Volume 4
WHAT’Snew
Number 14
July 10, 2015
Pennsylvania Hospital
When Less is Just Right Philadelphia is chock full of historical firsts, including in the field of medicine. Just last month, two of Penn Medicine’s big “firsts” celebrated their birthdays: the Perelman School of Medicine at the University of Pennsylvania — the nation’s first medical school — turned 250 and PAH, the nation’s first hospital, turned 264. For over two and a half centuries, both institutions have been home to `` Shown here, Patricia A. Ford, MD, founder and director of the CBMS at PAH, speaking at a patient education symposium.
Almost 20 years ago, Ford performed the world’s first bloodless autologous stem cell transplantation in a nonHodgkin’s lymphoma patient.
Inside When Less is Just Right Continued.............................................. 2 UPHS Nursing Clinical Excellence Award Winners.................................... 2 More High-Fives for PAH Heart Heroes............................... 3 New IS Self-Serve Portal................... 3 Prepping for Philly to Host World Meeting of Families and a Papal Visit ................................. 4 Penn’s Fourth Annual 5k for the IOA and Memory Mile Walk.............................................. 4
individuals on the cutting edge of clinical care.
One area of ongoing innovation is overseen by Patricia A. Ford, MD, the founder and director of the Center for Bloodless Medicine & Surgery (CBMS) at Pennsylvania Hospital, director of the Peripheral Stem Cell Transplant Program, and clinical professor of Medicine. Almost 20 years ago, Ford performed the world’s first bloodless autologous stem cell transplantation in a non-Hodgkin’s lymphoma patient. A stem cell transplant was the only chance of a cure for this patient, yet a typical autologous stem cell transplant was out of the question, since this patient was one of Jehovah’s Witnesses. He, as do all Witnesses, firmly believes that blood “stands for life…has special significance…and should not be misused” or removed from the body and stored as it would via a transfusion. These beliefs call Witnesses to seek bloodless medicine and surgery, which refers to a variety of techniques that allow a patient to be treated without blood or blood products.
Ford, who established the CBMS in 1996, making it one of the oldest and largest bloodless centers in the U.S., has been at the forefront of treatment for patients without using whole blood or blood products such as red cells, white cells, platelets and plasma. But let’s get back to that first patient in 1995. An autologous stem cell transplant — a type of transplant in which the person’s own stem cells are used — was the recommended course of treatment. In such a transplant, the cells are collected in advance and returned to the body to replace stem cells damaged by high dose chemotherapy used to treat certain types of cancers. However, at that time, it wasn’t thought possible to successfully treat a patient with an autologous stem cell transplant without a blood transfusion or other blood product support. It was thought to be unsafe — and unsurvivable — since blood products are customarily used to prevent and treat infections that may arise due to depleted white and red blood cell supplies during the period before the transplanted cells “engraft” / / / Continued on page 2
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When Less is Just Right
/ / / Continued from cover
Ford has performed
bloodless autologous stem cell transplants at PAH.
and begin producing new blood cells in the patient’s body. Yet this patient did survive and lives today, disease free.
teaching the protocol to other clinicians around the world. Ford has performed 138 bloodless autologous stem cell transplants at PAH.
After the success of the first patient, Ford and colleagues wondered, can another individual survive a stem cell transplant without blood products? Sadly, two weeks post-transplant, the second patient didn’t make it.
This spring in the Journal of Clinical Oncology, Ford and her colleagues reported that autologous stem cell transplantation can be safely performed without blood product support in patients with hematologic malignancies, or blood cancers.
“After the second patient’s case study, we had to stop and ask the really tough questions,” Ford said. “Is it ethical to continue this work? What mortality rate and chance of cure is acceptable? While I and the team were emotionally devastated from the loss of this patient, family members met with me to tell me how much they appreciated what I had attempted to do as no one else had given them any hope. And they asked me to continue to treat others in the same situation.” Determined to honor her patient and the family’s wishes, Ford continued to treat others, refining and perfecting the procedure and
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The study included 125 Jehovah’s Witnesses with lymphoma, multiple myeloma, or amyloidosis who were treated with high-dose chemotherapy and autologous stem cell transplantation between 1996 and March 2014. The team reported they were able to manage all bleeding complications without the need for blood transfusions. There were few complications and no patient deaths during the study. Adopting such practices are proving both clinically and cost effective since they reduce transfusion-associated risks and complications including: human
error; platelet refractoriness (the failure to achieve desired platelet levels, posttransplant); acute transfusion reactions such as fever, chills, and hives; transfusiontransmitted infections; and transfusionrelated lung injury. “We’ve shown that patients can survive with blood levels never before thought possible all without receiving transfusions,” said Ford. “By applying very specific medical strategies — such as priming patients with intravenous iron and erythropoietin to increase their hemoglobin levels prior to transplantation — we can effectively and safely care for these Witness patients. This type of ‘pre-procedure management’ also applies to treating bloodless surgery patients as well.” The CBMS receives an average of 1,000 referrals annually for various medical and surgical conditions and treats over 700 bloodless patients a year at PAH. While blood management and conservation strategies were originally developed for Jehovah’s Witnesses who reject transfusions because of their beliefs, they are now becoming standard practice throughout Pennsylvania Hospital.
PAH Award Winners
`` Shown from here from left to right: Mary DelGuidice, CNO, Jon Paolini, Lynn Mulligan, Judy Vitali and Karen Trinidad. Not shown: Pam Power.
UPHS
Nursing Clinical Excellence Award Winners C o n g r a t u l a t i o n s to the PAH recipients of the 2015 UPHS Nursing Clinical Excellence Awards! And thank you for all you do, every day, to ensure the best experiences for our patients and their families.
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Each year, the UPHS Nursing Clinical Excellence Awards recognize nurses for their exceptional commitment to high quality patient care as well as their clinical knowledge and professional achievements. Highlighted at a ceremony held the end of National Nurses Week, nurses chosen from each health system entity — PAH, HUP, PPMC, GSPP, CPUP, Penn Home Care/ Hospice — are honored in the following five areas: Judy Vitali, BSN, RNC-NIC, CN, IV, Intensive Care Nursery Dorothy Botdorf – Clinical Leadership Karen Trinidad, MSN, RN, CN, III, Intensive Care Unit Helen McClelland – Clinical Scholarship Jonathan Paolini, MSN, CRNP, RN, AGACNP-BC, CN, III, Emergency Department Lillian Brunner – Clinical Judgment and Decision Making Lynn Mulligan, MSN, CMS-RN, CN IV, 5 Cathcart Rosalyn Watts – Nurse-Patient/Family Relationship Pamela J. Power, DNP, RN, ACNS-BC, CENP, Nursing Clinical Director, Women’s Services Victoria L . Rich – Transformational Leadership
MORE High-fives for
PAH Heart Heroes
Folks inspired, motivated and moved by others making a heartfelt difference in the Philadelphia region are sharing
IS Self Service
New IS Self-Serve Portal
their stories and highlighting heart and vascular staff at PAH and throughout UPHS. Most recently, Fermin C. Garcia, MD. and Anna Santos were nominated by coworkers as “Heart Heroes” — employees who consistently go above and beyond to help their cardiovascular patients, their families, and coworkers demonstrating extraordinary compassion in the delivery of patient care.
Corporate Information Services is pleased to announce expanded functionality within the IS Self Service Portal. New ticket creation is now available within the portal and both new Service requests and Incident requests can be submitted via this portal.
What is the IS Self Service Portal? PAH Heart Hero Garcia Fermin C. Garcia, MD, director of the Electrophysiology Laboratory at PAH and an assistant professor of Clinical Medicine, often sees patients with complex conditions who have had failed procedures elsewhere. Searching for answers, they come to him for hope and a sense of confidence that he won’t settle for anything but the best. As one of his patients says, “Dr. Garcia has been my doctor for years. He gives it to me straight. He makes my wife feel at ease, doesn’t rush us even though these procedures could take hours. Dr. Garcia saved my life and for that he is my Penn Heart Hero!”
PAH Heart Hero Anna Santos A highly skilled nurse in the cardiac catheterization lab at PAH, Anna Santos, BSN, RN-BC, CRT, has an energy and enthusiastic attitude that is infectious. “Never failing to show empathy and compassion, Anna puts her patients and their loved ones at ease,” said a colleague. “Combined with her warm, kind and caring personality, these qualities make her a true heart hero of many patients every day and an inspiration to her co-workers.”
The IS Self Service Portal allows you to perform Service Desk activities on your own; no longer requiring a phone call or e-contact to the IS Service Desk (662-7474). The IS Self Service Portal is the key tool that will improve your end user experience in communicating with CORP IS. The IS Self Service Portal is geared for individual users as well as department managers; allowing you to track tickets that you or someone from your department opened through the Service Desk. You will be able to check on ticket status, add comments to existing open tickets, and now, open new tickets; all without picking up the phone. Based on feedback from you, key features and functions will continue to be added to the portal to make your experience even better. The IS Self Service Portal is easy to access; simply look for the new “IS Self Service” button on the PAH home page, or type ISSELFSERVICE (all one word) at the Internet Explorer URL prompt.
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Prepping for Philly to Host World Meeting of Families and a Papal Visit A letter to all staff from Ralph W. Muller, chief executive officer, UPHS As most everyone is aware by now, Philadelphia will be hosting a very large international conference on the value of families the week of September 21st, to be culminated by a three day visit by Pope Francis starting on Friday, the 25th. The conference itself is set to attract up to 1 million visitors to the area while the papal visit at the end of that week is likely to swell the crowd to 2 million. The World Meeting of Families (WMOF) will have its meetings at the Philadelphia Convention Center, but various activities are scheduled all over the City. The Pope’s official activities during the weekend will be mostly focused on the Parkway where on Sunday His Holiness will say mass from the steps of the Art Museum. However, Pope Francis is likely to make additional special visits around the City which will draw crowds to those locations as well. More information about events
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during this week can be found at http://www. worldmeeting2015.org/papal-visit/. We share in the City’s pride at having been selected to host these events, but needless to say, the addition of this many visitors to Philadelphia — many of whom will not have English as their first language — coupled with a visit from world dignitary requiring the absolute highest level of security will cause significant disruption to transportation and place major stress on the City’s infrastructure, including its health care facilities. To provide some relief, decisions have already been made to close public and parochial schools at the end of the visit week and only essential city offices will be open during the Papal visit. Other institutional closures may be forthcoming, and we expect travel on major streets to be heavily restricted. I have convened a team to focus on how best for the Health System to plan for this
Everyone’s cooperation will be needed to respond to this “once a lifetime” event, but I am confident that the Health System can meet this challenge and contribute well to a successful and safe City event. For more information regarding the how the World Meeting of Families and Papal visit will affect the City of Philadelphia, please the News Section of the PAH Intranet Homepage (http://uphsxnet.uphs.upenn. edu/pahhome/) for Mayor Nutter’s and City Officials’ news release.
WHAT’Snew
Penn’s 4 th A n n u al 5K for the IOA & Memory Mile Walk
EDITORIAL STAFF
ark your calendars for Penn’s Fourth Annual 5K M for the IOA and Memory Mile Walk on Sunday, September 20, 2015.
Barry Ogburn Photography
Join colleagues from all across Penn and help raise vital research dollars for Alzheimer’s and other aging-related diseases at Penn’s Institute on Aging (IOA). With your help, the IOA can make the difference that yields new knowledge, finds cures, and changes the lives of millions of people suffering from Alzheimer’s and other aging-related diseases.
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momentous event; we will include the Perelman School of Medicine in these planning efforts. The health system will use our Snow Emergency Plan as the basis for out readiness plan. Updates will be provided as soon as information and resulting decisions are confirmed.
Olivia Fermano Editor and Photographer Pamela Furches Design Graphic Design
ADMINISTRATION
Susan E. Phillips Senior Vice President, Public Affairs Holly Auer Director of Communications Sally Sapega Director of Internal Communications
The event will be held on Penn’s campus, starting at Shoemaker Green between the Palestra and Franklin Field, and runs through Penn Park, with terrific skyline views of Center City Philadelphia. Online registration will close on Thursday, September 17, at midnight. Walk-up registration is available on race day.
Contact What’snew at: Department of Communications Pennsylvania Hospital Philadelphia, PA 19106
P lease visit pennmedicine.org/5kIOA to sign up, volunteer or donate today! > > > For information, contact: Michael Sofolarides, 215-573-0187, msof@upenn.edu.
WHAT’Snew is published biweekly for PAH employees. Access WHAT’Snew online at http://news.pennmedicine.org/inside/whats-new/.
phone: 215.829.6799 email: olivia.fermano@uphs.upenn.edu