. Gardner, M.D., medical director of the Center for Heart & Vascular Health and past national president of the American Heart Association. “It signifies that our services have met the requirements needed
“Our program continues to strive to do the right things for congestive heart failure patients and to define our program as a regional and national center of excellence. This certification is a major step toward maintaining excellence and continually improving the care we provide.” to achieve long-term success in improving outcomes. It’s also a signal to the community that we can effectively manage the unique and specialized needs of heart failure patients, and that there is no need for them to leave the state to find the highest level of care.” “Disease-specific advanced certification in heart failure is the culmination of a tremendous team effort within the
Before receiving certification, Christiana Care underwent a rigorous on-site survey. A team of Joint Commission expert surveyors evaluated Christiana Care for compliance with standards of care specific to the needs of patients and families with heart failure, recognizing its progressive care models, levels of staff engagement and collaboration among providers.
Dr. Weintraub writes AHA policy statement on prevention
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illiam Weintraub, M.D., the John H. Ammon Chair of Cardiology at Christiana Care, is the lead author of a policy statement published in the print edition of the July 26 issue of Circulation: Journal of the American Heart Association that says preventing heart disease before it starts is a good long-term investment.
The statement summarizes years of research on the value of investing in William Weintraub, M.D. prevention, particularly through community-based changes to make it easier to live a healthy lifestyle: n Every dollar spent on building trails for walking or biking saves $3 in medical costs.
n Companies that invest in workers’ health with comprehensive worksite wellness programs and healthy work environments have less absenteeism, greater productivity and lower health care costs. n Initiating a nationwide plan to cut the salt in the food supply to support an average intake of 1,500 mg per day may reduce high blood pressure in the country by 25 percent, saving $26 billion in health care costs annually.
As a call to action, the statement puts an equal amount of responsibility on individuals and on society — specifically federal, state and local policy-makers. “People often don’t realize the power to stay healthy is in their own hands,” said Dr. Weintraub in a press release from the American Heart Association. “But it’s not something many individuals or families can do alone. It takes fundamental changes from society as a whole.” A u g . 1 9 , 2 0 11 F O C U S
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TRANSFORMATION
Christiana Care nurses earn statewide honors From left, Dana Estrada, RN, Marsha Babb, MS, BSN, RNII, CNOR, Linda Lewis, MSN, RN, NE-BC, Jessica Marvel, RN, Jessey Jennings, RN, MSN, PCCN, FNP-BC, Maureen Seckel, RN, APN, MSN, ACNS-BC, CCNS, CCRN, Beth Rathmanner, RN-BC, Cheryl Swift, BS, RNC, MSN, Susan Siano, MSN, RN-BC, RNII, Carolyn Arnold, BSN, CCRN, Paula Smallwood, RN, MSN, NE-BC.
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aureen A. Seckel, RN, APN, Medical Critical Care Pulmonary CNS, received the Advance Practice Award at the 2011 Delaware Excellence in Nursing Practice Award Celebration July 14.
In addition to Seckel, Christiana Care had 10 other finalists in Delaware’s foremost nursing award celebration: Acute Care Non-Critical n Marsha Babb, RN
The Delaware Nurses Association and n Jessey Jennings, RN n Cheryl Swift, RN the Delaware Organization of Nurse Executives coordinate the awards. The Community Based event recognizes nursing professionals n Jessica Marvel, RN who consistently promote, excel and bring a positive approach to their area of nursing practice.
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Dana Estrada, RN
Nurse Leader n Paula Smallwood, RN n
Linda Lewis, RN
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Beth Rathmanner, RN
Outpatient n Susan Siano, RN n
Carolyn Arnold, RN.
Nursing Excellence Awards correspond to Forces of Magnet
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he Advance Practice Award winner and distinguished finalists honored at the 2011 Delaware Excellence in Nursing Practice Award Celebration deserve additional recognition for demonstrating the following Forces of Magnet traits as outlined by the ANCC Magnet Nursing program:
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Award
Forces of Magnet
Acute Care Non-Critical
Exemplary Professional Practice
Community based
Structural Empowerment
Nurse Leader
Transformational Leadership
Outpatient
New Knowledge, Innovations and Improvements
TRANSFORMING LEADERSHIP
Delivering value is basis for fulfilling our mission to community
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n this volatile world, we still must fulfill our mission, delivering services that are valuable to our community,” Christiana Care president and CEO, Robert J. Laskowski, M.D., told physicians and staff at the Aug. 10 Forum for Leadership Behaviors. “Our strategy is about providing value as professionals and value for those we serve.” Strategy for delivering value Dr. Laskowski praised Christiana Care’s performance in terms of quality and cost and dramatic improvements in patient safety as well. “We should feel good about that,” he said. Following Dr. Laskowski’s presentation the audience viewed a videotaped lecture by the vacationing James Newman, M.D., FACP, senior vice president and executive director of the Christiana Care Value Institute. “We've done a great job with quality and safety,” Dr. Newman said. But, “how do we use our resources in a responsible way when we're being paid less than cost?" Dr. Newman called the expectations that we will do better for less, continue to push drivers of quality and safety, and figure out how to extract overuse and misuse out of the health system “daunting tasks.” “But Christiana Care understands and commits to this challenge,” he said. Following Dr. Newman’s dialog, leaders of the four Value Institute Centers formed a panel that fielded many questions, submitted both verbally and through smart phones and other
Value Institute leaders formed a panel to answer questions at the forum. From left, William Weintraub, M.D., director of the Christiana Center for Outcomes Research; Richard Derman, M.D., director of the Center for Health System Design Research; Sharon Anderson, RN, MS, director of the Center for Quality and Safety; and Vernon Alders, corporate director of Operational Excellence and director of the Center for Operational Excellence.
hand held devices at the forum. The Aug. 10 event drew a full house at the John H. Ammon Medical Education Center. The forum objective was to provide “a framework to seize opportunities to transform the organization,” said moderator Barbara Monegan, director of Talent Management, System Learning.
HUMAN RESOURCES FREQUENTLY CALLED NUMBERS
Such shared beliefs and behaviors provide “a baseline to use opportunities to change and transform,” she said. For a more detailed accounting of the Q & A component and the featured speakers, including comments by Dr. Laskowski on a recent Value Institute analysis of robotic surgery, log on to Yammer and join the Leadership Forum network. Not a member? Visit www.yammer.com to join. A u g . 1 9 , 2 0 11 F O C U S
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Jay Luft, M.D., journeys to Addis-Ababba, Ethiopia to heal children and teach surgical skills
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magine having a painful ear infection and no access to medical care within many miles. Imaging struggline to find transportation across the long distance and rough terrain to one of only two large, overcrowded hospitals in your nation. “In all of Ethiopia,” says Jay Luft, M.D., “where 88 million people live, there are not as many doctors practicing as there are in Delaware, home to less than a million people.” Dr. Luft, former chief of the Department of Surgery’s Otolaryngology section at Christiana Care Health System, says a colleague called on him late last year to join an Otolaryngology team heading for Black Lion Hospital, in Addis-Ababa, Ethiopia, on a 2011 spring mission for the Philadelphia area chapter of Healing the Children, a non-profit humanitarian organization. Christiana Care’s OR at Wilmington Hospital helped support the mission with donations of surgical instrument trays and soft materials, such as bandages. The lack of health care providers in Ethiopia enables the advance of many diseases that probably would be corrected in early childhood in the United States, Dr. Luft says. “The majority of the surgeries we performed were done to help children hear better and decrease infection by closing chronic perforations, which are caused by recurrent ear disease without treatment,” Dr. Luft says.
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Healing the Children’s mission, as always, was two-fold: to treat as many children as they could handle; and to improve medical education. “The teaching is more beneficial in the long term than doing the work ourselves,” Dr. Luft says. “We taught a soft tissue course, using pigs feet to show their residents how to do local skin flaps.” He learned a lot about practicing medicine without the tools and support to which he is accustomed, too. For example, at Black Lion Hospital he took part in a surgical procedure on a 12-year-old girl to correct bilateral cholanal atresia, a birth defect marked by bone growth blocking the nasal passageways that prevented the girl from breathing through her nose.
Jay Luft, M.D.
health care the condition usually “Throughout her life, this girl had been would be addressed on the day of breathing only through her mouth,” Dr. birth. Luft reports. In countries with advanced Dr. Luft said he learned how the procedure is done without high tech instruments, such as the VTI/CT Scan available at Wilmington Hospital, which would enable the surgeon to navigate easily to the blockage and use other high-tech equipment to remove it.
Otolaryngologic surgeon Jay Luft, M.D., center, instructs Ethiopian doctors how to perform a nasal septal reconstruction, a common procedure in America that the African surgeons had only read about and never before seen.
“They don’t have that,” he says. “They do a great job with what they have. But there’s no finesse. The surgeon at Black Lion, Abebe Melaku, M.D., showed me how they do it with very little equipment. He got it done quickly, because he had to. You do what you have to do.” Otolaryngologists, anesthesiologists and others interested in joining future missions are welcome to e-mail Dr. Luft, jay.luft@aol.com, for help and information.
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Doctor finds unsolved ear pain is often migraine ness, chronic sinus pain, tinnitus, sensitivity to sound and earache, among others symptoms.
them migraine treatment and most of them responded.”
Many patients were never diagnosed “A lot of people who have migraine are On average, these patients had been undertreated,” said Michael Teixido, M.D., an otolaryn“Of all the people with migraine, gologist and director of the Balance and Mobility Center only about half know they have it.” of Christiana Care. “Of all Michael Teixido, M.D. the people with migraine, only about half of them suffering with ear pain for at least five know they have it. And only about 30 years. Many of them had never been percent of people with diagnosed diagnosed with migraine. Once Dr. migraine are satisfied with treatment. Teixido initiated migraine therapies, There is a lot of room for improvement patients began to feel relief within two in migraine therapy.” to three weeks. Dr. Teixido has spent 15 years learning about and treating atypical migraine symptoms. Earlier this year, he published an article describing a sevenMichael Teixido, M.D. year study showing that unexplained ost people don’t go to their ENT ear pain can be a symptom of migraine for a migraine. Then again, most and alleviated by migraine therapy. people may be unaware that headache The paper, titled “Otalgia Associated pain is only one of many symptoms of with Migraine,” appeared in the February issue of the journal Otology & migraine, which can present as dizziNeurotology.
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“Over a seven-year period, I treated many patients with ear pain, and in 50 I could not discover the cause of their pain,” Dr. Teixido said. “I offered all of Christiana Care’s Compliance Hotline can be used to report a violation of any regulation, law or legal requirement as it relates to billing or documentation, 24 hours a day, 7 days a week. All reports go directly to Compliance Officer Ronald B. Sherman. Callers may remain anonymous. The toll-free number is: 877-REPORT-0 (877-737-6780).
at 302-623-2873.
When ear pain doesn’t seem to have a cause, it might be migraine.
Using rigorous scientific standards to account for placebo effect and the possibility his patients were improving spontaneously, Dr. Teixido came to the conclusion that he had identified a new clinical entity he calls migraineassociated otalgia. The findings could have life-changing implications for those patients who live with atypical migraine symptoms for years without receiving a diagnosis or finding effective treatment. Physicians also should take note of the study’s results, Dr. Teixido says. Primary care physicians and otolaryngologists, who normally consider migraine to be the provenance of neurologists, likely see patients every day with unexplained ear pain, dizziness or other symptoms that could be related to migraine, even if the patient isn’t experiencing the typical headache pain. “In my specialty, every doctor knows these patients,” Dr. Teixido says. “We’ve done CT scans and MRIs and looked at their throats and ears and when we can’t figure out the cause of their symptoms, we should treat for migraine.” A u g . 1 9 , 2 0 11 F O C U S
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A year after sudden-death event Delaware teen celebrates life
reached the ED. Then we had a good handoff. It was as synchronous of a team event as we could ever have.” Neurologically, Brian survived the harrowing event intact, his doctors say. He is now an honor student. On July 15, Brian and his parents returned to Christiana Care to celebrate his life and survival with the people who cared for him in his direst hour and a representative from the American Heart Association, who called their actions a textbook case of how things are supposed to happen. View more photos at http://www.flickr.com/photos/christianacare
Brian Atkins, seated, was surrounded by his life-saving team of providers, including, back row, from left, Blaine Zumar, Meg Salter, NREMT, Gary Bollinger, RN, Oksana Iwaskiw, RN, Mike McMichael, NREMT, E.J. Castagna, NREMT, Tom Shoemaker, NREMT. Front row, from left: Mitchell Saltzberg, M.D., Jennifer Henry, RN, Paul Sierzenski, M.D., Betsy Foster, RN, Melissa Ivey, RN, Marla Sanabria, RN. Brian Atkins is seated.
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rian Atkins, a seemingly robust and healthy 15-year-old Delaware teen, went into cardiac arrest, experiencing “sudden death” on Sunday morning, May 2, 2010. He had gone to visit a friend’s home, where a family gathering was under way. He collapsed shortly after arriving there. Someone attending the party, Betty Foster, a retired nurse, started cardiopulmonary resuscitation (CPR) on the spot. On the way to the Christiana Hospital Emergency Department and for more than an hour after arrival, emergency responders continued CPR until Brian regained a pulse. Melissa Ivey, RN, CEN, says in her 20 years of experience in the Emergency Department, it has become difficult sometimes to feel optimistic about cases like Brian’s. Ivey, who is often 8
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part of the critical-care transport team, was instead “floating” as a nurse in the Emergency Department and ready to jump in when Brian arrived. She was shocked when she recognized Brian’s father, who had been her friend in high school.
Cardiopulmonary resuscitation guidelines changed
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id you know that American Heart Association (AHA) cardiopulmonary resuscitation (CPR) guidelines changed last fall? The AHA rearranged the three steps of CPR. What used to be A-B-C — for airway, breathing, compressions is now C-A-B — for compressions, airway, breathing.
“This case strengthened my faith in God and my confidence in the career path I chose,” Ivey says. “But after we revived Brian we still didn’t feel the joy as much as the worry about the possible outcome, which is far better than we imagined that day.”
Here is a step-by-step guide from Christiana Care Training Center, based on the new American Heart Association-recommended CPR method:
Paul R. Sierzenski, M.D., the attending physician, praised the way everyone involved performed that morning. “Resuscitation is like a relay that begins with an all-out sprint,” Dr. Sierzenski says. “It starts with a bystander performing CPR — that is the most critical component before he
2. Look for no breathing or only gasping. Try to get the victim to respond; if the person doesn't respond, roll the person onto his or her back.
1. Make sure the scene is safe. Yell for help.
3. Send someone to call 9-1-1 and to find the nearest Automated External Defibrillator (AED) if one is available. (If you are by yourself you make the call and get the AED yourself.)
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OR Tech Bryan Bristow says caring colleagues saved his life
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ryan Bristow, a certified surgical technologist (CST) assigned to Christiana Hospital’s main OR, says he feels like his OR coworkers saved his life. After experiencing discomfort throughout one day at work in July Bristow felt chest pain. “I kind of ignored it thinking it would go away,” he recalls. But after Bristow returned from an errand to the Labor & Delivery unit some distance from the OR, he “felt like something wasn’t right.” Bristow spoke to OR colleague Angela Thomas, RN, who told Bristow not to ignore the symptoms. Together with Denise Shearon, RN, Thomas led Bristow to the adjacent post-anesthesia care unit where they knew they could use an available EKG monitor. “My heart rhythm was not right and my blood pressure was “off the scale,” Bristow reports. “I went downstairs to the ED where they have a more sophisticated EKG machine,” he says. The EKG showed a right bundle branch block — a defect in his heart's electrical conduction system. Doctors admitted Bristow and ordered
CPR
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From left, Denise Shearon, RN, Bryan Bristow and Angela Thomas, RN.
a stress test. The test results showed three coronary blockages requiring intervention in the cath lab. The cath lab physician cleared the blockages and placed stents to support the reopened arteries before discharging him.
Bristow, who works every weekend and has weekdays off, says he had time to reflect on what happened before returning to work July 16.
“I feel better than I have in 10 years,” he declares. “It’s amazing what flow of blood will do for you.”
“But I was in the right place at the right time. I feel like they saved my life.”
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4. Start chest compressions: - Place the heel of your hand on the center of the victim's chest. - Put your other hand on top of the first with your fingers interlaced.
breaths. If you choose not to do this, go to Step 8 6. Resume chest compressions (30 compressions) 7. 30 compressions to 2 breaths for 5 cycles, about 2 minutes. After the 5th cycle of CPR, reassess and if needed continue with CPR.
- Push straight down on the chest (lower half of the breastbone), to at least 2 inches depth at a rate of at least 8. Resume or continue giving com100 pushes a minute. (That's about the pressions at a rate of 100 per minute, same rhythm as the beat of the Bee same depth. After each push, make Gee's song "Stayin' Alive.") sure the chest comes back to its 5. Open the airway and give 2 normal position.
“At 42, I thought I might be too young for this kind of deal,” he says. “If it wasn’t for them caring….
When the AED arrives, interrupt performing CPR, turn the AED on and follow the prompts. Continue with this sequence of CPR and the use of the AED until EMS arrives. Portable automated external defibrillators (AEDs) are available in many public places.
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H E L E N F. G R A H A M C A N C E R C E N T E R
Christiana Care CCOP is patient accrual champion
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he Cancer and Leukemia Group B, known as CALGB, places Christiana Care’s Community Clinical Oncology Program (CCOP) at the top for recruiting patients for clinical trials for the period from May 1, 2010 to April 30, 2011. Christiana Care was fifth overall out of 45 participating organizations, and first among non-university cancer centers. Christiana Care’s accrual rate is 23 percent of all patients, far above the national average of 4 percent. In part, that is because of recruiting community physicians to CCOP and making nurses available to the offices of oncology practices at the Helen F. Graham Cancer Center to provide patients with information about clinical trials. Clinical trials play an essential role in cancer research. Top five accrual ranking n Dana-Farber - 623
n University of North CarolinaChapel Hill - 431 n Washington University School of Medicine - 431 n
The Ohio State University - 394
n Christiana Care Health System, Helen F. Graham Cancer Center – 359 patients.
To learn more about Christiana Care’s Community Clinical Oncology Program, go to: christianacare.org/communitycancerprogram.
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What a sweet thing to do!
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mployees of the Marble Slab Creamery, a neighbor of Christiana Care’s Helen F. Graham Cancer Center, have started a program at the ice cream maker’s shop across Delaware Route 58 to support the Cancer Center. The employees donate tips collected on Wednesday to a fund for periodic donations. “Part of our business philosophy is to give back to the community; this is just one way we do so,” say Marble Slab owners Mark and Rhonda Quinlan. “The Marble Slab CreameryChristiana, is an example of the continued community support that the Helen F. Graham Cancer Center has received over the last nine years,” says Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center. “Without community support, we would not have a cutting-edge cancer program.”
Nicholas J. Petrelli, M.D. (right), , receives a check from Mark and Rhonda Quinlan, proprietors of the Marble Slab Creamery, on behalf of the ice cream vendors’ generous employees.
UD student earns research fellowship at Center for Translational Cancer Research
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niversity of Delaware undergraduate researcher Matthew Ralston received a fellowship award to sponsor his thesis project titled “Rhodependent Matthew Ralston Apoptosis Mechanism Induced by Statin Treatment.” Ralston, who is mentored by Bruce Boman, M.D., Ph.D., director of Cancer Genetics and Stem Cell Biology, and
researchers at the Center for Translational Cancer Research at the Helen F. Graham Cancer Center, describes his project as part of an effort to effectively target the elusive cancer stem-cell while giving a lethal blow to a drug-resistant and tumorgenerating subset of cells. Ralston’s role is to help determine whether two drugs for treating high cholesterol, Lovastatin and/or Simvastatin, can kill the drug-resistant cells. “It is a great honor to be immersed in the challenging, supportive, and inspirational atmosphere that permeates the CTCR lab,” Ralston says.
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Christiana Care nurses explore complex ‘hoarding’ behavior Hoarding is a behavioral disorder that can contribute to a host of health and safety problems.
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or years, hoarding was a secret obsession that grew out of control for millions of Americans. “Today, reality TV shows put drama in the hoarding phenomenon — but that doesn’t really educate the public,” says Anita Symonds, RN, forensic nurse examiner coordinator at Christiana Hospital. Symonds and Jeannie Janney, RN, a psychiatric Anita nurse, are working Symonds, RN together to explore the complex condition, which impacts an estimated 10.6 million Americans. Their goal is to bring hoarding into the open so that more people who have the condition can be treated. Regina Janney, RN
They are sharing three non-confrontational questions that will help nurses identify hoarders: n Do you notice yourself collecting items that other people might not think of as valuable?
Are areas in your home cluttered with your collections? n
n Do you experience difficulty or find it impossible to discard any of your collection items?
In the hospital, hoarders often will
keep items from their food trays, including paper napkins and condiments, Janney explains. Or they might ask for extra dressings to take home. Symonds and Janney wrote an article, “53 Reasons Why Mary Needed Our Understanding and Compassion,” a composite portrait of a patient who was admitted through the ED as a result of behavior connected to hoarding. The article will be published in Nursing 2011. Mary, the fictional patient, tripped over one of the dozens of cats in her home and broke her hip. Hoarding can contribute to various health problems, says Sandeep Gupta, M.D., Christiana Care director of Psychiatric Emergency Services. Health risks of hoarding The stove might be covered with debris, so the hoarder can no longer cook and becomes malnourished. If the bathtub is filled with litter, the hoarder cannot bathe and hygiene suffers. If hoarders share their homes with many pets, animals and their waste can contribute to disease. Treating people with hoarding issues can take an inpatient and outpatient approach, depending on the severity of the condition. Dr. Gupta says medications for obsessive compulsive disorder and depression can help hoarders who have those underlying condi-
tions. They also may benefit from cognitive behavioral therapy. Unless neighbors or relatives alert social service agencies to the problem, hoarding will continue indefinitely, putting the hoarder at risk for injury from falling objects, fire and reactions from taking expired medications or the wrong drugs. That is why it is especially important to identify hoarders so they can receive treatment. “Hoarders do not voluntarily ask for help,” Dr. Gupta says. “They do not think they have a problem.” The phenomenon of hoarding was first identified in 1947, when the Collyer brothers of New York City were found dead in their brownstone among 130 tons of refuse, including the chassis of a Model-T Ford, 14 pianos and hundreds of bundles of decades-old newspapers. Disorder often rooted in childhood The disorder is frequently rooted in childhood and has been observed in foster children who hoard food to make certain they will have enough to eat, Janney says. “Shopping online gives hoarders more opportunities to buy things,” Symonds says. “Extreme couponing gives them a rational reason to buy large quantities of things they will ultimately never use.” Treatment of hoarding requires a comprehensive effort. Janney and Symonds are compiling a list of community resources, such as animal rescue groups and housing agencies that can help hoarders through the difficult process of decluttering their lives. In November, they will give a presentation on hoarding to the Delaware Emergency Nurses Association. “Hoarding is a difficult problem,” Janney says. “Education is the first step toward a solution.” A u g . 1 9 , 2 0 11 F O C U S
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Register now to join American Heart Association annual walk
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he 20th American Heart Association Annual Heart Walk will be here in just a few short weeks. The Heart Walk, scheduled for Sunday, Sept. 11 at the Wilmington Riverfront, promotes awareness about heart disease and stroke while raising funds to fight the diseases. Each year, Christiana Care employees, families and friends turn out to support this great event. You can register a walking team at www.heartwalk.kintera.org/wilmingtonde. Individuals can join one of the several teams from Christiana Care already listed on the site. Or call your co-workers, friends and family and start your own team. On-site registration begins at 8 a.m. Register today to receive a special Annual Heart Walk T-shirt.
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This year’s Christiana Care Heart Walk T-shirt is fun and colorful. The first 1,000 employees and their team members to register receive this special, free T-shirt.
Upcoming Events
Co-Ed soccer Christiana Care’s New Castle County Soccer League team for women 18 and older, men 30 and older, starts play the first week in September, continuing through early December. Interested players should contact Tep Kang via Outlook or call 733-6333.
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FOCUS Aug. 19, 2011
Sherry A. Monson appointed vice president Women’s and Children’s Services
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herry A. Monson, RN, MBA, MSN, has been appointed vice president, Christiana Care Women’s and Children’s Services. Monson joined Christiana Care after serving as director of Nursing at Lancaster General Health’s Women and Babies Hospital. Previously, she was vice president of Women and Children’s Service at Rose Medical Center in Denver. She has more than 18 years’ experience in hospital leadership, with the last 10 dedicated to women’s and children’s health services. Her clinical and administrative career includes previous work in emergency medicine, behavioral
health, strategic planning, process redesign, project management and health information systems. Monson has been a registered nurse since 1980 and lived and practiced in Utah until 2008. She is certified in executive nursing practice through the American Organization of Nurse Executives. She received an MS degree in Nursing from the University of Phoenix, Arizona, an MBA from the University of Utah, and a BS in Health Services Administration from Weber State University, Ogden, Utah. To contact Monson call 733-1286. Sherry A. Monson, RN, MBA, MSN
Annual blood drive looking for big finish
Melissa Donovan, M.D., named July 2011 Resident of the Month
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lood Bank of Delmarva’s 9th annual Summer Blood Challenge ends on September 11. There is still time to earn points for Christiana Care and help us take home the title of the “Top Lifesaving Employer.” Christiana Care's next on site blood drive is Monday, Aug. 29 in the Auditorium of the John H. Ammon Medical Education Center. We need 100 donors in order to hold our on site blood drives…we need you! It only takes about an hour from start to finish. Call 737-8400 today to schedule your appointment.
ongratulations to Melissa Donovan, M.D., the July 2011 Resident of the Month. Donovan, a fifth-year Surgery resident, received nominations from other residents and nursing staff, which included such comments as “She is honestly one of the most compassionate and attentive residents I've ever worked with." Other residents reported having “the good fortune of working with her on night float and other assignments, where she has proven herself time and time again to be a significant resource to all who work with her.” Another co-worker described her as “resourceful, strong, intelligent and a pleasure to work with, especially in highly stressful situations."
Melissa Donovan, M.D.
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CHRISTIANA CARE PHARMACY
Trent Beach appointed Baldridge award examiner
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rent A. Beach, Pharm.D., MBA, MHA, FASHP, received an appointment from the U.S. Department of Commerce’ National Institute of Standards and Technology (NIST) to serve on the 2011 Board of Examiners
for the Malcolm Baldrige National Quality Award. The Baldridge Award, created by public law in 1987, is the highest level of national recognition for performance excellence that a U.S. organization can receive. As an examiner, Beach is responsible for reviewing and evaluating applications submitted for the Award. The board is composed of approximately
500 leading experts selected from industry, professional and trade organizations, education and health care organizations, and nonprofits (including government).
Trent A. Beach, Pharm.D
Therapeutic notes Dietary Supplements By Cynthia Barlow, Pharm. D., BCOP
claims may lead to patient misinterpretation. For example, dietary supDietary supplements are defined by plements containing ginkgo biloba the Dietary Supplement Health and cannot be labeled as treating memory Education Act of 1994 as products loss or Alzheimer’s disease, but, can “intended to supplement the diet” that be labeled to enhance brain function contain vitamins, minerals, herbs, or and cognition in patients. A consumer other botanicals. Familiar examples of may interpret these two claims as one herbals include: St. John’s Wort, echiin the same. nacea, ginkgo biloba, saw palmetto, The popularity of dietary supplements and black cohosh. Consumers are has grown steadily in the United often attracted to these products secStates. It is estimated that more 38 ondary to the belief that they are effec- million adults in the United States use tive and natural, hence, safe. dietary supplements. However, it is
However, the safety and efficacy of these agents have not been proven to the Food and Drug Administration (FDA), because these agents are classified under food products and not drug therapy. Opposite of the drug approval process, the proof of efficacy or safety does not have to be demonstrated to the FDA prior to marketing of agent. With regard to efficacy, marketing of dietary supplements cannot claim activity in the specific treatment of a specific disease or condition, however, claims can be made that suggest an effect on the function of the body without the burden of proof to the FDA. The differentiation of these two 14
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estimated that only 1/3 to 1/2 of patients will share with their provider that they are utilizing these supplements.This lack of reporting is of concern because of the potential for serious drug-herb interactions. For example, decreased anticoagulant activity with the combination of ginseng and warfarin, increased risk of bleeding when ginkgo biloba is combined with antithrombotics, or a potentially fatal result of serotonin syndrome from the use of St. John’s wort in combination with selective serotonin reuptake inhibitors, to name a few. To prevent the omission of this information, providers should routine-
ly ask patients whether they are using dietary supplements. Providing examples may be helpful in understanding what is being asked. Christiana Care supports the use of select dietary supplements. Requests for the addition or deletion of agents to the formulary may be submitted to the Pharmacy and Therapeutics Committee. If the agent is on the formulary, it will be provided by pharmacy services or the dietary department. Dietary supplements not on the formulary may be used if the physician enters an order for the patient to “use their own dietary supplement” and the dietary supplement is considered safe by Pharmacy and Therapeutic Committee. The following supplements have been determined to be safe for use by patients of Christiana Care: Bilberry, black tea, black cohosh, black pepper, cascara, cayenne, chamomile, chondroitin, cranberry, echinacea, garlic, ginger, ginkgo, ginseng, panex and Siberian glucosamine, grape seed extract, hawthorn, milk thistle, passion flower, SAMe, saw palmetto, soy, St. John’s wort.
Formulary update - July-August, 2011
United Way of Delaware supports First State School
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delegation from the United Way of Delaware delivered much-appreciated books and backpacks in August to help out students at First State School. United Way’s message: One of our primary focuses is education, because a solid education is critical for a good quality of life. United Way supports many programs that promote reading and education in general for preschool children through high school ages, as well as a variety of health and income initiatives to promote physical health and financial stability.”
United Way representatives (from left) Sarah Kenney, Jeff Haas, Gerald Rocha, Kanani Hines and Reggie Coston visited the First State School (FSS) at Wilmington Hospital, bearing gifts. From left, FSS students Henia, Madison, Kiara, Samsan, Zie and Maura received the special United Way backpacks filled with summer reading selections, just a few of the 4,000 bags distributed throughout Delaware.
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Dr. Meara receives grant to promote academic careers among oral-maxillofacial surgeons
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hristiana Care’s Department of Oral and Maxillofacial Surgery Director of Training and Research Daniel J. Meara, M.D., D.M.D., has received the American Association of Oral and Maxillofacial Surgeons/Oral and Maxillofacial Surgery Foundation, Faculty Educator Development Award.
retain and recruit oral and maxillofacial surgery faculty. Dr. Meara is one of only four 2011 national award recipients. “Dr. Meara is our rising star and brings a new dimension and expertise to our training program for oral and maxillofacial surgery in the full scope of surgical procedures,” says Edwin L. Granite, D.M.D., Chair and program director of the Department of Oral and Maxillofacial Surgery and Hospital Dentistry. “I can think of no one better qualified to teach the teachers and surgeons of tomorrow who are learning here in our highly advanced, nationally recognized training program.”
Disbursed over three years, the financial award is used to encourage and support promising young oral and maxillofacial surgeons and their academic careers in the specialty. It also provides an incentive to Commission on Dental Accreditation (CODA) accredited residency programs to Daniel J. Meara, M.D., D.M.D.
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An apple for the teacher, the dentist—and you
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he approaching school year is a reminder to educate ourselves on ways we can help to keep ourselves healthy. Think of an apple for the teacher to remind yourself of two good habits: packing nutritious brown bag lunches and scheduling regular dental checkups, the better to bite into that crisp fruit. Healthy lunches are a great way to get your kids on the path to nutrition because the help eliminate opportunities for youngsters to make poor food choices on impulse. Because you control what goes into the bag, you dictate the fat content and calorie count. That also goes for grownups. You might start by rethinking the sandwich, that brown bag staple. Whole-grain breads, such as rye and wheat, are typically more nutritious than white bread. They also hold up better in the lunch box and are less likely to get limp and soggy.
By getting dental checkups every six months, you can take care of concerns such as cavities, broken fillings and gum disease before they become large, expensive and painful problems.
Choose lean meats, such as turkey. Eliminate the cheese or try a low-fat alternative, such as part-skim mozzarella. Hold the mayo. Try a little hummus, instead. It’s spreadable, tasty and much lower in fat.
Set yourself up for success by stocking grab-and-go items you can toss in your lunch when you are pressed for time, such as low-fat yogurt cups, bananas, apples and pre-measured 100-calorie snack packets of almonds.
To keep brown bag boredom at bay, mix things up by trying new combos on vegetarian sandwiches, such as bell peppers, arugula and spinach, with low-fat cheese. Or make a green salad topped with lean protein, perhaps grilled chicken breast. (Tip: Save time by grilling a few extra chicken portions when you make dinner and use the extra for lunches.)
Steer clear of soda, which is packed with sodium, sugar and calories. Instead, go for water, no-fat milk or a sugar-free soft drink. It’s better for your waistline — and eliminating sugar also lessens your odds of tooth decay. (Tip: Adding a frozen bottle of water to your sack will keep your lunch cold. And when it thaws, you can drink it.)
By getting dental checkups every six months, you can take care of concerns such as cavities, broken fillings and gum disease before they become large, expensive and painful problems. Poor oral hygiene also can contribute to bone loss and increase your risk of heart disease and stroke. The dentist also will examine your mouth for signs of oral cancer, which is highly curable if it is diagnosed in the early stages. So, if it’s time for a checkup, don’t ignore that reminder from your dentist. Make an appointment — and smile!
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Service milestones adding up to 60,000 hours called for a celebration June 29 at the University and Whist Club in Wilmington. From left are some of the latest milestone achievers, including volunteers Anna Marie Brown, Mary McCready Diane Margolin, Girija Parameswaran, James Dugar, Jack Cooney, Philip Faix Jr., Janet Buell, Judy Vassar, Joanne Patchak, and Janet Sashihara.
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Preventive Health Services wants to help you control asthma wo dynamic initiatives, part of Christiana Care’s commitment to improving employee health, are helping workers with two chronic diseases to keep their conditions under control.
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Enrollees also have self-management goals and benchmarks. They can gauge their improvement at follow-up appointments after three months, six months and nine months.
More than 90 people signed up for a program designed to help adults 18 and older with asthma, says Karen Anthony, MS, CHES, program manager, Preventive Health Services.
“A lot of people don’t think they have asthma unless they are having an attack,” Anthony says. “In the program, they learn about the importance of maintenance medications and are educated about asthma triggers, such as allergy season.”
The goal is to reach as many Christiana Care employees and dependents with asthma as possible by providing education and medication at a convenient location at no cost. Anthony says an estimated 1,200 workers, spouses and dependents over 18 suffer from asthma. “From our results so far, we are hearing that people are ecstatic about how much better they feel,” she says. “We hope to help many more to understand and better manage their asthma.”
Preventive Health Services is a partnership between The Eugene DuPont Preventive Medicine & Rehabilitation Institute, the Department of Family and Community Medicine and Employee Health Services, created to improve and promote employee health and wellness. In addition to helping employees, the programs also have the potential to
benefit the entire health care system by reducing medical costs. To learn more about the asthma program, call Preventive Health Services at 302-661-3050.
Evaluating diabetes program More than 330 people with diabetes enrolled in a disease management program that provides diabetes education and nutrition counseling. Individuals who are compliant with the program receive medications and supplies at no charge. Enrollment is currently closed to new participants while the program is being evaluated, but preliminary results indicate that enrollees show significant improvement in their cholesterol values and blood sugar control.
When asthma is under control, people feel better and need to take fewer sick days. Asthma affects ability to work “Asthma definitely impacts whether people can come to work or how they feel after they get to work,” she says. At the beginning of the asthma program, more than half the participants reported their asthma was uncontrolled or poorly controlled. After three months, only 22 percent reported their asthma was uncotrolled. In the program, participants meet with a nurse manager, who educates them about their asthma and how to properly use their various medications to that they can better understand their conditions and adhere to their asthma action plans.
It’s never too early to read Focus! Little Siya Edupuganti takes an interest in FOCUS. Reading FOCUS is part of Siya's early childhood education, says her mother, Kavitha Edupuganti, injury prevention educator with the Christiana Care PEEPS team.
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PRSRT STD U.S. POSTAGE
External Affairs P.O. Box 1668
PAID
Wilmington, DE 19899-1668
WILMINGTON DE PERMIT NO. 357
www.christianacare.org
How Preston’s dream of bike-riding became reality
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hen Deborah Buenaga saw a photo of a boy with mitochondrial disease riding a specially made bike, she wanted one for her 12-year-old son, Preston, who has the developmental disease, too. Excited, she posted a picture of the bike on her Facebook profile and asked her friends if they knew anything about the company that made it. A friend saw the post and sent Buenaga a message telling her she was going to start a “Facebook Event” page to raise enough money to buy Preston the $2,200 bike. Her friend created a page named “Pay It Forward for Preston's Love Bike,” and invited their friends to participate. Within five days they collected more than they needed in pledges for Preston's bike. Now Buenaga plans to use money left over to buy another custom-made bike for another child in need. Preston Buenaga received his custom-made orange bike Aug.11. With him in the photo are his Christiana Care Physical Therapy PLUS rehabilitation team, from left, Exercise Tech Allison Siple, Michele Jones, OTR/L, Lisa Ross PT, DPT, PCS, Travis Ross PT, DPT; and his parents, Deborah and Stephen Buenaga.
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