FOCUS Center for Heart & Vascular Health surpasses national treatment standards
T Inside New OB/GYN Research
Protocol screens for drinking problems on admission 5 Multidisciplinary center for skin cancer
What’s new in Occupational Health & Wellness? 8 Jefferson Award winner
Transformation brewing on ACE units
Stress busting foods
he Christiana Care Center for Heart & Vascular Health received the American Heart Association’s “Get With The Guidelines” Gold Performance Achievement Award for Heart Attack and Heart Failure and the American Stroke Association’s “Get With The Guidelines” Bronze Performance Achievement Award for stroke care. “Get With The Guidelines” is a quality improvement initiative that provides hospital staff with core standards developed from evidence-based guidelines for treating patients and preventing future hospitalizations. “Get With The Guidelines” standards for heart attack and heart failure ensure that patients immediately receive risk reduction therapies and medication. Patients also may receive counseling for smoking cessation,
alcohol or drug use and for thyroid or weight management, as well as referrals for cardiac rehabilitation. Awards recognize high compliance The Gold Awards recognize that Christiana Care reached an 85-percent compliance to core standard levels of care as outlined by the AHA/American College of Cardiology for at least 24 months. The Bronze Award recognizes our success in implementing a higher standard of care for at least 90 days, according to nationally accepted standards and recommendations. “Christiana Care is dedicated to making our care for heart and stroke patients among the best in the country,” says Timothy Gardner, M.D., medical director and past president of AHA. “Implementing the ‘Get With The Guidelines’ programs helps us CONTINUED,
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Quality of care and treatment exceeds national standards Coronary Artery Disease Program team Members on hand for the award presentation included, standing, from left, AHA’s Stephanie Rhoads and Rena Cozart, Rebecca Brill, AHA’s Jonathan Kirch, Laura DeChant,Ola Adedeji, Caryn Rambo, Susan King, Margie Pankok and Maria Albert. Seated, William Weintraub, M.D., Linda Lewis, Thea Eckman, Ehsanur Rahman, M.D., Becky Haley and Joanne Matukaitus.
Heart Failure Program team Members on hand for the award presentation included, standing, from left, AHA’s Stephanie Rhoads and Rena Cozart, Jackie Mohn, Patti Buckalew-Bradley, Cheryl Alexander, Sue Scholl, Carolyn Moffa, Rocky Demaio, Shelly Hoglund, Catherine Johnson, Patti Christopher, AHA’s Jonathan Kirch and Denise Griffin, and Maria Albert. Seated, from left, Cathy Morris, Beth Rathmanner, Mitchell Saltzberg, M.D., Lisa Nellius, Susan Felicia, and Joanne Matukaitus.
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Quality of care and treatment exceeds national standards CONTINUED
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accomplish this goal by making it easier to improve the long-term outcome for these patients.” “‘Get With The Guidelines’ programs help our staff develop and implement prevention guideline processes,” Dr. Gardner adds. “The programs include quality-improvement measures such as care maps, discharge protocols, standing orders and measurement tools. The quick and efficient use of guideline tools enables Christiana Care to improve the quality of care we provide, save lives and ultimately reduce health care costs by lowering the recurrence of heart attacks and strokes.” “The American Heart Association applauds Christiana Care for its success in implementing the appropriate evidence-based care and protocols to reduce the number of recurrent events and deaths in cardiovascular disease patients,” says Gregg C. Fonarow, M.D., national chairman of the “Get With the Guidelines” Steering
Stroke Program team Members on hand for the award presentation included, standing, from left, AHA’s Stephanie Rhoads and Jonathan Kirch, Becky Barnett, Svetlana Shulkov, Susan King, Joanne Matukaitus, and AHA’s Rena Cozart and Denise Griffin. Seated, from left, Maria Albert, Jason Nomura, M.D., Barbara Albani, M.D., Anthony Munson, M.D., Mary Ciechanowski and Teresa Zack.
Committee and director of the implementing these life-prolonging Ahmanson-UCLA Cardiomyopathy treatments.” Center. “Christiana Care has achieved a high level of performance in terms of
START! Heart Walk supports vital research
he annual START! Heart Walk is Sept. 12 at the Wilmington Riverfront. Registration begins at 8 a.m. Walkers still have time to sign up as a captain and build a team or to join a team already created. American Heart Association representatives will be in the cafeteria at Christiana Hospital on Tuesday, Aug. 31 from 11 a.m.-1 p.m. to assist with registration. They will be in the Wilmington Hospital cafeteria the same hours on Wednesday, Sept. 1. Everyone who walks will receive a T-shirt to wear in the walk. To join visit www.startheartwalk.org and click on Delaware on the
interactive map. The START! Heart Walk supports projects such as: n Putting up-to-the-minute research into doctors’ hands so they can better prevent and treat heart disease among patients. n Groundbreaking pediatric heart and stroke research. n Getting information that can save lives, such as how to eat better, how to recognize the warning signs of heart attack and how to talk to a doctor about critical health choices, to people who need it most.
Ray Blackwell, M.D., honorary chairman of the 2010 START! Heart Walk.
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Christiana Care study focuses on induced labor and C-sections
eborah Ehrenthal, M.D., of the Departments of Obstetrics and Gynecology and Internal Medicine at Christiana Care was lead researcher on a new study published in the July issue of Obstetrics & Gynecology. The study found that first-time mothers who have their labor induced may face a greater risk of needing a cesarean section than those who go into labor naturally. The study examined 7,800 first-time mothers who gave birth at Christiana Hospital from 2003-2006. Researchers found that those who had their labor induced were twice as likely to need a C-section. Xiaozhang Jiang, senior bio-
statistician at the Christiana Care Center for Outcomes Research, performed the data analysis. “The current findings suggest that putting more limits on elective inductions would help lower the number of C-sections performed nationally,” says Dr. Ehrenthal. “The bottom line for pregnant women is that they should understand the reasons for and potential risks of all types of delivery methods and to have a frank discussion with their doctor about all of their options.” Read the article from Obstetrics & Gynecology online at http://inet/externalaffairsnews/Ehrenthal.pdf.
Deborah Ehrenthal, M.D.
Dr. Hoffman co-authors JAMA article on infant respiratory problems
hristiana Care participated in a study published in the July 28 issue of Journal of the American Medical Association that finds the likelihood of having a baby with respiratory problems shortly after birth substantially increases for late preterm infants— those born between 34 and 36 weeks— compared with full-term births at 38 to 40 weeks. Data from 15,000 births at Christiana Care contributed to the findings. Matt Hoffman, M.D., director of OB/GYN Education & Research at Christiana Care, was a co-author.
Matthew K. Hoffman, M.D.
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A retrospective analysis of more than 200,000 deliveries in the United States over a six-year period found that rates of respiratory distress syndrome and other lung problems were significantly increased for late preterm babies
compared with full-term infants—but the odds decreased with each added week of gestational age up to 38 weeks. “We believe this study represents an important opportunity to educate both parents and obstetricians about the impact of delivering between 34 and 36 weeks,” says Dr. Hoffman. “Members of the research team in the department of OB/GYN at Christiana Care were honored to both help develop and participate in this research,” he says. This study, which combined information on deliveries from 12 institutions, will continue to provide valuable information on how to better deliver care to pregnant women and their children.” Read the article in JAMA online at http://jama.ama-assn.
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Identifying problem drinkers on admission improves care
protocol that identifies problem drinkers when they are admitted to the hospital is enabling doctors to intervene before patients develop alcohol withdrawal. Rolled out in October 2009, the results are dramatic, with a significant reduction in length of stay and disruptions caused by patients suffering from withdrawal. “Alcohol use is common,” says Terry Horton, M.D., of the Department of Medicine. “It’s a safety issue not only for the patient, but for the people caring for the patient.” “Because of the stigma of alcoholism, an important medical problem was often pushed aside,” says Julie Silverstein, M.D., director, Department of Medicine Patient Safety and Performance Improvement. “This program acknowledges the high rate of alcoholism in the community and allows for safe intervention.” Every patient screened Now, Christiana Care nurses screen every patient admitted, using the Alcohol Withdrawal Risk Assessment. Once the assessment is ordered by a physician, nurses assess patients at risk for withdrawal severity under Alcohol Withdrawal Care Management Guidelines (CMG). The CMG include an assessment tool used to evaluate, determine the appropriate dose of medication, monitor for response and adjust dosing accordingly. Wilmington Hospital typically has three patients under alcohol withdrawal management at any given time. The Computerized Provider Order Entry system includes an Alcohol Withdrawal power plan, which is currently the sixth most common power plan ordered.
In the months since the program was launched, diagnoses of withdrawal are up and cases of DTs are down. The use of restraints has declined and transfers to the intensive care unit for DTs as a secondary diagnosis have fallen. Early trends suggest a dramatic reduction in length of stay for patients who receive indicated interventions for potential alcohol withdrawal. Some findings have been surprising. Two-thirds of DTs cases are secondary diagnoses, with primary diagnoses such as pneumonia or kidney disease. Nearly one in four of these patients is 65 or older. Dr. Horton notes that developing the protocol was a dynamic, multidisciplinary initiative involving a team of nurses, pharmacists and physicians working with performance improvement, data acquisition and informa-
Sources: Delaware Department of Health and Social Services, Division of Public Health and the
Identifying problem drinkers at time of admission enables doctors to intervene before patients develop alcohol withdrawal.
tion technology staff. The program was a grassroots effort, grounded in concerns raised by nurses for patients who were not identified as problem drinkers at admission who subsequently went into alcohol withdrawal. “One of the nurse managers was extremely frustrated because a patient had barricaded himself in the waiting room at 2 o’clock in the morning,” recalls Jo Melson, APN, a nurse practitioner. “These types of outbursts were commonplace and very disruptive.” The protocol is attracting attention elsewhere in the health care community. In July, Melson and nurseresearcher Ruth Mooney, Ph.D, presented “Show me the Evidence— Improving Alcohol Withdrawal Outcomes in Acute Care” at the University of Texas 2010 Summer Institute for Evidence-Based Practice in San Antonio. Dr. Horton says the program has farreaching possibilities for certain patients. “The hospital can be the place that establishes linkage toward recovery,” he says.
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New multidisciplinary center targets all types of skin cancer
he Helen F. Graham Cancer Center at Christiana Care specializes in diagnosing and treating all skin cancers.
treatment options, including surgery, electrodesiccation and curettage, radiation therapy and chemotherapy. A dedicated Melanoma MDC treats of invasive melanomas.
“Anyone with a suspicious mole, non-healing erosion or spot on the skin should not hesitate to come in for a skin check,” Dr. Zieff advises. “A Like all of the skin screening is about finding cancer multidiscipli- early when it most treatable, but it is nary Centers also an opportunity to determine a (MDCs) at the person’s risk for skin cancer and to offer education about preventing it.’’ Graham Cancer Skin screening counts Jonathon Zieff, D.O. Center, the Each year, more than 2 million Skin Cancer MDC wields the expertise Americans are diagnosed with skin of a team of specialists. These include cancer, including 60,000 cases of a dermatologist, medical oncologist, melanoma. Incidence of melanoma, in radiation oncologist, plastic surgeon particular, is rising among young peoand others as needed. ple and adults 65 and older. The team works closely with patients, Everyone over 60 should get an annufamilies and referring physicians to al skin check, but Dr. Zieff recomdevelop the most effective plan of care mends starting as young as age 30 for for each patient’s needs. people at higher risk: people with fair “Multidisciplinary care at the Helen F. Graham Cancer Center is about tackling a patient’s particular type of cancer from every angle with the full force of the best available expertise,” says Bank of America Endowed Medical Director Nicholas J. Petrelli, M.D. “The Skin Cancer MDC is the newest of our targeted clinics providing comprehensive, coordinated and cutting-edge cancer treatment.” Skin cancer is most common Dermatologist Jonathon Zieff, D.O., leads the Skin Cancer MDC team. “Skin cancer is the most common cancer, but it is highly curable when detected and treated early,” he says. The new MDC offers screening exams, consultative evaluations and treatment for basal cell and squamous cell skin cancers—the two most common forms—and melanoma. The skin cancer MDC experts offer a wide range of 6
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skin, a high number of moles or previous sun damage or those who spend a lot of time in the sun or tanning booth, as well as anyone with a family history of skin cancer. Excellence in skin cancer care A nationally recognized leader in cancer care, the Helen F. Graham Cancer Center is a National Cancer Institute (NCI) Community Cancer Center. As such, multidisciplinary care at the Skin Cancer MDC includes the opportunity to participate in NCI clinical trial research. Patients have their own nurse navigator who provides support, education and access to cancer research resources as well as support services within the community and at the Cancer Center. These resources and services include social workers, genetic counseling, dietitians, chaplains, cancer researchers, the oncology data center, librarians, health psychol-
ogists, wellness coaching, complementary-medicine providers and community-resource providers. For information about the Skin Cancer MDC or an appointment, call 623-4500.
Symposium to focus on prostate and colon cancer
he 2010 Cancer Symposium will focus on prostate and colon cancer prevention topics. It will be held Wednesday, Sept. 29, 6-8:30 p.m. at the John H. Ammon Medical Education Center. The annual symposium and dinner program provides greater insight into the new laboratory discoveries transferring into new interventions that provide direct benefits to patients.
Featured lectures and events include: n The Annual NCI CCOP Awards presentation. n The Controversy Over Prostate Cancer Screening, with Stephen S. Grubbs, M.D., principal investigator of the National Cancer Institute Community Clinical Oncol-ogy Program at the Helen F. Graham Cancer Center at Christiana Care. n A National Colon Cancer Prevention Trial: NSABP P4, with Bruce Boman, M.D., Ph.D., MSPH, FACP, director for Cancer Genetics and Stem Cell Biology.
Register online at www.christianacare.org/cancersymposium.
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Many Faces of Breast Cancer event unites community
ore than 100 people attended the Many Faces of Breast Cancer event at the Helen F. Graham Cancer Center, sponsored by Astra Zeneca,this summer. The event focuses on the unique needs and issues of survivors and provides the latest information on breast cancer. A panel of experts provided valuable information to the audience, according to the program survey. The question and answer period following the presentation was filled with tears of joy, applause and laughter as survivors asked questions and shared their stories. Audience questions ranged from the risks associated with dietary supplements to the treatment options and procedures available for women with various types of breast cancer. Many attendees asked questions about getting involved in clinical trials.
United Way of Delaware campaign starts Sept. 14
The Many Faces of Breast Cancer event featured a panel of Christiana Care experts, including (from left) Emily Penman, M.D., medical director of the Breast Center, Diana Dickson-Witmer, M.D., associate medical director of the Breast Center, David Biggs, M.D., chief of the Oncology Section at Christiana Care, and Scott Siegel, Ph.D, director of the Survivorship Multidisciplinary Center. Seated at far right is breast cancer survivor and panelist Krista Gioffre.
hristiana Care's United Way of Delaware campaign kicks off this year on Sept. 14 and runs through Dec. 10. Our goal is to increase participation from previous years. Every gift—no matter the size—is important and counts towards our goal. As in previous campaigns, you may designate to support any of the following: n
The Community Impact Fund.
n Five strategic focus areas to support Delaware's most crucial needs. n A specific 501(c)3 nonprofit organization of your choice.
Stay tuned to Focus and the portals for more information about how you can participate and help a neighbor in need.
Delaware First Lady Carla Markell shared her personal story of surviving breast cancer at the “Many Faces of Breast Cancer” event.
O C C U PAT I O N A L H E A LT H & W E L L N E S S S E R V I C E S
Christiana Care supports UD nurse-managed health center
hristiana Care and the University of Delaware (UD) have combined resources to launch a new Nurse Managed Health Center (NMHC) at UD’s Newark campus. The NMHC is staffed by experienced board-certified nurse practitioners who provide physicals and health screenings for employees and follow-up care for workers who have been injured on the job. ‘An exciting collaboration’ Paula Stillman, M.D., senior vice president for special projects at Christiana Care, says “This is an exciting collaboration with our Allen Prettyman, NPC, (left) a member of the Delaware Health Science Christiana Care OHWS team and an instructor in UD's School of Nursing, helps manage and set up Alliance Parter (DHSA), the University of Delaware. We are the new, on-campus health clinic. delighted to participate in this new them and our other partners in DHSA model of care delivery.” to develop additional clinical services Christiana Care Occupational Health in the future,” says Kathleen Matt, & Wellness Services (OHWS) provides dean of the College of Health Sciences. key infrastructure support, such as Offering state-of-the-art services electronic medical records, and a State-of-the-art services will include streamlined process for referring physical exams, comprehensive vision and patients to Christiana Care Health hearing screenings, EKGs, respiratory System. Christiana Care OHWS spirometry, blood work, and immuDirector Carine Sakr, M.D., provides nizations. All services will be covered the nurse-managed facility with immeby workers' compensation insurance diate physician consultation. or health care insurance in the same Allen Prettyman, NPC, a member of way they would be if obtained in an the Christiana Care OHWS team and outpatient provider’s office, medical an instructor in UD's School of aid unit, or testing facility. Nursing, “helped set up the physical “Because we'll be seeing only individenvironment,” says, UD School of uals from the UD community, we hope Nursing Interim Director Kathy Schell. to provide services with little to no “But more importantly, he has helped wait time,” Prettyman says. develop affiliations and partnerships internal and external to the university Vision for future which are necessary to promote sucIn the future, plans call for the center cess for all those involved.” to offer care to employees working for contractors at UD and to provide pri“We're pleased to be collaborating mary care to the University communiwith Christiana Care on this project, and we look forward to working with ty at large. All students, however, will 8
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continue to be treated by Student Health Services. “Our long-term vision is to have an entire suite of clinics, where patients can move seamlessly from one to the other for exams, blood work, physical therapy and so on,” Prettyman says. “We want it to be as interdisciplinary as possible and able to provide the community with cutting-edge, convenient, cost-effective care.” Housed in 119 McDowell Hall, the NMHC hours are from 8 a.m. to noon Mondays and Fridays and noon to 4 p.m. on Wednesdays, with a view to add services for UD faculty and staff and expanded hours of operation over the next year. Visit the health care center's website at http://www.udel.edu/nmhc.
hristiana Care Occupational Health & Wellness Services (OHWS) launches its 2010-2011 flu vaccine program targeting Delaware’s workforce on Sept. 20. The OWHS team already has more than 60 companies booked for corporate onsite influenza clinics this year. For companies with 10 or fewer employees, OHWS offers conveniences such as a voucher system, walking distance from downtown and free parking at Wilmington Hospital. The vaccine this year combines seasonal influenza and H1N1 protection. For information e-mail Barbara Melvin, RN, email@example.com.
Debbie Long is July Jefferson Awards winner
ebbie Long is no stranger to volunteering her time and talents to help others. Since 2003, Long, administrative assistant at the Christiana Care Center for Outcomes Research, has assisted local hospice patients at nursing homes, an in-patient unit with Compassionate Care Hospice and in their private homes, where she provides emotional support. She also offers family members respite from the demands of care and provides bereavement services after they lose a loved one.
clean the facility to prevent infections due to public health issues because of the disaster. Debbie, who has two daughters with Type I diabetes, has also volunteered with the Juvenile Diabetes Research Foundation, served on the board of directors of the Delaware Chapter for more than 20 years, helped the organization in fundraising and government relations, operated support groups and organized events. Each month the Jefferson Awards program spotlights an outstanding employee or volunteer who provides community services beyond the work they do each day for Christiana Care.
In March she volunteered for a week in the Ninth Ward District of New Orleans to help a family still without a home following Hurricane Katrina build a new house. In the immediate aftermath of the hurricane in 2005, she volunteered for three weeks at several shelters in Louisiana. She cooked breakfast for families and provided residents emotional support and information about available social services.
Debbie Long, an administrative assistant at CCOR, volunteers with Compassionate Care Hospice regularly and has traveled to distant places such as New Orleans to lend a hand when disasters strike.
To nominate someone for a Jefferson Award, use the nomination form on the portals at http://inet/externalaffairs/jeffersonawards.html. For more information, call Margarita Rodriguez-Duffy, manager of Volunteer Services, at 733-1284.
At one of the shelters, she helped
o make appointments for electroconvulsive therapy (ECT) more convenient for our patients and the family members Christiana Care now offers ECT in the afternoon at the Roxana Cannon Arsht Surgicenter at Wilmington Hospital. â€œFor more than 70 years, ECT has remained a lifesaving treatment for severe depression and is often the treatment of choice when medications
have failed to relieve symptoms,â€? says Chair of Psychiatry Harold Rosen, M.D. Christiana Care is the only provider of ECT in Delaware. To learn more, contact Sandeep Gupta, M.D., or Debbie Croft, RN, at the Center for Comprehensive Behavioral Health at 428-2300.
Roxanna Cannon Arsht Surgicenter
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CHF treatment challenge: Solve the blood volume puzzle
n article published in the journal US Cardiology by Mitchell Saltzberg, M.D., medical director of the Christiana Care Heart Failure Program, discusses a new analytical approach that could make it easier to treat hypervolemia in patients with congestive heart failure (CHF). Dr. Saltzberg’s article reviews the potential use of blood volume analysis to guide fluid removal by ultrafiltration. “Ultrafiltration is the process of separating salt water from the bloodstream and safely removing this from the patient,” Dr. Saltzberg explains. “This technique allows our team to remove up to one pound of fluid per hour to get the patient back to their baseline weight as quickly as possible.” Fluid retention is the primary presenting symptom in approximately 90 percent of the 1 million annual hospitalizations for heart failure. Diuretics such as (furosemide) Lasix, which
cause patients to excrete water, are commonly prescribed to treat fluidoverloaded heart failure patients. Direct fluid removal via ultrafiltration is also performed when the patient no longer responds adequately to diuretics. But it is difficult to determine when congestive heart failure patients have achieved their normal fluid volume, regardless of the fluid removal process used. Patients with overloaded fluid volume are at higher risk for adverse outcomes, including early rehospitalization and death. However, if physicians remove too much fluid, patients may experience low blood pressure and deteriorated kidney function, possibly leading to kidney failure. Physicians often rely on clinical criteria such as improvement in swelling of the legs and chest X-rays and changes in various blood
markers to estimate how much fluid to remove. Even so, these clinical findings correctly identify patients’ volume status only 51 percent of the time, relative to a measured blood volume analysis. “In our approach, we take advantage of data obtained during a blood volume analysis test to determine how much fluid to remove without making the patient too dehydrated,” Dr. Saltzberg says. “By measuring changes in the serum blood concentration, the ultrafiltration machine automatically stops removing fluid once a target value is reached. We are investigating whether this approach will prove to be safer for heart failure patients in our TEAM-HF trial here at Christiana Care." Dr. Saltzberg’s article may be viewed at www.touchcardiology.com and search for Saltzberg.
Outpatient Pharmacy enhances Coumadin® safety procedures
ate in 2009, the Joint Commission on Accreditation of Healthcare Organizations (JC) initiated new safety measures regarding the anticoagulant warfarin (Coumadin), a “high-risk” medication, and offered criteria for its use. Outpatient Pharmacy Manager Sebastian Hamilton says the guidelines govern how Coumadin prescriptions are processed in his area, since the outpatient pharmacy is hospitalaffiliated. As a learning organization, Christiana Care conducts “No Harm Intended” sessions that share stories with staff from front-line providers and patients. This forum promotes awareness of systems issues and process improvements to achieve safer and more effec10
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tive patient care. One such recent session highlighted Coumadin interventions by the outpatient pharmacy. Prior to this presentation, staff were largely unaware of the critical role the outpatient pharmacist plays in meeting the JC safety goals and the number and importance of the “saves” the pharmacist can make.
Coumadin should be withheld. A low INR risks excessive clotting (a condition that is one reason for Coumadin therapy initially) and can be caused by several factors, such as medication non-compliance on the patient’s part. In that case, intervention and counseling by the pharmacist are the most appropriate next steps.
Now, before dispensing or renewing a prescription for Coumadin, the pharmacist must verify the patient’s international normalized ratio (INR), a measurement of anticoagulation achieved at the patient’s current dose. For safe and effective treatment of most conditions, the therapeutic INR range with Coumadin is between 2 and 3. Too high an INR might lead to bleeding, and a reading of 7 could indicate an emergency situation when
Hamilton has seen a few instances of INRs outside the therapeutic range while a Coumadin prescription was pending. Although a number of potential medication complications have been averted, whether actual events or emergency situations were avoided is somewhat more difficult to say. “Better safe than sorry,” he says. “You never know and that’s exactly the point.”
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Practice Change Fellowship will help transform care and assisted living facilities. With more than 2,000 patient discharges last year, the Christiana Hospital ACE unit is ideal for Lyons’project.
enise L. Lyons, MSN, GCNS-BC, clinical specialist in Gerontological Nursing and WISH Program Coordinator, is the winner of a 2010 Practice Change Fellowship.
“This project could indeed change practice at Christiana Care,” says Patricia Curtin, M.D., FACP, CMD, section chief of Geriatrics and ACE unit medical director. “We are optimistic that what we learn working with patients on the ACE unit about reducing functional decline can be applied on other inpatient units at both hospitals and can universally promote functional assessments as part of the standard of care for older adult patients.”
Lyons is one of only eight fellows accepted for this national award from Atlantic Philanthropies and the John A. Hartford Foundation. It is aimed at building leadership among nurses, physicians and social workers who have operational responsibility for geriatric care. Fellows receive a stipend and support from local and national mentors to hone leadership skills and complete a project toward implementing a new geriatric service line or aging program. Fighting functional decline in seniors Lyons is examining the functional decline among hospitalized older adults. Her target group consists of patients admitted to the 39-bed Acute Care of the Elderly (ACE) unit at Christiana Hospital. “Functional decline among hospitalized seniors is a significant clinical problem that can lead to long-lasting adverse outcomes,” Lyons explains. Nursing interventions can help
Seiple earns Delaware 2010 Nurse Leader Award
enny Seiple, MSN, RN, NE-BC, FACHE, vice president, Patient Care Services, Wilmington Hospital received the Nurse Leader Award at the 2010 Delaware Excellence in Nursing Practice Awards at the Modern Maturity Center in Dover in July.
Denise L. Lyons, MSN, GCNS-BC
prevent potential consequences such as loss of independence, diminished quality of life, falls, decreased socialization and increased caregiver burden and risk of nursing home placement. Two ACE units—one at Christiana Hospital and a 14-bed unit at Wilmington Hospital—are designed to promote the health, well-being and independence of senior patients admitted from home, extended care
Forces of Magnetism No. 1: Quality of Nursing Leadership
Organization of Nurse Executives, the Excellence in Nursing Practice Award recognizes nursing professionals who consistently promote, excel and bring Coordinated by the Delaware Nurses a positive approach to their area of Association and the Delaware nursing practice.
Transformation ahead Lyons plans for transformation on the ACE unit include: n Revitalizing the current walking and mobility program. n Incorporating a functional assessment tool into the nursing assessment process and at interdisciplinary rounds. n Tracking functional status as one key outcomes measurement.
An educational component for nurses at Christiana Care focuses on the importance of function and the consequences of immobility in older adults. The two-year project begins Sept. 1.
Vice President, Patient Care Services, Wilmington Hospital, Penny Seiple earned the 2010 Nurse Leader Award from the Delaware Nurses Association and the Delaware Organization of Nurse Executives.
Rapid education, quick action helps control gestational diabetes Editor’s note:
GDM is usually diagnosed in the third trimester, giving patients a limited amount of time to make a difference. Most women can achieve good glycemic control through changes in diet and activity. This requires rapid and intensive education, which unfortunately is not a covered or affordable service.
Christiana Care Endocrinology Physicians are hoping the Third Annual Sugar-Free Mile will continue to make a difference in education and prevention of gestational diabetes in our community. They ask everyone to join in supporting the Sugar-Free Mile on Thursday, Sept. 16. (See Upcoming Events for details, p. 14.)
The Sugar-Free Mile is helping to create scholarship money for these women. Our hope is that we can not only help women to have a healthy baby, but positively affect their offspring's health for decades to come.
estational diabetes mellitus (GDM) affects 4-7 percent of all pregnancies and is increasing rapidly, most likely due to the obesity epidemic and our increasingly sedentary lifestyles. Good evidence exists that poor glycemic control during pregnancy can lead not only to problems for the mother and baby at the time of delivery but can also lead to a change in the baby’s genes, rendering
From left, Ripu Hundal, M.D., Ronald P. Monsaert, M.D., Prakash Seshadri, M.D., and James Lenhard, M.D., of Endocrinology Physicians.
James Lenhard, M.D. Medical Director, Center for Diabetes & Metabolic Diseases
him or her more susceptible to diabetes, obesity and heart disease later in life.
Physician assistants event features cutting-edge lectures
he Delaware Academy of Physician Assistants Fall Continuing Medical Education Meeting at the Wilmington/ Christiana Hilton will be Saturday and Sunday, Sept. 25-26. The two-day meeting is for physician assistants, physicians, surgeons, nurse practitioners, registered nurses and health care professionals. Here’s a look at some of the educational opportunities in store, starting at 7:30 a.m. Saturday n Hypertension, Gilbert A. Leidig, M.D. Pulmonary Nodules, Vinay Maheshwari, M.D. n
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n Evaluation of the Neck Mass, Joseph Ramzy, M.D.
Sunday n Health Care Reform, speaker from DHSS to be announced n Falls and Osteoporosis, Matt Dane Baker, PA-C, DHSc
n Abnormal Uterine Bleeding, Janice E. Tildon-Burton, M.D. n Breast Cancer, Emily J. Penman, M.D. n
Hepatitis, Amy M. Patrick, M.D.
n Integrative Medicine, Seth D. Torregiani, D.O. n Updates in Type II Diabetes Mellitus, Ripudaman S. Hundal, M.D.
n Pediatric Rashes, Jonathan E. Zieff, D.O. n Treatment for Atrial Fibrillation: Current Options and a Look to the Future, John G. McGinnity, MS, PA-C
Shoulder Pathology for the Primary Care Provider, Randeep Kahlon, M.D. n
Get all you need to register at www.delawarepas.org.
Brochure helps people who want to say thanks and make a gift
octors, nurses and other Christiana Care staff have a profound effect on the people they serve each day. Patients and their loved ones often wish to share their thanks for a particular doctor, nurse or other caregiver, and many express a desire to do something more to give back. As a result, Christiana Care has created “Making a gift that makes a difference,” a special brochure designed for use by patients and families, enabling them to thank an individual or team and, if they wish, make a gift to Christiana Care in their honor. Many patients and families already give generously to Christiana Care; however, often people are not sure how to thank particular doctors or nurses for care received. This brochure
provides a means to directly support the work of the medical professionals who helped them, and at the same time convey personal thanks. The “Making a gift” brochure is already being used by more than 30 inpatient and outpatient departments, as well as the Christiana Care Visiting Nurse Association. To obtain a supply for your department, contact Natalie Dyke, Special Gifts Officer, firstname.lastname@example.org, 302-3273306. Christiana Care is a private not-forprofit health care system and relies in part on the generosity of individuals, foundations and corporations to fulfill its mission. All gifts to Christiana Care are tax-deductible to the extent permitted by law.
A new, special brochure lets patients and families express thanks and make a gift in honor of a caregiver.
Publishing, Presenting, Appointments, Awards Publishing Presenting
Appointments Sebastian Hamilton, RPh, MBA, was elected president of the Delaware Board of Pharmacy for the 2010-2011 term. Hamilton is in his second threeyear term as a professional member of the board and is active in many board committees.
Did you know? The Helen F. Graham Cancer Center has received official certification as a wildlife habitat site from the National Wildlife Federation. The certification is based on the ability to provide food sources for wildlife, as well as water, places for cover, places to raise young and sustainable gardening.
FOCUS Aug. 26, 2010
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Some foods can relieve stress, boost energy, lift spirits
ots of people eat too much when they are under stress.
But did you know that some foods actually can help to relieve stress? A healthy diet is a powerful stress buster. Foods such as bananas and fatty fish can reduce our levels of cortisol and adrenaline, the stress hormones that can take a toll on our bodies over the years, leading to high blood pressure, heart attacks and strokes. Starting the day feeling anxious? Dig in to complex carbohydrates, such as comfort foods like whole-grain cereals and oatmeal, which boost levels of serotonin, a chemical that calms the brain. Stay away from simple carbs, especially sweets and soda, which are digested quickly and can make us edgy. Oranges and other citrus fruits also reduce cortisol levels while contributing to a strong immune system. Buy OJ that is enriched with calcium and Vitamin D, especially if you are a woman over 50. Like Popeye, stay strong to the finish when you eat your spinach. That’s because the leafy green veggie is high in magnesium, which gets depleted when we are stressed. Salmon also is rich in magnesium, which makes grilled salmon over steamed spinach a great low-stress meal—and it’s quick and easy to prepare, too. A deficiency in potassium leads to elevated levels of cortisol, the fight-orflight hormone that tells our bodies to begin storing fat around our middles to weather an impending crisis. Avocados and bananas are both naturally high in potassium, so make cer-
Salmon and spinach, poached, steamed or grilled, make a delicious dinner combo that is high in stress-busting magnesium and easy to prepare.
tain you have one or the other ripening in the kitchen. Instead of grinding your teeth in stress, nibble a handful of pistachios. The nuts can help to lower blood pressure so the next adrenaline rush won’t hit you quite as hard. Calm down with black tea Coffee and caffeinated drinks can give us the jitters. But there is evidence that black tea, made from leaves that are fermented and more oxidized than oolong or green tea, has a calming effect. Warm milk really does contribute to a good night’s sleep, and the calcium content also helps to soothe muscle cramps. Adults should drink the milk but avoid the fat. Choose skim or lowfat milk instead of whole milk. We can’t always control the stressful situations that arise at work and at home. But we do have a say in what we eat.
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Welcome, new Junior Board officers
he Junior Board of Christiana Care elects officers each April to twoyear terms beginning on July 1. Christiana Care Health System welcomes and congratulates these Junior Board members for their dedication and service as incoming officers.
Ann Kappel, President
Carol Coughenour, Secretary
n Christine Frysztacki, 1st Vice President, Hospital Ways & Means
n Harriet Porter, Administrative Secretary
n Jeanne Checkel, 2nd Vice President, Hospital & Patient Services
Diane Thomas, 3rd Vice President, External Affairs n
Annette Hively, Treasurer
Judy Kirlan, Assistant Treasurer
Angela Case, Membership Chair
n Midge Bernhardt, Provisionals Co-Chair n
Mary Julian, Provisionals Co-Chair
Barbara Burd, Ex Officio.
First State School program ends with a special event Students make their own precious stuffed animals
Decisions, decisions. Which loveable toy would you choose to create?
(Above) Bob Laskowski, M.D., Christiana Care president and CEO, has a laugh with his brother, Tom Laskowski, who volunteered to help manage the First State School end-of-summer event at Wilmington Hospital.
tudents, parents and First State School teachers and staff celebrated another successful summer program, ending with a special arts and crafts program. They built their own stuffed animals and created splendid graphic designs using spin art technology.
(Below) Volunteer & Student Administration Manager Margarita Rodriguez-Duffy admires one young artistâ€™s talents.
FOCUS Aug. 26, 2010
Did you know?
hristiana Care’s Department of Radiation Oncology scored in the 97th percentile of cancer centers in the United States in the most recent Press Ganey patient satisfaction ranking. “This statistic is a phenomenal tribute to all the hard work and shows the culmination of more or less steady improvements over the last two years,” says Christopher Koprowski, M.D., MBA, chair of the Department of Radiation Oncology.
From left, Karen Karchner, RN, OCN, Christopher Koprowski, M.D., MBA, chair of Radiation Oncology, Mark Liberti RTT, MBA, and Rebecca Dalton RN, BSN, received this special thank you poster created by patient John Mantakounis (pictured on the poster).
Christiana Care earns News Journal top workplace honors
or the seventh consecutive year, the News Journal has named Christiana Care a Top Workplace employer. The newspaper bases the honor on employee surveys from 90 companies in the Delaware region. Only 50 companies made the best-place-to-work list this year.
Here is what some of our employees say: n I believe this organization is going in the right direction. n I have many opportunities to learn and grow at this organization. n I have the flexibility I need to balance my work and personal life.
Forces of Magnetism No. 4 - Personnel policies and programs. No. 7 - Quality improvement. No. 14 - The organization values and supports the personal and professional growth and development of staff.
Focus on Excellence - Best Practice Review Consistent with our strategies for engaging staff in continuous improvement and best practices, we regularly review important topics in Focus to help reinforce safe-practice behaviors. These tips reinforce information and enable staff to better articulate our safety practices during an unannounced survey.
Promote Clear Communication of Medication Orders Q. Can prescribers write “resume all” or “continue all” medication orders postprocedure and at discharge? A. NO. Too often errors result from resuming or continuing previous orders. Medication prescribing must be a safe and controlled process. Prescribers are not permitted to write “resume” or “continue previous medication” orders. n
Medications are not automatically discontinued when the patient goes to the OR.
Previous medication orders are automatically continued unless modified or discontinued.
New medication orders must be written when transferred to an ICU—new orders must be written.
Discharge medications must be written on the appropriate discharge instruction form.
Q. What should I do if a “resume all” or “continue all” medication order(s) is written? A. Notify the physician and inform him or her of the policy restricting “resume all” medication orders. Request that the full medication orders be written. Well-informed Caregivers and patients are the vital link in the safety chain to prevent errors
Formulary Update - July 2010
FOCUS Aug. 26, 2010
Section chiefs honored for service
Dr. Galinat elected to American Orthopaedic Assn.
From left, Virginia U. Collier, M.D., Hugh R. Sharp Jr. Chair of Medicine, Anthony Cucuzzella, M.D., and Josette Covington, M.D., MPH.
nthony Cucuzzella, M.D., and Josette Covington, M.D., MPH, were honored at Medical Grand Rounds on July 15, for their service as section chiefs of Physical Medicine/Rehabilitation and Occupational/Preventive Medicine, respectively. After 30 years of service as section chief, Dr. Cucuzzella will be replaced by Kelly Eschbach, M.D., and Dr. Covington will be replaced after four years as section chief by Carine Sakhr, M.D.
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Brian Galinat, M.D., Chair of Orthopedic Surgery
rian Galinat, M.D., chair of the Department of Orthopedic Surgery at Christiana Care Health System, has been elected to membership in the American Orthopaedic Association (AOA). Founded in 1887, the AOA is the oldest orthopedic association in the world. Its mission is to identify, develop, engage and recognize leadership to further the art and science of orthopedics. Election to membership requires a nomination from a current member and approval from the membership as a whole. AOA members are committed to the specialty as a whole and are seen as leaders in thought and action. Fifty-eight of the approximately 1,500 members of AOA were elected to the association last year.
Christiana Care hosts visit by Sen. Tom Carper
hristiana Care leaders joined Bob Laskowski, M.D., president and CEO, on Aug. 16 in hosting a visit by Tom Carper. Following a discussion with clinical leaders on a wide range of health care issues, Sen. Carper and his staff spent the afternoon touring innovative programs at Christiana Care including the Virtual Education Simulation Training Center and the eCare program.
Delaware U.S. Sen. Tom Carper (left), gets a primer on how things work in a virtual ICU from Christiana Careâ€™s eCare Medical Director/Director of Critical Care Medicine Marc Zubrow, M.D.
Sen. Carper also received a hands-on demonstration of our Computer Provider Order Entry System.The visit afforded our leadership team the opportunity to demonstrate how Christiana Care is transforming health care and increasing value for our patients.