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FOCUS TOPICS WOMEN’S HEALTH • CNO ROUNDTABLE • HEALTHCARE EDUCATION • PAIN MANAGEMENT

May 2019 >> $5 ON ROUNDS

Southern Through and Through Women’s Clinic OBGYN, Dr. Madhav Boyapati’s roots are Indian but gripped in Tennessee soil For Madhav Boyapati, MD, deciding to practice obstetrics and gynecology in the South was an easy decision. He grew up in Tupelo, Mississippi and his southern accent is as tried and true as almost any Southerner’s.

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Accessing the Spectrum of Quality Care Reflections on Women’s Health as ACOG Wraps its Annual Meeting The American College of Obstetricians and Gynecologists (ACOG) has just wrapped the 2019 Annual Clinical and Scientific Meeting.

Reimagining Residency

AMA’s Next Push in Transforming Physician Training By CINDy SANDERS

In 2013, the American Medical Association announced an ambitious effort to accelerate change in medical education. Starting with 11 founding medical schools on a mission to better prepare physicians to meet the future of medicine, the initiative has now grown to 37 participating schools. Yet, residency training has not mirrored those transformations … until now. The AMA recently launched a fiveyear, $15 million Reimagining Residency grant program to rethink how graduate medical education (GME) could best address the workforce needs of the current and future healthcare system, better support physician well-being and enhance preparedness to practice. It’s the next phase in the AMA’s quest to transform physician training. (CONTINUED ON PAGE 3)

HealthcareLeaders

CNO Point of View

It’s about nursing’s joys, challenges and meeting a community’s needs By SUZANNE BOyD

May 6-12, we celebrated nurses during National Nurses Week and rightfully so since the profession is a critical part of healthcare. Nursing is the nation’s largest health care profession with more than 3.1 million registered nurses practicing nationwide. Nurses comprise the largest single component of hospital staff, are the primary providers of hospital patient care, and deliver most of the nation’s long-term care. The nursing profession is not immune from many of the issues facing other healthcare professionals as well as

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Light at the End of the Tunnel? Pilot program tackles problem of addiction, overdoses The numbers are staggering.

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Jan Zimmer

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Lori Brown

Wendy Trickey

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We’re the biggest name in babies. And healthcare. Every year, we deliver over 4,000 bundles of joy. In fact, if you’re from anywhere in West Tennessee, odds are, we’ve been taking care of you since day one. And with comprehensive healthcare serving over half a million people, we’re the name our region trusts.

The Care You Trust, Right Here.

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PhysicianSpotlight

Southern Through and Through

Women’s Clinic OB-GYN, Dr. Madhav Boyapati’s roots are Indian but gripped in Tennessee soil By SUZANNE BOYD

For Madhav Boyapati, MD, deciding to practice obstetrics and gynecology in the South was an easy decision. He grew up in Tupelo, Mississippi and his southern accent is as tried and true as almost any Southerner’s. For the past 18 years, he has been bringing new southerners into the world in his practice at the Woman’s Clinic, PA. as well as trying to address one of the most prevalent health issues in the South, obesity. Boyapati, whose parents migrated to the United States from India in the 1960’s, was born in Indiana, a fact that he says is really a technicality. His father was pursuing a master’s degree in Engineering at Mississippi State in Starkville and was in Chicago for the summer working. “Since my mother was pregnant with me, she was staying with her cousins in Lafayette, Indiana,” said Boyapati. “And I decided to come into the world a little earlier than they had planned.” Once his father completed his master’s degree, the family moved to Tupelo which is where Boyapati grew up. In high school he competed on the decathlon team that captured the state title several times as well as competed on a national level. Boyapati, who excelled in chemistry and math, graduated in 1988 as valedictorian of Tupelo High School. At Vanderbilt, Boyapati pursued a chemical engineering degree knowing he would eventually get his PhD in it or go to medical school. A summer job dur-

ing college at Tupelo Medical Center gave Boyapati a taste of the medical field and piqued his interest. At the end of his sophomore year, Boyapati had a solid GPA and applied to Vanderbilt’s early medicine program which would give him a guaranteed spot in medical school after graduation. He was one of only ten sophomores selected. While he did have an aunt who was an OB/GYN, Boyapati says it was toward the end of his rotations in medical school that confirmed his choice of specialty.

“When I was considering my options, I knew first and foremost you have to pick something you can and want to do for 30 years are more,” he said. “OB/GYN offered a mix of office work as well as surgery. The patients are typically healthier and get better, which is not always the case with other specialties.” Before heading to Columbia, South Carolina for his residency training, Boyapati made another big life decision, to marry his college sweetheart, Sonia. While he completed his residency requirements at Palmetto Richland Memorial Hospital, Sonia got a PhD in epidemiology. After residency, Boyapati knew he wanted to return to Tennessee to practice. His parents had relocated to Jackson in 1992 and his mother encouraged him to consider looking in Jackson. “I put out some feelers and sent my resume to a couple of clinics in the area,” said Boyapati. “The Woman’s Clinic had an opening, and everything fell into place. We moved here in 2000 and I began practicing.” Over his years in practice, Boyapati has seen firsthand the growing trend in obesity among the population. While it is an issue that is nothing new to the South, especially with seven of the ten states with the highest obesity rates in the nation being in the South, Boyapati also saw obesity related issues, such as hypertension and diabetes, growing among his patients as well as the impact it can sometimes have on fertility. “Obesity is a complex and often intractable problem, and America’s obesity

epidemic continues to have serious health and cost consequences for individuals and their families,” he said. “Obesity is the most prevalent chronic disease in our society. Yet, many physicians are not trained in how to manage it. In an effort to be able to better serve patients that were dealing with this issue, I got certified in obesity management from The American Board of Obesity Medicine.” Boyapati admits there is no magical solution to losing weight and what works for one person may not be what will for another. “There are various options that can help patients lose weight, but they have to want to do it,” he said. “And it is not always a matter of just eating less because sometimes the body just does not want to lose it. There are so many options out there including diets, programs, medications to surgical options such as gastric by-pass or the sleeve. It is just a matter of finding what is right for the patient and getting them the support needed to be successful.” Family is an important aspect of Boyapati’s life. He and his wife have two daughters, which keep him busy watching his oldest play tennis and the younger one doing gymnastics. Besides living close to his parents, his younger sister and his sister-in-law and their families are both only about two hours away in Nashville. They also enjoy traveling together as a family and have made trips to India and Hawaii. They have plans to go to London this summer to take his father, who is a big tennis fan, to see some of the action on the courts at Wimbledon.

this year, the organization put out a call for innovative proposals with a bold vision to promote systemic change in GME with Letters of Intent due Feb. 1, 2019. Last month, that large pool was narrowed down to 30 applicants who have been asked to submit full proposals. Skochelak said she anticipates eight will be selected for funding with the announcement coming in June at the 2019 AMA Annual Meeting in Chicago. The response has been tremendous. “We had more than 250 entities write Letters of Intent,” Skochelak noted, adding the entries represented more than 300 organizations including state medical societies, specialty societies, consortiums, nonprofits and others. “We’re really very intrigued with the fact that the response with the Letters of Intent was broader than just traditional residency programs. It says that people are really interested and excited to move forward with innovation and change,” she added. Skochelak said about 20 percent of the Letters of Intent addressed physician burnout. Other workforce issues including

addressing provider shortages and ideas tied to the impact of social determinants were also recurring themes. The eight proposals selected will share in the $15 million set aside to fund the initiative and will be divided up over five years. Like the medical school programming, Skochelak anticipates there will be a year of planning prior to implementation with these new residency learners followed over subsequent years. After selection, the eight institutional partners receiving grants will meet to agree upon standardized criteria for student assessment, resident selection procedures, onboarding and transitions, core curriculum in health systems science and common evaluation standards to measure performance. No matter which eight are ultimately chosen, Skochelak said she is excited about the depth and breadth of ideas and the response from the larger medical community. “Clearly, it indicates we’re in a climate where people know we can improve and do better, and they want to partner with others who can really help them reimagine residency,” she concluded.

Reimagining Residency, continued from page 1 “When we really looked deeply at the changes being made in medical schools, we realized we’ve brought these now thousands of students through changes in undergraduate medical education (UME) but hadn’t changed residency,” said Susan Skochelak, MD, group vice president for Medical Education with the AMA and the driving force behind efforts to transform the way physicians learn and train to meet the demands of a rapidly evolving healthcare system. Skochelak said the first cohort of students who benefitted from curricular innovations are now interns. “Each subsequent year, there will be thousands more students coming through these new med school programs,” she pointed out. Skochelak said the concern was there would be an implicit message that the training they undertook during medical school didn’t really matter if they arrived at residency only to find no disruption in the status quo. “The next logical step is to say it’s a continuum of training and to bring these same principles and concepts of educawesttnmedicalnews

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tion forward to residency,” explained Skochelak. “We want to make a better handoff – a better connection – from medical school to residency in terms of learning approach.” She added practitioners must take the important new concepts that are part of health system science and understand how quality, safety and patient-centered care are implemented in daily operations to ensure readiness for practice. Skochelak continued, “We want to support a positive learning environment … not just for students but for faculty and staff, as well.” Building off the successful model used to transform UME, Skochelak said those chosen for the new residency grant funding will join an AMA-convened consortium. “The best way, we’ve proven, to accelerate the change is to bring people together in a community of innovation,” she explained. The group will evaluate successes and lessons learned and work together to broadly disseminate successful initiatives to residency training programs across the country. In late 2018, the AMA announced the new program. At the beginning of

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CNO Point of View, continued from page 1 the industry as a whole. The challenges have different faces depending on whether you are a nurse manager or working directly with patients, but one thing remains true, nursing is one of the highest callings with one of the highest levels of stress. Chief Nursing Officers have to manage not only the challenges facing the nursing staff of their facility but also juggle other challenges the facility and industry are dealing with. This role can be compounded in the rural setting where many facilities are struggling to just keep the doors open and the lights on. Regardless of the issues they face, one theme tends to resonate among CNO’s in West Tennessee – they are passionate about nursing. Three CNO’s from across West Tennessee weighed in on what they love about the profession, why they chose it, the issues they face and what they hope to accomplish. In addition to being CNO’s, the roundtable participants have all lived or worked in rural areas of the South for a significant amount of time. They all hold Master of Science in Nursing Degrees. And they are all very passionate about not only being a nurse but the role nurses play. Born and raised in Huntsville, Alabama, Dyersburg Hospital’s CNO, Jan Zimmer’s father was a member of Wernher von Braun’s team in the early years of the space program. Her undergraduate degree is from Jacksonville State University and she has a master’s degree in Critical Care Nursing/Nursing Education from the University of Alabama in Huntsville. “A college education was always a family priority for me. In my senior year of high school, it became important to me to pursue a profession focused on others and the more I learned about nursing the more I felt drawn to it. The summer after I graduated high school, I worked for a long-time family friend that was a Director of Nursing in a nursing home,” said Zimmer. “Ms. Ruth assured me that one summer with her would help me make up my mind about nursing and she was right. My first day as a nursing assistant a precious, sweet patient held my hand and told me how kind I was. I immediately fell in love with the profession and all it could/ should be for patients and families. The day of my college graduation my father told me he had always prayed one of his daughters would be a nurse. I was overjoyed when I realized that my father’s prayers had gently guided me to this noble profession.”

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Zimmer says she would not be the nurse she is today were it not for role models along the way. “My very first clinical instructor, Jean Dukes, RN, MSN, PhD was a daily role model of professional nursing for me and to this day inspires me to the best I can be,” she said. “Early in my career I worked with a CV surgeon that taught me more about patient centric care than any book ever could. My job description was literally ‘make this experience better for our patients and their families.’ Thanks to what I learned from him, I always knew that if I had the opportunity, I would want to create an environment where patients and families were at the heart of all we do.”   Wendy Trickey, CNO at Hardin Medical Center in Savannah, was born in Monticello, Illinois but moved to Cairo, Mississippi at the age of ten. The Mississippi girl loves living in a small rural town and all the things they have to offer. She received an Associate Degree in Nursing from Northeast Mississippi Community College. The working mother of twin boys earned her BSN from the University of North Alabama and ultimately completed an MSN in Nursing Leadership from the University of Alabama. “I chose nursing because I wanted to do something that mattered, that affected others in a positive way, and be part of something that made a difference. I believe most nurses feel this way and that is why nursing is the most trusted profession. Nursing is a hard job and not everyone can do it. We are with people in some of the best moments of their lives, but also in some of the worst moments,” said Trickey. “For me the reason I do what I do is in the answer to a question I sometimes ask myself, ‘Does what I am doing matter?’ It does and so I am still here.” Early in Trickey’s career, a charge nurse gave her some sage advice. “She told me that if you get really comfortable with what you are doing then you need to find something else to do. This keeps it interesting and you will continue to grow as a nurse. To me, continuing to learn is an important aspect of being a nurse,” said Trickey. “I once had a Director of Nursing that also impacted me. She was one of the kindest and most compassionate nurses that I have ever met. She always made me think about things from many different perspectives, not just mine. This makes it easier to connect with patients and staff so that we can work together better.” Baptist Memorial Hospital – Union City’s CNO, Lori Brown also hails from Illinois. She moved to Northwest Tennessee when she was 16 and has never left. She graduated with an Associate Degree in Nursing from the University of Tennessee at Martin in 1983 then completed her BSN and MSN degrees at Western Governors University in 2014. Brown chose nursing due to the impact it has had on her life. “As a child I was ill the first five years of my life which caused frequent visits to the hospital,” she said. “As a teenager my grandmother was in ICU for an extended period of time.

One of her nurses really served as a role model and facilitated my decision to become a nurse. I actually got to see her about 20 years ago at a nursing banquet and thanked her for the role she played in my life.” Besides those that influenced her to enter nursing, Brown has also had mentors throughout her career. “Some of my nurse managers early on in my career pushed me to become a leader by getting me involved in projects,” she said. “Several of my CEO’s recognized my desire to become a leader and actually put me in positions to help advance overall knowledge of information outside of clinical that would help in my current role.” As a CNO for over 25 years in two different states, Zimmer has seen the national nursing shortage in many different phases. “Today, more than ever, our communities need devoted, compassionate nurses in all settings but especially in the acute care setting,” she said. “Our profession has grown tremendously over the years and the expertise nurses bring to the workforce is highly respected and desired. This opens up many exciting doors for nurses while at the same time creates a void in the traditional bedside nursing positions. Thankfully, there are many educational partners working in nursing to help remedy the problem and produce highly skilled, energetic graduates to support the needs of the community. In Dyersburg, we are extremely fortunate to have Dyersburg State Community College literally right next door.” Retention and recruitment are high on Brown’s to-do list for 2019. “We will be recruiting or next group of Clinical Nurse Residents as well as Nurse Interns,” she said. “We also hope to improve overall nursing retention through the continued roll out of a Clinical Ladders Program. We will hold two Nurse Camps this summer. This is a program for high school students that is one of our strongest recruitment initiatives. We currently have about 18 nurses who actually participated in Nurse Camp while in high school.” Joining the West Tennessee Healthcare family is a tremendous opportunity for Dyersburg Hospital in Zimmer’s opinion. “We are collaboratively working on standardizing and optimizing patient care throughout the entire system. A part of that process is the implementation of a single source electronic medical record for all facilities, which is a significant accomplishment for Dyersburg Hospital,” she said. “For the remainder of this year we will continue our journey toward integration as well as focus on attracting and retaining the talent we need to provide the very best care.” “A huge concern I have as a nurse leader is being able to continue to impact the health of our community,” said Trickey. “With so many closures of small rural hospitals in the past several years, this is a real concern to me. Access to healthcare has been negatively impacted. People in rural areas that have lost their local hospital must drive further for their

healthcare needs. They no longer have a hospital in their community that they can go to and some are simply unable to travel to get their healthcare needs met.” Keeping up with the latest technology and utilizing it fully is a challenge for Hardin Medical Center. “Tele health has been utilized in the past and we are once again evaluating it,” Trickey said. “Can we offer services like this to the people in our community and will they be utilized? Developing ways to identify, then meet the healthcare needs of those in our community by offering beneficial and sustainable services are important.” With the U.S. projected to experience a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows, our CNO’s encourage those who are considering a career in healthcare to look at nursing. “If you have a passion for nursing and want to be involved in making a difference in your community, this profession is for you and by all means pursue the goal,” said Trickey. “Nursing is a wonderful profession that is encompassed by the human experience.” For nurses who want to move into administrative roles, Zimmer encourages them to devote themselves to all aspects of the profession and learn it inside and out. “Find a mentor that inspires you to get out of your comfort zone and explore new opportunities. Seek wisdom and guidance. Enroll in an educational track that will teach you about this business of healthcare and the awesome responsibility healthcare leaders have today,” she said. “Understand the political environment that influences our ability to care for our communities. Join professional organization(s).  Start leading, be it a committee, a task force, a group at church, a group at your children’s school, just start leading.  Bring optimism to the workplace and never, never give up.”  “Nurses who want to move into leadership roles need to participate in ongoing education, whether it is advancing their degrees to getting certifications, to reading articles,” said Brown. “They need to place themselves in positions to get leadership experience such as on teams and committees.  They need to ask for projects to be a part of and let leaders in the hospital know they eventually want to be a leader.  This will open opportunities to participate in education as well as projects that will advance their overall knowledge and leadership skills.” “Nursing is the best job in the world, and we are blessed to be able to do what we do, yet we have so many challenges that make what we do sometimes very difficult. We will always face difficulties. We will always wish that things might be better so I want to help work with other nurses and see if we can be the change to make it better” said Trickey. “I have a very optimistic outlook when I think of where we can go as a profession. I believe it is possible, but only if we can work together as professionals. We do make a difference every day, yet we can do better.” westtnmedicalnews

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Accessing the Spectrum of Quality Care Reflections on Women’s Health as ACOG Wraps its Annual Meeting By CINDy SANDERS

with access to family planning and preventive health services and information. The American College of ObstetriRecent actions by the Administration cians and Gynecologists (ACOG) has just to change Title X will limit access to vital wrapped the 2019 Annual Clinical and healthcare services to low-income women, Scientific Meeting. Held men, and adolescents. in Nashville from May These actions restrict 3-6, the theme for this information that phyyear’s national gathersicians can provide to ing was “Accessing the their patients, weaken Spectrum of Quality safeguards that ensure Care.” that Title X-funded proThe conference grams offer evidencealso sets the stage for based contraception, leadership transition. and impose medically ACOG President Lisa unnecessary requireM. Hollier, MD, MPH, ments on healthcare faFACOG, welcomed cilities that will exclude colleagues to the 67th qualified providers from annual meeting before offering care to low-inpassing the gavel to come women. 2019-20 President Ted Last year, ACOG L. Anderson, MD, PhD, Lisa M. Hollier and other leading during the annual busimedical groups actively ness meeting. opposed these proposed changes and Now Immediate Past President, Holsubmitted public comments to the U.S. lier shared thoughts on the past year as she Department of Health and Human Serled the organization of more than 58,000 vices. On April 9, 2019, ACOG and leadmembers. ing medical groups filed amicus briefs in several cases across the country in support Medical News: What were of states’ and organizations’ motions for some of the key issues preliminary injunction to stop the recently addressed during the meeting issued changes to Title X from going into and over the past year? effect. Dr. Hollier: This year’s meeting’s theme – Accessing the Spectrum of QualMedical News: What key ity Health Care – included an informaclinical areas were explored tion-packed program that addressed the during the recent meeting? most timely and challenging topics our Dr. Hollier: The trifecta clinical members face as ob-gyns. Healthcare acseminars covered topics that are most cess has been a key component of everyimportant to ACOG members, includthing we’ve been working on during my ing endometriosis, genetics, substance use year as president, so having access as a disorder and trauma-informed care, and focus of the meeting was vitally important. DVT prophylaxis. This year we had a new Access to quality healthcare is a key session, EdTalks, which were three powto ensuring the health of women. ACOG erful, 10-minute presentations followed is pursuing policy and legislative soluby a Q&A panel with the speakers. The tions to address the rising rate of maternal EdTalks topics covered financial models, mortality and severe maternal morbidity reproductive endocrinology and infertilin the United States. This includes advoity, menopause, microbiomes, polycystic cacy for Medicaid coverage for women ovary syndrome, the annual well-woman up to a year postpartum, support for state visit, sterilization, and the environment. perinatal quality care collaboratives, supThis was all in addition to more than 700 port for efforts to reduce racial and ethnic scientific ePosters with cutting-edge redisparities in maternal health outcomes, search in women’s health. and support for the Alliance for Innovation on Maternal Health (AIM), a national Medical News: Maternal data-driven maternal safety and quality mortality rates have been a big improvement initiative to improve materpart of your efforts as ACOG nal outcomes in the U.S. president, what are your ACOG has always supported acthoughts on improving care? cess to affordable healthcare, and we Dr. Hollier: The United States is will continue to oppose every attempt to the only developed country with a rising roll back critical women’s health gains in maternal mortality rate. This has been the Affordable Care Act, particularly for a tremendous impetus for change. My women with preexisting conditions. We Presidential Program at the meeting and also continue to oppose efforts to deny acall of my presidential initiatives focused cess to reproductive healthcare and access on implementable solutions to eliminate to qualified providers through the Title X preventable maternal mortality. We are Family Planning Program. Title X is the seeing changes in the leading causes of only federal program exclusively dedimaternal mortality. With reductions in cated to providing low-income patients pregnancy-related deaths due to hemorWESTTNMEDICALNEWS

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rhage and hypertension, we are seeing that cardiovascular disease and cardiomyopathy are the leading causes. Fortunately, we know from maternal mortality review committees in states across the country that as many as 60 percent of maternal deaths are preventable. Because of the important role of cardiovascular disease in maternal mortality, a large part of my presidency was dedicated to updating ACOG’s clinical guidance on pregnancy and heart disease. Cardiovascular disease and cardiomyopathy account for about 1 in 4 maternal deaths and disproportionately affect black women. I am proud to say that the dedicated, multidisciplinary members of my presidential task force completed comprehensive guidance on this topic that covers screening, diagnosis and management of cardiovascular disease in pregnancy and the new Practice Bulletin was released during the annual meeting. ACOG members have also been working hard across the country to promote a culture of safety in hospitals, particularly in labor and delivery units. With the infrastructure and support provided by AIM, hospitals are implementing standardized, evidence-based practices that reduce complications and improve women’s outcomes. AIM is a national data-driven maternal safety and quality improvement initiative to reduce maternal mortality and severe morbidity. Over the last several years, and with an additional $10 million grant from the Health Resources and Services Administration, the AIM program has grown and now enrolled 26 states … and counting. Our goal is to have participation from all 50 states, and I am confident that we will do it.

Medical News: During the national meeting, you passed the gavel to Dr. Anderson. Could you share some reflections on your time leading this organization over the past year?

Dr. Hollier: ACOG has made incredible progress on behalf of patients and our members in just one short year. Our committees have created and updated our clinical guidance. We’ve developed and created programs and education that help our members implement our Practice Bulletins and Committee Opinions in their clinics and in hospitals. ACOG members have taken to the Hill and gone to their state legislatures to ensure the leading voices of women’s healthcare are heard and influence legislative and regulatory policies. It’s been a year of accomplishment, and I am so proud to have handed the gavel to Dr. Ted Anderson as our 70th president of ACOG. I’m really proud of the advocacy work we’ve done with our partners to get better data on the causes and contributing factors to maternal mortality. We recently celebrated the passage of the Preventing

Maternal Deaths Act, which was subsequently signed into law in December. ACOG staff, along with our dedicated members, spent nearly 10 years advocating for this important legislation that will now ensure funding and infrastructure for state-based maternal mortality committees. I’m thrilled that I could help usher this bill across the finish line and that it became law during my tenure. To help ensure that advocacy holds a central role in our organization and our specialty, I created the ACOG Annual Junior Fellow College Advisory Council Advocacy Leadership Training program. This innovative and immersive program offers exclusive opportunities and experiences to our next generation of ob-gyn leaders, our JF chairs. We’ve also invested in our Levels of Maternal Care program this year. The initial guidelines were developed and published in 2015 and were designed to promote collaboration among maternal facilities and healthcare providers with the goal that pregnant women receive care at a facility appropriate for their risk. ACOG and the Society for Maternal Fetal Medicine (SMFM) have worked together to develop and pilot the levels of maternal care verification program. The lessons learned from the pilot were published this year.

Medical News: Any other thoughts on the state of healthcare for women?

Dr. Hollier: Healthcare providers and facility leaders can all make a difference — can all do more to improve the health of women. There are so many opportunities to implement policies, procedures, and guidelines that are effective in promoting better outcomes. We know that women’s lives are worth saving, and we need to focus on our common goals. Together, we must make women’s healthcare a national priority and ensure that women have access to the spectrum of high-quality healthcare.

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Light at the End of the Tunnel?

Pilot program tackles problem of addiction, overdoses By LAWRENCE BUSER

The numbers are staggering. On average, 115 people die every day nationwide from overdoses of opioids. In West Tennessee’s Shelby County, 159 people died from opioids in 2017, up from just 51 in 2011, according to the Shelby County Health Department. By next year, the total there could exceed 250 such deaths annually. More people are dying from opioid overdoses than from car accidents. Last year, 854 patients showed up at area hospitals presenting signs of opioid overdoses. Last year, in conjunction with the Tennessee Hospital Association (THA), Regional One Health (ROH) and other hospitals across the state began a pilot program called Opioid Light to cut back on the number of opioid prescriptions being issued from emergency rooms, often the front line of medical care in this overdose society.  “You do a physical exam – usually unconscious with pinpoint pupils is one sign – plus we get some background from the family, from the EMTs or whoever brought them in, and from police,” said Dr. Chantay Smartt, an emergency medicine physician at ROH. “Since we started this program in June of last year, we’ve been able to reduce our opioid use by about 20 percent, and for this institution that’s big because we see a lot of burns and trauma and we’re a major clinic for sickle cell pain. We have a lot of patients that other hospitals don’t.” Dr. Smartt and emergency room pharmacist Justin Griner, PharmD, agree that Opioid Light is the way to go, to reduce a patient’s exposure to opioids whenever possible and to spread the word throughout the hospital. “We’ve tried different things, providing Naloxone for patients to take home and reducing the number of opioids we send patients home with prescriptions for acute pain conditions,” Griner said. “The Opioid Light is an initiative we’ve been working with the THA on reducing the opioids patients receive when they’re in the emergency department in acute pain. It doesn’t mean we’re not treating acute pain, but we’re trying to use other nonaddictive agents when that’s appropriate.” As the only Level 1 Trauma Center within 150 miles, Regional One sees far more than its share of critically injured patients in severe pain, making the drive to pull back on opioid use a difficult daily

use other treatments like physical therapy and nerve blocks,” Dr. Smartt added. “It’s really been a collaborative effort.” Griner said gathering and providing data is a key element in the battle against opioid addiction. “Providing data is sometimes all that it takes,” he said. “Once a certain provider sees that a peer is using 30 percent fewer opioids to treat the same patients, that may be all it takes to say, ‘Hey, I need to explore some of these other options and reduce my own opioid use.’ Data is a big part of what we’re trying to do. “Our overall reduction so far is 20 percent and we hope there is still room for improvement, but with our trauma population and our sickle cell population we honestly don’t know. We’re playing this by ear a little bit in seeing how far we can go while still providing appropriate care to our patients.” Dr. Chantay Smartt and Justin Griner

decision. “There are some conditions that obviously you’re going to give opioids for – major trauma, burns, sickle cell patients, post-surgical pain – but we’re trying to get the providers, the staff and the patients themselves to be aware that you can use an opioid, but you can also use non-steroidal things like Ibuprofen and Aleve,” said Dr. Smartt. “You can use opioids for breakthrough pain, but your main medication should be a Tylenol or Aleve or an Advil if your medical condition requires it. “Some patients – your end-stage renal, severe diabetics and congestive heart-failure patients – can’t take nonsteroidal medications, or if you’re allergic to them, but we’re trying to get other patients and their families thinking that there are other options that patients can use for pain control that are non-addicting.”  The U.S. Centers for Disease Control published a study in 2017 noting that the more opioids a patient is exposed to for acute pain, the more likely that patient will be using opioids a year later. “That speaks partially to the addictive nature of opioids,” Griner said. “Some manufacturers and even some medical journals in the past have indicated that opioids weren’t addictive, but obviously they are. I think that more and more institutions and providers are going to be moving toward the model of ‘if we can treat you appropriately with a medi-

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cation that is not an opioid, then that is going to be our first choice.’” With the use of opioids so ingrained in the treatment of pain – there are more opioid prescriptions than people in Tennessee – changing the mindset is like trying to turn around a battleship, yet there are some positive signs. “Actually it’s been surprising that there has not been a lot of pushback,” said Dr. Smartt. “Most of our patients appreciate being educated. Once you tell them there’s a potential for addiction with this particular class of drug, a lot of them will say ‘then don’t give me that one.’ We do have patients who are already addicted, and for those we have places in the city where we can refer them. We can’t force them to go, however. “We’ve also just partnered with an organization called Navigation, and they send ‘navigators’ out to the hospitals. Most of them have recovered from addictions so they can talk on a one-on-one level with the patient about what it is like to go through detox and that type of thing.” Under Opioid Light, ROH doctors and pharmacists try to determine how many opioid pills a patient might need – or if they need them at all – and provide the minimum with the short-range goal of switching to less potent options. The program includes an all-handson-deck Opioid Stewardship Committee that includes staff from chronic pain specialists, internists, anesthesiologists, general, orthopedic, plastic and trauma surgeons, to pharmacists, in which data is collected and literature reviewed in the effort to decrease the use of opioids if indicated, with the overall objective being to providing better, safer care for patients. “Treatment of pain in some services can be very challenging, but maybe they can switch to fewer pills per day and/or

PUBLISHER Pamela Z. Haskins pamela@memphismedicalnews.com EDITOR Pepper Jeter editor@westtnmedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com GRAPHIC DESIGNERS Susan Graham Katy Barrett-Alley CONTRIBUTING WRITERS Suzanne Boyd, Lawrence Buser Cindy Sanders All editorial submissions and press releases should be sent to pamela@memphismedicalnews.com Subscription requests can be mailed to the address below or emailed to pamela@memphismedicalnews.com. West TN Medical News is now privately and locally owned by Ziggy Productions, LLC. P O Box 1842 Memphis, TN 38101- 1842 President: Pamela Z. Haskins Vice President: Patrick Rains Reproduction in whole or in part without written permission is prohibited. West TN Medical News will assume no responsibility for unsolicited materials. All letters sent to West TN Medical News will be considered the newspaper’s property and unconditionally assigned to West TN Medical News for publication and copyright purposes.

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GrandRounds Jackson-Madison County General Hospital Honors Doctor of the Year

JACKSON – We are very proud to announce that Vernessa Davis-Tharpe, MD, has received the “Doctor of the Year” Award for 2019. This prestigious award was presented by Tina Prescott, our Executive Vice President/COO/CNO, on behalf of the employees of Jackson-Madison County General Hospital last night at the Full Medical Staff Meeting. The Doctor of the Year award affirms our principles and honors physicians who exhibit these characteristics. The nominations were judged on the following criteria: • Integrity and professionalism • Good conflict management skills •Willingness to go beyond the scope of duty • Attitude of respect for other healthcare professionals • Care and concern for patients and families. As stated in one of the nomination letters, “Dr. Davis is the most caring and patient doctor I have ever met. She always has a smile on her face and consistently acknowledges all hospital staff and families of patients in a meaningful personal way. Even though she is brilliant and highly skilled, she still takes time to do small tasks, like get a Sprite for her patient. She always goes above and beyond, and these small gestures underscore what an amazing doctor she is. We all love her!”

2018 President’s Award Presented to Deena Kail

JACKSON – West Tennessee Healthcare is pleased to announce Deena Kail as the 2018 President’s Award recipient. The President’s Award, which is awarded annually, recognizes a Department Director that goes above and beyond their day-to-day responsibilities by exhibiting a selfless manner within their career, community and civic involvement. Kail was presented with the honor during the April Department Directors’ Meeting. Kail has been an employee of West Tennessee Healthcare for 36 years. She holds a Bachelor’s Degree in Nursing, a Master’s Degree in Business Administration, and is currently serving as the Executive Director of the West Tennessee Women’s Center and Ayers Children’s Medical Center. Kail said winning the President’s Award is a humbling experience and loves taking care of patients. Kail is active with numerous professional, community and civic organizations, including the Tennessee Initiative for Perinatal Quality Care. She has been instrumental in improving and expanding neonatal care for rural West Tennessee, advocating for grieving parents, and implementing specialized emergency care for expecting mothers.

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MAY 2019

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