Headlines aringAugust 5, 2010 CCRNAs Certifi ed registered nurse anesthetists

Nurse anesthetist, Celeste Day, CRNA, prepares to administer anesthetic agent to patient during procedure in the Electrophysiology Lab. See senior vice president for Patient Care, Jeanette Ives Erickson’s column on page 2. The newsletter for Patient Care Services Massachusetts General Hospital Jeanette Ives Erickson

Certifi ed registered nurse anesthetists opportunities abound for nurses practicing in this critical, expanded role

ou almost never hear a patient request an anesthesiologist or nurse anesthetist by name. You A certifi ed never hear a patient say, “My nurse anesthetist was great, I’m registered nurse going to refer her to a friend.” anesthetist is an This highly specialized discipline that involves pharmacologically advanced practice YYinducing a state of unconsciousness or lack of sensation may not be a high-profi le health profession. But the Jeanette Ives Erickson, RN, senior vice president nurse with a ability to allow patients to undergo surgery without for Patient Care and chief nurse feeling pain is one of the most crucial services provided minimum of one in operating rooms. Nurse anesthetists: According to the American Association of Nurse • perform physical assessments year experience in a Anesthetists, nurse-delivered anesthesia was the fi rst • provide pre-operative teaching critical-care setting, clinical nursing specialty back in the late 1800s. And • prepare for the anesthetic management of each nurse anesthetists have been involved in the full range patient has attended an of surgical procedures ever since, including contribut- • administer anesthesia to keep patients free of pain ing to the development and refi nement of anesthesia • maintain anesthesia throughout the surgical proce- accredited nurse practice and equipment. dure Today, a certifi ed registered nurse anesthetist • oversee recovery from anesthesia anesthesia education (CRNA) is an advanced practice nurse with a mini- • follow patients’ post-operative course through recov- program, and mum of one year experience in a critical-care setting, ery to the patient care unit has attended an accredited nurse anesthesia education Regulations guiding the practice of nurse anesthe- passed the national program, and passed the national certifying exam. tists vary from state to state and hospital to hospital. In Different from an anesthesiologist both by education more than 2/3 of rural hospitals in the United States, certifying exam. and training, nurse anesthetists perform in much the nurse anesthetists are the sole providers of anesthesia same capacity, meeting patients’ anesthesia needs be- care. At MGH, nurse anesthetists practice under the fore, during, and after surgical or obstetrical proce- supervision of an anesthesiologist, meaning an anes- dures. thesiologist must be present when the patient is ini- continued on next page

Page 2 — Caring Headlines — August 5, 2010 Jeanette Ives Erickson (continued)

tially induced and when the patient wakes up from an- We’re autonomous, we have a strong skill set, and we esthesia. One anesthesiologist can supervise as many as make critical decisions all the time. It’s hands-on, fast- four nurse anesthetists, making the employment of paced, and high-risk. It’s everything I love.” nurse anesthetists a cost-effective strategy in meeting Says Wilton Levine, MD, clinical director, Ane- the growing need for anesthesia care. sthesia, Critial Care and Pain Medicine, “CRNAs are Nurse anesthetist, Celeste Day, CRNA, still remem- an integral part of our department. We want to make bers the day she made that career choice. “On my fi rst sure we provide them with the education and opportu- day of nursing school at Boston College, a nurse anes- nities they need to succeed and become leaders in their thetist spoke to our class. I’d never heard of a nurse fi eld.” “CRNAs are anesthetist before, but it sounded like a great job. After Shortly before press time, we learned that a bill had I graduated from nursing school, I went back to school been approved by the Massachusetts House and an integral part of to become a nurse anesthetist as soon as I could.” Senate (awaiting the signature of Governor Patrick) Celeste never regretted that decision. “The exciting giving certifi ed registered nurse anesthetists the au- our department. thing about anesthesia,” she says, “is that you learn thority to write prescriptions and order tests under the about chemistry, physics, pharmacology, patho-physiol- supervision of a physician as it affects the immediate We want to make ogy — then, when you administer medication, you see it perioperative care of patients. Nursing and medical all come together right before your eyes. And I love the boards will co-regulate this new practice. sure we provide human side. Some patients come to us on the worst day For more information about the role of certifi ed of their lives. It’s rewarding to be able to show them registered nurse anesthetists, call 6-3030. them with the compassion, kindness, and maybe a little humor. I try to Updates help every patient think of something relaxing and education and I’m pleased to announce that Christine Gryglik, RN, peaceful before they go to sleep. The more comfortable will assume the position of clinical nurse specialist for they are when the go to sleep, the more comfortable opportunities they the Cardiac Surgical Intensive Care Unit, effective they are when they wake up.” August 9, 2010. need to succeed Nurse anesthetist, Bhavika Patel, CRNA, worked in Vivian Donahue RN, has accepted the position of the Surgical-Trauma ICU at Tulane Hospital in New nursing director for the Cardiac Surgical Intensive and become leaders Or leans before coming to MGH two years ago. For her, Care Unit on Blake 8. being a nurse anesthetist is ‘the whole package.’ As a And Zary Amirhousseini is the new disabilities in their fi eld.” nurse anesthetist, she says, “We work collaboratively program manager within the MGH Offi ce of Patient with the anesthesia team taking into consideration any Advocacy. and all concerns of other members of the care team. — Wilton Levine, MD, clinical director, Anesthesia, Critial In this Issue Clinical Nurse Specialist ...... 10 • Marion Phipps, RN Care and Pain Certifi ed Registered Nurse Anesthetists ...... 1 The Carol A. Ghiloni, RN, Oncology Medicine Jeanette Ives Erickson ...... 2 Nursing Fellowship ...... 12 • Certifi ed Registered Nurse Anesthetists CRP Survey Results ...... 13 Hospital Clowning ...... 4 Fielding the Issues ...... 14 Youth Programs ...... 6 • Maintaining a Clean Environment • A ProTech Narrative Announcements ...... 15 Clinical Narrative ...... 8 • Amber Lessard, RN Medication Manual in Trove ...... 16

August 5, 2010 — Caring Headlines — Page 3 Innovative Care

Hospital clowning Never underestimate the healing power of ‘clowning around’

— by Shelly Bazes, RN, nurse practitioner and quality improvement nurse specialist

he cry came from a room at the baby’s head from a displaced nebulizer mask. When the other end of the corridor the woman looked in my direction, I gestured for per- at Safra Children’s Hospital mission to enter the room. Smiling, she nodded. in the Tel Hashomer Medical I disinfected my hands and tip-toed toward them Center in Tel Aviv. It was a accompanied only by the faint tinkling of bells on my signal for me to go to work. I ankles. I cranked out Somewhere Over the Rain bow on slid closer to the open door my tiny music box as I inched closer. The crying sub- (L-r): Shelly Bazes, RN, with members of the and looked inside. Huddled sided. The baby opened her eyes and stared. Her breath Dream Doctors Project between the crib, the IV pole, settled as she started to relax. She broke into a big of Israel, Talia Safra and assorted stuffed animals was a sweat-soaked woman smile as the last tear fell from her cheek. When our and Anat Zonenfeld TholdingT a crying baby. There was steam wafting around eyes met, I twinkled my nose, raised my eyebrows, and smiled back. I cooed with her as she stared at my small, red, star- shaped nose. Just then, a nurse hurried in, paused, then grinned when she caught on to what was happening in the room. It was one of those magical moments — one I had come 6,000 miles in search of. My name is Shelly Bazes, (aka: Tweedles, the clown). I have been a hospital clown for the past eight years. I’ve worked as a quality improvement nurse specialist with the Performance Improvement and Analysis Group for the past year. And I oversee the MGH Relaxation and Humor Channels (45/46). During my two-week holiday in Israel, I had an opportunity to clown, listen, play, make music, and share stories, experiences, and ideas with an amazing team of hospital clowns. The 53-mem- ber Dream Doctors Pro ject of continued on next page

Page 4 — Caring Headlines — August 5, 2010 Innovative Care (continued)

Israel integrates professional medical clowning with the thera- The day I clowned with the Dream Doctors at peutic teams in pediatric wards and clinics at 17 Israeli hospi- Safra, they were being fi lmed for a news program tals. Their work overlaps the work of child life specialists but that became the basis for a video about their ef- with a unique twist — non-scary clown ing with a psychological forts to create an ‘Island of Sanity’ for patients and therapeutic focus. (check YouTube for Dream Doctors Project + Hearing about this project motivated me to explore the Island of Sanity). I returned to the United States a possibility of an exchange program between the Israeli Dream changed clown. I hope to explore how the Dream Doctors Project and the hospital clown troupe I’m a member of Doctors’ methods support the work of the clinical here in Boston, the Hearts and Noses Hospital Clown Troupe. team without being an intrusion — in fact, by be- The Dream Doctors Project seeks to transform clown therapy ing a therapeutic asset. into an offi cially recognized health profession with specialized My time with the Dream Doctors Project raised academic training. In collaboration with Haifa University, so many questions: How do you create a fantasy they’ve developed a special BA curriculum that incorporates moment for a child within the context of critical theatre arts, psychology, biblio-therapy, and nursing theory. care? What does it mean to ‘clown to the healthy side of a child?’ And does it make a difference? The Boston-based Hearts and Noses Hospital Clown Troupe has decided to invite members of the Dream Doctors Project to At right: Bazes with continue this remarkable clown colleagues cultural exchange program at Safra Children’s here in Boston. Hospital in Israel. Below left: Bazes For more information with Cheryl Lekousi about hospital clowning, (TicToc) and Brian at contact Shelly Bazes at: Franciscan Hospital for [email protected]. Children in Boston. For information about Below right: the Dream Doctors Project Bazes with Nimrod of Israel, go to: http://www. Eisenberg (Max) and le-haim.org.il/site/index. Tamar at Hadassah asp. Hospital in Jerusalem.

(Photos provided by Bazes

August 5, 2010 — Caring Headlines — Page 5 Education/Support

Youth programs provide inspiration and opportunities to high-school students — by Julie Goldman, RN, professional development manager; and Tywanda Coston, ProTech student

outh programs offered by the able to their science, technology, engineering, and ProTech student, MGH Center for Community math education. In grades 11 and 12, students are eligi- Tywanda Coston, a Health Improvement provide ble to participate in paid after-school and summer in- graduate of the Edward students with academic, life, and ternships. M. Kennedy Academy for Health Careers, at her career skills that help expand their ProTech, one MGH youth program, is an internship internship position on educational and career opportuni- for high school juniors and seniors interested in pursu- the Blake 4 Endoscopy ties. Programs provide students ing health and/or science careers. The ProTech pro- Unit. Coston is mentored by operations associate, YYwith hands-on experience, career-exploration opportu- gram combines work-site rotations, professional-devel- Yvette Chappell. nities, and mentoring relationships that can be invalu- opment forums, and college-planning assistance with an 18-month paid internship to introduce stu- dents to the broad range of careers in health care and the sciences. Each year at the Youth Programs Volunteer Appreciation Celebration, sponsored by the MGH Center for Community Health Improvement, students have an opportunity to share their experiences. On June 29, 2010, Tywanda Coston, ProTech senior, spoke about her experience. Following, is the text of her remarks.

My name is Tywanda Coston, and I’m happy to be here this afternoon to share my experience with you. Let me to tell you a little about myself. I’m 18 years old and just graduated from the Edward M. Kennedy Academy for Health Careers. This fall, I’ll be attending Virginia State University. This is a proud moment for me. I have four brothers and two sisters, and I am the fi rst one in my family to go to college. I’m very ex- cited. Since I was a little girl, I knew I wanted to

continued on next page

Page 6 — Caring Headlines — August 5, 2010 Education/Support (continued)

do something related to health care. I plan to major in Since my introduction to MGH in my freshman year, Psychology and Criminal Justice. I’ve had nothing but positive experiences with MGH I’m currently an intern on the Endoscopy Unit staff — shadowing a nurse on the OB/GYN Unit, par- where Yvette Chappell is my mentor. I support the op- ticipating in professional-development forums, listen- erations associates and operations managers in their ing to MGH speakers. work. It is a challenging environment where I get to Last year, Peter Slavin, MD, president of MGH, see employees in action, observe procedures, and meet offered the opportunity of a life time to me and three patients. I learn something new every day. I’m amazed other students — a tour of Historical Black Colleges. by staff I work with — their compassion, their work It was a trip like no other. It inspired me to dream big. ethic, and what they do for patients. Because of that trip, I chose to attend Virginia State ProTech students, Jennifer Pierre (center), Before coming to the Endoscopy Unit, I interned in University. As if that weren’t enough, I was the recip- soon to be a junior at The Institute for Patient Care, where I worked with ient of two MGH scholarships that will help pay for East Boston High School, executive director, Gaurdia Banister, RN, and her assis- my college tuition, fees, and books. and Ivana Maya (right), a tant, Robyn Stroud. It was a busy offi ce where I learn ed I’ve met some extraordinary people at this hospi- graduate of the Edward M. Kennedy Academy for the importance of time-management, accuracy, and tal. My supervisors and co-workers are more than just Health Careers, work with prioritizing. I was introduced to clinical educators and supervisors and co-workers. They have been support- their mentor, Kelly-Ann a whole other side of health care I didn’t know existed. ive in so many ways. They inspire me to be successful Brathwaite in the White 13 General Clinical How did I get here? These amazing opportunities and follow my dreams. They advised me on college Research Center. were provided to me through the ProTech program. and career planning, gave me the fl exibility I needed when I was struggling in school, taught me im- portant skills like prioritizing, balancing school and work, and what it means to be a good em- ployee. They guided me when I had questions about college and even some personal matters. They stressed the importance of education, working hard, and staying focused. I admire my supervisors and co-workers; they show me that great things are possible regardless of where you come from. They taught me what it means to be respectful, committed, and compas- sionate. They demonstrate this in the work they do every day to deliver the best possible patient care. I am so fortunate to have these wonderful individuals in my life as role models and men- tors. I would like to thank MGH for all they do for patients, families and employees. Thank-you to my supervisors and mentors, Robyn, Guardia, Yvette, Mary Ellin Smith, Sabrina Ciulla, and others who guided and supported me during my time here. Thank-you to MGH Youth Programs for providing these opportunities to young peo- ple. Don’t ever stop doing what you’re doing.

August 5, 2010 — Caring Headlines — Page 7 Clinical Narrative

New nurse sees fi rst-hand how trust impacts patient care

y name is Amber Lessard. Five years ago, I was a wait- ress doing volunteer work Four years ago, at Children’s Hospital a few I packed my hours a week. I played with children as they waited for knapsack and walked their appointments. I re- member looking at the nurses with envy, wanting to be Amber Lessard, RN, staff nurse MM Bigelow 13 Burn Unit into Bunker Hill one of them. Four years ago, I packed my knapsack and walked into Bunker Hill Community College to start was a hummingbird in my throat, but I don’t think my Community College my journey toward a new career. My fi rst class was patients ever noticed my fi ngers shaking. to start my journey Anatomy & Physiology, an unfi tting choice for an I became a nurse on February 25, 2008. English major, I thought. I knew the arm bone was Since then, I’ve become more comfortable in my toward a new career... connected to the hand bone, and I knew a fever was role as a nurse. Looking back to my fi rst year, it was 12 bad, but that was about it. months of simply becoming comfortable with the basic I knew the arm bone Three years ago, I started nursing school at Sim- aspects of the role — completing the necessary tasks was connected to mons College. Finally, I was going to learn to be a during my shift. I was just that: task-oriented. I wanted nurse. Over the summer, I had learned the basic skills to be able to draw blood on the fi rst stick, control a pa- the hand bone, and that would allow me to start my fi rst clinical experi- tient’s pain, do all my documentation perfectly so se- ence with some basic knowledge. nior nurses would think highly of me at shift change. I I knew a fever was It seems like just yesterday that I took my Synthesis was focused on mastering the kinds of things you can class. It was then that, (for a lack of a better word) teach anyone. It doesn’t take years of practice to mas- bad, but that was things really started to ‘synthesize’ in my head. I started ter simple nursing tasks. about it. to put the pieces together, knew some of the questions This year was a year of tremendous growth for me. I should be asking my patients, and while the thought I’ve been less focused on tasks and more focused on of hanging an IV was daunting, I approached the task embracing the true art of nursing. I hate to bring nurs- as if I knew what I was doing. My heart felt as if there ing theory into this narrative, but I hark back to my continued on next page

Page 8 — Caring Headlines — August 5, 2010 Clinical Narrative (continued)

studies of Hildegard Peplau, whose research focused on outside. I asked Tom how long it had been since he’d the nurse-patient relationship as the foundation of been outside. It had been almost three months. nursing practice. This year, I came to understand fi rst- I told him we would go outside together. I bundled hand the need for a true partnership between nurse him up in a wheelchair. We stopped at Coffee Central and patient. While it’s easy to see why that relation- for a mocha, then we went outside for a walk around ship is benefi cial to the patient in the sense that we de- the Bul fi nch lawn. To this day, the look in Tom’s eyes velop trust, honesty, and open communication; little still moves me. Nursing can do patients realize how benefi cial that relationship is to My time spent caring for Tom made me realize the be dirty, gritty, me as a nurse. importance of the nurse-patient relationship. I looked One patient in particular will always stand out in beyond his history. He trusted me. I truly think our messy, and heart- my memory. ‘Tom’ was a young man who had a past I friendship was more benefi cial to him than the antibi- could only imagine — addiction, personal tragedy, and otics and the medications he was receiving. I still think breaking. Every an attempt to take his own life. Thankfully, he failed, of Tom every once in a while and hope he’s okay. day, I’m inspired, allowing me to get to know and care for him. He has As I refl ect on my journey, I know I’ve made great done more for me than he will ever understand. strides. As I grow older, I no longer differentiate be- challenged, Tom was trached and couldn’t speak. One night, tween the person I am and the person I’ve become. I’ve early in his admission, he was agitated and tried to get discovered I have a deep concern for the human condi- enriched. Every out of bed. I went into his room to help another nurse tion; it’s apparent in every interaction I have with my day, I encounter settle him down, and he wrote on his note pad, “I just patients. I care about their well-being. By fi nding com- don’t want to die.” passion in my experiences as a nurse, I have developed something fun, I was puzzled, bothered, and saddened by his com- greater compassion for others. ment. It stayed in my thoughts for days. A few weeks Nursing can be dirty, gritty, messy, and heart-break- comforting, and later, I started caring for Tom. The fi rst few days were ing. Every day, I’m inspired, challenged, enriched. diffi cult; he was a medically and psychologically com- Every day, I encounter something fun, comforting, and exhilarating. plex patient. I sensed a lack of trust between us, which exhilarating. I’ve met the most incredible individuals I’ve met the was understandable. He had at various times been se- whose stories sometimes bring tears to my eyes. dated or restrained. I probably wouldn’t have trusted I think back to when I was a waitress, envious of most incredible anyone in scrubs, either. that nurse at Children’s Hospital, and I’m thankful I Over the next few days, we somehow broke the si- accomplished my goal. I love being a nurse. individuals whose lence as I administered medications, cleaned suture Comments by Jeanette Ives Erickson, RN, stories sometimes lines, and packed wounds. Slowly, we started to be- senior vice president for Patient Care and chief nurse come friends. He talked about Judge Judy and how ex- Patients are our greatest teachers. This narrative is a cited he was about the upcoming Law and Order mara- bring tears to testament to the clinical and life lessons we take from thon. I’ll never forget the fi rst time he was able to walk our interactions with patients. Every intervention is an my eyes. around the unit. He touched everything, took a drink opportunity to grow and develop our human, clinical, from the water fountain every time he passed it. It was and communication skills. Amber’s presence and en- as if he were a child seeing things for the fi rst time. thusiasm triggered something in Tom. He trusted her. Watching him and the progress he was making And as Amber rightly observed, a trusting nurse-pa- made me feel hopeful inside. I knew for sure he, “didn’t tient relationship can be stronger than the strongest want to die.” medicine. I’m sure Tom is thankful Amber achieved Finally, near the end of his stay, it was a beautiful, her goal of becoming a nurse, too. crisp, fall Saturday. The sky was that perfect blue-bird Thank-you, Amber. color you only see a few times a year. I longed to be

August 5, 2010 — Caring Headlines — Page 9 Clinical Nurse Specialists

CNS sees opportunities for complementary therapies in clinical practice — by Marion Phipps, RN, clinical nurse specialist

everal years ago, a former colleague asked if I would participate in a Reiki class she was teaching. I was unsure at fi rst, but after giving it some thought, I decided it would be a nice way to spend time with an old friend. The class was an entire day of learning Reiki and practicing with the other folks in the class. Though I never S Despite my initial hesitation, I found the class enjoy- formally practiced able and informative. Though I never formally practiced the techniques I the techniques learned in the Reiki class, I do incorporate some prin- ciples of Reiki and yoga into my practice — guided im- I learned in the Marion Phipps, RN, agery, breathing techniques, and meditation. I can re- neuroscience clinical nurse specialist call a number of patients in the past year whom I be- Reiki class, I do hair, and her face had become puffy from the steroids. lieve were helped by these interventions. Perhaps hear- She had been admitted for surgery on her skull, where incorporate some ing these stories will inspire staff to use these tech- the disease had now spread. Mrs. M needed to sleep in niques in their own practice. principles of Reiki a special bed to prevent pressure on her head. The Mrs. M was re-admitted to the Neuro Unit for tube-shaped bed requires patients to ‘sink’ into sea of and yoga into my treatment of leiomyosarcoma, a disease few of us had silicone beads. When she saw it, she was terrifi ed and practice — guided heard of. During her fi rst admission, she had been very became hysterical. She said it looked like a casket. She anxious and afraid. She knew she had a terminal dis- thought she’d be suffocated by the beads. imagery, breathing ease. Her 8-year-old son had recently died of a brain I sat with her and told her I understood her fear. I tumor. She and her son had gone through radiation offered to get into the bed and show her how it worked. techniques, and and chemotherapy treatment at the same time. During As I got in the bed, I assured her she wouldn’t sink or meditation. her fi rst admission, she had cried often and was fearful get smothered. She was still frightened, but said she’d of all interventions. She was a beautiful woman in her give it a try. I asked if she’d like me to employ the re- late 40s. laxing techniques of Reiki to help her feel less fright- By the time of her second admission, Mrs. M’s ap- ened. With the support of her nurse and me, Mrs. M pearance had changed dramatically. She had lost her got into the bed and began to cry uncontrollably. continued on next page

Page 10 — Caring Headlines — August 5, 2010 Clinical Nurse Specialists (continued)

I calmly instructed her to listen to my voice as I put tions. I worried that delaying them might contribute to my hands on her shoulders the way I had learned in the dysarthria. I asked the nurse to crush her pills and class. With my voice and my touch, I helped her slow give them to her in a little applesauce. her breathing and imagine a place that brought her Later, I learned Ms. C. had been admitted to White comfort. After a few moments Mrs. M stopped crying 12. She was out of control, insisting she be allowed to and began to breathe more slowly. I stayed with her for wear her own clothes and sit on the edge of her bed. about ten minutes, repeating these guided-imagery Traci, her nurse, was very patient and kind. At one These stories techniques until she fell asleep. She slept for about an point Ms. C insisted on transferring to a chair. Traci hour before requesting to get out of bed. We practiced and I attempted to help her, but she screamed for us suggest that the use these techniques again later in the day, and by after- not to touch her. She almost fell, but we held her at noon, she was confi dent she’d be able to sleep in the the waist and assisted her to the chair. Misunderstand- of complementary bed that night. Mrs. M and I chatted over the next few ing our intentions, she thought we were trying to hurt techniques days of her admission. She was a remarkable woman. her. Traci explained we were just trying to keep her She talked about her impending death, about her two from falling, but Ms. C insisted she wasn’t at risk for such as Reiki, remaining children, her husband, parents, and her life. falling. I’m most grateful for the connection we made. In late Wanting to help her relax, I asked if she might therapeutic touch, January, Mrs. M’s obituary appeared in The Boston want to do some breathing exercises. She said she’d and controlled Globe. It refl ected a woman who, despite great tragedy, “chase me with a frying pan.” Her way of relaxing was had led a full, rich life. through work, work, work. breathing exercises The next afternoon Ms. C’s stroke extended. She I met Ms. C in the ED. I’d been asked to perform a needed an emergent MRI and CT scan. I accompanied swallow exam as she had presented with signs of a might have broader her to the MRI. Ms. C became hysterical in the imag- stroke. I found a very distressed woman lying on a ing machine. I tried to explain that she had the power application in our stretcher, her upper body in only a bra as she’d re- to gain control of herself by regulating her breathing. moved her hospital gown. She said she desperately practice. I hope Together, we practiced some breathing techniques. needed the swallow exam because she had Parkinson’s After the MRI, she became hysterical again. Soothing disease and couldn’t be without her medications. The to explore ways touch and controlled breathing again helped ease her whole time I was with her, she was talking on her cell anxiety. The CT was quickly completed, and we re- to incorporate phone. A young woman with her identifi ed herself as turned to the unit. Ms. C’s daughter. She wanted me to know that her these therapeutic The next day, Ms. C asked if we could do the mother was very intelligent and would make her own breathing exercises again. I reminded her that she had techniques into decisions about her care. control; she could concentrate on her breathe and con- As I observed Ms. C, I noticed she had a marked trol her anxiety any time she wanted. We practiced for care on our dysarthria making it diffi cult to speak. I performed the a while. I don’t know if it had any impact, but for a few swallow exam and found she had a yeast infection in unit. minutes she was able to draw on her personal resources her mouth. With the head of her bed at 30 degrees, she and bring herself out of her fear and frustration. coughed when she tried to drink water. I raised the bed and she was able to swallow better. Although she had These stories suggest that the use of complementary somewhat passed the swallow exam, I still wanted to techniques such as Reiki, therapeutic touch, and con- consult a speech-language pathologist because I was trolled breathing exercises might have broader applica- worried about her dysarthria. tion in our practice. I hope to explore ways to incorpo- As we waited for a consult, Ms. C and her daughter rate these therapeutic techniques into care on our became irate that she wasn’t able to take her medica- unit.

August 5, 2010 — Caring Headlines — Page 11 Education/Support

The Carol A. Ghiloni Oncology Nursing Fellow ship — by Mandi Coakley, RN, staff specialist

ow in its tenth year, the Carol preceptor, Sarah Brown, RN, on Phillips House 21. A. Ghiloni Oncology Nursing Stevens, a student at Clayton State Univer sity in Fellowship provides two stu- Georgia, worked with preceptor, Peg Baldwin, RN, on dent nurses an opportunity to Bigelow 7. Then they switched units to give them both learn about oncology nursing experience on a medical oncology and surgical oncol- as a specialty at MGH. Since ogy unit. June 1, 2010, nursing students, Nazarro and Stevens had a chance to observe nurs- Alison Nazarro and Gabrielle ing practice in Radiation Oncology, Interventional Below left: Liz Stevens, have been observing the varied roles that Radiology, the Infusion Unit, and the outpatient dis- Johnson, RN; precepts NN nurses play in oncology care and learning about the ease centers in the Yawkey Building. They attended nursing students, Alison many career opportunities available upon graduation. Schwartz Center Rounds, spent time in the Blood Nazzaro (center), and The fellowship was developed in 2001 to provide a Transfusion Center, and took advantage of other learn- Gabrielle Stevens. learning experience with the hope that students would ing opportunities within the Cancer Center, such as Below right (l-r): accept an oncology nursing position upon graduation. the HOPES program and the Cancer Resource Room. Johnson; Carol Ghiloni, RN; Jackie Somerville, RN; To date, 18 fellows have completed the program, ten The Carol A. Ghiloni Oncology Nursing Fellow- Mandi Coakley, RN; and have accepted positions at MGH upon graduation. ship received partial funding from the Hahnemann Peg Baldwin, RN. Seated: For the fi rst four weeks of the ten-week program, Hospital Foundation. For more information, Call Stevens and Nazzaro Nazarro, a student at UMass, Amherst, spent time with Mandi Coakley, RN, at 6-5334.

Page 12 — Caring Headlines — August 5, 2010 Clinical Recognition Program

Clinical Recognition Program survey results — by Mary Ellin Smith, RN, professional development manager

mplemented in 2002, the Clinical Recognition Pro- Almost 40% of staff who responded said they planned to ap- gram (CRP) was designed to formally recognize pro- ply for recognition at the advanced clinician or clinical scholar fessional clinical staff within Patient Care Services level in the next two years, though they expressed concern at for their expertise. Over the past eight years, all clin- the amount of time needed to complete the portfolio. Clin- icians have been recognized at the entry and clinician icians noted two primary barriers to seeking recognition: the levels of practice, and close to 400 clinicians have impact of a colleague’s refusal to support them and a perception been recognized as advanced clinicians and/or clinical that some of those recognized did not consistently practice at scholars. The CRP Review Board and Steering Com- the new level after being recognized. mittee wanted to get a The results of the leadership sense from PCS clinicians and survey found that more than 90% IIleadership as to their understand- had a favorable opinion of the ing and perceptions of the pro- program. They viewed recognized gram and the impact it’s had on staff as leaders on the unit or their units, practice, and the within the department. Lead- MGH community. ership acknowledged the chal- In November, 2009, surveys lenges they face ensuring staff were sent electronically to staff recognized as advanced clinicians and leadership throughout Patient and clinical scholars continue to Care Ser vices. The survey found practice at that level after being that staff was very familiar with recognized. They also acknowl- the Clinical Recognition Program, edged the challenges many staff and that a majority had a favor- face in preparing their portfolios able opinion of the program. for submission. Advanc ed clinicians and clinical The CRP Review Board and scholars reported that recognition Steering Committee will work had brought a sense of professional over the next few months to syn- and personal pride, and that since thesize the survey fi ndings, de- being recognized they had come velop recommendations, and cre- to serve as resources and role mod- ate an action plan. Look for more els for others. The survey had a information about the Clinical 65% return rate among leadership, Recognition Program in future is- and 31% among staff. sues of Caring Headlines.

August 5, 2010 — Caring Headlines — Page 13 Fielding the Issues Maintaining a clean environment: a crucial part of patient care

Maintaining a clean environment is a crucial part of safe patient care. We’re fortunate to have a team of skilled unit service associates who understand the importance of maintaining a clean environment for patients and caregivers. Over the past year, Clinical Support Services embarked on an ambitious campaign to improve the products, processes, and techniques involved in keeping patient care units clean. New products, training, and practices were introduced to enhance the cleaning process and increase satisfaction with the hospital environment. Success will require the support and participation of every MGH employee.

Question: What is the new practice for cleaning patients’ rooms? Question: How long does it take to clean and disinfect a room? Jeanette: During daily and discharge cleaning, surfaces are disinfected using a micro-fi ber cloth dipped in a cleaning/disinfecting solution. Jeanette: To effectively clean and disinfect a room for Cloths are not re-dipped; they’re put in the hamper when no longer suffi - discharge takes one person 45 minutes to an hour (less if ciently wet or when they’re visibly soiled. The solution is applied wet and the room is cleaned by a team). must be allowed to air dry for ten minutes. Question: Why are operations managers interviewing Question: Why do surfaces have to remain wet? patients? Jeanette: We use the most advanced techniques and hospital-grade Jeanette: We want to know what patients think about cleaning products to ensure optimal resistance to germs. In order to be ef- their environment and address any concerns they may fective, the cleaning solution must go on wet and air dry. We’ve launched have. We’re learning a lot through these interviews and at an awareness campaign to highlight this aspect of the new process — the same time reinforcing the message that we’re commit- we’re calling it, ‘Wet is the new clean!’ One nice side-effect of the clean- ted to a clean, safe hospital. ing solution is that there’s no harsh chemical smell like there is with many other cleaning products. Question: What can we do to help? Jeanette: Research suggests that satisfaction with clean- Question: Are we doing anything to increase patient awareness about liness is infl uenced by the overall neatness of a patient’s our new cleaning practices? room. To help, staff can: Jeanette: Earlier this year we piloted a “Patient Perception of • throw away wrappers from dressings or medications Cleaning” initiative, whereby unit service associates introduce themselves • discard gloves in trash receptacles to patients, explain their role, and let patients know how to reach them • ask patients if you can throw away old newspapers or if/when their room needs attention. Unit service associates now leave a anything else that might be contributing to clutter signed card in each room verifying that rooms and bathrooms have been • keep windowsills and counters free of linen and supplies cleaned. The initiative was rolled out in inpatient areas July 7, 2010. • let a unit service associate know if a room needs atten- tion so he/she can address it in a timely manner Question: How often are patients’ rooms cleaned? • let it be known that we care about the cleanliness of ev- ery room Jeanette: Patients’ rooms are cleaned every day, and unit service asso- For more information, contact Stephanie Cooper, senior ciates are always available for additional cleaning. Rooms and bathrooms operations manager at 617-724-7841. are checked on all unit service associates’ shifts and cleaned as needed.

Page 14 — Caring Headlines — August 5, 2010 Announcements Published by Caring Headlines is published twice each month by the department of Patient Care Services at Massachusetts Call for Applications The Clubs at Charles Pathways of Healing General Hospital Jeremy Knowles Nurse River Park Mind-Body-Spirit Publisher Continuing Education Program Jeanette Ives Erickson, RN Preceptor Fellowship All summer memberships to presented by senior vice president The Clubs at Charles River Park for Patient Care Applications are now being the MGH Nurses’ Alumnae are now 40% off, and MGH accepted for the Jeremy Knowles Association employees can join for less than Managing Editor Nurse Preceptor Fellowship that Susan Sabia recognizes exceptional preceptors $11 a week. Membership includes September 24, 2010 a complementary orientation 8:30am–4:00pm for excellence in educating, Editorial Advisory Board inspiring, and supporting new session with a certifi ed O’Keeffe Auditorium personal trainer! Chaplaincy nurses or nursing students in Speakers Michael McElhinny, MDiv their clinical and professional For more information, Dr. Herbert Benson, director, Editorial Support development. call 617-726-2900 MGH Mind-Body Institute; Marianne Ditomassi, RN Mary Ellin Smith, RN The one-year fellowship provides Amanda Coakley, RN, staff fi nancial support to pursue specialist Materials Management Edward Raeke educational and professional $30.00 for MGHNAA members opportunities. Ramadan at MGH and MGH employees Nutrition & Food Services $40.00 for all others Martha Lynch, RD Applications are due by Join Muslim patients and staff in Susan Doyle, RD September 10, 2010. Register by September 17, 2010 celebrating the Holy month of Offi ce of Patient Advocacy at: www.mghsonalumnae.org For more information, contact Ramadan. An Iftar is the breaking Sally Millar, RN or e-mail mghnursealumnae@ Mary Ellin Smith, RN, at 4-5801. of the fast at sunset during the Offi ce of Quality & Safety month of Ramadan. partners.org Keith Perleberg, RN In the spirit of unity, Patient Care 6 Contact Hours Orthotics & Prosthetics Services, Human Resources and Mark Tlumacki the MGH Muslim community invite you to a community PCS Diversity Knight Visiting Deborah Washington, RN Iftar dinner. Medication policies Scholar All are welcome. Physical Therapy now in Trove Occupational Therapy Patricia M. Reilly, RN, Thier Conference Room Michael Sullivan, PT Effective July 1, 2010, medication- program manager for Integrative Tuesday, August 24, 2010 Police, Security & Outside Services Care at BWH is the 2010 Knight 7:00–8:30pm related policies, procedures, and Joe Crowley Visiting Scholar. A recognized Iftar (breaking of the fast) guidelines can now be found in a single Medication Manual Public Affairs expert in complementary will be at 7:32pm Suzanne Kim therapies, Reilly has lectured in Trove. This includes: For more information or to RSVP extensively on stress-reduction, 1) general policies and procedures Respiratory Care leadership-development, and e-mail Firdosh Pathan at fpathan@ Ed Burns, RRT partners.org. 2) medication-specifi c policies and caregiver fatigue. Her research procedures, formerly located in Social Services Ellen Forman, LICSW focuses on the impact of the Nursing Procedure Manual complementary therapies on 3) the medication guidelines Speech, Language & Swallowing patients and clinicians. Disorders and Reading Disabilities formerly located in the MGH Carmen Vega-Barachowitz, SLP Reilly will present, “The Shift is Nursing History IV Medication Reference and Nursing Procedure Manual: Training and Support Staff on! Are you ready to take the Call for photos and artifacts Stephanie Cooper Quantum Leap?” • Adult Critical Care Tom Drake In preparation for the MGH • Adult General Care Thursday September 23, 2010 Pediatric Critical Care The Institute for Patient Care bicentennial, the department • Gaurdia Banister, RN Grand Rounds: 1:30-2:30pm of Nursing is creating a book • Pediatric General Care O’Keeffe Auditorium commemorating major Volunteer Services, Medical Consolidating these documents Interpreters, Ambassadors, For more information, contact nursing milestones. in Trove ensures consistency and and LVC Retail Services Mary Ellin Smith, RN at 4-5801. The Nursing History fosters best practice throughout Paul Bartush Committee is looking for the hospital. photographs, articles, artifacts, Distribution For more information, contact Ursula Hoehl, 617-726-9057 and information that would help Sue Tully, RN, at 6-7928; or Joanne describe the journey of MGH Empoliti, RN, at 6-3254. nurses, especially pre-1995. Submissions All stories should be submitted If you have anything you’d like to: [email protected] For more information, call: to suggest or lend to the effort, 617-724-1746 please contact Georgia Peirce, director, PCS Promotional Next Publication Communications and September 2, 2010 Publicity, at 4-9865.

August 5, 2010 — Caring Headlines — Page 15 Medication Safety

New Medication Manual in Trove standardizing medication-related policies, procedures and guidelines

he safe, effective administration of med- The challenge was to identify existing documents ications is a top priority in hospitals throughout the institution; review and update documents everywhere. At MGH, every discipline, to ensure they refl ected current best practice and regulatory department, and service has policies requirements; and submit documents to MESAC for re- and procedures guiding the use of med- view and approval. The fi nal step in the process was com- ications. These policies and procedures pleted July 1, 2010, when all approved documents were had been kept in various locations, in moved to the new Medication Manual repository in Trove. both hard-copy and electronic ver- The Medication Manual repository consists of six sec- TTsions. Periodically, regulatory agencies would change or tions: amend requirements necessitating policies and procedures to 1) General Policies and Procedures be expanded and/or updated. 2) Medication-Specifi c Policies and Procedures (formerly MESAC (the Medication Education, Safety and located in the Nursing Procedure Manual) Approval Committee) recognized a need to better manage 3) Adult Critical Care Medication Guidelines these important documents. So a multi-disciplinary group of 4) Adult General Care Medication Guidelines nurses, pharmacists, and physicians came together to estab- 5) Pediatric Critical Care Medication Guidelines lish a standardized process to: 6) Pediatric General Care Medication Guidelines • provide a single, easily available, up-to-date, consistent (3–6 were formerly located in the MGH IV Medication source for all medication-related policies, procedures and Reference and Nursing Procedure Manual) guidelines The new Medication Manual can be found in the Trove • support sound medication practices and medication-man- library. Since this move represents a change for users, re- agement processes gional pharmacists are available to assist staff in locating • meet regulatory requirements documents if necessary. For more information, contact: • integrate multi-disciplinary, medication-related policies, Chris Coley, MD; Dena Alioto, RPh; Susan Tully, RN; or procedures and guidelines Joanne Empoliti, RN.

First Class US Postage Paid Headlines Permit #57416 aringAugust 5, 2010 Boston, MA C Returns only to: Bigelow 10 Nursing Offi ce, MGH, 55 Fruit Street Boston, MA 02114-2696

Page 16 — Caring Headlines — August 5, 2010