Headlines CaringOctober 15, 2015 Case Management celebrates 20 years of service at MGH

See story on page 4 and clinical narrative on page 10

Case manager, Angela Wynder, RN (right), and nutrition support nurse, Michelle Picard, RN, review patient’s nutritional needs in preparation for discharge. The newsletter for Patient Care Services Massachusetts General Hospital Jeanette Ives Erickson In recognition of our incredible support staff

om Brady may be the most recognizable name on the New At MGH, we England Patriots’ roster — and he deserves all the accolades have some high- he receives. But every football fan knows that no quarter back profile ‘stars’ on our is solely responsible for the success of the team. Every roster; we’re #1 in player, coach, trainer, and every other member of Tthe team, on and off the field, makes a meaningful our field; and we’re contribution to the team’s performance. And so it is Jeanette Ives Erickson, RN, senior vice president with health care, as well. At MGH, we have some for Patient Care and chief nurse known far and wide high-profile ‘stars’ on our roster; we’re #1 in our field; and we’re known far and wide for the world- come up to me to tell me what a great job they’re for the world-class class care we provide. As any knowledgeable health­ doing or share a personal story of how someone in a care provider or consumer will tell you, none of that support role has made a difference in their hospital care we provide. As would be possible without our world-class support experience, or in their lives. But I had to chuckle any knowledgeable staff. when I started gathering information for this col- I’m talking about our unit service associates, umn and realized that every manager, supervisor, healthcare provider operations associates, patient care associates, staff and director in Patient Care Services thinks that assistants, surgical technologists, physical and occu- his or her support staff is the best in the hospital. or consumer will pational therapy assistants, information associates, They literally clamored to have their teams men- operating room assistants, practice access coordina- tioned by name or highlighted in some way in rec- tell you, none of tors, managed care coordinators, IV technicians, re- ognition of their diligence, compassion, and service. spiratory therapy aides, operations coordinators, I wish I had room to mention everyone by name, that would be physical therapy aides, patient service coordinators, but what I can do is share a few of the comments I patient care information associates, sterile process- heard and perhaps some of our support staff will rec- possible without ing technicians, endoscopy technicians, OR equip- ognize themselves in these words. ment technicians, and all the other role groups that From one director: “Our support staff is indis- our world-class keep this organization operating smoothly and effi- pensable. They’re the face of our practice, they ciently every single day. I can’t imagine trying to identify gaps in customer service and are the go-to support staff. run this hospital without them. people when we need questions answered. They’re I’ve always known that patients, families, and flexible and accommodating; multi-tasking is the professional staff value the work of our support norm. I can’t imagine what life would be like with- staff — a day doesn’t go by that someone doesn’t out them. They are amazing.” continued on next page

Page 2 — Caring Headlines — October 15, 2015 Jeanette Ives Erickson (continued)

From a clinical staff member: “Our USA (unit service as- From a director: “In so many settings, support staff are the first im- sociate) takes pride in everything he does. He’s flexible, reli- pression patients and families have of MGH. They have great influ- able, and sensitive to the needs of patients and the team. He ence on hospital operations and the patient and family’s experience takes initiative, always looking for ways to make a patient’s of care.” experience more enjoyable. You can count on him to get From the OR: “Operating room assistants (ORAs) have an import- things done and to do it with a positive attitude.” ant role, preparing patients for transfer, ensuring they feel cared for, From a nursing director: “Our patient care associate (PCA) is taking the time to explain what to expect as patients travel to the OR deeply committed to providing every patient with exceptional to meet other members of the surgical team. And ORAs play an inte- care. She’s articulate and caring; her passion for her work and gral part in preventing infection with a rigorous, standardized clean- her patients is evident in her practice every day.” ing approach.” From a member of the PCS Executive Team: “I had occa- From a nursing director: “Recently, a family member called looking sion to be in the Yawkey Infusion Unit the other day, and I for a six-hundred-dollar phone his wife had accidentally left behind was struck by the rapport that staff at the reception desk had when she was discharged. She thought she’d left it in the pocket of with every patient who came in. You expect a cancer infusion her johnny. I knew the soiled linen was still in our storage room. Our unit to be a serious place, but patients approached the recep- USA was fantastic! She knew exactly which laundry bag to look in. tion desk with smiles on their faces; they were greeted by sup- We opened the bag, and there was the phone in the johnny pocket. port staff who obviously knew them; they shared stories and We have the best USAs.” joked around. It felt more like a social club than a hospital From Infection Control: “USAs make sure patient rooms are waiting room. It was really something.” thoroughly cleaned and disinfected, keeping the environment safe From a nursing director: “I know operations associates are and infection rates low.” indispensable on all units, but on the pediatric units, they From MGH Back Bay: “Our administrative support team ensures play a key role in preventing the abduction of children and patients have easy access to their PCPs when scheduling appoint- infants. They monitor the comings and goings of staff, pa- ments. They coordinate follow-up care and close the loop on exams tients, and visitors, and they manage to do it without making and referrals. Patients come to know them, which helps deepen the anyone feel uncomfortable.” sense of trust they have with the whole practice.” From an associate chief nurse: “Many MGH support staff Clearly, our support staff are loved and appreciated. While I’m re- come to us from other roles or departments, so they have a great minded of their good work and contributions on a daily basis, I hope understanding of our culture, the larger organization, and how they know what critical members of the team they are, and how much patients navigate the system. I hear so many people comment we rely on their knowledge, insights, actions, and countless acts of on the positive impact support staff make and how they look kindness. Tom Brady and the Patriots may be the reigning Super Bowl forward to seeing them — patients and professional staff alike.” champs, but I’d choose our support team over theirs any day of the week!

Paul W. Cronin and Ellen S. Raphael Award In this Issue for Patient Advocacy...... 12 Case Management...... 1 National Health Literacy Month...... 13 Jeanette Ives Erickson...... 2-3 Patient-Education Materials on IVC Filter Removal...... 14 Our Incredible Support Staff • Patient-Education Materials on COPD...... 15 Case Management Celebrates 20 Years...... 4-5 Unacceptable Abbreviations...... 16 Bystander Awareness...... 6 Professional Achievements...... 17 Disabilities Awareness...... 7 Announcements...... 18 PCS Scholarships...... 8-9 Policies, Products & Procedures...... 19 Clinical Narrative...... 10-11 Partners eCare Update...... 20 • Angela Wynder, RN, and Michelle Picard, RN

October 15, 2015 — Caring Headlines — Page 3 Case Management

Case Management celebrates 20 years at MGH — by Janice LaMontagne, RN, ED case manager

his year, Case Management celebrates a milestone 20 years of service at MGH. In honor of the occasion, Nancy Sullivan, executive director of the de- partment since its inception in No matter 1995, shared some remembrances of her career and the develop- where case ment of case management over the past two de- Tcades. Recalls Sullivan, “My entire career has been managers spent at MGH. The first position I held was secre- tary/technician in the Pediatric Pulmonary Lab. It practice at MGH, was as director of Utilization Management & Qua­ lity Assessment (UMQA) that I worked closely their goal is to with Peter Slavin, then the director of the Clinical Care Management Unit [now MGH president], on empower patients Nancy Sullivan, shaping the case manager role. I recall long hours of director of Case Management planning with Joanne Wooldridge, associate direc- to manage the tor of UMQA and Dr. Slavin, working out the de- ment in three phases over six months to ensure impact of their tails of the role.” that each area of the hospital had a smooth transi- Ten months later, with input from an inter-disci- tion to case-management coverage. illness and enable plinary committee of physicians, nurses, and social From the very beginning, Case Management workers, the role of nurse case manager was defined. has enjoyed the crucial support of staff in the Case them to function The role called for a special combination of medical Management Support Unit (CMSU), who handle expertise, business acumen, and compassion. Case clerical responsibilities, referrals, communication, optimally in the managers would help patients navigate the compli- and so much more. cated landscape of healthcare delivery while help- In 2003 the highly successful Clinical Docu­ community. ing to ensure cost-effective care. mentation Improvement (CDI) program was cre- Case management was introduced to the hospi- ated with CDI nurses reviewing documentation to tal very methodically. Sullivan and Slavin met with improve the accuracy of Medicare reimbursement nurses, physicians, social workers, and physical ther- (and other DRG-based payers). More accurate apists to explain the case-management concept and documentation better reflects the severity of ill- get their input on how to integrate it into care- ness and mortality risk among our patient popula- delivery without interrupting or duplicating work. tions resulting in more accurate and favorable re- The decision was made to introduce case manage- imbursements. continued on next page

Page 4 — Caring Headlines — October 15, 2015 Case Management (continued)

In 2006, the Integrated Care Management (iCMP) program was created with care managers working out of Primary Care practices. These nurse care managers focus on a select group of medically complex patients, managing their care with primary care physicians and outpatient clinical teams. The iCMP team is a multi-disciplinary approach that includes social workers, com- munity resource specialists, pharmacists, and a pharmacy techni- cian. Patients are followed through all transitions of care. The goal is to enhance the patient experience, have a positive impact on clinical outcomes, and decrease overall utilization. Since 1996 the scope and responsibilities of case managers has grown. Originally, there were 33 case managers at MGH, today there are more than 70. Says Sullivan, “We’re pleased to celebrate twenty years of ex- ceptional case management at MGH. We have a number of events planned to commemorate the occasion.” Between October 5th and 19th, Case Management posters will be on display in the Main Corridor. You can visit the Case Management information booth in the Main Corridor on Thursday, October 15th, from 8:00am–3:00pm. And on Tuesday, October 27th, from 12:00– 1:00pm, Suzanne O’Connor, RN, will present “Winning with Changes and Changing to Win: Building Agility for a Faster- Moving Healthcare System,” in O’Keeffe Auditorium. No matter where case managers practice at MGH, their goal mum benefit from the healthcare services available throughout the is to empower patients to manage the impact of their illness and continuum of care. enable them to function optimally in the community. Case man- For more information about case management or the work of case agers work with patients and families to help them derive maxi- managers on any specific unit, call 617-726-3665.

Above: case manager, Nora Arbeene, RN (right), meets with patient, Robin Gurlitz, to complete an assessment and craft an appropriate discharge plan together. At left: director, Nancy Sullivan (center front), with case managers and support staff on the steps of the Bulfinch Building. (Photo by Michelle Rose) (Photo by

October 15, 2015 — Caring Headlines — Page 5 Safety Bystander Awareness Training how to respond to situations of intimate-partner violence — by Matthew Thomas, CNY day-shift operations supervisor, MGH Police & Security

ntimate partner violence (IPV) is a world-wide epidemic that touches Imagine being a witness to, or learning about, a everyone. Years ago, the MGH Domestic Violence Working Group (DVWG) situation involving intimate-partner violence. Per­ was created to try to end intimate-partner violence. The group posited haps you’ve already witnessed a situation, wished that the active participation of men in these efforts would be hugely bene- you’d taken action, but didn’t know what to do. On ficial, and so was born MGH Men Against Abuse (MMAA), a group September 8, 2015, MMAA hosted an event to comprised entirely of male employees from numerous departments through- help educate staff about bystander awareness and out the hospital. The goal of MMAA is to end intimate-partner violence ways to respond in these situations. by raising men’s awareness of the issue and providing educational tools to Guest, Alan O’Hare, and two actors from Life help men understand its causes and dire effects. The tag-line of the group is, Story Theatre, Carol Feldman Bass and Nancy I“See it... Step up... Stop it.” They pledge to never, “commit, condone, or remain Capaccio, enacted a scenario that could happen in silent about men’s violence against women; to respect, listen to, and share power any real-life, work setting. Two women co-workers with the women” in their lives. sat side-by-side, one troubled and distraught by what’s going on in her home life, the other focused on work and frustrated by the other’s lack of atten- tion. Between scenes, O’Hare facilitated discussion about what attendees might do in a similar situa- tion. Members of HAVEN, the Employee Assistance Program, and MGH Police & Security were on hand to answer questions about the many ways victims of intimate-partner violence can be supported at MGH. Different versions of this bystander training have been held at MGH in the past. Like those, the September 8th event was well-received and a great opportunity to educate and empower staff. The DVWG and MMAA feel it’s important that employees feel prepared to act appropriately should they ever encounter or become aware of instances of intimate-partner violence. For more information about intimate-partner violence or MMAA, contact Debra Drumm, of HAVEN at MGH, at 617-726-7674; Matt Thomas, of Police, Security & Outside Services, at 617-643- 0806; or Lenny Debenedictis, of the Employee Assistance Program, at 617-724-2206. Actors, Nancy Capaccio (left) and Carol Feldman Bass, enact scenario of intimate-partner violence as part of a bystander awareness training session.

Page 6 — Caring Headlines — October 15, 2015 Disabilities Awareness Think outside the call bell improving accessibility for patients with disabilities — by Zary Amirhosseini, disability program manager, and Stephanie Smith, OTR/L, clinical specialist

or many, using a call bell is to ensure optimal patient safety and com- The pilot also introduced a flexible hos- easy — it’s as simple as pushing fort, and make unit operations more effi- ing system called, Loc-Line, that allows a button. Call bells give patients cient. various items, such as call bells, cell a sense of security, knowing Last year, The Office of Patient Advo­ phones, or tablets to be attached to beds, that someone is nearby and cacy, Occu­pational Therapy, and Mater­ wheelchairs, or recliners, allowing patients ready to help, whether they’re ials Management developed a program to to access devices they might otherwise not Ffeeling sick or need to use the bathroom. pilot a variety of adaptive call bells on be able to use. Loc-Line, Big Red, and Jelly So access to call bells is an essential asset in Lunder 7 (Neurology), Bigelow 9 (Resp­ Bean provide patients with more options terms of patients feeling safe and involved iratory­ Acute Care) and Ellison 14 for communicating with staff, hopefully in their care. (Burns and Plastic Surgery). Feedback giving them a greater sense of security, Imagine having an injury or illness that was collected from each unit, and patients comfort, and control over their environ- makes it impossible to use the call bell, and staff agreed on two options, affec- ment. unable to contact the front desk or call for tionately called, ‘Big Red’ and ‘Jelly To request an adaptive call bell or a a nurse. For patients with amyotrophic Bean.’ Testimonials­ such as, “Jelly Bean Loc-Line mounting system, call Customer lateral sclerosis (ALS), traumatic brain in- is particularly useful for patients who Service­ at 6-9144. To ensure competency, jury, spinal cord injuries, and many other have minimal movement of their ex- make sure patients can activate call bells disabling conditions, pushing a call bell tremities,” and “Big Red is perfect for pa- successfully three times in a row. can be a daily challenge. At MGH, in an tients who are intubated,” reinforced our Go to the MGH Accessibility Resource effort to make call bells as universally ac- decision to add these call bells to our al- Site under Partners Applications to see a cessible as possible, we’ve introduced ready comprehensive inventory of adap- list of all adaptive call bells, or e-mail: adaptive call bells, an innovative solution tive devices. [email protected]. Big Red Jelly Bean Loc-Line hose

October 15, 2015 — Caring Headlines — Page 7 Education/Support

Presentation of the 2015 PCS Scholarships — by Julie Goldman, RN, professional development manager

n September 22, 2015, Jeanette Said Ives Erickson, “We’re thankful to all our Ives Erickson, RN, senior vice donors: Mr. Norman Knight; Mr. and Mrs. Gil president for Patient Care, wel- Minor; the staff of Lunder 10 and Cox 1; and the comed friends, family, and col- Dowling family for funding these programs that leagues to this year’s PCS schol- help advance higher learning and increase the arship presentations. Scholar- number of diverse nurses and healthcare profes- ships support MGH staff inter- sionals practicing at MGH.” Below: senior vice ested in earning a degree in The following scholarships were presented: president for Patient Care Jeanette Ives Nursing or one of the health professions. Providing fi- • The Norman Knight Doctoral Nursing Erickson, RN, presides Onancial assistance to those wishing to further their edu- Scholarship (Photo 1, l-r) over PCS scholarship cation, and increasing the diversity of our workforce are • Debra Burke, RN; Carol Casey, RN; Jennifer presentation basic tenets of our MGH philosophy and an important Clair, RN; and Julie Cronin, RN ceremony. part of our mission and values. continued on next page

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Page 8 — Caring Headlines — October 15, 2015 Education/Support (continued)

• The Charlotte and Gil Minor Nursing and Linda Caruso, RN; Alexa O’Toole, RN; Health Professions Scholarship to Advance Tara Belisle; Scott Farren, RN; Amira Workforce Diversity in Patient Care (Photo 2) Hamzic, RN; and Karin Rallo, RN • Melissa Joseph, RN; Michael Grasso, RN; • The Pat Olson, RN, Memorial Scholarship Rai Singh, RRT; and Jane Martell, RN (Photo 5) • The Cathy Gouzoule Oncology Scholarship • Michele Alvarez (Photo 3) Through the generosity of supporters, a re- Michele Golden, RN cord 25 scholarships were presented this year. • The Norman Knight Nursing Scholarship For more information about the Patient Care (Photo 4) Services Scholarships contact Julie Goldman, • Alicia Shulman, RN; Jessica Robertson, RN; RN, professional development manager, at 617- Charlene Badolato, RN; Jessie MacKinnon, RN; 724-2295.

2 3

4 5 (This photo Autumn Aguiar) by

October 15, 2015 — Caring Headlines — Page 9 Clinical Narrative

Inter-disciplinary collaboration ensures safe progression for elderly couple

y name is Angela Wynder, and I’ve had the privilege of being an inpatient case manager for the Oncology, Leukemia, and Transplant services for the past three Mr. A was an years. Mr. A was an elderly gentleman with ad- Angela Wynder, RN, case manager (right), elderly gentleman vanc­ed cancer who was non-responsive to chemo- and Michelle Picard, RN, nutrition support nurse Mtherapy. He was admitted for failure to thrive. We with advanc­ed soon discovered that in addition to dealing with his tive system and supplying a nutritional solution di- own health issues, Mr. A had been caring for his rectly into a vein). Mr. A’s discharge plan would de- cancer who was wife of many years. Mrs. A had advancing dementia pend on Angela’s assessment and the wishes of Mr. and refused to acknowledge her condition or allow A and his family. non-responsive to family members to assist. Wynder: I met with Mr. A, his wife, and two of chemotherapy... We My name is Michelle Picard, and I have been a their adult children. Mr. and Mrs. A lived together nutrition support nurse for many years. Upon initial in a two-story home. They had family in the area soon discovered consult, a colleague in my department met with Mr. but did their best to maintain their independence A and his family. The following morning, my col- and not ask their children for assistance. Mrs. A that in addition to league shared her assessment of Mr. A. He was mar- was Mr. A’s designated health care proxy. Mr. A ried; his wife had some signs of dementia that had retained capacity and was able to answer all my dealing with his become apparent over the past few months. They questions with short, direct answers. Mrs. A often had five adult children, two of who were in the asked why I was asking certain questions and what I own health issues, medical profession. I knew from experience that planned to do with the information. Mrs. A ini- this wasn’t going to be an easy home plan because tially came across as cold and withdrawn, perhaps Mr. A had been of Mr. A’s age, his advanced diagnosis and decon- even angry. But as our conversation progressed, I ditioned state, the proposed plan of treatment, and recognized the fear and suspicion in her eyes. My caring for his wife the fact that Mr. A’s primary caregiver was his wife. grandmother has dementia, and I’m very familiar I met with Mr. A’s case manager, Angela with that tell-tale expression. Michelle had told me of many years. Wynder. I filled her in on the information I had and that Mrs. A was experiencing dementia, so I wasn’t shared my concerns with her. Mr. A was fragile and completely surprised by her behavior. at high risk for complications on total parenteral I could see that it was important for the family to nutrition, or TPN (a method of bypassing the diges- allow Mrs. A to participate in decision-making and continued on next page

Page 10 — Caring Headlines — October 15, 2015 Clinical Narrative (continued)

help direct the plan of care. I came out of that con- Picard: When I met with Mr. A, he deferred the versation with the acute understanding that Mr. planning process to his family. His adult children were and Mrs. A’s primary goal was to maintain indepen- lovingly concerned for their parents; they knew they dence at home. I knew I’d need to convince them were failing but wanted to honor their wishes to try it of the need for additional assistance in order to their way. It came down to deciding on the safest plan make their goal of returning home a realistic and possible even though it might not have been Mr. A or safe possibility. his family’s first choice. I empathized with them be- Mr. and Mrs. After meeting with the family, Mr. A’s daughter cause I had been through something similar recently, caught up with me in the hallway and expressed watching close family members hold onto their inde- A chose to great concern, not just for her father, but also for pendence at the end of their lives. There’s something her mother. She explained that her father had been to be said for dying with dignity and assisting patients allow their concealing the severity of her mother’s dementia in their ability to do that. from everyone, including the family, for a long Wynder: Mr. and Mrs. A chose to allow their daughters to time. She went into great detail about her mother’s daughters to come to their home daily and administer paranoia at having anyone else in the home. And come to their TPN to Mr. A. As Michelle said, it wasn’t the ideal she talked about her father’s hesitation at allowing plan. I had real concerns about this family’s ability to anyone to see the degree of assistance Mrs. A now home daily influence Mrs. A’s decision-making for the tough needed. choices that would need to be made in the future. It Over the next five days, I met with Mr. A and and administer may not have been a perfect plan, but it allowed Mr. A his family many times. I sat with Mr. and Mrs. A and his wife to return home together and maintain the and reviewed the need for round-the-clock support. TPN... It may dignity and independence they so desired. They had many questions about TPN and the need not have been for a PICC line to be placed for easier administra- Piccard: Mr. A was discharged home five days after tion. I answered all their questions and reviewed starting TPN. Everything he needed was in place. In a perfect plan, the criteria for inpatient rehab. For Mr. A, dis- my department, we follow patients on home TPN with charge to an inpatient rehab would have been the the primary team vendor. One evening when I was on- but it allowed obvious choice. However, when taking into ac- call, I got a page from Mr. A’s daughter seeking advice. count his age and advanced cancer diagnosis, the She knew what needed to be done; she was just look- Mr. A and his better plan was clearly one that allowed him to stay ing for validation. She was letting herself be the daugh- with his wife and maintain the independent life ter. wife to return style he valued for the short time he had left. Mr. A continued treatment for another week before Two days prior to Mr. A’s discharge, I coordi- deciding to stop everything and transition to hospice. home together nated an educational session with the vendor who He passed away about two weeks later. We feel fortu- would be providing the TPN for Mr. A at home. nate to have been able to help Mr. A achieve his goals and maintain I’ve seen many fiercely independent patients who with the support of his family and other caregivers. thought they could master TPN administration the dignity and Comments by Jeanette Ives Erickson, RN, only to find that they weren’t able to do it when senior vice president for Patient Care and chief nurse independence asked to demonstrate the multi-step process. As sus- pected, neither Mr. nor Mrs. A was able to grasp or Through this narrative, Angela and Michelle gave us a glimpse into the complex ethical issues and care plan- they so demonstrate the technique, and they ultimately re- quested an alternative. ning that go into ensuring a safe discharge while at the same time respecting the patient’s wishes. They role- desired. I provided Mr. and Mrs. A with information about private-duty care. And I discussed the possi- modeled the need to listen to Mr. and Mrs. A and al- bility of having one of their children assist with TPN low them to retain as much control as was safely possi- administration. Both options called for someone to ble. Together with the family, they crafted the optimal come to the home, which had the added advantage solution, ultimately allowing Mr. and Mrs. A to stay of someone being able to check on Mr. and Mrs. A together during his final days. to ensure they were both doing well. Thank-you, Angela and Michelle.

October 15, 2015 — Caring Headlines — Page 11 Recognition

Paul W. Cronin and Ellen S. Raphael Award for Patient Advocacy — by Julie Goldman, RN, professional development manager

n September 17, 2015, of patients and families. Cronin and Raphael be- Lunder 9 staff nurse, Denise lieved that empowering the people who care for pa- Elias, RN, and unit service tients allows them to grow and flourish and excel in associate, Carlos Henriquez, the important work they do. were honored as the 2014 The award criteria are based on patient advocacy Award recipients, Denise and 2015 recipients of the and empowerment. The selection committee looks Elias, RN (front left), and Paul W. Cronin and Ellen for candidates who seek solutions to patient prob- unit service associate, S. Raphael Award for Patient lems; partner with other disciplines to provide the Carlos Henriquez (front Advocacy. The award was established in 1999 in highest quality care; and demonstrate flexibility in right), with associate chief nurse, Debra Burke, RN Omemory of Cronin and Raphael and in recognition their practice. (tan suit); nursing director, of the exemplary nursing care they received at In her remarks about Elias, Lunder 9 nursing di- Barbara Cashavelly, RN MGH. The award recognizes a clinical and/or sup- rector, Barbara Cashavelly, RN, said, “Denise was at (brown plaid jacket); and port-staff member who consistently demonstrates the top of the list for this award. She is seen as one staff of Lunder 9. excellence in identifying and addressing the needs of the most flexible and positive forces on the unit. She’s always focused on finding a solution. She’s first to offer help to her colleagues. She individual- izes the care she provides and always goes above and beyond to meet their needs.” About Henriquez, Cashavelly said, “Carlos takes great pride in his work as out unit service associate; he’s committed to keeping our unit clean. Carlos does anything that’s asked of him with a smile. I’ve asked Carlos to find bed extenders, and he’s scoured the entire hospital to find them. Patients love his bright personality and willingness to help.” Associate chief nurse, Debra Burke, RN, noted, “As I listened to Barbara speak, I saw everyone nod- ding their heads. That tells me that Denise and Carlos were excellent choices for this award. Thank- you for your advocacy for our patients and families.” For more information about the Paul W. Cronin and Ellen S. Raphael Award for Patient Advocacy, call Julie Goldman, RN, at 617-724-2295.

Page 12 — Caring Headlines — October 15, 2015 Patient Education

October is National Health Literacy Month — by Amber Leigh Blough, RD; Julie McCarthy, RN; and Vita Norton, RN for the PCS Patient Education Committee

ealth literacy, the ability to As the baby-boomer generation approaches re- obtain, process, communicate, tirement age, the effects of poor health literacy are and understand health infor- compounded. In order to promote health literacy, it’s mation, is a crucial part of essential that health information be provided clearly patient-centered care and and simply. Providers should use plain language, en- pivotal in terms of health- sure understanding by asking open-ended questions, Even highly related decision-making. In and use techniques such as the “teach-back; show- educated people an effort to empower patients and caregivers, the back” method when providing patient education. HPatient Education Committee­ is observing National The Patient Education Committee’s­ booth will are at risk for Health Literacy Month with an information booth have resources for clinical staff, patients, and visi- in the Main Corridor on Wednesday, October 28, tors. Clinicians can learn about services available at low health 2015. the hospital such as the Blum Patient & Family Although health information is one of the top Learning Center, interpreter services, and other tools literacy, but the three most frequently searched topics on-line, only and resources available to support patient education. elderly, newly 10% of the adult population in the United States Patients can pick up helpful tips on topics such possess the skills needed to use the health informa- as, “How to Speak with your Child’s Doctor,” “How immigrated, tion available. With increased access to medical to Prepare for a Medical Appointment,” and “How knowledge via the Internet, it’s more important to be Medication Smart.” Information will be avail- and those with than ever that healthcare providers educate and able on Patient Gateway, iHealthSpace, and how support patients and caregivers using the basic prin- these on-line programs can enhance communication multiple, chronic, ciples of health literacy. between patients and healthcare providers. health conditions Low literacy skills aren’t the only barrier to com- Members of the Patient Education Committee prehension. Technical jargon, the complex­­ity of in- will be on hand to answer questions. Stop by and are especially formation, navigating an unfamiliar healthcare­ sys- test your own health literacy with the Wheel of tem, and the emotional stress of being confronted Knowledge. Members of the MGH community are vulnerable. with their own or a loved one’s diagnosis all impact our greatest assets in championing health literacy. a person’s ability to process and understand health For more information about the Patient Educa­ information. Even highly educated people are at tion Committee, health literacy, or the October risk for low health literacy, but the elderly, newly 28th educational booth, contact Gail Alexander, immigrated, and those with multiple, chronic, health RN, patient education and simulation professional conditions are especially vulnerable. development specialist, at 617-726-0359.

October 15, 2015 — Caring Headlines — Page 13 Patient Education

Patient-education material on IVC filter-removal now available new, multi-specialty, patient- Caring for Yourself after Your IVC Filter Insertion education document has was developed in tandem with a broader patient- Data shows been developed by the Fire- education initiative in collaboration with the man Vascular Center to Corrigan­ Minehan Heart Center. Both centers, in a low rate of ensure that patients who’ve partnership with the Maxwell & Eleanor Blum received retrievable inferior Patient and Family Learning Center are working to filter-retrieval vena cava (IVC) filters have standardize their patient-education materials. A key their filters removed when part of that standardization is creating materials us- nationwide... clinically appropriate. Experts from Vascular Med­ ing the principles of plain language. Caring for Aicine, Vascular Surgery, the Department of Radio­ Yourself after Your IVC Filter Insertion was designed Sometimes, filter- logy, and the Knight Center for Interventional­ to be accessible to all patients, regardless of their removal isn’t Cardiovascular Therapy health-literacy level. It is the first contributed to the develop- of many improved patient-educa- scheduled because ment of the document, tion materials to be developed by called, Caring for Yourself af- the Fireman Vascular Center and patients aren’t ter Your IVC Filter Insertion. the Corrigan Minehan Heart Data shows a low rate of Center. aware that filters filter-retrieval nationwide The centers are working to es- for a variety of reasons. tablish production guidelines for are intended to be Sometimes, filter-removal all print, on-line, and audiovisual­ isn’t scheduled because pa- materials in the hope of reducing temporary; so they tients aren’t aware that fil- duplication of efforts and improv- ters are intended to be tem- ing patient care. don’t follow up porary; so they don’t follow Caring for Yourself after Your up with providers to deter- IVC Filter Insertion can be found with providers to mine if and when the filter in the Partners Handbook, located should be removed. The in Partners Applications > Clinical determine if new document, Caring for References.­ For standardized use Yourself after Your IVC Filter across specialties, the document is and when the Insertion, strives to engage listed as: IVC filter form placement patients in their care, rein- and can be found under the filter should be force the message that filters are usually intended Cardiac, Procedure/Device, and Vascular folders of to be temporary, and encourage patients to follow the MGH Patient Education Documents page. removed. up with the clinician who placed the filter as well as For more information, contact Kalyn Horst, their primary care providers. health education project manager at 617-643-0062.

Page 14 — Caring Headlines — October 15, 2015 Patient Education

New COPD care instructions and patient-education materials now available n Tuesday, September 29, 2015, Provider Order Entry (POE) began prompting discharging clinicians to access COPD-management and pa- tient-education materials. The prompt is diagnosis-dependent, similar to the Stroke and Pneumonia prompts. A COPD tab appears in the Core Measure folder, asking the provider if an adult patient (18 years old or Oolder) has COPD. If the answer yes, additional questions are triggered. These are required questions for adult COPD patients and support optimal care for this patient population. The discharging nurse will be asked if the patient has re- ceived educational documents and can access the documents directly from the Post Hospital Care Plan folder. The folder contains three patient-education documents: • COPD Symptom Tracker, containing tips for early recognition of COPD exacerbation • Living well with COPD, containing information on what COPD is, how to manage it, and the benefits of pulmonary rehabilitation • Energy Conservation Techniques, containing tips on how to modify daily activities to be able to do more with less physi- cal exertion To see the new COPD patient-education documents, go to: Partners Handbook > COPD patient education. Or go to: Partners Applications > Clinical References > Partners Handbook, and follow the prompts to MGH Patient Education Documents, Respiratory. For more information, contact: Susan Morash, RN, at 617- 726-3130; Nancy Davis, RRT, at 617-724-4496; or Alison Squadrito, PT, at 617-724-7488.

October 15, 2015 — Caring Headlines — Page 15 Safety Unacceptable abbreviations revisiting an important, patient-care concern — by Patti Shanteler RN, staff specialist (Re-printed from the September 17, 2015, issue of Caring)

bbreviations are a useful, time-saving tool The list on this page comes from the MGH Patient Health for clinicians when documenting patient Record Policy. In addition to eliminating these potentially dan- care. But like any tool, they must be used gerous abbreviations in all patient-care documentation, staff are accurately and correctly in order to be encouraged to limit the use of abbreviations specific to certain effective. In 2001, the Institute for Safe practice areas or disciplines. Using abbreviations that are known Medication Practices (ISMP) issued a only to a select few can lead to confusion and the need to ‘guess’ warning about certain abbreviations that the intended meaning. One of the goals of an integrated record is contribute to confusion and increase po- to provide complete and accurate information to all caregivers tential for patient harm. That same year, The Joint Commission who come in contact with the patient. Ajoined the ISMP in voicing its concern, issuing Sentinel Event For more information about unacceptable abbreviations, con- Alert # 23: Medication­ errors related to potentially dangerous ab- tact Patti Shanteler, RN, staff specialist, PCS Office of Quality breviations. and Safety, at 6-2657. In 2004, The Joint Commission elevated attention to the mat- ter by addressing abbreviations in National Patient Safety Goal #2 Unacceptable Abbreviations and Symbol Dose related to effective communication. All hospitals were required­ to Expressions adopt the list of abbreviations recommended by The Joint Commission and to identify any additional abbreviations within (the following abbreviations should not be used) their institutions that could be considered problematic. Today, the • Q.D. and Q.O.D. requirement for maintaining a list of unacceptable abbreviations is • MS, MSO4, MgSO4 Standard IM.02.02.01. Compliance with this standard is evalu- • H.S. (for half-strength or bedtime) ated by Joint Commission survey teams, as the use of unaccept- • ss able abbreviations is considered a practice that could result in di- • ug for microgram rect harm to patients. • U or u The danger was initially attributed to hand-written abbrevia- • IU tions. It was thought that a combination of illegible handwriting • Per os (for oral) and certain ambiguous or misleading abbreviations could create • qn (for nightly) confusion and the potential for error. However, the risk of harm • BT (for bedtime) has carried over into the electronic age. • Zero after a decimal point (1.0mg); may be mis-read While the electronic medical record has decreased the poten- as 10mg if decimal point is not seen (correct dose tial for error by eliminating the ability to use certain abbreviations expression is 1mg) in templates and drop-down boxes, when it comes to inputting • No zero before a decimal point (.5mg); may be mis- free text, the potential for confusion and misinterpretation still ex- read as 5mg if decimal point is not seen (correct dose ists. And when there’s potential for misunderstanding in the medi- expression is 0.5mg) cal record, there is potential for errors that lead to patient harm.

Page 16 — Caring Headlines — October 15, 2015 Professional Achievements

Blanchard appointed Guevara certified Stacy certified Clinical Recognition Howard Blanchard, RN, clinical Ellison 12 staff nurse, Anna Maria Medical oncology staff nurse Program nurse specialist, Knight Center Guevara, RN, has become certified Kendra Stacy, RN, became certified Clinicians recognized for Interventional Cardiovascular in Medical-Surgical Nursing by the in Oncology Nursing by the May–September, 2015 Therapy, was appointed co- American Nurses Credentialing American Nurses Credentialing chairperson of the Membership Center. Center in July 2015. Advanced Clinicians: Committee for the National • Christina Alexander, RN, Association of Clinical Nurse Oncology Specialists, August 25, 2015. • Jason Beal, PT, Physical Therapy Mulgrew presents Scott publishes • Mallia Bourque, RN, Cardiac Surgical ICU Jackie Mulgrew, PT, physical therapy Katrina Scott, MDiv, chaplain, • Sarah Brooks, RN, General Larrivee certified clinical specialist, presented, “Physical published the article, “Being Bipolar Medicine Therapy Management of Patients in Boston,” in Harvard Divinity • Sarah Callahan, RN, General Kathleen Larrivee, RN, professional with Heart Failure,” at the Allied School’s Cosmologics magazine, Medicine development specialist, The Norman Health Education forum in Raleigh, August 25, 2015. • Elizabeth Daley, RN, Newborn Knight Nursing Center for Clinical North Carolina, on August 13, 2015. ICU & Professional Development, • Elizabeth DeBruin, RRT, became certified as a professional Respiratory Therapy development nurse by the Stacy certified • Ashley Fowler, RN, Neurosciences American Nurses Credentialing LaSala presents Staff nurse, Mary Stacy, RN, • Judy Gullage, RN, General Center, on August 14, 2015. Cynthia Ann LaSala, RN, Phillips became certified in Oncology Medicine 22 nursing practice specialist, Nursing by the American Nurses • Kaitlin Hudson, RN, Neurosciences presented, “Advance Care Planning, Credentialing Center • Sara Hunter, RN, Yawkey Infusion Communication, and Shared in July, 2015. Center Beauchamp ‘co-stars’ Decision-Making,” as part of the • Jeana Kaplan, SLP, Speech-Language Pediatric ICU clinical nurse specialist, American Nurses Association Pathology Meredith Kweskin, RN, General Kathryn Beauchamp, RN, is now webinar, September 10, 2015. • Salon appointed Medicine appearing in the critically acclaimed • Jennifer Mantia, RN, Medical ICU movie, Black Mass, with Johnny Heather Salon, PT, physical therapist, J. Naomi Martel, RN, General Depp, about the life of Boston mob • Arnstein presents was appointed a member of the Medicine boss, Whitey Bulger. Not surprisingly, Neurology Section Programming • Kristin Merli, RN, Yawkey Infusion Beauchamp plays a nurse, and early Paul Arnstein, RN, clinical nurse Committee for the American Center speculation is that she’ll clinch the specialist, Pain Relief, presented, Physical Therapy Association, • John Opolski, RN, Yawkey Infusion Oscar for Best Performance by a “Tapentadol Therapy to Manage in June, 2015. Center Nurse in a Supporting Role! Moderate-to-Severe Pain: Key • Joy Orpin, PT, Physical Therapy Considerations for Nursing,” at • Allison Pinsince, OTR/L, the national conference of Pain Occupational Therapy Management Nursing in Atlanta, Whitney honored • Lisa Rattner, RN, General Surgery Tighe Ventola certified September 18, 2015. Kevin Whitney, RN, associate chief • Justine Romano, LICSW, Social Ellen Tighe Ventola, PT, physical nurse, received the 2015 Mary B. Work Kim Smith Sheppard, RN, CRC therapist, became certified in Conceison Award for Excellence • Pregnancy and Postpartum Physical • Stacey Sullivan, SLP, Speech- in Nursing Leadership, from the Language Pathology Therapy by the American Physical Folger appointed Organization of Nurse Leaders • Stephanie Smith, OTR/L, Therapy Association’s Section on Abby Folger, PT, physical therapist, of Massachusetts, Rhode Island, Occupational Therapy Women’s Health, was appointed chair of the Patient and New Hampshire, at the ONL • Donna Tito, RN, Psychiatry on August 31, 2015. Advocacy Day Scope of Practice quarterly meeting, in Norwood, on • Danielle Van Eron, RN, Cardiology Fair Committee for the American September 11, 2015. • Georgette Young, RN, Pediatrics Physical Therapy Association of Massachusetts, in August, 2015. Clinical Scholars: • Adam Barrett, RN, Surgical ICU Folger was also appointed a • Lyndsey Farrow, RN, member of the Specialization Peri-Operative Services Academy of Content Experts, • Abby Folger, PT, Physical Therapy Cardiovascular and Pulmonary, for • Christine Joyce, RN, Cardiac the American Board of Physical Catherization Lab Therapy Specialties, • Saheeda Mohammed-Kelly, RN, through 2016. Labor & Delivery • Kristen Nichols, RN, GYN- Oncology • Richard Soria, RN, Medical ICU

October 15, 2015 — Caring Headlines — Page 17 Announcements

Apply for an Yvonne Blum Center Events Make your ACLS Classes L. Munn Nursing Please note the different times for practice visible: submit Certification: Research Award each program. a clinical narrative (Two-day program “Infection Prevention is Everyone’s Day one: lecture and review Eligible MGH nurses are Caring Headlines is always Day two: stations and testing) invited to apply for a Munn Business” interested in receiving clinical Nursing Research Award to Tuesday, October 20, 2015 narratives that highlight the Day one: pursue a clinical investigation. 1:00pm–2:00pm exceptional care provided by November 2, 2015 Proposals should focus on: presented by Dolores Suslak clinicians throughout 8:00am–3:00pm original research; advancing Patient Care Services. “Talking to Your Doctor Day two: evidence-based practice; or Make your practice visible. November 3rd performance improvement. about Pain” Submit your narrative for Wednesday, October 21st 7:00–11:30am Research teams must include a publication in Caring Headlines. (Note early start time) PhD-prepared nurse mentor. 12:00pm–1:00pm All submissions should be sent via presented by Paul Arnstein, RN e-mail to: [email protected]. Instructor class: To learn more about the December 2nd National Physical Therapy Month For more information, award, e-mail: Kim Francis, RN, call 4-1746. 7:00am–3:00pm at [email protected] or “We’ve Got Your Back!” Mary Larkin, RN, at MLarkin1@ Thursday, October 29th Locations to be announced. partners.org. 1:00pm–2:00pm Some fees apply. Learn how to arrange your Letters of intent due: Patient Care For information, contact Jeff work environment to best fit you Chambers at [email protected] October 16, 2015 and your body and reduce Associates Proposals due: stress and injury. To register, go to: December 11th presented by Tara Pai, PT Work Environment http://www.mgh.harvard.edu/ For more information, go to the Survey emergencymedicine/assets/ Munn Center website: at http:// Programs are free and open to Library/ACLS_registration%20 www.mghpcs.org/munncenter/ MGH staff and patients. As part of our overall evaluation form.pdf. Munn_Center_Research_Award. No registration required. of staff perceptions of their work asp. All sessions held in the Blum environment, the Patient Care Patient & Family Learning Center. Associates – Work Environment Survey (PCA -WES) was For more information, distributed the last week of call 4-3823. September. The survey is being conducted on-line; PCAs can complete the survey in one session or return The MGH Blood to it as many times as necessary; Donor Center all responses are anonymous. PCAs will have one month to The MGH Blood Donor complete the survey, which will be Center is located in the lobby used to promote a positive work of the Gray-Jackson Building. environment. The center is open for whole- blood donations: For more information, call Gaurdia Banister, RN, executive director Tuesday, Wednesday, Thursday, of The Institute for Patient Care, 7:30am – 5:30pm at 617-724-1266, or the Munn Friday, 8:30am – 4:30pm Center for Nursing Research at 617-643-0431. (closed Monday) Platelet donations: Monday, Tuesday, Wednesday, Thursday, 7:30am – 5:00pm Friday, 8:30am – 3:00pm Appointments are available Call the MGH Blood Donor Center at 6-8177 to schedule an appointment.

Page 18 — Caring Headlines — October 15, 2015 Policies, Products & Procedures Published by Caring Headlines is published twice each month by the department of Patient Care Services at Massachusetts General Hospital Publisher Jeanette Ives Erickson, RN senior vice president for Patient Care Recently updated Managing Editor Susan Sabia

Editorial Advisory Board Chaplaincy policies, products & Reverend John Polk Disability Program Manager Zary Amirhosseini Editorial Support procedures Marianne Ditomassi, RN Mary Ellin Smith, RN The following were reviewed by Patient Care Service’s Policies, Products & Procedures Maureen Schnider, RN Committee during August and September and have been updated in ellucid. Medical Interpreters Anabela Nunes Materials Management New: Edward Raeke

• Remedy Z-Guard Nutrition & Food Services Indicated for the relief of discomfort associated with diaper rash caused by wetness, Donna Belcher, RD Susan Doyle, RD urine and/or stool, and other macerated skin conditions Office of Patient Advocacy Robin Lipkis-Orlando, RN

Reviewed with changes: Office of Quality & Safety • Cooling Blanket/Warming Blanket Colleen Snydeman, RN Revision: Use of the bear hugger is the preferred method of warming for Orthotics & Prosthetics patients with non-clinically-induced low body temperatures Mark Tlumacki PCS Diversity • Nx Stage CVVH Circuit Blood Prime for Patients Weighing Less than 25 Kg. Deborah Washington, RN Revision: reflects the use of a new product — See-Leur caps Physical Therapy Occupational Therapy • Oral Care for the Patient Undergoing Cancer Treatment Michael Sullivan, PT Update: For patients with dentures, soak the dentures in sterile water when not Police, Security & Outside Services being used Joe Crowley • Subcutaneous Administration of Medication for Pain- and Symptom-Management Public Affairs (Continuous-PCA-Intermittent Infusion) Colleen Marshall Updates: Respiratory Care Ed Burns, RRT 1) If therapy is suspended for more than 6 hours, remove the needle. Insert new sub- Social Services cutaneous needle in a different location when and if therapy is resumed Ellen Forman, LICSW 2) Remove ketamine as it can be associated with painful skin lesions when adminis- Speech, Language & Swallowing tered subcutaneously Disorders and Reading Disabilities Carmen Vega-Barachowitz, SLP

Service Excellence Reviewed with no changes: Rick Evans Aerosolized Ribavrin—Patient Care • Training and Support Staff • Blood Culture Stephanie Cooper • Drain Care: Abscess, Percutaneous Drainage Catheter The Institute for Patient Care • Lumbar Drain External Cerebral Spinal Fluid- Drain Management Gaurdia Banister, RN • Oxygen Therapy Volunteer Services Jacqueline Nolan • Percutaneous Transhepatic Biliary Catheter Drain Irrigation Ventricular Catheter- Dressing Change Distribution • Milton Calderon, 617-724-1755 Submissions Retired: All stories should be submitted CitricAid Clear to: [email protected] • For more information, call: • Baza Protect 617-724-1746 Next Publication Ensure your practice is current by reviewing changes to policies and procedures in ellucid: (https://hospitalpolicies.ellucid.com). November 5, 2015 For more information, contact Mary Ellin Smith, RN, professional development manager, at 4-5801.

October 15, 2015 — Caring Headlines — Page 19 Partners eCare

Important eCare go-live dates approaching — by Demet Donnell, project specialist

Important Partners eCare go-live dates are approaching: ployment dress-rehearsals. A large part of preparing for • Wave 1A, December 10, 2015 implementation is the work being done at the divi- • Wave 1B, January 14, 2016 sional level. Those efforts are spearheaded by clinical • Wave 1C, January 28, 2016 champions working closely with the project team. Readiness efforts throughout the hospital are ramping The next few months leading up to the go-live dates up as we get closer to implementing the for Wave 1 will require in- clinical portion of Partners eCare. creased involvement of staff. Currently, efforts are focused on ensuring Partners eCare go-live dates: The MGH eCare project team that work-flows are aligned with the new • Wave 1A, December 10, 2015 is always available to answer system. Numerous­ work groups with repre- • Wave 1B, January 14, 2016 questions and provide guid- sentation from all clinical departments are • Wave 1C, January 28, 2016 ance throughout the transi- actively working to identify potential issues tion. They stress the impor- and recommended solutions. All issues are tance of completing all readi- being tracked and reported to ensure they’re resolved ness activities in your areas in a timely manner to en- before going live. sure successful transition. The MGH eCare project team has been meeting with For more information about Partners eCare activi- Wave 1 practices in preparation for go-live. Efforts in- ties, go to the MGH Partners eCare website (https:// clude identifying super users, peer educators, and creden- partnersecare.partners.org/hospital-networks/mgh/), or tialed trainers; mapping hardware; and conducting de- seek out an eCare clinical champion in your area.

First Class US Postage Paid Permit #57416 Headlines Boston, MA aringOctober 15, 2015 Returns only to: CVolunteer Department, GRB-B 015 MGH, 55 Fruit Street Boston, MA 02114-2696

Page 20 — Caring Headlines — October 15, 2015