Volume 3
WHAT’Snew
Number 22
October 31, 2014
Pennsylvania Hospital
Pe n nsy P.M. A Snapshot of the Nation’s First Hospital After Dark > > >
`` Engineering night shift mechanics, Clinton Land and John McClelland.
It was a chilly, rainy and moonless night. While the rest of North America was slumbering the night of October 22 and into the morning of October 23, What’s New made the rounds through Pennsylvania Hospital to shine the spotlight on our night shift employees. This special issue of What’s New is dedicated to all who contribute to our mission of providing excellent care and keeping our fine institution running smoothly, 24-7. For more coverage of the night shift life at Penn Medicine, visit the latest issues of HUPdate and the Presby Bulletin at PennMedicine.org/news.
When Things Go ‘Bump’ in the Night
`` Paula Hess and Darcell Ruff, PETU
Inside Pennsy P.M. continued.........2-3 What’s Happening....................4
during overnight emergency surgeries), power outages, elevator malfunctions, floods, leaky roofs, broken pipes, faulty If there’s a ceiling leak or elevator stuck nurse call systems, fire alarms, and heating at night, who ya gonna call? The night and air condition issues. Night mechanics mechanics of Engineering Services — that’s perform daily system inspections and handle who — the Mr. Fix-its who provide electrical, daily gas tank deliveries, such as oxygen, to plumbing, structural and mechanical the hospital. solutions as needed overnight at PAH. Clinton Land and John McClelland work the Night shift mechanics are also responsible first night shift. Both men address problems for keeping the hospital’s pneumatic tube in any of the 19 individual buildings (that’s all system running — no small feat when you except Penn Medicine Washington Square) consider PAH averages approximately 3,000 across Pennsy’s campus — including both pneumatic tube transactions per day. When parking decks. “We respond to everything,” more unconventional situations arise, such said Land. “If we can’t actually fix the as a pigeon invasion in the Emergency situation ourselves, we’re the ones who Department waiting room or an opossum make sure it gets done.” chillin’ in an airway pit of the Cathcart Building (Animal Control was promptly called Land and McClelland tackle a wide variety in to safely remove the nocturnal critter), of problems making them proverbial jacks well, the night mechanics tackle that too! of all trades: clogged toilets, TV and lighting problems (including OR surgical lamps Continued on Pages 2-3 / / /
Ebola Preparedness at Penn Medicine......................4
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Pe n n sy P.M.
Continued from Cover / / /
Every Aspect of Nursing
`` ED nurse Kenya Lindsay
When ED nurse Kenya Lindsay, BSN, RN, starting working the night shift at PAH this past May — the first time she ever worked overnight hours in her nine-year nursing career — she was worried. “I’m married with two small children,” said Lindsay, “And I wondered… am I going to like it? Will it work for my family? How will my body react to it?” As it turns out, Lindsay’s worries were unfounded. “I love it! I’m able to have dinner with my family, help my children with their homework and still get the rest that I need.”
Lindsay also appreciates the unique experiences that come from working in the ED. “I love the variety. You get to experience every aspect of nursing in a hospital — oncology, heart, stroke, pregnant and injured patients — you name it, we see it,” said Lindsay. “ED nursing allows me to care for all these patients and I am part of a wonderful team who work so well together. I feel a great sense of support where people are looking out for you.” While her body did have to go through the process of adjusting to a night shift schedule, Lindsay says the discomfort is temporary and offset by other advantages. “The hospital is different at night. The work flow is no less but hospital personal and visitor traffic is less. There’s less people congestion so the atmosphere is more mellow,” said Lindsay. “Plus, there are no Lab or Radiology delays during overnight hours.” The ED also has its share of cases unique to the overnight hours. “We do see a lot of homeless patients and we have to be sensitive to their needs to figure out what the problem really is,” said Lindsay. “Often all they really want is hot meal or to lie down on a stretcher for a half hour. We also get a lot of alcohol intoxication cases at night and will monitor and care for them until we know they are safely able to leave.” `` Pharmacist, Gregg Jugla, BS, RPh
The Machines Talk to Us At first glance, with a staff of only two, you can’t get a sense of all that’s going on late at night in PAH’s inpatient Pharmacy. However, pharmacist Gregg Jugla, BS, RPh, and certified pharmacy technician Pemy Chhim, CPhT, were hard at work. “We get ED requests for meds all night long and are responsible for redirecting medications to the proper place for patients who move within the hospital, such as a patient going from a critical care room to a step down unit,” said Jugla. The pneumatic tube system runs throughout the night with medications going out of the Pharmacy to all over the hospital. Jugla and Chhim also fill patient medication needs via computerized physician orders or directly through the Pharmacy walk-up window as well as aid Anesthesia techs working in the ORs. `` Pharmacy tech Pemy Chhim
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“Our number-one priority is the needs of patients right now,” said Jugla. “Then we need to concentrate on preparing all the morning meds for patients, including prepping for the needs of all 34 ORs for the next day.” This includes all IV drips and other special meds `` Zaneta Trossi, FNS, and Charles Baillie, MD, that need mixing in the sterile Internal Medicine clean room. “This is where, for example, if an open heart surgery case is scheduled for tomorrow we’ll prepare a ‘heart pack’ which includes a special mix of heart meds, irrigation fluids and antibiotics.” From 10 p.m. to 2 a.m., Jugla and Chhim “field whatever” requests come their way. After that, a total of all 96 machines (including 41 of the Pyxis automated dispensing cabinets and 55 anesthesia systems) need restocking for a 4 a.m. delivery start. Deliveries go until 6 a.m. throughout the main hospital patient units and the Spruce Building. “All the machines ‘talk’ to us,” said Jugla. “We get three levels of warnings from each machine — a first warning that supply is going down, a second minimum level alert and then a ‘critically low’ alert. This warning process from minimum to out-of-stock takes six hours so we we’re able to make sure we never run out.”
The Refueling Station Most of us are familiar with that ebb in energy called “the afternoon slump” — that time between lunch and the end of the work day when you need a jolt of caffeine. Well, for night shift employees it’s no different, except for perhaps the time. “I definitely see a crush time when employees need a boost,” said Zaneta Trussi, who has been working shifts at the Coffee Cart for Food & Nutrition Services for the last seven months. The Cart is open as a service to hospital employees and overnight visitors from 10 p.m. to 2 a.m. Trussi, who also works in the cafeteria (you can sometimes see her on the grill) during day shift, likes staffing the Coffee Cart at night. “It gets really busy around midnight — I mean really busy like the line goes all the way out (to the Preston Lobby). But I enjoy seeing employee regulars and serving family members of patients who stay overnight.”
The ED for Pregnant Women Paula Hess, CNS, RN, a nurse who has been working in the Perinatal Evaluation Treatment Unit (PETU) at PAH for the past 22 years, is a seasoned night shift employee. She’s able to rattle off stats and answer anything you might want to know about the PETU. “We have nine beds in the PETU, and it can go from zero to 60 up here in a second,” said Hess. “This is the ED for pregnant women and we see them all at any time before delivering all the way up to 41 days post-partum.”
Paula likes working the night shift because there are less distractions and she appreciates the closeness of the staff. “We work well together, like a family,” said Hess. “We have to be close because, like everyone who works this shift, we have fewer resources. We all help each other out.” Not everyone who comes to the PETU ends being admitted to the Labor and Delivery Unit. Sometimes patients stay in PETU where staff monitors them for 23 hours before it’s determined they are cleared to go home. “Then there are times when we have to deliver here,” said Hess, “Like when Labor and Delivery is full or those times when baby just can’t wait.” Typical overnight PETU staffing consists of a third year obstetrics resident, two RNs, an OB scrub tech and a unit clerk.
The Only Unit with 24-7 Mood Lighting Immediately inside the Intensive Care Nursery (ICN) entrance is brightly lit. Once you go further into the unit, which is a Level III nursery, the highest level of care, you find yourself in a place unlike any other in the hospital. The nurseries are constantly low-lit for the comfort of our tiniest, most precious patients — those born premature (as young as only 23 weeks gestation) and those born critically ill or in need of special care. “We have a total of 45 bassinets and five extras we can deploy if the ICN is at capacity,” said ICN nurse Luke Mitchell, BSN, RN.
We Help People Shirley Ortega-Cortes, a weekend night shift supervisor in Security, has worked the overnight hours `` Security Officer Shirley Ortega-Cortes at PAH since 2006. This particular night she was starting her shift at the front desk inside the hospital’s main entrance. “Every night is different working this shift,” said OrtegaCortes, who rotates the front desk post with working in the ED and the Crisis Response Center down the street in Hall Mercer. “It’s more stressful for people in the ED during off hours so we may be needed more to maintain calm and order,” said Ortega-Cortes. In additional to typical duties such as checking IDs, guarding entrances and directing visitor and patients, more extreme situations can arise where Security staff assist staff on the floors to control unruly patients or visitors. Security staff also works closely with the Philadelphia Police in response to criminal activity in the hospital and on campus. “What we mostly do is help people,” said Ortega-Cortes. “We give information, directions and protection. We will escort anyone who asks to their vehicle within a two block radius. We want people to feel safe at and around Pennsylvania Hospital.”
Because of the constant dim lighting it may seem difficult to detect any difference between the day and night shifts in the ICN. Nurses bustle about tending to the little ones, per usual. Night Charge Nurse Carol Madigan, RN,and cradles and encouraged one infant boy so perfect and tiny he looked like a baby doll, trying to get him to feed from a bottle. Mitchell delicately tended to a preemie boy in an enclosed Isolette — only 24 weeks and four days old — checking his lines and making sure he was comfortable.
We Give Respite
This is Mitchell’s first year as a nurse. “I started my career in case management, working with those recently released from prison,” said Mitchell, “But I always wanted to be a nurse.” So he decided to switch career gears and was hired to work in the ICN right out of nursing school. He has been with PAH for the past year and rotates working the night shift. “I’m a morning person, so this was an adjustment for me,” said Mitchell. “However, it is quieter at this time. We don’t do rounds and while parents are in the ICN at all hours, it is easier to do things like change Isolettes and bathe the babies. I like it here. It’s a good gig.”
The CRC can see anywhere from five to 25 patients in a single night. “Some people come in on their own and others are brought to us by family members, the police, or our ED staff,” said psychiatric nurse Lary Campbell, RN, who has worked the night shift in the CRC for the past 15 years. “We are here to differentiate between those patients who should be admitted and those who should be discharged with a referral to get the help that they need.”
Housed in Hall Mercer almost a block away from the main hospital building, the Crisis Response Center (CRC) addresses the immediate needs of the mentally ill and drug addicted of our community. “There are no holidays here,” said Larry Brinkley, who has staffed the CRC command center from 9 p.m. to 1 a.m. for the past 11 years. “We’re open to help people 24 hours a day, seven days a week, all year round.”
“This is my first night shift here,” said Olga Achildi, MD, the only physician working overnight in the CRC. “It is very interesting and I do like it. We deal with patients who, in addition to medical issues, also have a lot of social issues. We work with them to show them how to cope with their issues and symptoms.” Beth Dunn, RN, another psychiatric nurse who has worked at PAH since 1997, transferred to the night shift in the CRC full-time three months ago. “I like it more,” said Dunn. “There’s more autonomy and less traffic which means we can concentrate more on the patients. In addition to providing medical care, we also give people respite.” There is one gentleman who usually spends the night on one of the benches in the little park behind Hall Mercer. When the weather is bad, as it was this particular night, staff invite him in. “We’ll give him shelter, a sandwich and let him watch some TV,” said Dunn.
`` ICN nurse Luke Mitchell, BSN, RN
Both Dunn and Campbell have night time “regulars” — chronic outpatients who are not acute enough for hospital admission but come back to the CRC just to visit the nurses whose care they cherish. “Sometimes people just need a little TLC,” said Dunn.
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WHAT’S H a p p ening
Y our resource for events and happenings throughout PA H and P enn M edicine
For complete events listing, please visit What’s New on the Inside Penn Medicine web site at: http://news.pennmedicine.org/inside
Until December 1
Ebola Preparedness at Penn Medicine
Free Employee Flu Vaccines
Fall 2014
Penn Program for Mindfulness Courses & Special Events
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. This 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 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. For Ebola guidelines and further information about preparedness, visit the PAH Intranet homepage.
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November 8
Run For The Stripes 5K Run/Walk
November 8
2014 American Heart Association Heart Walk
November 15
NEW! 5th Annual PPMC Periop Nursing Conference
November 18
2nd Annual PAH Cookies for Kids’ Cancer Bake Sale
WHAT’Snew EDITORIAL STAFF Editorial Staff Olivia Fermano
Sally EditorSapega and Photographer Director of Internal Communications Pamela Furches Design Olivia Fermano Graphic Design Editor and Photographer Barry Ogburn Pamela Furches Design Photography Graphic Design
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Barry SusanOgburn E. Phillips Photography Senior Vice President, Public Affairs Holly Auer
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Susan E. Phillips Senior Vice President, Public Affairs Sally Sapega Director of Internal Communications Contact Contact What’snew What’snew at: at: Department Department of of Communications Communications Pennsylvania Pennsylvania Hospital Hospital Philadelphia, Philadelphia, PA PA 19106 19106 phone: phone: 215.829.6799 215.829.6799 email: email: olivia.fermano@uphs.upenn.edu olivia.fermano@uphs.upenn.edu WHAT’Snew WHAT’Snew isis published published biweekly biweekly for for PAH PAH employees. employees. Access Access WHAT’Snew WHAT’Snew online online at at http://news.pennmedicine.org/inside/whats-new/. http://news.pennmedicine.org/inside/whats-new/.