Focus: June 18, 2009

‘One Voice’ concept puts patients and families on the health care team

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new program at Wilmington Hospital’s Acute Care of the Elderly (ACE) unit has patients, families and care providers working together to achieve optimum patient care.

The “One Voice” program is based on the concept of integrating patients and their families into the health care team. The ACE unit, with its large number of patients with adult children who are deeply concerned about their parents’ care, was a natural place to inaugurate the program.

“Our emphasis has been on

improving communication,” says Janine Jordan, M.D., physician advisor in the Office of Quality and Patient Safety.

Last fall, a team from Christiana Care traveled to the Medical College of Georgia to study its program, and staff training began in January 2009.

Natural team building “We put systems into place so patients and families know what’s going on with their care at all times,” says Paula Tomanovich, RN, BSN, BC, nurse manager of the ACE unit. “We’re finding that making patients and families

3 Helen F. Graham Cancer Center expands

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New test sought for inherited cancer genes

As a member of his own health care team, Wilmington campus ACE unit patient Richard H. Hurst talks to Elvina Kipoto, RN (right), and Samantha Eannone, RN, about “how the patient is doing.”

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part of the team comes naturally.”

New procedures include giving reports at the patient’s bedside, empowering the patient to become part of the discussion. Carts now carry laminated cards with bullet points describing the 24 most commonly prescribed medications to aid nurses in educating patients on medication side effects.

Plan of care in plain language Larger white boards allow for greater detail in each daily plan of care, written in language patients can readily understand. Wall racks with literature about each patient’s condition have been installed in rooms, clearly labeled for patients and their families.

And caregivers on the unit now put greater emphasis on anticipating what patients will need for a healthy recovery after they are discharged so they won’t have to be readmitted as often.

Seeking grant to widen the circle “One Voice has brought a lot of people together to talk about patient and family-centered care,” Dr. Jordan says.

“Sharing ideas, feeling that exchange of energy is exciting.”

To widen the scope of the program, Christiana Care has applied to the Picker Institute Challenge Grant program for a grant to educate internal medicine and family and community care residents in the principles of family- and patient-centered care.

“It’s a long journey, changing the way we care for patients,” Tomanovich says. “But in the end, everyone benefits.”

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Christiana Care wins Thomson Reuters’ 2009 Healthcare Advantage Award

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hristiana Care Health System’s efforts to optimize the number of tests doctors order and the amount of time patients spend in the hospital earned a 2009 Healthcare Advantage Award from Thomson Reuters, a nationally known provider of health information.

Christiana Care was one of only five organizations in the U.S. honored in the health and clinical outcomes category.

Engaged staff and physicians “What's really behind this award is the commitment and engagement of staff and physicians in making sure all patients receive the care they need, when they need it, in the appropriate setting and in accordance with bestpractice standards,” says Virginia Collier, M.D., the Hugh R. Sharp, Jr. Chair of Medicine.

After analyzing clinical results of patients admitted to the hospital with specific diagnoses and comparing the information to national bench marks, an interdisciplinary Christiana Care team shared physician-specific data with doctors who admit patients to hospital medical units. At the same time, subspecialty experts talked to the doctors about evidence-based best practices for patients with those same diagnoses.

Reducing tests and LOS When combined with feedback on the data, this training, which took place over six months in 2007, helped to reduce the number of diagnostic tests the doctors ordered by 12 percent and shorten length of patient stay by up to 34 percent. Savings amounted to $256,000.

“Our goal is for 100 percent of our patients to receive 100 percent of best practice interventions 100 percent of the time,” says Dr. Collier. “Through our collective efforts, we have made significant progress. As we focus on excellence in inpatient care, our team is working harder than ever to achieve continued improvement.”

Staff recognition Several Christiana Care physicians and staff were instrumental in the effort: Robert Dressler, M.D., vice chair of the Department of Medicine; Diane Bohner, M.D., medical director of Utilization Management; Julie Silverstein, M.D., director of Patient Safety and Performance Improvement for the Department of Medicine; and Donna Mahoney, director of Data Acquisition and Measurement.

“The key to our success is teamwork.

This award acknowledges that everyone is working on behalf of the patient to achieve better clinical results while at the same time managing costs more effectively,” Dr. Collier says.

Christiana Care’s eCare team begins connecting across Maryland

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on May 18, Calvert Memorial Hospital in Prince Frederick, Md., became the first of six hospitals in the Maryland eCare network to connect in real time to critical care physicians and nurses at Christiana Care’s eCare Central.

“We are thrilled to bring rural Maryland patients this enhanced level of care,” says Marc T. Zubrow, M.D., Christiana Care’s director of Critical Care Medicine and medical director of Maryland eCare.

“We are looking forward to providing all the hospitals in the Maryland eCare Network with this specialized care.”

Memorial will work most closely with eCare on nights, weekends and holidays, times typically difficult for local specialists to remain on site.

Studies show improved outcomes and decreased lengths of stay for patients in ICUs managed by physicians who specialize in critical care.

Providing care close to home

Yet, a current shortage in critical care physicians makes keeping them on site 24 hours a day difficult for most hospitals.

With eCare, patients benefit from receiving timely, critical care when they need it and where they are most comfortable: close to home. Momentby-moment monitoring quickly detects changes in patient condition,

Two more in 2009 Later this year, Peninsula Regional Medical Center in Salisbury and St. Mary’s Hospital in Leonardtown come online. By 2011, Christiana Care will connect to almost 80 ICU beds in the Maryland eCare network.

The eCare team uses a sophisticated eICU® program in use at Christiana Care’s own intensive care units since 2005. Christiana Care was the first health system in the country to adopt the technology to monitor critically ill patients in its Emergency Departments and post anesthesia care units. eCare connects physicians, nurses and patients virtually via voice, camera and data, enabling hospitals to provide the highest level of specialized care around the clock. Calvert

watching trends in crucial indicators such as blood pressure, heart rate, oxygen levels and respiratory rates, allowing remote staff to alert and work with on-site staff to improve patient status. eCare does not take the place of bedside staff. Rather, it provides an extra set of eyes and ears, adding a layer of safety to prevent a medical crisis.

For on-site caregivers, in-room help is available at the push of a button.

Maryland eCare hospitals are: Atlantic General Hospital, Berlin; Calvert Memorial Hospital, Prince Frederick; Civista Medical Center, La Plata; Peninsula Regional Medical Center, Salisbury; St. Mary's Hospital, Leonardtown; and Washington County Health System, Hagerstown.

Forensic nurse examiners earn praise and grant money for excellent service to community

The University of Delaware’s VDay chapter executive board members—from left, Bailey Kung, Sam Withrow, Jessica FitzPatrick and Bess Davis—present Anita Symonds, RN, center, with a $4,500 gift for the Forensic Nurse Examiners program. VDay is a global movement to end violence against women and girls.

Often subpoenaed

Expanded services

Gordon Reed, M.D., received the Visionary Award from the International Association of Forensic Nurses (IAFN). Dr. Reed has been the medical director of the forensic nurse examiner team at Christiana Care since 1996.

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Cancer Center’s Sarcoma MDC helps father and son with rare genetic disorder

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oming to the Helen F. Graham Cancer Center was a lifesaver, for both Daniel Cheeseman and his 4-year-old son.

Following nerve surgery in 2008, a small lump under Cheeseman’s left knee grew to softball size. For a year, excruciating pain compromised his mobility and threatened his job as a forklift operator.

After diagnosing a malignant nerve tumor, surgical oncologist Joseph Bennett, M.D., suggested Cheeseman join him at the Sarcoma Multidisciplinary Disease Center (MDC) to explore treatment options.

With Dr. Bennett, the Sarcoma MDC team included medical oncologist Kathir Suppiah, M.D., radiation oncologist Christopher Koprowski, M.D., orthopedic surgeon Mihir Thacker, M.D., and oncology rehabilitation and pain specialist Theresa Gillis, M.D. Daniel Cheesman and his son, Daniel Jr., find the care they need at the Helen F. Graham Exceeding expectations Cancer Center.

“I didn’t expect so much care,”

Cheeseman recalls. “All these doctors were there in the room to talk with me about my condition. It made me feel more confident about our decisions moving forward.”

At that meeting, Cheeseman learned that the growth under his left knee as well as growths on his right leg and neck were a symptom of neurofibromatosis, a genetic nervous system disorder. Cheeseman was born with this disease, and from his family medical history, doctors suspected that his son was, too.

“Neurofibromatosis causes tumors to form anywhere in the body where nerve tissues are present, including the brain, spine and peripheral nerves,” Dr. Gillis explains. “They

sometimes cause severe pain and impair function if they grow.

Although there is no cure, we can treat the effects of the disease for good quality of life.”

Brighter future The MDC team developed a treatment plan and referrals for Cheeseman and connected his son with doctors in the neurofibromatosis specialty program at Nemours/A.I. DuPont Hospital for Children.

On doctors’ advice, Cheeseman decided against surgical attempts to save his leg. Just one month after his amputation, Cheeseman’s prosthetic leg is fully functional and ready for physical therapy. Now he has much less pain, and he and his son have more of what fathers and sons like best—more time together.

Expansion of Helen F. Graham Cancer Center brings more world-class services under one roof

A view from across the pond shows the full expanse of the Helen F. Graham Cancer Center. With the expansion, the Graham Cancer Center has more than tripled in size, bringing together the entire continuum of cancer care resources. Having all of a patient’s related care in one place facilitates interaction among specialists and promotes the transfer of knowledge about new technologies, drug regimens and treatments for cancer, which is the essence of Christiana Care’s multidisciplinary approach to cancer.

Fast-tracking initiatives Cancer Genetics and Stem Cell Biology and CTCR associate director, says h

Accelerating cancer research

rapid advances in cancer stem cell biology and human cancer genetics, is one of the leading programs of its kind in the country,” Dr.

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Boman adds. “This

In the Oncology Data Center on the second floor, a staff of seven collects, analyzes and conducts lifetime follow-up for all cases of cancer and benign central nervous system tumors newly diagnosed or treated at Christiana Care. “Our database contains 50,600 analytic cases, with 23,600 cases actively followed,” says Manager Robert McBride. “Access to treatment information is easier now, which helps keep the registry data complete.”

Ali-Khan Catts, MS, CGC, directs the program.

Getting care is easier

Developing new programs

Researchers are developing a better test to identify two inherited cancer genes

CTCR Associate Director Cancer Genetics and Stem Cell Biology at the Helen F. Graham Cancer Center, CTCR researchers are focusing on two specific genes, MSHZ and MLH1, known as DNA mismatch repair genes.

“I cancer,” Dr. Boman says.

More specialists

CLINICAL NEWS

Therapeutic Notes

Risk factors

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Formulary Update

500 mg once 1000 mg once 500 mg daily 1000 mg daily 500 mg BID 1000 mg BID

650 mg once 975 mg once 650 mg daily 975 mg daily 650 mg BID 975 mg BID

500 mg every 4 hours or as needed

650 mg every 6 hours or as needed

1000 mg every 4 hours or as needed 500 mg every 6 hours or as needed

650 mg every 8 hours or as needed

1000 mg every 6 hours or as needed 500 mg every 8 hours as needed

650 mg every 4 hours or as needed

650 mg every 8 hours as needed

1000 mg every 8 hours or as needed 500 mg TID

650 mg every 4 hours or as needed

975 mg every 8 hours or as needed

650 mg every 8 hours

1000 mg TID or as needed 1000 mg QID or as needed

975 mg TID or as needed 975 mg QID or as needed

CLINICAL NEWS

What costs physicians ‘ownership’ of their patients’ care?

Christiana Care’s Cynthia E. Barlow named Pharmacist of the Year

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Guest lecturer Lori Mosca, M.D., encourages listeners to care for their hearts

Cheerios $5,000 grant recognizes dedication to community outreach

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he spirited commitment and dedication of Christiana Care Community Health and Faith Ministries Outreach Program colleagues Rhonda Coleman and Lavaida Owens-White, RN, has earned a $5,000 grant from the makers of Cheerios breakfast cereal.

Coleman, the Community Outreach coordinator, and White, the Health Ministries coordinator, over the past two years have helped to serve 987 high-risk African Americans living in Delaware.

Coleman arranges community events to provide cholesterol testing and heart education and white, a faith community nurse, provides outreach at faith organizations, community events and state service centers.

The program reaches the most vulnerable individuals with the message to make lifestyle changes for cardiac health.

Leading by example Both Coleman and White exemplify a heart healthy lifestyle by often wearing pedometers, always “knowing their numbers,” and by adopting healthy lifestyle changes. They lead by example, having an impact on families, friends and everyone else they encounter.

The grant has been gifted to Christiana Care Health System.

Cheerios received nearly 100 nominations for individuals and organizations from across the U.S.

between Feb. 1 and March 14, 2009.

Winners were selected by a panel of judges based on their creativity, quality of service, reach and impact of their work and their direct ability to help educate women on the importance of lowering their cholesterol.

Circle of Helping Hearts The grants are part of Cheerios Circle of Helping Hearts® broader hearthealth initiative, which provides consumers with important information on heart disease prevention and provides steps to a heart healthy lifestyle through diet, exercise and regular cholesterol and blood pressure screenings.

Knee surgery live webcast is June 30 at 5 p.m.

On June 30 at 5 p.m., Alex Bodenstab, M.D., and Steven Dellose, M.D., will webcast two knee-replacement surgeries, back-to-back, from Wilmington Hospital. Leo Raisis, M.D., medical director of the Center for Advanced Joint Replacement, will host the webcast.

During the event, an online chat will be held on Twitter featuring Terry Foraker, nurse manager of the Center for Advanced Joint Replacement, and several former patients.

This educational event will celebrate a major milestone, the Center for Advanced Joint Replacement’s 10,000th patient.

To view the this webcast, visit www.or-live.com/kneesurgery or follow the link from the home page of our Web site, www.christianacare.org.

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Determined Sandra Perez dropped three dress sizes Perez has gone from a size 20 dress to a size 14. As the pounds have come off, her doctor has reduced the dosage for her blood pressure medication.

Perez says she has blossomed over the past two years, losing 64 pounds and gaining self esteem. “I feel better than I ever thought I could,” she says.

“I’m at a very good number right now,” she says.

Tried and failed before

Monday through Thursday, Perez heads to the fitness center on the Christiana campus, where she exercises for about an hour and a half. She spends 45 minutes on the treadmill or elliptical trainer, followed by work with free weights. Every Saturday, she walks for at least three miles.

Perez has worked at Christiana Care for 29 years, starting as an aide in the dietary department when she was 16.

Before taking advantage of the onsite fitness center and $100 per year reimbursement for Christiana Care employees, she had tried and failed to lose weight several times.

“It was very difficult at first, but I learned to stick with it,” she says.

“There always seemed to be something that got me off track, taking care of the kids, all sorts of things,” she recalls.

In addition to exercise, Perez attends weekly Weight Watchers meetings. At home, she weighs food on a kitchen scale so she can accurately track calories. Measuring portions each evening for the next day’s meals, she sets herself up for success.

In her 40s, Perez decided she owed it to herself to take responsibility for her well-being.

“Both my parents suffered from heart disease,” she says. “They were both overweight.”

Helps motivate others Alisa Carrozza, an exercise technician who helps Perez train at the gym, says the active wife and mother of two grown daughters is an inspiration to others who want to lead healthier lives.

“She notices when people are new and uncomfortable in their exercise program and offers her personal story and strategies for success,” Carrozza says.

On a recent afternoon, Perez reached out to a fellow employee who was discouraged because she had little stamina.

“When I first started on the elliptical, I could only do seven minutes,” she recalls. “I tell people that it takes time.

But if you stick with it, you will feel better than you ever thought possible.”

Adopted routines “Portion control works for me,” she says. “It’s my routine now.”

She also is making healthier choices.

She eats oatmeal or scrambled egg whites for breakfast, and cottage cheese and fruit for lunch, or perhaps a low-fat frozen meal. Dinner is typically chicken and vegetables.

“And I have my Weight Watchers ice cream every night,” she says. “That’s my treat.”

Cardiac cath technician Sandy Perez lost 64 pounds over two years by practicing a healthy lifestyle, including exercise, diet and joining Weight Watchers.

Join the American Heart Walk Sept. 13

Your T-shirt design could be the one that all your Christiana Care colleagues wear!

To enter your T-shirt design: ■ Draw your art work on plain white (unlined) 8.5 x 11-inch paper.

■ Draw and submit two sketches for judging.

- One sketch should be a simple black outline of your design.

- The other should be a color version of the black-and-white sketch.

■ Send computer drawings or files via e-mail as .pdf attachments. Please be prepared to provide separations or black-and-white artwork.

Win a pizza party

■ Send your entry to Joanne Matukaitis, RN, MSN, CNA, BC, director, Patient Care Services, Cardiovascular/Critical Care in Suite 1003. If you need more information, call 302-733-2633.

All entries must be received by July 20.

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Memories of Porcupine

The PEP Department congratulates Aliciann Buffington on attaining her MSN. Way to go Alicia.

We are very proud of you!

Congratulations to Mary T. Williams, RD. on achieving certification as a Specialist in Gerontological Nutrition.

The Professional Advancement Council congratulates and welcomes new RN IIs Mercy BaduNkansah (Joint Replacement Center), Patricia Briggs (5E), Ruth Garibian (L&D), Lori Smith (L&D), and Jamie Bailey (CICU).

Wilmington Hospital Nursing Leadership Team would like to congratulate the following PCCs for passing their certification exams!

Sarah Breitenbach, Rehab, Clinical Nurse Specialist-Gerontology Arlene Peirce, 5 E/W, Progressive Care (PCCN) Sherry Mars, WACE, Gerontology Lauri Mahoney, 3 Med-Surg, Medical Surgical Steve Beltran, 3W, Psychiatric & Mental Health

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Follow the flip-flops

Christiana Care and Delaware Tech graduate 64 new allied health professionals

Danya Johnson (Mount Pleasant), right, and Ariana Kathryn Gibson, (A.I. du Pont) received high school diplomas at graduation ceremonies at the First State School

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‘Virtual colonoscopy’ to be added as a covered benefit

Screening recommended for those over age 50

Steve Elliott of Sunoco (left) and Rochelle Sparks of Nuclear Medicine, celebrate Sparks’ knowledge and ability of CPR enabling her to come to the aid of another stricken in the marketplace.