Health + Wellness Magazine Summer 2018

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Health + Wellness

Living healthier together.

Summer 2018 | cheshiremed.org

Nurses such as Certified Registered Nurse Anesthetist, Latasha Heape play vital roles in every aspect of our patient care.

Medical Center Update

Making Healthy Choices

Health Education & Support

Making a Difference

Raising the bar on high quality, patient-centered care.

Precautions and preventions for a safer summertime.

Reserve your spot in one of our upcoming Health+Wellness programs.

Supporting the efforts of local towns to live healthier together.

FROM THE CEO/PRESIDENT/CHIEF MEDICAL OFFICER

Recognizing quality, safety, and Cheshire Medical Center is proud to be home to eight “Top Doctors”.

Together, we’re raising the bar on high quality, patient-centered care.

Healthcare has many dimensions. The health concerns and needs of patients are as unique as the individuals themselves. Meeting the diverse healthcare needs of our patients in the Monadnock Region, from the newly born to those at end of life, requires the skills of Cheshire Medical Center’s team of over 1,500 employees working in partnerships within the Dartmouth-Hitchcock Health system and within the communities we serve.

In looking back at issues of Health + Wellness magazine from the past year, I noted that we took great care to share the value of our new electronic health record (EHR) system, EPIC, and other technological advancements. The spring 2018 issue featured the personalized care in the Farnum Rehabilitation Center. In this issue, we’re taking the opportunity to further share some of the behind-the-scenes ways our employees are working together effectively to improve outcomes.

Cheshire has been recognized nationally with high grades in patient safety. The quality and breadth of care provided here in Keene rivals that in large urban areas. To consistently provide state-of-the-art services, teams here at Cheshire are raising the bar on high value care every day.

Each spring, we celebrate our employees’ service and the accomplishments of teams at our annual Recognition of Service ceremony. One of the many highlights of the ceremony is the annual Chairman’s Award, presented by the Board Chair of the Cheshire Medical Center Board of Trustees. The Chairman’s Award recognizes the outstanding work of staff teams coming together to solve complex problems and to implement solutions.

Several outstanding projects were nominated this year. The organization updates section on pages 2-3 of this issue highlights the three Chairman’s Award winning improvement projects accomplished by teams here at Cheshire, representing just a few of the ways that attention to quality is demonstrated here daily.

It isn’t possible to acknowledge the hard work and dedication of our employees without calling attention to the nursing profession. Nursing overall embodies more than 30% of our workforce at Cheshire, and are represented in most areas and departments.

Nursing may be one of the greatest influences in today’s healthcare. Yet, many people may not be aware of the breadth of the nursing profession. This issue’s feature story highlights a sampling of the diverse skills and specialties of nurses here at Cheshire.

It is the patient-centered high-quality care, creative problem-solving skills, and determination of our employees that make Cheshire Medical Center a valuable healthcare asset for the Monadnock Region.

Don Caruso, CEO/President/Chief Medical Officer

2 Summer 2018 | Health + Wellness

Congratulations to our physicians voted by their peers as top New Hampshire doctors in the New Hampshire Magazine annual Top Doctors issue: Family Medicine-Barbara Bates, MD; the entire Orthopaedic Surgery team-Paul Bettinger, MD; Cherie Holmes, MD; Greg Leather, MD; Anthony Presutti, MD; Mark Silbey, MD; Hospice & Palliative Medicine-Lisa Leinau, MD; Hematology-Jill Winslow, MD.

Chairman’s Award 2017- 2018 The Cheshire Medical Center Chairman’s Award recognizes the work of teams to continuously improve the quality of our health services. This year’s nominees represented teams across a range of services and areas, from patient care on the Kingsbury Unit to Mohs procedures in dermatology, and from advanced breast care to substance misuse and -use disorder care coordination.

All of the projects teams nominated identified an opportunity and developed and implemented a strategy to receive outstanding results. Below are details of the winning projects.

Clinical Informatics and Superusers Team The successful conversion from multiple electronic health records (EHRs) to a shared single Epic platform took a great deal of planning, the right organizational structure to keep the flow of information moving, and a lot of highly motivated, well organized individuals with real-life knowledge of the work that takes place on the front lines of patient care.

For 18+ months, Clinical Informatics worked closely with colleagues from within Cheshire Medical Center and the DartmouthHitchcock Health system to learn the Epic software, the new workflows, and to identify changes that would be necessary to meet the needs of our community medical center.

In addition to the Clinical Informatics team, it was necessary to engage more people, the right people-SuperUsers, staff who represented their department teams during the building and testing of the new EHR. This group was instrumental in sharing what they learned with

excellence of care at Cheshire Medical Center their colleagues. When the new EHR went live, SuperUsers provided direct support for end users. They answered questions, helped end users navigate the system, reported issues to the project team to support prompt resolution, and supported staff morale.

SuperUsers continue to provide feedback and suggestions to improve both the software and the workflows their departments use.

Neonatal Resuscitation Team The first few moments of a newborn’s life can be the most critical. If needed, effective emergency care during this transition can prevent harm. Neonatal Resuscitation is intervention after a baby is born to help it breathe and to help its heart beat.

Neonatal resuscitation isn’t a common occurrence at Cheshire Medical Center.

When it does occur, it is an event of considerable magnitude.

Staff reviews of updated American Academy of Pediatrics Neonatal Resuscitation Program (NRP) guidelines revealed opportunities to improve neonatal resuscitation processes. Women and Children’s Health Unit (WACHU) nursing staff, pediatricians, and Quality and Patient Safety team members collaborated to develop a neonatal resuscitation improvement plan. Actions included changes to the equipment and medications on the neonatal code cart and more realistic training with a new neonatal resuscitation mannequin. Pediatricians participated in neonatal resuscitation skills trainings facilitated by a Dartmouth-Hitchcock Health system neonatologist, and WACHU nursing staff attended neonatal resuscitation skills trainings. Both groups jointly participated in mock codes.

This dedication and commitment by WACHU nursing staff and pediatricians has helped ensure that we provide the best possible care to babies born at Cheshire.

Second Stage Situational Awareness Team The second stage of labor is from full dilation until delivery. During this time, a nurse and midwife are usually in the room

with the laboring mother, focusing solely on her. This intense, sometimes lengthy focus can lead to tunnel vision and a loss of situational awareness. The loss of situational awareness can affect the team member’s ability to fully comprehend all details of the current situation.

Women and Children’s Health Unit (WACHU) nursing staff, OB/Gyn providers, and a member of the Quality and Patient Safety team proactively collaborated to develop a process for this stage of labor using a checklist created by Northern New England Perinatal Quality Improvement Network.

The process for completion of a

Situational Awareness Second Stage checklist (SASS) was developed to be completed for patients in the second stage of labor. The process includes completion of the SASS and a huddle between direct caregivers and a clinical staff member not actively involved with the patient, multiple times during the second stage of labor. All WACHU nursing staff and OB/Gyn providers were educated on the form and process.

The SASS process has helped to maintain situational awareness and provides an additional safety measure as we care for laboring mothers and their babies.

FROM THE CENTER FOR POPULATION HEALTH AT CHESHIRE MEDICAL CENTER The Center for Population Health (CPH) at Cheshire Medical Center was established to integrate and support efforts toward health and wellbeing into the daily lives of those residing in the communities we serve. My update for this issue is about a recent initiative embraced

by CPH to advance the community health goals of Monadnock Region towns, known as SCALE. SCALE, Spreading Community Accelerators through Learning and Evaluation, is a national model for community transformation by developing the skills and behaviors that can lead to culture change and sustainable improvements in health, wellbeing, and equity. CPH is one of only 18 organizations awarded a SCALE project grant in a national contest for funding.

In May of this year, five of my CPH colleagues and I attended the Community Health Improvement Learning Academy (CHILA) in Denver, Colorado. CHILA offers training for population health professionals and community leaders, enabling them to provide the support required for communities participating in a SCALE project. This education prepared our CPH staff with the necessary skills to provide coaching and facilitation to community partners to set them up to succeed in their SCALE project efforts and to track relevant data to ensure growth and continued success.

I invite you to read the story on pages 14-15 of this issue to learn more about SCALE and the exciting opportunities it presents to empower communities in their efforts to create movement of the barriers to good health and wellness.

Shawn LaFrance, Vice President of Population Health & Health Systems Integration

Health + Wellness | Summer 2018 3

Cheshire Medical Center FEATURE STORY

As care providers, leaders, teachers, advocates, critical thinkers, and innovators,

nurses serve all areas of our community medical center.

Healthcare in the U.S. has changed dramatically in the last 50 years.

Considering that nurses comprise 29% of today’s healthcare workforce, the largest segment by far, it is understandable that nursing is one of the most rapidly evolving professions in healthcare. This evolution has resulted in nurses being trained to a higher level of care than ever before and acknowledged as respected healthcare professionals because of their extensive education and hands-on skills.

Yet, unless you or a loved one has spent time in a hospital or needed chronic care, you may not fully understand the breadth of expertise and knowledge that nurses bring to healthcare.

“

Our nurses inspire me daily with

their professionalism, expertise, and compassion, as well as their critical thinking and innovative solutions to meet the everyday challenges and

”

demands of healthcare.

- Cindi Coughlin, MS, RN Senior Vice President Patient Care Services/CNO

The foundation of nursing has always been respect for human dignity and an intuition for patients’ needs. Today’s nursing profession builds on that foundation with rigorous academic programs and specialized skills. There are a wide variety of programs, specialties, degrees, and certifications for different types of nursing.

Nurses at Cheshire Medical Center are found in almost every department, from every aspect of patient care to specialized roles outside of patient care, and are leaders at every level of the organization. Each nurse brings specific strengths, passions, and expertise to healthcare. Their presence 24/7 is truly the lifeblood of our medical center.

To demonstrate some of the specialized skills and services that nurses bring to healthcare, we’ve highlighted just a few of the amazing nurses making a difference every day at Cheshire.

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Adina Hebert, APRN

Latasha Heape, CRNA

The right care at the right time As the needs for access to healthcare increase, Advanced Practice Registered Nurses (APRNs) are helping to meet the demand by providing the right level of care at the right time. An APRN is a type of Registered Nurse who has earned a graduate-level degree and been specially trained in one of the four recognized APRN roles: Certified Registered Nurse Anesthetists (CRNA), Nurse Practitioners (NP), Certified Nurse Midwives (CNM), and Clinical Nurse Specialists (CNS).

APRNs across all four specialties at Cheshire Medical Center work independently or in collaboration with physicians in both clinical settings, such as primary care, and in hospital settings, such as Medical/Surgical.

APRN NP in Primary Care teams

New Hampshire is one of 23 U.S. states in which APRNs have full practice authority, allowing for nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications.

Adina Hebert, APRN is a Master’s-Prepared Nurse Practitioner and one of the providers at Cheshire’s Walk-In Care clinic.

“Patients receive the same advanced level of care they would at their primary care provider’s office,” Hebert says of the walk-in clinic, where she performs triage, evaluates patients, goes over their medical history, does a physical exam, orders x-rays, cultures or blood work, makes a diagnosis, and creates a care plan that may include prescribing medication.

APRN CRNA in Medical/Surgical teams

As a Certified Registered Nurse Anesthetist, Latasha Heape, CRNA provides anesthesia and related care before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures.

Heape provides anesthesia to patients for all types of surgical procedures at Cheshire Medical Center. “One day I may give anesthesia to children for ear, nose, and throat procedures, and the next I may be placing an epidural for a laboring woman, or intubating a critically-ill patient in the ICU,” explains Heape.

Before a procedure, Heape discusses with patients any medications they are taking and any allergies or illnesses they may have to ensure patient safety. She then administers general anesthesia to put the patient to sleep so they feel no pain during surgery, or administers a regional or local anesthesia to numb an area of the body. Heape monitors patients’ vital signs and adjusts anesthesia as necessary throughout a procedure.

Float Pool Nurses and Nursing Council members, Margaret Bard, RN and Benjamin Smith, RN

Shared governance strengthens nursing practice and patient care Nursing Councils embrace the challenges of an ever-changing healthcare environment and enrich nursing practice. The Professional Nursing Councils at Cheshire Medical Center identify opportunities for improvement in nursing practice and ensure that nurses at every stage of their career have a voice in decisions impacting patient care and nursing practice.

At Cheshire Medical Center there are three Nursing Councils with different areas of focus: Nursing Practice Council, Quality Council, and Competency Council. The councils include nurse representatives from each patient service area and meet monthly to discuss interdepartmental practice issues that impact patient care.

Continually improving quality in nursing care

Float pool nurses like Benjamin Smith, RN move between inpatient units, including surgical, medical, and critical care, as additional staffing is required.

As the only Float Pool Nurse working the nightshift, Smith says his input on the Nurse Quality Council is particularly valuable. This Council defines and measures performance to enhance the quality and safety of patient care and includes members from clinical service areas and the inpatient areas of the medical center, as well as leadership and administration. “With all those eyes, ears, and experience, everyone can provide input and create an action plan,” says Smith.

One of Smith’s contributions as a council member was a proposal to update practice in the use of compression stockings for patients which was adopted by the council, “It was an opportunity to be part of the solution,” explains Smith.

Ensuring consistent, high quality care While issues and policies may be discussed in the Quality and Competency Councils, the Nursing Practice Council ensures that changes in nursing practice are carried forth across all areas of patient care—defining, promoting, and supporting evidence-based professional nursing practice.

Margaret Bard, RN is a Float Pool Nurse and co-leader of the Nursing Practice Council.

Health + Wellness | Summer 2018 5

Certified Wound Care Nurses, Michelle Cournoyer, RN, WCC and Susan Sperry, RN, WCC

“The Practice Council consists of practicing nurses with the most frontline patient care experience having a say in how we do our jobs and promoting the professional nurse practice model,” says Bard.

“The (Nursing Practice) Council is the last set of eyes before something goes live,” she explains. “After a new practice or a change in practice goes into effect, members of all Nursing Councils and staff are informed.”

Taking an interdisciplinary approach to optimizing patient care Wound care can be a complex and sometimes fragile process that is a crucial part of healing and rehabilitation. Nursing staff at Cheshire are taking an interdisciplinary approach to wound care to ensure every patient has the same chance for a positive outcome.

A consistent and cohesive approach

The Wound Care Committee at Cheshire, comprised of nurses from various units, guides practice and promotes a consistent and cohesive approach to care using evidence-based practice.

Certified Wound Care Nurse, Michelle Cournoyer, RN helped form the committee that gathers monthly to collectively focus on the best wound care across all areas of the patient care.

As part of a newly-created position within Podiatry, Cournoyer works collaboratively with two podiatric surgeons, and closely with home care nurses preparing wound treatment plans and conducting training.

“If a nursing home or home healthcare want specific (wound) dressings, I’ll do a training at the facility,” says Cournoyer.

As part of the Wound Care committee, she discusses treatments and products, always with an eye for improvement to wound care.

“We discuss what’s working and what isn’t.” she says, “It’s a very collaborative approach.”

Supporting patients with a continuum of care

Susan Sperry, RN, a Certified Wound Care and Ostomy Nurse, says the collaboration of the wound care committee is invaluable in providing the best treatment.

“We learn from each other,” she said. “We share patients-we can bounce things off each other.”

Sperry provides bedside wound care in all units, including the

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Care Coordinator Nurse, Nicole Prescott, RN and Medical Home Coordinator, Kathleen Dexter, RN.

Emergency Department. She works with bedside nurses to create a treatment plan for the patient, and collaborates with provider colleagues to determine appropriate medication, diagnostic tests, or bed surface needs.

Sperry also provides wound care education to bedside nurses and patients. That may mean teaching the latest treatment technologyfor example, negative pressure wound therapy, which uses a vacuum dressing to promote healing in both acute and chronic wounds. She also provides preventative education to patients.

Sperry emphasizes that this approach to wound care helps patients heal with fewer complications and hospitalizations, and that providing information about disease management and prevention helps them increase strength and endurance to become more independent.

“When we take a comprehensive approach to patient care,” says Sperry, “better outcomes are the result.”

Coordinated care = better care Care coordination means different things to different people.

For patients and their families, it means the patient’s needs and preferences are addressed across functions and sites. It can also include help in navigating the health care system.

For medical teams, it involves determining where to send the patient next and what patient information is necessary to transfer among health care entities. It creates a seamless transition between points of care and support, education, and communication after the patient leaves the hospital.

Two crucial nursing roles that ensure coordinated care are our Care Coordinators and Medical Home Care Coordinators.

Care Coordinator Nurses

As a Care Coordinator Nurse, Nicole Prescott, RN facilitates the discharge process and communicates the patient’s follow-up needs to the primary care team. Prescott also ensures patients have all the tools they’ll need to manage their health once they go home. She establishes a plan for the patient at the time of discharge and serves as the first link in the chain of communication to other departments regarding that patient’s care plan.

Thinking ahead is crucial. Before filling out discharge paperwork,

Vital support to patients and healthcare teams, from start to finish

Licensed Practical Nurses, Kendra Severance, LPN and Heidi Clark, LPN.

Prescott is laying groundwork: making follow-up appointments; scheduling lab work; calling the pharmacy to determine if a medication is available and at the lowest cost.

As a patient advocate, Prescott troubleshoots issues as they arise. She may provide education, for example, to a patient newlydiagnosed with diabetes who needs to learn how to use a glucometer to check their blood sugar or practice insulin administration. Or she may determine a patient needs a follow-up call from a social worker.

“We focus on making sure things don’t fall through the cracks,” says Prescott.

Medical Home Care Coordinators

Prescott partners with Kathleen Dexter, RN a Medical Home Coordinator.

“She lets us know what the patient needs-any tests, lab work, appointments, and disease or condition management information,” says Dexter.

“Some patients are overwhelmed,” she says, “I help make sure the care planning that Nicole did in the hospital is carried out.”

Dexter works with the primary care provider and with specialists and other departments, and if a need is identified, institutions such as nursing homes and social services organizations.

“Each patient has such different needs,” she points out.

Dexter carries out a patient progress assessment, which includes asking a series of questions regarding management of home care, reviewing discharge instructions, and going over medication lists.

Sometimes patients need more services in home, which she’ll arrange. This may mean scheduling a home healthcare nurse, medical equipment, transportation to appointments, or mental health services.

“When a patient goes home, navigating the waters can be overwhelming,” says Dexter. “I’ve heard from families, especially caregivers, that they appreciate someone they can go to directly who knows the patient’s history. Our ultimate goal as Care Coordinators is to keep people from having to go back to the hospital.”

Licensed Practical Nurses (LPN) are essential in meeting the need for nurses in healthcare. LPNs are licensed professionals whose duty is to provide routine care, assist physicians, APRNs, and RNs, and provide instructions to patients regarding medication, home-based care, and preventative lifestyle changes.

LPNs are connectors in the continuum of care, keeping accurate communication flowing between providers, specialists, surgeons, and patients. LPNs may be the first caregiver a patient sees in the exam room, providing an initial assessment and checking vital signs. The LPN role in patient care continues after appointments and procedures with essential information and support.

For our healthcare teams and patients at Cheshire Medical Center, these nurses are highly appreciated for the practical knowledge they bring to patient care.

LPN support is primary in Primary Care

It takes a team of skilled professionals to meet patients’ primary care needs. LPNs serve as a key link between patients and providers, assisting patients with actions such as specialist referrals, prescription refills, and reviewing lab results.

As a Phone Triage Nurse in Primary Care, Kendra Severance, LPN helps patients who are unsure of the level of care they may need. Severance provides an initial assessment over the phone and then consults with the patient’s primary care provider (PCP) or an RN on her team to confirm a care plan. She then communicates that plan with the patient and provides support for next steps, such as home care instruction or scheduling an appointment with their PCP. Severance helps to ensure patients receive the right care, in the right place.

LPNs support our surgical patients

In busy outpatient surgical departments, LPNs ensure that surgeons and patients have the information and resources they need, from confirming appropriate diagnostic tests are completed prior to surgery, to explaining post-operative instructions or addressing home healthcare needs.

Heidi Clark, LPN is a Phone Triage Nurse in the Orthopaedics surgical care unit serving as a liaison between surgical staff, patients, and primary care teams. Clark answers basic questions such as whether it is okay to take a bath with stitches as well as more complex concerns. “Patients may leave with a large packet of information post-surgery, but they still need to know they can call and talk to someone if they have questions,” says Clark.

Throughout Cheshire Medical Center, from non-clinical departments like Clinical Informatics and Quality & Patient Safety, to specialized treatment centers like the Norris Cotton Cancer Center at Kingsbury Pavilion and the Farnum Rehabilitation Center, nurses are innovating, influencing, and inspiring—every day. Find out more about all our available services at cheshiremed.org.

Health + Wellness | Summer 2018 7

Making Healthy Choices TIPS & TOOLS

Precautions and preventions for a safer summertime Heat-related illness-what to look for and what to do

· Wait for cramps to go away before resuming physical activity

Heat-related illnesses are preventable.

Learn the symptoms and what to do if you or a loved one shows signs of having a heat-related illness. The Centers for Disease Control and Prevention make the following recommendations:

Get medical help right away if: · Cramps last longer than 1 hour · Person is on a low-sodium diet · Person has heart problems

HEAT STROKE Look for: · High body temperature (103˚F or higher) · Hot, red, dry, or damp skin · Fast, strong pulse · Headache · Dizziness · Confusion · Nausea · Losing consciousness (passing out)

Lyme disease and other tickborn diseases are a significant cause of illness in New Hampshire. Measures to avoid getting bitten by a tick include: · Using insect repellent according to product label directions · Wearing protective clothing such as longsleeved shirts and long pants · Staying away from tick-infested areas such as overgrown grass and brush · Perform tick checks regularly

What to do: · Call 911 right away-heat stroke is a medical emergency! · Move to a cooler place · Help lower the person’s temperature with cool cloths or a cool bath · Do not give the person anything to drink HEAT EXHAUSTION Look for: · Heavy sweating · Cold, pale, and clammy skin · Fast, weak pulse · Nausea or vomiting · Tiredness or weakness · Headache · Dizziness · Fainting (passing out) What to do: · Move to a cool place · Loosen clothing · Put cool, wet cloths on body or take a cool bath · Sip water

Tips for preventing tick-borne disease

Get medical help right away if: · Person is vomiting · Symptoms are worsening or last longer than an hour HEAT CRAMPS Look for: · Heavy sweating during intense exercise · Muscle pain or spasms What to do: · Stop physical activity and move to a cool place · Drink water or sports drink

If you discover you have been bitten by a tick , the New Hampshire Department of Health and Human Services recommends the following actions to prevent tick-borne disease: · Remove the tick immediately by grasping

Steps to healthy fruits and vegetables from the store to your table Fresh fruits and vegetables are an obvious choice when shopping for summertime meals. But did you know that harmful germs, like Salmonella, E. coli, and Listeria, can sometimes be on fruits and vegetables? There are steps that can help keep you healthy—and your fruits and vegetables safer to eat—from the store to your table.

At the store or market

Choose fruits and vegetables that are free of bruises or damaged spots, unless you plan to cook them.

Keep precut fruits and vegetables cold and choose precut and packaged fruits and vegetables that are refrigerated or kept on ice.

Separate fruits and vegetables from raw meat, poultry, and seafood in your shopping cart and in your grocery bags.

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At home

Wash your hands before and after food preparation and wash all fruits and vegetables under running water before eating, cutting, or cooking.

Refrigerate cut, peeled, or cooked fruits and vegetables as soon as possible, or within 2 hours, or within 1 hour if the temperature outside is above 90°F. Store fruits and vegetables away from raw meat, poultry, and seafood in the refrigerator.

Use a separate cutting board for fruits and vegetables that is never used for raw meats, poultry, or seafood. Wash cutting boards, counter tops, and utensils with hot, soapy water before and after preparing fruits and vegetables.

Healthier Together SPOTLIGHT

Helping individuals put a plan in place for honoring their care decisions the head with fine-nosed tweezers as close to the skin as possible, using a slow, steady, upward motion to minimize the chances of leaving the head behind. Clean the bite area with soap and water or alcohol. · Consult a healthcare provider if the tick has been attached for at least 36 hours for possible treatment with a prophylaxis (single dose of the antibiotic doxycycline). This prophylaxis can only be given to people 8 years of age or older and must be given within 72 hours of tick removal. One study found that if this was done, the prophylactic treatment was 87% effective in preventing early Lyme disease. · If concern of illness arises after the tick bite, whether or not prophylactic treatment was administered, or you do not recall having been bitten by a tick but notice that you have a rash or a fever, a healthcare provider should be contacted to discuss whether testing or treatment is needed.

To learn more about Lyme and other tick-borne diseases, visit New Hampshire’s Department of Health and Human Services at dhhs.nh.gov/dphs/cdcs/lyme.

And remember you never need an appointment to be seen at Cheshire Medical Center’s Walk-In, open 365 days a year. Learn more at cheshiremedwalkin.org

What type of health care would you want if you became too sick to tell the doctor yourself?

Advance care planning involves learning about the types of decisions (Left to Right) Nicole Boudle, RN and Jennifer McCalley, ACP Program Coordinator that might need with two of our volunteer ACP facilitators, Priscilla Reyns and Diana MacVeagh. to be made, considering those decisions ahead of time, and then letting others know—both your family and your healthcare providers—about your preferences. These preferences are often put into an advance directive, a legal document that goes into effect only if you are incapacitated and unable to speak for yourself.

But just making a document like an advance directive may not fully guarantee a patient’s wishes will be understood. A well-informed Healthcare Agent (also known as a Durable Power of Attorney for Healthcare) can best advocate for a patient when s/he understands that person’s goals, values, and wishes and is willing to honor them—even if they personally don’t agree with them.

As part of Honoring Care Decisions, a Dartmouth-Hitchcock program designed to assist in Advance Care Planning (ACP) for adults 18 or older, facilitators at Cheshire Medical Center work with individuals to establish an advance directive and to facilitate ACP conversations that can help them express their goals, values, and wishes to their Healthcare Agent and loved ones so everyone is prepared if ever needed.

As Program Coordinator for Honoring Care Decisions, Jennifer McCalley, MSW, ACHP-SW not only leads educational sessions, she also trains local volunteers.

“The best part of my role is coordinating the excellent team of volunteer facilitators,” says Jennifer, “ We’re so lucky these folks have chosen to give their time to the community in such an important way.”

Jennifer goes on to share that participants appreciate the value of getting guidance on how to talk about their wishes.

“We often hear people tell us that, while they realized it is an important topic, they didn’t quite know how to start the discussion. The response to the facilitated ACP conversations has been overwhelmingly positive.”

In addition to leading educational sessions, Cheshire collaborative care nurses, Nicole Boudle, RN and Lori Guyette, RN help spread the word to their patients.

“Without the documents in place and wishes known, families can be torn apart at what is already a very stressful time.” Nicole shares, “Give your family the gift of knowing your wishes.”

For more information about Honoring Care Decisions, visit dartmouth-hitchcock.org/ supportive-services/advance-care-planning.

Ask your collaborative care nurse or your provider about how to request assistance in preparing an advance directive. Turn to page 11 to find out about upcoming ACP educational sessions.

Call (800) 730-7577 to request a 1:1 ACP conversation with a certified volunteer facilitator.

Health + Wellness | Summer 2018 9

Upcoming Programs Together, we can be our healthiest.

These classes and programs are brought to you by the Center for Population Health at Cheshire Medical Center and are part of the many ways we are working to help our community be one of the nation’s healthiest.

Cheshire Medical Center established the Center for Population Health as a department dedicated to guiding and facilitating the implementation of community-based health and wellness projects and

Health Education and Support for the Monadnock Region.

policies, integrating our clinical care

Please join us!

sites, schools, and the community.

At Cheshire Medical Center, we believe that the health and

into these efforts, and providing resources for education, outreach, and support to individuals, families, workThe Center for Population Health is part of the Leadership Council

wellness of every member of our community matters. And we are

for a Healthy Monadnock, a group

committed to being community partners in support of healthy and

of 30+ individuals representing

resilient living for all.

schools, organizations, coalitions and

Please join us for one or more of the upcoming programs designed

businesses that oversees the Healthy

to provide learning opportunities and supportive connections with

Monadnock Community Engagement

others on similar paths to optimal wellbeing.

Initiative. All of the Center’s project priorities align with the Healthy Monadnock initiative and Cheshire

REGISTER TODAY!

Reserve your place by calling (603) 354-5460 or visiting health-wellness.cheshiremed.org/events.

10 Summer 2018 | Health + Wellness

Medical Center is a proud Healthy Monadnock Organizational Champion.

Advance Care Planning: It’s About the Conversation!

Jennifer McCalley, MSW, ACHP-SW Program Coordinator,

Honoring Care Decisions or Nicole Boudle, RN, and Lori Guyette, RN, Collaborative Care Nurses, Cheshire Medical Center What if a sudden illness or injury left you unable to speak for yourself? Who would you want to speak for you? What would you want them to know about your values and wishes? Advance care planning is a process that helps any adult at any state of health think about your values and goals; consider health care choices you may have to make in the future; talk about your choices with your doctor and your loved ones; and make or update a written plan for the future (advance directive). Join us in a thought-provoking conversation to help make your wishes known. Learn vocabulary, reflect on your values, choose a healthcare agent, explore goals for treatment, and take the first steps toward completing an advance directive. You will have the opportunity to complete or update your advance directive if you are ready or sign up for a 1:1 meeting with a trained Honoring Care Decisions facilitator for a more in depth conversation. Choose a date: Thursday, July 17 10:00-11:30 a.m.

North Conference Room 1 Wednesday, August 1 5:00-6:30 p.m.

Auditorium B

Future Planning for Your Family Member with a Disability John S. Kitchen, Esq., John Kitchen Law Offices, Laconia NH Are you a parent and/or caregiver for someone with a disability? Do you have a vision of how your loved one will live when you are no longer here? Have you formally identified a guardian, conservator, or trustee for your loved one? Do you have a Special Needs Trust set up to preserve government benefits such as social security and/or Medicaid benefits?

Have you made provisions to fund your loved one’s trust with life insurance or other assets? Have you coordinated your Special Needs planning with other relatives? Are you confident you have done everything possible to protect your loved one’s financial future? If you answered ‘no’ to any of these questions or are simply unsure, this workshop will provide you with important information relative to Special Needs Trusts, NH ABLE Accounts and Guardianship and how to prepare a Special Needs Future plan to provide the vitally important support structure that is so necessary to protect your child in your absence. Monadnock Developmental Services (MDS) and the Center for Population Health are proud to co-sponsor this important workshop for parent(s) /caregiver(s) of an individual with a disability of any age.

Health Education & Support | Upcoming Programs

All programs are held at Cheshire Medical Center, 580 Court St., Keene, NH unless otherwise noted.

All programs require registration and are free, unless otherwise noted. If special accommodations are required for you to attend any of our programs, please call the Center for Population Health at (603) 354-5460.

Tuesday, September 18 6:00-8:30 p.m.

North Conference Rooms 1 and 2

Wednesday, September 19 3:00-4:30 p.m.

Auditorium B

Equally important to establishing an advance care plan is sharing it. Written advance directives are free, legal documents to be shared with family or friends and your healthcare providers, so they can understand and honor your wishes.

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Upcoming Programs How to Lower Blood Pressure Naturally!

Did you know that high blood pressure can silently damage your heart, brain and kidneys for years? Learn how to choose and prepare nutritious foods that taste good while increasing your chances of lowering or eliminating the need for blood pressure medication.

Thursday, September 20 1:00-2:00 p.m.

Auditorium B

Understanding Alzheimer’s and Dementia

Carrie Amorim, Alzheimer’s Association, Massachusetts/ New Hampshire Chapter Alzheimer’s disease is not a normal part of aging. This program provides information about the disease and related dementias, the benefits of early detection, causes and risk factors, treatment, and services offered by the Alzheimer’s Association.

Tuesday, September 25 3:30-5:00 p.m.

Auditorium A and B

Cheshire Walkers Program

The Cheshire Walkers Program is a series of easy-going walks organized by the Cheshire Medical Center in partnership with the City of Keene Parks and Recreation Department and extends throughout the Monadnock region.

Walks are every Wednesday in the fall, starting in early September, and offer participants the opportunity to increase physical activity, make social connections, and learn about the region’s rich history.

The fall schedule will be available in August. To learn more visit: health-wellness.cheshiremed.org/cheshirewalkers-program or call the Cheshire Walkers Coordinator, at (603) 354-5454 ext. 2791.

REGISTER TODAY!

Reserve your place by calling (603) 354-5460 or visiting health-wellness.cheshiremed.org/ events.

Green Dot Bystander 60-minute Overview Imagine a map of your community where each red dot on this map represents an act of power-based personal violence (physical or sexual violence, stalking, bullying, child abuse, or elder abuse).

Now imagine adding a green dot in the middle of all those red dots on your map.

● A green dot is any action that promotes safety for all our citizens and communicates utter intolerance for violence.

● A green dot is pulling a friend out of a high risk

situation, displaying an awareness poster in your room or office, or striking up a conversation with a friend or family member.

● A green dot is simply your individual choice at any given moment to make our world safer.

Green Dot is a bystander-focused initiative aimed at reducing the rates of power-based personal violence. At this overview of the Green Dot Program, you will learn more about how you can become part of the solution and how to recognize the behaviors that may constitute sexual assault, dating violence, or stalking, as well as how to effectively intervene.

Green Dot Bystander 60-minute Overview trainings are available during the summer upon request for specific groups/organizations such as employers, church and social groups, and organizations at your location. Great for membership organization meetings or employee trainings.

Contact Keene Green Dot greendot@mcvprevention.org to discuss scheduling a training.

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Cheshire Medical Center offers a variety of ongoing programs and support groups. To learn more about these offerings, including contact information, visit health-wellness.cheshiremed.org/support-resources.

Ongoing Programs

Prenatal Education Classes

• Cardiac Rehabilitation—Phase II (Physician referral needed)

Visit cheshiremed.org for applicable fees or call (603) 354-5454 ext. 8388.

• Pulmonary Rehabilitation (Physician referral needed)

• Childbirth Education 4-Week Series

• Tobacco Treatment Programs for Adults

• Childbirth Express Class

• Family Resource Counseling Program

• Beyond Birth - Caring for Baby

Health Education & Support | Upcoming Programs

Ongoing Programs and Support Groups

• Breastfeeding 101

Support Groups

• Introduction to Baby Wearing

• Cancer Support Group

• Keeping Baby Safe

• Prostate Cancer Education and Support Group

• Prenatal Yoga

• Parent Networking Group

• Prenatal Aquatic Exercise Class

• Talkin’ Diabetes Discussion Group

• Prenatal Smoking Cessation Education and Support Group

• Tobacco Free or Trying to Be Support Group

Senior Connections • Senior Passport Program (Discount meals at the Art Nichols Café for senior citizens 60 years and older)

Postpartum Classes and Resources • Sibling Class • “Moms” Club • Mom & Baby Exercise Class • Breast Pump Rentals and Car Seat Checks

Health + Wellness | Summer 2018 13

Making a Difference NEIGHBORS HELPING NEIGHBORS

Targeting positive, impactful change Making positive, impactful change to the health and well-being of people in your community requires an informed understanding of their needs and scaled strategies to meet those needs.

That’s why the Center for Population Health (CPH) at Cheshire Medical Center is collaborating with others in the Monadnock Region to be one of 18 organizations nationwide participating in SCALE (Spreading Community Accelerators through Learning and Evaluation), an initiative designed to help communities improve health, well-being, and equity by transforming the way they think and act as they work in partnership with people experiencing the specific issues they are seeking to address.

In early 2015, with the generous support of the Robert Wood Johnson Foundation, the SCALE initiative was launched by four 100 Million Healthier Lives partner organizations (Institute for Healthcare Improvement [IHI], Communities Joined in Action [CJA], Community Solutions [CS], and Network for Regional Healthcare Improvement [NRHI]).

A Model of Community Transformation

SCALE’s core strategies include fostering healthy, thriving equitable communities; creating connections across different types of organizations, like local government, faithbased organizations, schools, and healthcare organizations; and developing new culture and mindsets.

SCALE uses a model of community transformation entitled Community of Solutions, to meet communities where they are, beginning small, and as capability increases, applying skills and behaviors to address larger sets of challenges with growing and spreading impact.

CPH received a grant from the Robert Wood Johnson Foundation for the second phase of SCALE-to “spread” community solutions skills to a half-dozen communities in the Monadnock Region and other partner

Center for Population Health at Cheshire Medical Center staff, Tricia J. Wadleigh, MPH, Partner Manager, and Candace Hubner, MPH, Population Health Epidemiologist

organizations throughout the state.

“Right now we’re determining what that might look like,” said Tricia Wadleigh, Partner Manager with CPH and Local Improvement Advisor with SCALE. “We’re educating the community and giving (the initiative) exposure. We’re tackling each community solutions skill set one at a time, providing people with skills they can take back to their organizations and use.”

“We’re accelerating the population health work of the participating communities and evaluating it in new ways,” said Wadleigh. “It’s about measuring what matters-improving lives and making sure people are thriving.”

Surveying and measuring for ongoing improvement

An important tool in measuring outcomes with an eye for improvement is the 100 Million Healthier Lives Adult Wellbeing

14 Summer 2018 | Health + Wellness

Assessment survey, developed by the Institute for Healthcare Improvement (the SCALE convening organization) for 100 Million Healthier Lives. The survey is administered in the participating community to identify community specific data and to establish a base-line. The surveys are repeated every 1-2 months to monitor project progress and identify any need for modifications to specific efforts.

The survey asks for information in such categories as socio-economic status, race, gender, income, health, education level, and military service. It also includes “equityrelated” questions about emotional, physical and financial well-being, now and in five years -1 being the lowest level and 10 the highest on the “ladder.”

“We want to find the folks who aren’t thriving and move them up the ladder as

Healthier Together SPOTLIGHT

Becoming a community of solutions

Community members in the Town of Hinsdale, NH are launching new initiatives and measuring their progress

We’re accelerating the “population health work of participating communities and evaluating it in new ways.

It’s about measuring what matters-improving lives and making sure people are thriving.

”

-Tricia Wadleigh, MPH Partner Manager, Center for Population Health

much as possible,” said Wadleigh. “We want to find people who could benefit most from policy and environmental changes.”

If well-being scores aren't moving up ladder rungs, Wadleigh added, she will work to make improvements in needed areas. That may mean, for example, educating people in the community about food insecurity and access.

To learn more about the Center for Population Health at Cheshire Medical Center, visit health-wellness.cheshiremed.org/centerpopulation-health.

For more information about the vision and mission of 100 Million Healthier Lives and the SCALE Initiative, visit 100mlives.org.

The SCALE initiative is fully in practice in Hinsdale, where the Center for Population Health conducted interviews with community leaders to determine where their efforts can make the most impact.

In addition to beautification projects, instilling youth healthy habits, and increasing access to opportunities for physical activity led by school and town employees, the Hinsdale Farmer’s Market will be launching some new programs.

With grant funding from the Robert Wood Johnson Foundation, SCALE will Hinsdale community members and leaders of local SCALE provide the market with an EBT card project initiatives (L to R) Nicole Abby, Ann Marie Diorio, and Theresa Davis gather at the Hinsdale Farmers Market reader for low-income customers to use (not pictured is Katherine Lynch, Community Development their SNAP (Supplemental Nutrition Coordinator, Town of Hinsdale) Assistance Program) benefits to purchase locally-sourced foods. It’s a pilot program in Hinsdale.

“It will break down barriers for folks who aren’t thriving and move them up the ladder,” said Candace Hubner, Population Health Epidemiologist with the Center for Population Health who also works with Wadleigh as a SCALE Local Improvement Advisor.

Market manager Theresa Davis-a “Community Champion” under the SCALE labelsaid SCALE will also introduce the state-run Granite State Market Match program, which allows these customers to purchase twice the amount of food for half the cost at the market; and a voucher program for veterans at reduced prices.

“We’re also bringing more produce to market,” said Davis. “There will be more healthy and affordable options.”

Hubner is working with Davis to help her collect data in new and different ways once the new systems are in place.

“Data collected over time is significant,” said Hubner. “You can see trends.”

Using the SCALE model, which collects key demographic information on equity issues in a particular setting, Davis will be able to see the direct effects of these interventions. She and Wadleigh consider SCALE’s Model for Improvement in helping introduce any program in a community.

“We ask three questions: What are we trying to accomplish? How will we know the change is an improvement? And what change will we make that will result in an improvement?” she said.

Hubner said part of her role is to utilize SCALE’s Plan-Do-Study-Act model in doing this work in communities.

“We ask, ‘Did this serve us or do we make an adjustment?’ ” she said. “Right now (the market) records everything on paper. Maybe it would mean using a tablet to record the number of visitors electronically. It’s all about continuous quality improvement.”

Health + Wellness | Summer 2018 15

Every member of our community should have access to high quality, personalized, patient-centered care.

At Cheshire Medical Center, this belief drives all that we do.

Our powerful partnerships help make it possible.

As members of the Dartmouth-Hitchcock Health system, Cheshire's connections and collaboration with the Dartmouth-Hitchcock Medical Center-New Hampshire’s only academic medical center-enable us to deliver expanded care to the patients we serve.  Cheshire patients can access a single convenient portal to view health information related to care at Cheshire Medical Center and its satellite offices as well as Dartmouth-Hitchcock locations.  Cheshire is staffed by Dartmouth-Hitchcock physicians and providers.

We love living in the Monadnock Region and we are passionate about caring for those who live here too.

 Cheshire offers local access to highly specialized physicians and surgeons from D-H Medical Center.  Cheshire patients have opportunities for access to clinical trials of new treatments.  The D-H Health System supports seamless connections in the transition of care for high acuity patients.

Located in Keene, New Hampshire with satellite offices in Walpole and Winchester.

cheshiremed.org