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FOCUS Open heart surgery program receives highest quality ranking

Our three-star ranking by the Society of Thoracic Surgeons means that Christiana Care is among the top 11.7 percent in the Society’s 1,007-hospital cardiac surgery database.

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hristiana Care’s Center for Heart & Vascular Health has been awarded three stars—the highest national ranking—from The Society of Thoracic Surgeons (STS) for 2009.

Inside Mended Hearts volunteers

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June’s Jeff Award winner

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Employee diabetes program

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Formal Magnet recognition

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Sydnor’s volunter work recognized by Alzheimer’s Association

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Look Good, Feel Better

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Avoiding heat-related illness

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The STS comprehensive rating system compares the quality of cardiac surgery among hospitals across the country. Only 11.7 percent of hospitals nationwide received this year’s STS three-star rating. Christiana Care is one of 1,007 participants in the STS cardiac surgery database.

nation,” says Timothy Gardner, M.D., medical director and past president of the American Heart Association. “The three-star rating from STS is widely regarded by clinicians as the gold standard by which to evaluate cardiac surgery programs.”

“Achieving the best outcomes for cardiac surgery patients requires real coordination among team members so that patients can move seamlessly through the care process," says Michael Banbury, M.D., the W. Samuel “Our patients and community deserve Carpenter III Distinguished Chair of Cardiovascular Surgery at Christiana the best, and STS’s highest national Care. “It is evident by this great award ranking clearly places Christiana that everyone here is focused on cliniCare’s Center for Heart & Vascular Health among the top programs in the cal quality and outcomes.” STS developed this comprehensive SEE

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Mended Hearts volunteers share open heart experience

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or nearly a quarter century, dedicated volunteers at Christiana Care have given their whole hearts to helping patients undergoing cardiac surgery and their families.

Kersey Vakharia, current Mended Hearts president, says the volunteers have received tremendous support from Timothy Gardner, M.D., medical director of the Center for Heart & Vascular Health, and Michael Banbury, M.D., FACS, W. Samuel Carpenter III Distinguished Chair of Cardiovascular Surgery.

“We are not medical people but we can address real life after surgery,” says Diane Margolin, past president of the local chapter of the Mended Hearts Inc., a national nonprofit organization affiliated with the American Heart Association.

Vakharia had quadruple bypass and valve replacement surgery 15 years ago. He began volunteering in 2008 after he retired.

All Mended Hearts volunteers have undergone open-heart surgery themselves. Margolin had a double-bypass 10 years ago. Telling patients what to expect Volunteers talk with the families of open-heart surgery patients, telling them what they can expect after their loved one has surgery, before and after discharge from the hospital.

Helen M. Mills (left) and Kersey G. Vakharia, are two among many Mended Hearts volunteers who have shared their personal experience and kindness with patients about to have open heart surgery at Christiana Hospital.

Volunteer & Student Administration Manager Margarita Rodriguez-Duffy, MSW, CAVS, calls Mended Hearts “a small but mighty group.” Between January and April, 15 volunteers made a total of 491 visits to 222 patients in the cardiac step-down unit, often following up with an encouraging note or phone call to the patient at home. The volunteers staff a desk at the Center for Heart & Vascular Health five days a week, and when they’re needed on weekends or holidays. The group also brings in monthly speakers on various health care topics. Rodriguez-Duffy knows firsthand

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how helpful the volunteers can be to patients and to people who have a loved one facing surgery. “When my father had open-heart surgery a few years ago, I got to see them in action and it was very comforting,” she says. Helen Mills first volunteered with Mended Hearts after a quintuple bypass 17 years ago, and resumed after a valve replacement a year ago. The group has been active at Christiana Care for 24 years. “I’m there to tell them ‘you can be fixed,’ and to be reassuring,” she says. “It’s a wonderfully nourishing experience to be able to help others.”

“We speak from personal experience,” he says. “If someone asks about lifestyle changes, I tell them I started reading food labels and I make certain no more than 30 percent of my calories come from fat.”

Currently, there are more than 250 local Mended Hearts chapters in medical facilities in the U.S. Volunteers receive thorough training before they begin working with patients and families. To learn more, call 302-733-1284 or go to www.christianacare.org/volunteer.


Three-star rating C O N T ’ D F R O M P.

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Sam Lewis wins June Jefferson Award

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hristiana Care’s Jefferson Awards winner for the month of June is Sam Lewis from Volunteer Services. 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.

Michael Banbury, M.D., the W. Samuel Carpenter III Distinguished Chair of Cardiovascular Surgery

rating system to allow for nationwide comparisons regarding the quality of cardiac surgery among hospitals. The system analyzes many different national cardiac surgical data categories on a yearly basis to determine which hospitals meet its stringent qualifications for the three-star rating. Christiana Care’s rating is for the period January 2009-December 2009. This data includes: n

Avoidance of mortality.

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Avoidance of major complications.

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Use of arteries as bypass grafts.

Our second-ever winner of the award epitomizes the concept of service before self. Sam Lewis serves in Volunteer Services at Christiana Care, but his additional volunteer work beyond our campus earns him this month’s honor. Together with his wife Jean, Sam helps provide transportation and arranges for temporary housing services—on his own time and at his own expense—to hundreds of Christiana Care patients, families and friends. His efforts alleviate worries over where to live while loved ones receive care at our hospitals.

Sam Lewis' daughter, Linda Lewis, RN, of 4E, accepted the Jefferson Award, presented by COO Gary Ferguson.

A Christiana Care social worker, Carmela “Mel” Longobardi, nominated Sam. She describes him as a giving, gentle, soul—traits that define volunteering.

How to nominate someone for a Jeff Award Any employee, manager or co-worker can nominate someone for a Jefferson Award using the online nomination form.

nominations before deciding on winners.

The Jefferson Awards is a national program started in 1972 as a prestin Ensuring that all patients receive Eligibility requirements: gious prize for public service. Coappropriate (evidence-based) medicafounders Jacqueline Kennedy n All Christiana Care employees, voltions pre and post operatively. Onassis, U.S. Sen. Robert Taft Jr. and unteers and Junior Board members are A non-profit organization, the STS repSam Beard urged a "Call to Action for eligible. resents nearly 6,000 surgeons, Volunteers" in local communities. n Groups of employees or volunteers researchers and allied health profesMonthly winners are eligible for sionals worldwide who are dedicated to are not eligible. national consideration by the Jefferson ensuring the best possible heart, lung, n Volunteer activities/services should Awards for Public Service. esophageal and other surgical procenot be part of every day work duties. For more information, call Margarita dures for the chest. Founded in 1964, A Christiana Care Jefferson Award Rodriguez-Duffy, manager of Volunteer the mission of STS is to enhance the committee reviews and researches all Services, at 733-1284. ability of cardiothoracic surgeons to provide the highest quality patient care through education, research and advocacy.


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Diabetes program for employees can lead to zero co-pay

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s part of Christiana Care’s commitment to improving employee health, employees with diabetes can receive free, confidential diabetes management services, including nutrition counseling and medications at no charge.

gram allows me to focus on staying healthy rather than thinking about the cost of my drugs.” When diabetes is under control, people feel better and need to take fewer

pocket expenses up to an additional $2,500 for diabetes management equipment and supplies after they have maxed out their $5,000 benefit.

Managing chronic conditions so they don’t get worse is an important initiative in helping peo“ T h e p r o g r a m a l l ow s m e t o ple to lead healthier, more Starting July 1, individuals who f o c u s o n s t ay i n g h e a l t hy productive lives while keepcomplete the requirements of the program can receive medications r a t h e r t h a n t h i n k i n g a b o u t t h e ing health care costs in check. Soon, Christiana Care will roll for diabetes, hypertension and c o s t o f my d r u g s .” out a program for employees cholesterol at zero co-pay. Donna Diorio with respiratory conditions, Employees must meet with a case hostess on 6-E such as asthma and COPD manager twice a year to establish (chronic obstructive pulgoals to help keep their diabetes monary disease). in check. They also must have lab sick days, says Karen Anthony, MS, Are you one of the 7-8 percent? work done twice a year to monitor the CHES, Program Manager, Preventive disease. Currently, 7-8 percent of Christiana Health Services and Delaware Care employees have diabetes, accordDiabetes Passport Collaborative. The program also has ing to their Health Risk Assessments. At the first meeting, employees who the potential to benefit the entire That is in keeping with the rate in commit to the program will receive a health care system by reducing medDelaware, which is slightly higher than Diabetes Passport in which they will ical costs. the national rate. record their test results and chart their Preventive Health Services is a partOverall, the incidence of diabetes has progress. The program also offers dianership between The Eugene DuPont increased dramatically in the last three betes education, including free face-toPreventive Medicine & Rehabilitation decades. From 1980 to 2007, the perface or group counseling with a nutriInstitute (PMRI) and Employee Health centage of Americans with the disease tionist or nurse on ways to maintain a Services created to improve and prohas risen 136 percent, from 2.5 percent healthy diet, as well as other informamote employee health and wellness. to 5.7 percent, according to the Centers tion on diabetes management. The Delaware Collaborative is a partfor Disease Control. Donna Diorio, a hostess on 6-E at nership between various individuals Christiana Care employees and their Christiana Hospital, is a participant in and organizations within the State of dependents over age 18 who have the original program and is looking Delaware and led by Christiana Care been diagnosed with diabetes and forward to committing to the new Health Services, focusing on diabetes have primary insurance coverage enhanced plan. The single mother of management and preventing obesity through Christiana Care’s Blue Cross three says the program eliminates the in children and teens. Blue Shield of Delaware (BCBSD) burden and worry associated with Employees can expect significant savhealth benefits plan are eligible for the paying for medications, needles and ings, too. Currently, the Durable program. other medical equipment and also Medical Expense benefits covers up to helps her to better control her diaTo register, call the Preventive Health $5,000 for devices such as insulin betes. ervices Department at 302-661-3050. pumps. In this program, employees “It is a godsend,” she says. “The procan receive reimbursement for out-of-

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FOCUS July 6, 2010


Magnet Nursing

Award recognizes Magnet Nursing designation

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n June 24, Christiana Care Health System formally received Magnet Nursing recognition from the American Nursing Credentialing Center (ANCC). Karen Drenkard, RN, Ph.D., director of ANCC's Magnet Recognition Program, presented the obeliskshaped award at a celebration in the John H. Ammon Medical Education Center attended by several hundred employees, including Christiana Care president and CEO Bob Laskowski, M.D., and Christiana Care Board Chair Carol Ammon. Magnet is the highest level of national recognition for health care organizations demonstrating sustained excellence in nursing care. Christiana Care is the first hospital in Delaware to receive Magnet recognition. The designation is achieved by only 6 percent of the nation’s hospitals. See more Magnet event photos on Flickr.

From left, Associate Chief Nursing Officer Janet Cunningham, ANCC’S Karen Drenkard, RN, Ph.D., Clare Shumate, RN, Chief Nursing Officer Diane Talarek, RN, MSN, Michelle Zechman, RN, Michelle Jonkiert, RN, and Faith Cooper, RN.

(Above, from left), Don Kirtley, Christiana Care Board of Directors, Christiana Care Board Chair Carol Ammon, Karen Drenkard, RN, Ph.D., of ANCC, Senior Vice President, Patient Care Services/Chief Nursing Officer Diane Talarek, RN, MSN, and Christiana Care President and CEO Bob Laskowski, M.D.


Alzheimer’s Association recognizes volunteer Linda Sydnor

Diane Talarek traces nursing history for UD Academy of Lifelong Learning

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inda Sydnor, APRN, a geriatric clinical nurse specialist at Christiana Hospital, received a volunteer of the year award from the Alzheimer’s Association Delaware Valley Chapter. Sydnor, a member of the Acute Linda Sydnor, APRN Care for the Elderly (ACE) team on 6A, began volunteering for the chapter as a team captain in the annual Wilmington Memory Walk. She later increased her activity with committee work and fund raising. To date, Sydnor has raised more than $12,000 for programs and services offered by the Alzheimer’s Association. “This a big honor, and recognizes all the work that Linda has done for the Alzheimer’s Association and on behalf of our Alzheimer's patients,” says ACE unit Medical Director Patricia Curtin, M.D., FACP, CMD. “Volunteer efforts are crucial to maintaining programs and services for those living with Alzheimer’s and other dementias and their families,” says Alzheimer’s Association Delaware Valley Chapter spokesperson Marilyn Dyson. “Our volunteers give tirelessly of themselves and we couldn’t manage as well without them.”

During her hour-long lecture she gave concise explanations of such topical nursing subjects as: n Various educational requirements and tests for nursing education leading to a registered nurse license. n The increasing interest of providers in promoting nursing specialty certification. n How a healthy economy affects the nursing job market.

Diane Talarek, RN, MSN

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enior Vice President, Patient Care Services, and Chief Nursing Officer Diane Talarek, RN, MSN, was the featured speaker at an Academy of Lifelong Learning lecture series event June 18 at Arsht Hall, the University of Delaware’s Wilmington Campus. Talarek took her audience on a journey through the history of modern nursing, from Florence Nightingale’s seminal career in both war and peace time to the wide range of careers available to nurses now and the challenges those nurses face at work each day.

n Recent media coverage concerning hospital-acquired infections.

Talarek received a master of arts degree in nursing education from New York University in 1976 and holds a certification in nursing administration. She also completed The Johnson & Johnson Wharton Fellows Program for Nurse Executives. She received her bachelor's degree in nursing from Fairleigh Dickinson University, N.J., in 1972. She is an adjunct faculty member at the University of Delaware and has more than 30 years of professional nursing leadership experience.

It’s Magnetic! “Forces of Magnetism” No. 12: Image of Nursing

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FOCUS July 6, 2010


Christiana Care named a Quality Respiratory Care program Christiana Care has been named by The American Association For Respiratory Care as a "Quality Respiratory Care Recognition Program" (QRCR) for 2010. About 700 hospitals out of the 5,000 in the U.S. have been named Quality Respiratory Care institutions. Christiana Care has been a part of this list and will continue to be for 2010.

Focus on Excellence - Medication Reconciliation - 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.

Medication Reconciliation Q. What is Medication Reconciliation? A. Medication Reconciliation is an interdisciplinary process that compares the patient’s list of home medications against the physician’s orders upon admission, transfer, and discharge, thereby decreasing potential adverse drug events. Q. How is the patient’s accurate Medication Reconciliation communicated to the next provider of care? A. The Medication Reconciliation is communicated by the discharging physician to facilities and community physicians at discharge, or at the end of an outpatient visit by one of the following methods: n

Interagency Discharge Order Form.

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Faxing the Discharge Medication Reconciliation Form (includes Inpatient & Outpatient) and Discharge Instructions.

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Sending a copy of the Discharge Medication Reconciliation Form and Discharge Instructions.

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Access ANYware/Centricity.


Look Good, Feel Better program starts with a mini makeover

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or many women the diagnosis of cancer can be overwhelming, but dealing with hair loss can be devastating to their self image. Women undergoing cancer treatment at the Helen F. Graham Cancer Center are finding hope and self-

confidence as a result of the proactive program. “The program supports treatment and recovery,” says Claudia Acero, patient/physician access coordinator at the Graham Center. “It empowers women with cancer and helps restore their selfesteem.” A cosmetologist guides participants through a mini-makeover, teaching them

how to care for their skin during treatment, apply cosmetics to diminish skin changes and care for their nails. The women practice tying scarves, wearing wigs and other beauty initiatives. At the end of the session, participants receive a tote bag of full-size skin care products and cosmetics. “This program is about helping women with cancer feel special,” says Acero. “When they see themselves in the mirror with hair and makeup again, it’s like they’ve rediscovered a long-lost friend. They leave invigorated with a renewed sense of self-confidence.” Many make friends at the makeover In addition to looking and feeling better, the women find an excellent opportunity to interact with other women in treatment. Women may invite a female friend to attend the program with them. Many make new friends and keep in touch via the phone, e-mail and social networking. Program is free to patients Look Good, Feel Better is a free monthly program sponsored by Christiana Care, the American Cancer Society, the Personal Care Products Council Foundation and the National Cosmetology Association. Staffing the program are volunteers from all the partner organizations, including Acero and other volunteers from the Helen F. Graham Cancer Center. If you or someone you know would like more information or to register for Look Good, Feel Better, call 302623-4500. When cancer care causes hair loss and other side effects that change a woman’s appearance, the free Look Good, Feel Better program is a friend in need.

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From three packs a day to none: It can be done enise Legates remembers caring for her mother, a heavy smoker dying of emphysema.

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ence. It dictated where she could go and how she would spend her free time. It impacted her budget.

“I was her primary caregiver and I saw how she suffered,” says Denise, a clerk in the sixth-floor Center for Rehabilitation at Wilmington Hospital, who has been a Christiana Care employee for 24 years.

She appreciates the freedom she has gained by conquering tobacco.

Her father, also a smoker, died of a heart attack at 48.

Because she knows firsthand how difficult it is to quit, Denise is dedicated to encouraging other people to kick the habit.

“I don’t have to go outside to smoke,” she says. “No running out for cigarettes; no scrounging around for the money to buy cigarettes.”

Denise smoked, too, typically three packs of cigarettes a day. She had a chronic cough and was often out of breath. “But after my mom died, something inside me changed,” she recalls. “I was determined to quit.” Started smoking at 15 Denise started smoking at age 15. “Peer pressure. All the kids were doing it,” she says. Over the next 25 years, she tried to quit several times. Denise would stop smoking for a week or two, then pick up the habit. In the crystal clear light of hindsight, she realizes that certain triggers made her vulnerable to smoking. “I was a stress smoker,” she says. “Whenever I would feel stressed, I would light up.” Determined to kick the habit for good, she visited Employee Health, where she obtained the patch, which delivers a low dose of nicotine through the skin to satisfy craving. She also got a prescription for Wellbutrin, an antidepressant that reduces the craving for nicotine and lessens the severity of withdrawal symptoms. Denise received personal support on many fronts, beginning with her adult daughter, who had been urging her to

“I will do all I can to help other people who are trying to quit because I am so grateful to the people who helped me,” she says. Denise Legates

In 2005, all Christiana Care facilities went smoke free, inside and out. As

quit since she was a little “ E m p l oye e H e a l t h w a s a h u g e h e l p . girl. To this I also had a lot of good support day, friends f r o m my f r i e n d s , f a m i l y a n d t h e who smoke refrain from n u r s e s I w o r k w i t h .” lighting up Denise Legates around her out Ex-smoker, Wilmington Hospital of respect for her commitment to stop smoking. leaders in the health care community, “Employee Health was a huge help,” she recalls. “I also had a lot of good support from my friends, family and the nurses I work with.” Smoke free for six years It wasn’t easy, but Denise gave up cigarettes, this time for good. She has lived smoke-free for six years. Her cough has subsided and she has more energy. Her daughter is proud of her—and happy that she need not be concerned about Denise smoking around her granddaughter. Looking back, Denise thinks about how smoking restricted her independ-

we are committed to setting an example to inspire and uplift our neighbors. That’s why Christiana Cares offers an extensive support program for employees who want to kick the habit. Employees will receive prescription medication and face-to-face counseling, both at no cost. You don’t have to go it alone.Employee Health is here to help smokers quit, every step of the way. To learn more, call the Tobacco Cessation hotline at 302-733-1878. Or contact the toll-free Delaware Quitline at 866-409-1858.


Formulary update FORMULARY ADDITION Medication – Generic/Brand Name Ibuprofen lysine injection / NeoProfen

Strength/Size Use/Indication Comments 10 mg/mL Closure of patent 2-mL single use ductus arteriosus in vial neonates. REVISED CHRISTIANA CARE MEDICATION POLICY Christiana Care-approved The Christiana Care-approved indications for fondaparinux are (1) prevention indications for fondaparinux of deep vein thrombosis in patients who have undergone surgery to replace a hip or knee joint, or repair a hip fracture, and (2) use by hematologists to treat patients with a history of heparin-induced thrombocytopenia Propofol bolus dose administration x Bolus doses of propofol can be administered to a patient when the patient policy is (1) in an intensive care unit; (2) hemodynamically stable; (2) on a mode of ventilation that provides a minimum rate and tidal volume; and (3) when a physician, nurse practitioner or physician assistant is available to respond to the ICU or monitor the patient via eCare. x Recommended maximum bolus dose is 0.4 mg/kg or 400 mcg/kg. Dose cannot exceed 0.6 mg/kg or 600mcg/kg. x Vital signs are monitored following the bolus dose. x Only orders for single bolus doses are permitted. Standing orders for bolus doses are unacceptable. x An alternative sedative should be considered when the patient is receiving a continuous intravenous propofol infusion at a rate close to 80 mcg/kg/minute. Level of HVIS Preparation and The HVIS Preparation and Holding Unit has been designated a level C unit for Holding Unit for medication medication administration. administration FORMULARY DELETIONS Codeine phosphate injection This product is no longer manufactured. Indocyanine green injection This product was deleted from the Christiana Care formulary because of lack of use. Indomethacin injection Replaced with ibuprofen lysine injection (see addition above). Magnesium hydroxide tablets This magnesium hydroxide dosage form is no longer manufactured. The suspension remains available. Prazosin capsules This medication was deleted from the Christiana Care formulary because of lack of use. Ribavirin This medication was deleted from the Christiana Care formulary because of lack of use.

Upcoming events

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Use common sense to avoid heat-related illness

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hile it is smart to stay indoors in an air-conditioned environment during a real scorcher, most of us enjoy spending time outdoors during the summer. But too much exposure to high temperatures can make us sick. Extreme cases, known as heat stroke, can be fatal.

Dress properly The first line of defense is dressing for the weather. In summer, it makes sense to wear clothing that is light-weight. There’s a good reason why people who live in tropical climates tend to wear white. Clothes that are light in color are cooler because they reflect heat, while dark colors absorb heat and make us feel warmer. And don’t forget your hat, preferably one with a wide brim that will shade your face.

on hold and toss a big salad with grilled chicken or shrimp. Work with Mother Nature to choose the best time for strenuous exercise. Plan your run for the early hours of the morning, before the sun is out in full force. When the sun is sizzling, stay in the shade or inside an air-conditioned building. Know the warning signs Know the warning signs of heat-related illnesses. Elderly people, infants and children are most vulnerable to these conditions. The first signal is muscle cramps, caused by the loss of salt and fluids during perspiration. The second and more serious stage is heat exhaustion.

Symptoms include pale skin that is cool and moist. People who are suffering from heat exhaustion also likely will have a headache and feel weak, depleted and nauseous. In case of heat stroke, call 911 Heat stroke is life threatening. At that point the body’s natural mechanism to cool itself has broken down. People stop sweating and develop a high fever. They are confused, have a rapid, weak pulse and shallow breathing. They might lose consciousness. If someone you know shows these symptoms, call 911 immediately and try to cool them down by sponging them with cold water or getting them into a cold shower as quickly as possible.

You don’t have to work up a sweat to get dehydrated in summer. So, keep the water flowing, drinking at least two eight-ounce servings of water every hour you are outdoors. The key is to drink water before you feel thirsty. In fact, you should not head to the tennis court, hop on your bike or embark on a long walk without your trusty water bottle. Avoid alcohol and caffeine Do not quench your thirst with an ice cold beer or a frosty cola, as alcohol and caffeine actually contribute to dehydration. Also avoid hot, heavy meals. Eat dishes that are cool and light. Put the spaghetti and meatballs

When feeling the symptoms of heat exhaustion or heat stroke, it’s best to find a place to quickly cool down.


Wilmington ICU visiting hours reflect family centered care

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he Wilmington Hospital Intensive Care Unit (ICU) June 15 celebrated its commitment to patient and family centered care by removing the restrictive visiting hours sign from the door. “This is a great opportunity for us to embrace increasing involvement of families in patient care,” says Christiana Care Senior Vice President and Executive Director, Wilmington, Janice Nevin, M.D., MPH. “Donna Casey and the Wilmington ICU staff have played a leadership role in including patients and families as members of the care team.” “The nation is focused on patient safety,” says Casey. “Evidence proves that patient and family centered care improves safety. Wilmington ICU embraces this opportunity to improve patient safety and satisfaction and improve the quality of care we provide as well, by partnering with our families.”

From left, Lew Messick-Klensch, RN, Karen Ellis-Brisbon, RN, CCRN, Nurse Manager Donna Casey, BSN, MA, RN, FABC, NEBC, and Janice Nevin, M.D., MPH, replace the visiting hours sign at Wilmington ICU with a simple welcome sign.


Focus: July 6, 2010