Presby Bulletin October 31, 2014 by Penn Medicine

Volume 9

Issue 22

October 31, 2014

PRESBYbulletin Penn Presbyterian Medical Center

Ebola Preparedness at Penn Medicine As an academic medical institution, Penn Medicine stands ready to provide expert clinical care under a broad range of circumstances, keeping the safety and protection of our patients and staff as our top priority at all times. The likelihood of an outbreak of Ebola in this country is extremely remote, but we are nonetheless prepared for the possibility of any of our facilities receiving a patient who may have been exposed to or infected with the Ebola virus. The Hospital of the University of Pennsylvania has agreed to be among hospitals to care for U.S. medical workers who contract the virus while working in Africa, if needed. To date, we have no patients suspected of or confirmed to have the Ebola virus in our facilities. We are following the CDC’s patient screening criteria for Ebola, including both travel history and symptoms that may be associated with the disease. Media reports have mistakenly indicated that HUP is a regional referral center for Ebola patients. That is not true. While there is ongoing discussion at the state and city levels about regionalizing care for patients with Ebola, there are currently no public health plans to institute this model. Any suspected or confirmed Ebola patients received at Penn Medicine facilities would be (continued on back)

A Behind-the-Scenes Look at Keeping the Lights On when it’s Dark Outside It was 10:30 p.m. when I walked into the Wright-Saunders lobby; a familiar scene that on this night was eerily unfamiliar in its silence. But what I learned over the course of the next few hours is that Presby at night is not at all silent; it’s alive and teeming with behind-the-scenes activity. The night shift is made up of the Penn Medicine men and women who care for Presby patients when most other people are fast asleep. They hold down the fort and function as a fully equipped hospital from the late hours of the night through the wee hours of the morning. While it may be quieter on the whole, working the nightshift comes with its own set of unique challenges.

A Different Life “You live a totally different life,” said Suzanne McPaul-Curran, RTR, (left) a Radiology Technician who has been with Presby since 1993 but switched to the night shift six years ago so she could spend more time with her son. How long did it take her to get used to the change? “About six years,” she says, laughing. (continued on page 2)

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“I’m starting to like it. I have more autonomy and more interaction with the folks in the ED and the SICU. We have a great rapport.” With greater autonomy and reduced staffing numbers also comes a greater sense of family, team work, and comradery. “It’s a different flow at night, and we have a very tightknit group,” says Diane Maccarone, RN, BSN, CEN, clinical nurse IV in the Emergency Department. “It’s like we speak our own language.” Brian Work, MD, MPH, Internal Diane Maccarone, RN, BSN, CEN, (left) and Beverly Brown, RN, BSN, CEN, help hold down Medicine the fort in the ED overnight Hospitalist, takes the night shift at Presby three days a week so he can spend his daytime hours working in free clinics with members of the community. He has a special affinity for the often-quiet “graveyard shift” which provides the opportunity to interact more with the patients who need it. “If someone just found out they have lung cancer and they’re scared, I want to be able to sit with them, hold their hand, and talk to them. That’s not something I ever had time for working in an outpatient setting, but the night shift is less regimented which means I can make better use of the time I have.”

nonclinical areas that keep the hospital running smoothly only recently added a night crew. Pam Gurley, inventory control for Materials Management, has been working the overnight since ever the department decided to add an off-peak staff member seven years ago. Before that, if supplies were needed, Security had to let staff members into the store room. “The problem was they didn’t know where anything was kept, or how the store room was organized, so it wasn’t very efficient. When the department was reorganized and a third shift was created, I volunteered for the position.” For Gurley, who enjoys working independently, the night shift position is “the best thing that’s ever happened to me.”

The Benefits of Late-Night Work For others, the night shift has always been a way of life. “My Dad calls me a vampire because I’m up all night and I take blood,” says Maccarone. “I’ve been on the nightshift for 18 years, and I wouldn’t have it any other way,” she says, adding that Katy Bonaventure, RRT, prepares a CPAP machine with three children for use on patients with obstructive sleep apnea between the ages 9-13, it can be difficult to balance work and family time, but working the night shift allows her more flexibility to be home during the day. Maccarone may be on to something. Contrary to what you might expect, studies show that night shift workers spend more time with their children than those with “normal” work hours.

“Working at night actually gives me more time with my family because my son’s activities take place during the day, so Pam Gurley keeps the shelves stocked and inventory in order I’m tired, but I don’t miss out,” said Katy Though patient care Bonaventure, RRT, respiratory therapist, who says units have always been staffed to handle cases working the off-peak shift works out better for her family. “My that may come up on off-peak hours, some of the husband works the day shift in Respiratory Care at HUP, so this

“It definitely takes a special kind of person to work the night shift,” Work says, explaining that patients are different at night. “A lot of conditions get worse during the night hours. Dementia, schizophrenia, and withdrawal – all of these things come out at night.”

works for us. If our son is sick, nobody has to take off of work because someone can always be home with him.” Perhaps nobody could agree with that more than Diane

And that’s just the tip of the iceberg. Presby’s cafeteria closes at 6:30pm, which means departments need to make sure they’re stocked up with the enough food for their patients, including those who may have special dietary needs or restrictions. As for staff, in the absence of a cafeteria or food trucks, most bring their dinners from home, while others have become very familiar with the 24hour restaurants in the area. “Working the night shift, you have to be self-motivated and enjoy working independently,” says Pearl Chambers-Adams, MHSN, BSN, RN, nursing administrative coordinator and 10-year veteran of

David and Diane Talemal have each been working their late shift for nearly 35 years

and David Talemal, Pathology & Laboratory Medicine evening and night shift supervisors, respectively, who met 30-some years ago on David’s very first day of work. “We’ve seen a lot of changes over the years, but this has always worked for us,” says Diane, adding that she and David used to use the one-hour overlap time in their shifts to have dinner together and hand-off their then very young kids. “I was at home during the day, so I could watch the kids or chaperone a field trip for school, and then when I went to work, he was there to take over cooking and helping with homework.” And the benefits don’t stop there. Many of the night owls say running errands during the day is much easier – and faster – than in the evening, and just because they keep different hours doesn’t mean they can’t have a social life. “If you work the day shift, you don’t go home and go to bed, you take time to wind down, have a glass of wine or run errands,” said Beverly Brown, RN, BSN, CEN, clinical nurse II in the Emergency Department. “We do the same thing, just in the morning. It’s a total reversal of life. We get out of work and go out for happy hour, too, ours is just in the morning when everyone else is eating breakfast.”

Special Forces at Work Despite the personal and professional benefits, Presby’s late-night employees will tell you it’s not a shift for everyone, and quieter doesn’t mean easier.

Brian Work, MD, and Pearl Chambers-Adams, MHSN, BSN, RN, collaborate on the night shift to coordinate placement of newly admitted patients into open beds

the night shift. “Most importantly, you have to be someone who can stay awake at these hours,” she jokes, adding that she prefers the quiet to the hustle and bustle of the day shift. “There’s a lot more thinking on your feet, because we have a smaller crew and not as many resources,” says Maccarone. For example, there’s no ultrasound or MRI at night, so patients who may be in need of those tests are triaged differently and cared for until morning. Of course, the night shift will see a lot of changes next year when Penn Medicine’s trauma program relocates to the new Pavilion for Advanced Care. But, most of Prebsy’s night shift is looking forward to the shift. “The trauma move will be exciting because of all the extra resources and additional staff we’ll be adding,” said Maccarone. “It’ll be an adjustment, but we’ll just be a bigger family.” Check out this week’s issues of HUPdate and What’s New for a look at the night shift life at the Hospital of the University of Pennsylvania and Pennsylvania Hospital.

Ebola Preparedness at Penn Medicine (continued from front)

transferred to HUP, which is prepared to isolate these patients in a Special Treatment Unit. This space is separate from other patient-care areas and has been designed to ensure both optimal medical care for Ebola patients and the safety of our staff and other patients. Two phone lines have been established to assist clinicians and staff around the clock: *Clinicians with patient-related questions should call 215.614.0524. A physician will answer and handle calls about screening, isolation and, if necessary, lead arrangements for patient transport to HUP from another entity. *General questions not pertaining to direct patient care can be directed to 215.615.2929. In tandem with ongoing training for staff who may care for a patient with Ebola, information is added daily to the UPHS Intranet site for Ebola preparedness, and clinical staff are encouraged to check this site regularly to stay abreast of updates: http://pennpoint.uphs.upenn.edu/ sites/ebola/default.aspx.

Penn Accredited as One of Six National Pulmonary Hypertension Care Centers Penn Medicine is now home to one of the first fully accredited Pulmonary Hypertension Care Centers (PHCCs) in the country, with its Pulmonary Hypertension/Pulmonary Vascular Disease Program at Penn Presbyterian Medical Center and the Hospital of the University of Pennsylvania. The Pulmonary Hypertension Association (PHA) just announced its first six accredited programs as part of their efforts to improve overall quality of care and ultimately improve outcomes of patients with pulmonary hypertension (PH), specifically pulmonary arterial hypertension (PAH) — a rare and debilitating disease of the lungs that affects the functioning of the heart and can lead to right heart failure. PHCC accreditation signifies that a PH program is dedicated to making a proper diagnosis and has the capacity to appropriately and comprehensively manage PH patients according to a set of criteria established by the PHA Scientific Leadership Council — 28 global leaders in the field of pulmonary hypertension. These criteria have also been developed with input from many PH stakeholders including physicians, allied health care professionals, patients and PHA leadership and are considered essential to delivering high-quality care for these complex patients. For more information on the announcement, please visit: http://www.uphs.upenn. edu/news/News_Releases/2014/09/phcc/

5TH ANNUAL PPMC NURSING PERIOPERATIVE CONFERENCE 2014 When: Saturday, Nov. 15, 7:45 a.m. - 12:15 p.m. Location: Kozart Auditorium

Don’t forget, there’s still time to apply for your Penn Medicine CAREs grant. Applications for the next round of grants are being accepted through December 1, 2014. Visit the CAREs Community Outreach link on the Intranet homepage, or http:// uphsxnet.uphs.upenn.edu/community/ for more information.

Free to UPHS employees; Non- UPHS RN $20, students $10 Continental breakfast and parking included. Pre-registration required: send name, address, phone number, entity, Penn ID or license number, and specify “Periop Jam” via e-mail to crystal.mitchell@uphs. upenn.edu or fax Crystal Mitchell at 215.662.9179. Space is limited, so register early. UPHS employees may also register by visiting Knowledge Link.