Focus: February 26, 2010

FOCUS Christiana Care achieves Magnet status Signifies gold standard for nursing excellence

C

hristiana Care has achieved Magnet status for excellence in nursing recognized by the American Nurses Credentialing Center (ANCC), a qualification earned by only 6 percent of the nation’s hospitals.

Magnet is the highest level of national recognition of health care organizations that demonstrate sustained excellence in nursing care. Christiana Care is the first hospital in Delaware to receive Magnet designation.

“Countless individuals have helped our organization achieve this milestone,” says Bob Laskowski, M.D., president and chief executive officer.

“A special thank you to our chief

nursing officer, Diane Talarek, and associate chief nursing officer, Janet Cunningham, for their leadership and perseverance throughout the review process. This achievement follows a rigorous evaluation process that included extensive interviews, review of nursing services and public comment.”

“This recognition reflects the efforts of our extraordinary nurses and our entire health care team, who work together every day to provide the very best of care to our patients,” says Talarek.

Magnet recognition is to nursing what the gold medal is to the Olympics or CONTINUED,

Clinical News CPOE launches successfully at Wilmington Campus

4

Cancer Center makes NYC patient feel at home

6

Cancer patient navigators provide invaluable help

7

General News Employee Engagement

11

Winter snowstorms bring out the best in us

12

Diversity & Inclusion Council established

13

Representing many areas of Magnet nursing are (from left), Lisa Wallace, RN, SDS, Wilmington Hospital, Susan Felicia, RN, SDS, 5E, Katie Muther, MSN, RN, Oncology SES Patient Care Services Education, Carol Boettler, RN, manager, Magnet Education, Amy Tyler, RN, SDS, CDU, BethFitzgerald, RN, perioperative nurse internship manager, Annette Rickolt, MSN, APN, clinical nurse specialist, Neonatalogy, and Barbara Szewcayk, RN, VNA, manager/senior education coordinator.

P.

2

COVER

S T O R Y, C O N T I N U E D

the Lombardi trophy is to football.

Drs. Mehmet Oz and Michael Roizen, authors of “YOU: The Smart Patient” said on ABC News’ Good Morning America “Magnet hospitals are where the best nurses work, the morale is highest and the hospital has the most resources. You want to be where the nurses want to be.”

Patients benefit Research shows there are clear benefits to hospitals granted Magnet status and to the communities they serve in consumer confidence, recruitment and retention and in maintaining quality of care.

At 1 p.m. on Feb. 18, hundreds of colleagues waiting at Wilmington (above) and Christiana (below) hospitals burst into applause at the announcement of official Magnet Magnet designation is maintained Nursing designation from the American Nurses Credentialing Center. for four years. During that period, the ANCC monitors facilities to ensure high standards of care continue.

Look to the Portals for more information about a future celebration to acknowledge this honor.

Nurses at the Delaware Hospital, near the site where Wilmington campus exists today, prepare meals for their patients nurses.

Nurses in an operating room monitor the equipment and surgical environment as well as the patient’s breathing and vital signs during abdominal surgery at Delaware Hospital.

n

n

n

Cancer treatment flows best with a care navigator’s help

C

ancer patients may face many challenges, but at Christiana Care, finding guidance along the journey isn’t one of them.

At the Helen F. Graham Cancer Center at Christiana Care, a multidisciplinary team addresses the full spectrum of cancer care, from prevention to early detection to treatment, guiding patients every step of the way.

In the not-too-distant past, Delaware was ranked number one in the United States in both cancer incidence and deaths. But by 2009, the state had dropped to eighth in the incidence of cancer and 11th in mortality. That’s due to a multi-pronged effort, including:

Kandie Dempsey, MS, RN, OCN, CCRP, is one of the best in the country and has received numerous awards from the NCI. This success is due to the participation of medical and radiation oncologists, together with the surgeons who participate in the cancer program.

“These programs and others are the reasons that Delawareans who are diagnosed with cancer do not have to leave the state for their cancer care,” says Nicholas Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center.

Cancer care navigators, each highly A state ban on smoking in the worktrained in one of seven of the most place and public places. common cancers, guide patients n Government funding for breast, certhrough their journey. The team also vical, colorectal and prostate screening includes nurses who manage discharge planning, social workers, dietitians, psychologists and a “The patients and their families are the financial assistant. The team center of care—where they should be.” collaborates on a comprehenTricia Strusowski, MS, RN sive plan so patients can devote their energies to getDirector, Cancer Care Management ting well.

Tricia Strusowski, director of Cancer Care Management (left), and Nora Katurakes, manager, Community Health Outreach and Education.

n

in more underserved people.

More African-Americans being screened for cancer. n

Genetic counseling, a statewide High Risk Family Cancer Registry and access to National Cancer Institute (NCI) and pharmaceutical clinical trials also are enabling more cancer patients to receive quality care close to home.

The NCI clinical trials program, under Director Stephen S. Grubbs, M.D., and

4

●

F O C U S Fe b . 2 6 , 2 0 1 0

“The patients and their families are the center of care— where they should be,” says Tricia Strusowski, MS, RN, director of Cancer Care Management.

Each day, the team meets to assess the changing needs of patients. Who is being discharged? Who needs a follow-up call? Who needs a ride to radiology? Who is losing insurance and needs coverage to fill that gap?

Navigators also help the health care system operate more efficiently by reducing duplication of tests. Patients

and their families don’t have to fill out repetitive paperwork. And they are able to leave the hospital sooner, with length of stay reduced from 7.8 days in 2007 to 7.4 days in 2009.

As one of 16 health care systems in the NCI’s Community Cancer Centers Program, the Graham Cancer Center’s navigation system is a recognized model, currently sharing best practices with other centers through the NCCCP Networking Committee. Starting this spring, our navigators will spearhead a Regional Networking Committee.

Navigators also maintain close ties to the community, where they can often find special programs, money and other resources to help cancer patients who have financial or logistical problems.

Through community outreach efforts, more poor and uninsured people have access to screening. For example, 951 women received mammograms as a result of outreach programs in 2009.

The tests detected breast cancer in 12

CA R E N AV I G ATO R S ,

CONTINUED

patients.

“When cancer is detected sooner, fewer people die,” says Nora C. Katurakes, RN, MSN, OCN, manager, Community Health Outreach and Education. “That is why it is so important to work on the front end of navigation.”

An outreach team of nurse navigators and lay navigators—including a Spanish and an African-American navigator—reach out to underserved individuals and to minority communities, distributing information about cancer screenings and offering programs to help smokers kick the habit.

They go where the people are, from the farmers market to senior centers.

“We work in the churches, libraries and community centers,” Katurakes says. “It isn’t enough to just stand at health fairs.”

Ultimately, patients benefit from basic science and translational cancer research. Clinicians and scientists are working together at the Center for

Translational Cancer Research, which provides 6,000 square feet of laboratory space on the fourth floor of the new pavilion of the Helen F. Graham Cancer Center.

Physicians at the cancer center collaborate with scientists at the University of Delaware in many areas, including: n

Colorectal cancer stem cell research.

n

Androgen-resistant prostate cancer.

n Breast cancer metastases to the brain. n

Artificial salivary gland development.

Together, these efforts have transformed cancer care in Delaware.

“Since 2002, the success of the cancer program has been a team effort between private practice physicians,

From left, Nicholas Petrelli, M.D., Kandie Dempsey, MS, RN, OCN, CCRP and Stephen S. Grubbs, M.D. employed physicians and paramedical personnel together with the administration,” Dr. Petrelli says.

“The cancer program at Christiana is a model demonstrating that by working hard together with the needed resources and compromising when necessary, a culture can be changed— and transformation results in new programs leading to excellent patient care.”

Formulary Update

Handwritten orders for as-needed (PRN) analgesics

Darifenacin 7.5 mg once daily

Long-acting tolterodine (Detrol LA®) 2 mg once daily

Darifenacin 15 mg once daily

Long-acting tolterodine (Detrol LA®) 4 mg once daily

If the handwritten order reads:

The PRN reason associated with the order will be:

n

PRN mild pain

n

Pain Scale – Mild 1 - 3

n

PRN moderate pain

n

Pain Scale – Moderate 4 - 6

n

PRN severe pain

n

Pain Scale – Severe 7 - 10

Clinical Decision Unit (CDU)

The CDU has been designated level BR for medication administration

Wilmington Hospital Surgery and Procedure Unit (SPU)

Up to 2 intermittent IV bolus doses of fentanyl can be administered in the SPU at Wilmington Hospital

Upcoming events The 21st annual Update in Cardiology conference for physicians, nurses and other health care professionals, Saturday, Feb. 27, 7:30 a.m.-4 p.m., at the John H. Ammon Medical Education Center covers clinical aspects as well as the latest emerging technology and research for the management and treatment of cardiovascular disease.

Conference speakers provide insight and information to enhance patient care along with the cost benefit and effectiveness of cardiovascular treatment. Cost is $40. Register online at Delaware Academy of Medicine Web site, www.delamed.org. For more information, call 302-452-3452, prompt 1.

Clinical Pearls Day at Medical Grand Rounds, Thursday, March 4, at 8 a.m. in the John H. Ammon Medical Education Center auditorium, with video transmission to Room 8119, Wilmington Hospital.

Abraham C. Verghese, M.D., MACP, Professor for the Theory and Practice of Medicine at the Stanford University

School of Medicine and bestselling author, shares his research and thoughts on “The Art of Medicine in a Technological Era.” Presentation: Sunday, March 7, 4 p.m., with a reception and book signing at 5:15 in the Hotel du Pont, du Barry Room, 11th & Market streets, Wilmington, Delaware.

Register by March 1 by calling 302654-9923 or e-mailing lmcfadden@hardininc.com.

National Patient Safety Awareness Week speakers and topics include John R. Grout, Ph.D., “New Responses to Medical Error,” Wednesday, March 10, 9:30-11 a.m., and James W. Saxton, Esq., “Disclosure: The Real Deal,” Thursday, March 11, 8-9 a.m., at the John H. Ammon Education Center main auditorium, videoconferenced to Wilmington Hospital 8th floor conference room. Register via Inet Education Center. For information about continuing education contact hours, contact Christine Carrico at 733-4968.

The 2010 Christiana Care Delaware Marathon Running Festival, Sunday, May 16, Tubman Garrett Riverfront Park, Wilmington, includes Delaware’s oldest and largest certified road-running marathon, a certified half-marathon, and a four-person team relay marathon.

See www.delawaremarathon.org. A portion of the proceeds benefits the Center for Heart & Vascular Health.

The 14th Annual Diabetes Update, Saturday, March 20, 7:30 a.m.-4 p.m., at the John H. Ammon Medical Education Center for physicians, RNs, NPs, dieticians, physician assistants, ophthalmologists and others. Fee: $70, $35 for students and emeritus. Register online and download a program under Events & Classes on physician, nursing and physician office staff portals.

Trauma Program hosts the 10th ThinkFirst 5K and 1K Children’s Fun Run on April 15 to support community injury prevention efforts. Register at www.races2run.com.

Publishing, presentations, appointments, awards Publishing

Surgery (2020) 142, 191-195.

A short story by Gail Sezna, RN, BSN, CPAN, a member of Christiana Care’s Cardiac Rehabilitation team, titled “My Boys - A Mother's Story after Multiple Losses,” was published by Grief Illustrated Press of Omaha, Neb., is available to order online at www.centering.org.

Michael Benninghoff, MS, D.O., et al, published an article, “Pulmonary crystalstoring histiocytosis diagnosed by computed tomography-guided fine-needle aspiration,” in Diagnostic Cytopathology, online October 2009.

Robert Witt, M.D., published “Lumen formation in three-dimensional cultures of salivary acinar cells,” in Otolaryngology-Head and Neck

6

●

F O C U S Fe b . 2 6 , 2 0 1 0

Christine Abazzia, Frances Adamo, RN, Brittney Gill, Rebecca Morrison, RN, Krista Volpe, RN, and Janice Prata, RN, published an article, “Pregnant patient in a persistent vegetative state,” in Critical Care Nurse (2010) 30: 40-46 and

online at http://ccn.aacnjournals.org.

Presenting An abstract, titled “Students Taking Charge: Youth working to improve health in six Delaware high schools,

by Brian H. Rahmer, program manager of the Center for Community Health has been accepted by the National Assembly on School Based health Care for a workshop presentation at the 2010 National School Based Health Care Convention June 17-20 In Arlington, Va.

Focus on: Children’s dental health Maria Cordero, D.M.D. (below), gives Wilmington Friends School kids a primer on brushing before asking for volunteers.

A lesson in brushing Preschool children from Wilmington Friends School visited the dental clinic at Wilmington Hospital Health Center to learn about dental health and hygiene. The American Dental Association (ADA) sponsors National Children’s Dental Health Month throughout February to raise awareness about the importance of oral health. Developing good habits at an early age and scheduling regular dental visits helps children get a good start on a lifetime of healthy teeth and gums.

Think of Yourself as a Patient and Safety First beliefs prevail despite major snowstorms Major operation at Christiana Hospital campus

At Wilmington Hospital, everyone came through

D

Janice E. Nevin, M.D., MPH, vice president of Medical Affairs, senior vice president/executive director, Christiana Care, Wilmington, saluted Penny Seiple, the VP for Patient Care Services at Wilmington Hospital.

“Penny was here during the peak of the storm, rounding on units and making sure that staff and patients got what they needed. She’s a tremendous leader,” Dr. Nevin says. Seiple says the nursing staff and support staff really came through for our patients. “It seems like same nursing coordinators, Sandy Hershey, Diane Kellmyer and Herb Green” are on duty every time we get a storm. They did a great job from managing nursing resources, as did the nurse managers with patient care,” Seiple says.

elaware’s extraordinary snow storms of early February, 2010 will long be remembered as a time when Thinking of Yourself As a Patient and putting Safety First impelled Christiana Care management and staff to accomplish extraordinary things.

According to Jeff Benyo, director of Public Safety, and Teresa Cathell, executive assistant to Chief Operating Officer Gary Ferguson, some efforts that showed great dedication and leadership in the blizzard, such as:

n Shirley Moran, RN, MS, CAN, director of Patient Care Services, and Jeff Donovan, director of Transportation, played key logistical roles, handling employee call off issues and keeping shuttle service going. “This was important because we didn’t want to endanger drivers or put vehicles on the road that might hamper snow clearing hazard plow operators,” Benyo say. “Jeff Donovan did a great job of improvising our first-ever shuttle service to nearby hotels, where several hundred employees lodged for several nights. That wasn't even in the prestorm plans. It came up, and the response of Jeff and his team was incredible.“

Jill Karpinski, corporate director of Facilities & Engineering, was everywhere at once, patrolling the hospital property to check snow conditions and directing the snow clearing operation, Cathell says. “She had a shovel in her van and on numerous occasions she was spotted digging out cars,” Benyo adds. n

Environmental Services Manager Jason Funyak and his team were spot on for helping establish “a regular old slumber party,” Cathell says. “We had more than 200 cots set up in the Ammon Center, E-tower conference rooms, 6D, 2D and elsewhere. A lot of people came in during the day Tuesday early evening for shifts starting at 11 p.m. or 7 a.m., just to ensure they would be there for the patients.” n

Comments from our neighbors “It was a phenomenal experience, not only for our Christiana Care guests but also for the hotel employees who stayed over to help keep things going, keep people fed and rested.

Brad Wenger, general manager, Hilton Christiana/ Wilmington “We were honored to lodge many of the hospital staff. We helped many of them dig out their cars before work. We were like one big family.”

Anup Patel, General Manager, Days Inn

8

●

F O C U S Fe b . 2 6 , 2 0 1 0

“Karen Amato, who kind of ‘managed the hotel,’ keeping track of the 30 to 40 employees we had sleeping over--where they were sleeping, when they needed to wake up, and whose turn it was to sleep in the bed next-was amazing. It was like working on a giant puzzle,”she says.

“And everyone loved Felicia Alderson for bringing a great load of food from the supermarket, which fed everyone through the weekend. People couldn’t believe they were smelling bacon on Saturday morning,” Seiple says.

“Overall, the morale was really high, even though it was busy and people were really tired. It just seems like when we have a disaster, that’s when we’re at our best.”

Visiting Nurse Association VNA President and CEO Lynn C. Jones, had this to say about the performance of the VNA clinical and office staff: “The VNA management team did an excellent job of anticipating the storms and taking care of as many home visits as possible before the snow arrived. We saw a few of the most critical patients at home during the storms and made up many visits on the days that followed. The staff’s diligence and willingness to brave the persistent conditions for several days after the storm, ensured our patients received the essential home care they needed. Thank you to the VNA team statewide.”

New Diversity & Inclusion Council accentuates positive benefits of our differences

S

omething that makes Christiana Care a great place to work at is the uniqueness of our employees. We all come from different backgrounds. Just as importantly, no two patients we serve are alike. Diversity is an important part of the fabric of every day activity at Christiana Care.

Diversity is revealed in many ways. It includes demographics, such as age, gender, and race. People come from diverse cultures, each of which may have its own values, religions and languages. Distinct systems further impact our jobs … including our unique roles and functions and even the locations where we work.

Benefitting from our differences It is one thing to recognize our diversity, it is another to take advantage of our different backgrounds to improve patient care. That’s where the notion of inclusion comes in.

Inclusion is creating a sense of belonging, feeling respected, valued and seen for who we are as individuals. An inclusive environment helps ensure all people have the opportunity to fully engage and embrace their strengths of our differences. In doing so, collectively we can best accomplish our goals.

Especially in a health care setting, fostering a culture of inclusion is important to the success of our organization.

An inclusive culture can help us leverage our diversity to enhance innovation, foster teamwork, and help improve the quality of care we provide to patients.

Christiana Care’s efforts to create a culture of inclusion continue to grow. Helping to bring focus to the effort is Rosa Colon-Kolacko, Ph.D, MBA, Vice President, System Learning.

Together with Dr. Ray Blackwell, Rosa leads Christiana Care’s Diversity and Inclusion Council.

The Council is spearheading our organization’s efforts to promote a culture of inclusion in many ways. Their initiatives include helping to: Develop Brand and key messages to enable internal/external recognition.

n

Determine as a baseline Christiana Care’s Diversity and Inclusion status.

n

Upgrade Diversity and Inclusion education offerings.

n

n

Expand language and cultural com-

Diversity and Inclusion Council members include, (from left) Dominic Kayatta, Melva Lane, Margarita Rodriguez-Duffy and Claudia Acero. petency services.

Strengthen partnerships with community leaders.

n

Launch employee resource groups/business impact teams.

n

Watch for more information on this important initiative in future editions of Focus. A culture of inclusion is about … you!

Diversity and Inclusion Council Rosa Colon-Kolacko, Ph.D., MBA, co-chair Ray Blackwell, M.D., co-chair Maureen Simpson-White Sean Ellsworth Michelle Eklund Nora Katurakes Timothy Rodden Carmen Riopedre Melva Lane Claudia Acero

Sharita Hutt-Lee Joel Brown II Samuel Rodriguez, Jr. Shawmay Kao Dominic Kayatta Margarita Rodriguez-Duffy Rob Redden-Huff Jineen Redden-Huff Tamekia Thomas Terre Gilchrest

Focus on Excellence – Best Practice Review – February 2010

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.

New Isolation Precaution Signs and Practice Changes Q. Why do we need new isolation precaution signs?

A. The new isolation precaution signs convey a simple, clear message to both staff and visitors.

Q. Why are the new isolation precaution signs now placed on patient doors?

A. Placing the isolation precaution sign on the patient door or door frame allows for better visibility prior to entering a patient room.

Q. Why must everyone, including visitors, wear a yellow gown and gloves in a Contact Isolation room?

A. Everyone must wear a yellow gown and gloves to protect themselves from organisms from the patient’s environment. Contaminated hands and clothing can be a source of transmission to yourself or others. Hand hygiene is also an important step in preventing transmission.

Q. Why a new special Enteric Contact Precaution sign for known or suspected C. difficile?

A. The new sign reminds staff that this is a C. difficile room. C. difficile is a spore that causes diarrhea and is difficult to kill with ordinary disinfectants. The sign is a reminder that this room requires special cleaning and disinfection with a bleach-based product. Do not use alcohol hand gel in these rooms to clean your hands. Soap and water is the most effective method of cleaning hands contaminated with C. difficile.

To access new isolation signs, go to http://inet/InfCont/Home Page.htm To ask questions, contact the content expert: Kathy Wroten, 733-3507. To reach the Safety Hotline, call SAFE (7233) from within Christiana or Wilmington hospitals. From outside the hospitals, call 302-623-SAFE. Further information is available on the portals in the Archives of Best Practices. From your portal, choose Focus on Excellence, Joint Commission Readiness, Ongoing Strategies, Educational Strategies, Monthly Q&A.

10

●

F O C U S Fe b . 2 6 , 2 0 1 0

Join the Lose for Life Encouraging my development Weight Loss Challenge today! aking Christiana Care a Great Place to Work

M

requires that we continue to grow and develop our strengths and build knowledge. Consider how you would respond to the following employee engagement statement from our survey:

The best prize of all is your fitness

“There is someone at work who encourages my development.”

This is all you have to do: n

Development refers to ongoing learning and growth. It is about pursuing roles that make the best use of your natural strengths, unique combination of skills, knowledge and talent. You can grow and develop within your current role or seek other opportunities within Christiana Care. Think of your career in terms of finding the right fit where you can both learn and contribute, rather than just fill a job title.

What can you do?

Self-reflect. Identify your primary strengths in terms of skills, knowledge and talents. Think also about what types of work give you satisfaction and the work environment you most enjoy. Write them down, share them with your manager and ask for feedback.

Identify opportunities to build job satisfaction and enrichment by volunteering for committees, projects, special assignments or tasks.

n

Talk with your manager about your career development. Ask about “job shadowing” another position within your department or another department within Christiana Care that fits your interests.

View development as a journey, not a destination. Set goals for yourself and plan how you will work toward them. Talk to your manager or another mentor about how to put your plan into action.

Take advantage of internal and external educational opportunities through continuing education or tuition assistance. Visit the online Education Center to learn about internal education opportunities available to you.

n

To register, go to www.delawareonline.com/health/christianacare.

Explore new and different opportunities through the internal job posting system. When we develop our strengths and build our base of knowledge about our job, we contribute to making Christiana Care a Great Place to Work.

Magnificent!

How sweet it is!

Christiana Care Chief Operating Officer Gary Ferguson, with Chief Nursing Officer, Diane Talarek (right) and Associate Chief Nursing Officer Janet Cunningham, celebrate the big Magnet Nursing recognition news Feb. 18.

Penny Seiple, RN (above, in red shirt), shares the elation of colleagues at Wilmington campus on hearing the news about Magnet.