Headlines CaringSeptember 1, 2016 Embracing diversity might mean making a few changes. Are you comfortable with that?

Comfort Zone

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Nursing and Patient Care Services Massachusetts General Hospital Jeanette Ives Erickson Recovery Month at MGH bringing knowledge, compassion, and evidence-based care to the treatment of substance-use disorders

or those who’ve never experienced an addictive illness, it may be diffi- Addiction is cult to appreciate the extent to which these disorders impact the lives of not a personal those affected. Many addictive ill- nesses are accompanied by physical, failing; rather, it’s a spiritual, emotional, and psychologi- cal side-effects that can be devastat- complex illness with ing — and among the most devastating are those re- Flated to substance-use disorders. neuro-biological Jeanette Ives Erickson, RN, senior vice president Each September, the Substance Abuse and for Patient Care and chief nurse and genetic Mental Health Service Administration (SAMHSA), a branch of the US Department of Health and health care embraces more holistic models of treat- components often Human Services, sponsors Recovery Month to help ment thanks to research and knowledge gained raise awareness around mental illness and substance- through evidence-based practice. rooted in trauma or use disorders and celebrate individuals in recovery. I’m happy to say that MGH is at the forefront of This year, MGH is holding its first Recovery this movement to promote innovative care and ho- stress. Changing the Month celebration to highlight the innovative care listic approaches to recovery. In response to a recent and interventions that make recovering from sub- assessment that identified substance abuse as a ma- culture to embrace stance-use disorders possible at MGH. The month- jor concern among local communities, MGH has long calendar of events (see schedule on page 4) offi- committed to addressing addiction as part of our this new paradigm cially kicks off Thursday, September 8th, from 12:00 ten-year strategic plan. We established the Sub­ requires education, to 1:00pm on the Bulfinch lawn, with remarks from stance Use Disorders initiative (SUDs) to expand MGH president, Peter Slavin, and Secretary of treatment options and help drive the paradigm shift commitment, Massachusetts Health and Human Services, Marylou toward more holistic methods of care and prevention. Sudders. The event is open to staff, patients, fami- At the root of this shift is an understanding that collaboration, and lies, community members, and anyone interested in addiction is not a personal failing; rather, it’s a com- learning about addiction care and prevention. plex illness with neuro-biological and genetic com- planning. Historically, addiction recovery programs have ponents often rooted in trauma or stress. Changing focused on the cessation of substance use, but absti- the culture to embrace this new paradigm requires nence-based models don’t work for everyone. For­ education, commitment, collaboration, and plan- tunately, new approaches are being introduced as ning — qualities we’re well acquainted with at MGH. continued on next page

Page 2 — Caring Headlines — September 1, 2016 Jeanette Ives Erickson (continued)

Peer specialists, known as recovery coaches, with the goal of providing compassionate, evidence- are already supporting patients with substance-use based care in sync with the patient’s readiness to re- disorders by accompanying them to appointments, ceive treatment. recovery meetings, court appearances, or just sitting The newly established Bridge Clinic serves as a with them to have a cup of coffee and listen. transitional walk-in clinic for patients who’ve been Supported by the department of Nursing, 30 recently discharged. Patients are stabilized and MGH nurses are currently enrolled in a pilot train- eventually transition to long-term care in their ing program to prepare for the Registered Nursing communities. Addiction Certification exam. Nurses are uniquely The MGH Center for Addiction Medicine, a Supported by positioned to engage with, educate, and motivate clinical research program within the department of patients to promote health and wellness. Psychiatry, evaluates, consults, and provides study­ the department of MGH physicians trained in addiction are lead- related care for patients who want to stop smoking ing efforts to provide access to pharmaco-therapy or control alcohol- and/or drug-related behaviors. Nursing, 30 MGH for patients with opioid-use disorders. They’re spear- The Addiction Recovery Management Service, heading efforts to train their colleagues in the care part of the Center for Addiction Medicine, pro- nurses are currently and treatment of SUD patients. vides rapid access to information, support, and out- enrolled in a pilot Staff from the Emergency Department have reach for young people, 14 -26 years old, and their worked hard to promote mindful opioid prescribing, families dealing with substance-related issues. training program safe monitoring of patients under the influence, Just as important as treating patients with sub- thorough evaluation of substance-use disorders, and stance-use disorders is trying to prevent addiction to prepare for referrals for further treatment. from developing in the first place. Prevention is the A multi-disciplinary, inpatient Addictions Con­ focus of a number of coalitions led by the MGH the Registered sult Team was established two years ago to assist Center for Community Health Improvement. These caregivers in providing evidenced-based, holistic coalitions engage with young people through school Nursing Addiction treatment for patients with medical and mental­ systems, advocate for treatment resources, and work health co-morbidities. To date, the Addictions with law enforcement to ensure a safe, supportive Certification Consult Team has provided nearly 2,000 consults response to substance-abuse situations. continued on next page exam. Nurses are uniquely positioned In this Issue to engage with, Embracing Diversity...... 1 Ben Corrao Clanon Award...... 12 educate, and motivate patients Jeanette Ives Erickson...... 2-4 New Leadership...... 13 • Recovery Month at MGH • Ann Marie Dwyer, RN to promote health Do We Need to Talk about Race at Work?...... 5 Reducing the Risk of Needlesticks...... 14-15 and wellness. MGH Global Nursing Fellowship...... 6-7 Fielding the Issues...... 16 • Trauma-Informed Care An Appreciation Luncheon...... 8 Announcements...... 17 Chaplaincy Milestone...... 9 Professional Achievements...... 18-19 Clinical Narrative...... 10-11 • Katie Perch, RN HCAHPS...... 20

(Photo on page 10 by Paul Batista)

September 1, 2016 — Caring Headlines — Page 3 Jeanette Ives Erickson (continued from page 3)

Recovery Month Calendar of Events

Reaching beyond our local neighborhoods, the MGH and the US Department of Health and Human Services rec- Lunder-Dineen Health Education Alliance of Maine is ognize that behavioral health is essential to maintaining overall good part of the MGH Substance­ Use Disorders Task Force, shar- health — and not just the health of the individual, the health of local ing best practices in addressing substance-use­­ disorders here at communities, states, and society at large. Substance-use disorders rep- MGH and in my home state of Maine. The ‘Time to Ask’ resent a public-health crisis. As healthcare­ providers, we have opportu- program is an inter-professional education model designed by nities throughout the continuum to impact this threat. We can and Lunder-Dineen to equip healthcare professionals with the must seize all opportunities to educate and protect our patients and knowledge, skills, and attitude needed to engage patients and the communities we serve. families in conversations about alcohol misuse. Time to Ask Our Recovery Month calendar includes educational offerings, pre- is being piloted in three primary-care settings in Maine with sentations, Q&A forums, and much more. I urge you to find time in your the goal of expanding the program throughout the state. The busy schedules to attend as many sessions as possible. And to get the Lunder-Dineen Alliance is the only one of its kind in the na- most out of these events, bring a friend or colleague... talk about what tion where knowledge and best practices are shared between you’ve learned... and share those lessons with staff who were unable to a large academic medical center and a neighboring state. attend. We can all play a part in spreading the message of recovery.

Page 4 — Caring Headlines — September 1, 2016 Commentary

Do we need to talk about race at work? — by Deborah Washington, RN, director, PCS Diversity

hom do you talk to when you have questions about race? Do those conver- sations happen often? Do you seek out friends or colleagues? Do you look to people of diverse backgrounds to have those conversations with? When we talk only to individuals who share our own racial identity, do we really learn anything about the day-to-day realities of people of other races? WI know it can be difficult to reach outside our comfort zone to have those conversations. But when we’re ‘comfortable,’ chances are we’re not being challenged. And when it comes to diversity, we all need to challenge ourselves to do better. Author, C.S. Lewis, once said: “I believe in Christianity as I Deborah Washington, RN director, PCS Diversity believe that the sun has risen: not only because I see it, but because by it, I see everything else.” Lewis saw the world through the filter Dr. Martin Luther King once described the work of of Christianity. What if we apply that metaphor to diversity. As a the civil rights movement as meeting, ‘days of chal- philosophy, diversity gives us a way to think about how we share lenge.’ Most of us are probably fairly homogeneous in our lives in an increasingly heterogeneous world. It raises the ques- our personal lives. But that all changes when we walk tion: What do we see when we embrace diversity; and what do we through the doors of MGH. Our hospital is a micro- miss when we don’t? cosm of a racially and ethnically diverse world. That From my observations, four things happen when we embrace being the case, we need the care we provide to be de- diversity: fined by the highest level of cultural competence and • Our ability to relate to one another across differences starts to sensitivity. We need an informed and diverse work- matter more force. We need every patient and family to receive the • By eliminating uncertainty about what it takes to build positive same high quality care and services. No one should feel relationships, our engagement with others increases under-served. • We have more positive interpersonal encounters. We take advan- As a hospital, we’re committed to zero tolerance for tage of opportunities to demonstrate our esteem for one another discrimination of any kind. If we truly ‘live’ our mission • Our respect for different points of view is reinforced and values, our practice will speak for itself — there will A friend recently commented that what makes America great is be no doubt of our commitment to diversity, inclusion, that it makes room for 300 million different opinions. Like America, and creating a place of healing for all. I urge you to talk MGH is a melting pot, a place to come together, to exchange ideas about race with your colleagues. Ask questions. Get to in various forums, meetings, gatherings, or simply when we have a know someone you might not ordinarily engage with. chat over a cup of coffee. Step outside your comfort zone.

September 1, 2016 — Caring Headlines — Page 5 Global Nursing

The MGH Global Nursing Fellowship spotlighting the importance of nursing mentorship — by Bethany Groleau, RN, staff nurse; Kara Olivier, RN, nurse practitioner; Pat Daoust, RN, nursing director; and Barbara Cashavelly, RN, nursing director

or more than a decade, the MGH with local staff to improve the quality of care in Center for Global Health has part- low-resource settings. During her time at Mbarara nered with Mbarara University of University,­ Groleau, worked with her Ugandan col- In the MGH Science and Technology in south- leagues to provide oncology nursing education and western Uganda to enhance patient develop culturally sensitive approaches to overcome Global Nursing care and support local clinicians in the social stigma associated with cancer in that managing a diverse range of medical country. Groleau spent six weeks in Mbarara teach- Fellowship, nurse conditions. Recently, the partnership ing a customized, oncology-focused curriculum and expanded to include nursing mentorship and educa- continued on next page fellows in under- Ftion through the innovative MGH Global Nursing Fellowship. In this new program, served areas nurse fellows in under-served areas provide instruction in the classroom and guidance provide instruction on clinical units to foster both professional development and excellence in clinical in the classroom practice. Earlier this year, Barbara Cashavelly, and guidance RN, nursing director for the Lunder 9 Oncology Unit, mentored staff nurse, on clinical units Bethany Groleau, RN, to help prepare her to foster both to apply for the inaugural fellowship. In May, work­ing with Pat Daoust, RN, nurs- professional ing director for Global Health, Groleau was recruited, oriented, and deployed­ to Uganda development as the first global nursing fellow. MGH is a champion of specialized nurs- and excellence in ing, recognizing it as an essential compo- nent of high-quality, patient-centered care. clinical practice. Partnering with local healthcare facilities where MGH enjoys long-standing rela- tionships, MGH nurse educators work (Photos provided by staff)

Page 6 — Caring Headlines — September 1, 2016 Global Nursing (continued)

caring for patients on inpatient and outpatient practice differences and the stigma associated with units. She worked closely with Sister Sarah Nabu­ a cancer diagnosis. shawo,­­ RN, charge nurse of the oncology unit at When Groleau arrived in Mbarara and met the Mbarara Hospital. nurses who tirelessly care for patients lined up out­­ As an oncology nurse at MGH, Groleau cares side each day, they proudly shared their desire to for patients with complex cancer diagnoses and sup- improve care and welcomed her as a valued resource. ports patients focusing on symptom-management. During her six-week deployment, Groleau contin- Opposite page: Mbarara nurses in oncology clinic Groleau’s work on Lunder 9 inspired her to seek out ued to reach out to Cashavelly and colleagues during classroom presentation. opportunities to care for patients with similar diag- back home for clinical information to help the Below: Groleau (right) with noses but who lack access to state-of-the-art re- Mbarara team. While the challenges faced by pa- Sister Sarah Nabushawo, RN. sources. For cancer patients and families in Uganda, tients, families, and providers in resource-limited Below right: Mbarara clinic long distances, long waits for diagnoses and treat- settings can seem overwhelming, the collabora- nursing team ment, and inconsistent drug supplies complicate ef- tion between these remote facilities, MGH Global fective chemotherapy treat- Health, and the MGH Cancer Center is a good ments that could potentially reminder that the compassion and motivation to save many lives. provide better care is universal. In the months prior to her Says Groleau, “Sharing knowledge and helping departure, Groleau worked others grow in their clinical practice was a privi- with Cashavelly and the lege. Through the Global Nursing Fellowship,­ I’ve MGH Global Health nursing been fortunate to build lasting professional and team to better understand personal friendships with my Ugandan colleagues. the needs of nurses and pa- I’m grateful to have had the opportunity to help tients in resource-limited set- educate such wonderful nurses and I thank them tings. Mindful of cultural dif- for all they taught me in return.” ferences and sensitive to For more information about the Global Nurs­ communication barriers, she ing Fellowship, contact Mary Sebert, RN, at 617- focused her preparation on 643-9197.

September 1, 2016 — Caring Headlines — Page 7 Appreciation Thank-you, Police & Security o offset some of the negative stories in the news of late, stop by. Says nursing director, Colleen Gonzalez, RN, “We work staff on White 8 wanted to make it very clear that, “We very collaboratively with Police & Security. They help us care love our colleagues in Police & Security.” So they held for patients in so many ways, often putting themselves in harm’s an appreciation luncheon on Wednesday, July 27, 2016, way to keep us and our patients safe. We’re so appreciative to in the White 8 visitor’s lounge. They brought in home- have such a competent, experienced, and responsive Police & Tmade baked goods and invited members of Police & Security to Security team — we just wanted them to know that.”

Nursing director, Colleen Gonzalz, RN, (right) with staff of White 8 (seated) and several officers from MGH Police & Security at recent appreciation luncheon

Page 8 — Caring Headlines — September 1, 2016 Chaplaincy

Concurrent graduating classes a milestone at MGH is a training site for professional chap- This represents a milestone in MGH history as they’re the first lains through the Association of Clin- residency and summer-unit classes to graduate concurrently in MGHical Pastoral Education. Pictured below the almost 80 years since clinical pastoral education has been are graduates of the 2016 graduating classes of Clinical Pastoral offered at MGH. In the 1930s, MGH became the first general Education residents and summer Chaplaincy students. Residents hospital in the country to host a CPE unit, initiated by MGH are full-time clinicians on staff for 12 months; summer students physician, Richard Cabot, MD, and visiting minister, Rev. fulfill a level-one unit in 11 weeks. Russell Dicks.

(Photo by Paul Batista)

September 1, 2016 — Caring Headlines — Page 9 Clinical Narrative

Compassion and advocacy go hand-in-hand for RACU nurse

y name is Katie Perch, and I am a nurse in the Respira- tory Acute Care Unit (RACU). Nurses in the RACU are constantly engaging with patients’ emotional, psycho- ‘John’ had been logical, and physical strug- gles. We’re on the front diagnosed with lines of ethical decision-making and implementing Mmedical decisions that affect patient’s quality of life ALS in his home forever. These situations do not get easier with Katherine Perch, RN time. But after years of experience and better un- staff nurse, RACU state a year prior derstanding, I’ve developed a deep compassion for discussed the nature of progressive illness, how he this patient population. would soon require more non-invasive support. to his admission. ‘John’ had been diagnosed with ALS in his Eventually, they’d need to make a decision about home state a year prior to his admission. Currently, whether John would want an artificial airway or Currently, he was he was able to breathe on his own for the majority focus more on comfort. As we spoke, I saw a look in of the day, requiring a BiPAP mask at night for re- John’s eyes, a look I’ve come to recognize after years able to breathe spiratory support while sleeping. John had been fol- of experience, a look of fear and despair. lowed as an outpatient in the MGH ALS clinic, but I called John’s nurse practitioner from the ALS on his own for the was admitted to the RACU due to difficulty breath- clinic to come visit. Even though she’s not part of majority of the day, ing after a fall from his wheelchair. It was discov- the RACU team, I knew she had a strong rapport ered that John had aspirated during the fall and de- with John, and he needed someone he could trust. requiring a BiPAP veloped pneumonia. She told me that they’d had in-depth conversations Over the course of a week, John’s pneumonia about the possibility of a tracheostomy and ventila- mask at night for cleared with antibiotics, but his underlying disease tor support when he was in the clinic. I told her he was progressing, and so was his emotional distress. was becoming anxious about his breathing, espe- respiratory support “What if I get back home and can’t breathe again?” cially about returning home. Many patients in this he asked me. population have similar fears. I asked the nurse while sleeping. John and I had become quite close; I was one of practitioner to provide more information to John his primary nurses. We often discussed his family, and his wife to help allay their fears. his home town, and things he and his wife enjoyed I arranged a ‘curb-side’ meeting­ with John, his doing. I developed a therapeutic relationship with wife, the nurse practitioner, another nurse from the both John and his wife, ‘Mary.’ Mary was staying at ALS clinic, and our social worker and respiratory a local hotel and was at John’s side every day. We therapist. We had an open, in-depth discussion continued on next page

Page 10 — Caring Headlines — September 1, 2016 Clinical Narrative (continued)

about what was involved with getting a trach and later re- “Are we doing the right thing?” she said. quiring a ventilator. We explained that as his diaphragm I knew she was struggling with the idea that became more impaired, the harder it would be to breathe her husband’s life was about to change dramati- on his own, at which point he’d need more invasive sup- cally. We sat together and talked and hugged. port. I stressed the importance of being able to communi- “I can’t imagine how hard this must be,” I said. cate once he no longer had his voice. “But you and John have discussed this. If this is In the next few days, our occupational therapist, speech what he truly wants, who’s to say what’s ‘right’?” I’ll never language pathologist, and I worked with John and Mary to I confirmed that this was the safest way for forget the develop a communication system using his eyes to convey John to travel to the OR, that he’d be well medi- common phrases. We encouraged him to share his con- cated, and would come right back to the unit after feeling I got cerns with us so we could incorporate what was meaning- the procedure. She gave me one of the tightest ful to him into a letter board for communication later. hugs I’ve ever received. Mary chose to step out when I heard Two weeks after being admitted, despite his pneumonia during the intubation after giving her husband a clearing, John had begun requiring longer periods of kiss. It was so clear to me why John had wanted he was able BiPAP. The skin on his face was beginning to break down the procedure done at MGH. He was safely intu- from wearing the mask. bated by the anesthesiologists at the bedside, then to go home John’s doctor advocated against performing a trach, off to the OR he went. noting that John’s diaphragm was still working, and in The first few days post-trach were the hardest. with his family. light of his anxiety, losing his voice would not be in his A sore and swollen John was visibly frustrated. But best interest. I told him the soreness from the surgical site would I knew this As his nurse, I advocated for the opposite. John’s fear go away, that he’d just had major surgery. Emo­ was that he was now requiring more non-invasive support. tional­ encouragement goes a long way with this wasn’t the end He was scared that if we didn’t perform the procedure population — it’s easy to get depressed with such a here, something would happen emergently, and it would chronic, progressive illness. John became more of his journey, be traumatic. “John wants the trach,” I said. “It’s within comfortable with his new style of communication his goals of care. He’d rather have it placed here, elec- and was eventually able to laugh and smile with but having been tively than be emergently intubated in front of his family.” his family again. After days of discussion with his entire team, John was The day John was discharged was bitter-sweet. able to care for scheduled for the procedure. I wasn’t on duty the day he left, but I’ll never for- On that day, as John was about to be taken to the OR, get the feeling I got when I heard he was able to John and his the nurse anesthetist asked, “Is this patient able to toler- go home with his family. I knew this wasn’t the family during ate lying flat?” end of his journey, but having been able to care for “No,” I said. “He can’t.” John and his family during such an eventful time such an eventful “Will we be able to Ambu-bag him en route to the was a monumental milestone in my nursing career. OR?” Comments by Jeanette Ives Erickson, RN, time was a I knew John wouldn’t be able to tolerate that. I shook senior vice president for Patient Care and chief nurse my head. “No. He’s requiring constant non-invasive sup- Living with a terminal illness requires numerous monumental port.” I told her. “We can’t take him to the OR on BiPAP,” she said. course-corrections along the way. Decisions made milestone in I grabbed our respiratory therapist and told her the di- early on are sometimes questioned when the real- lemma. She agreed that he couldn’t tolerate lying flat or ity of diminished capabilities sets in. John and his my nursing being Ambu-bagged. family were lucky to find themselves in Katie’s I suggested a controlled intubation at the bedside for care in the RACU. She was a compassionate guide career. airway protection until he could get to the OR for the and strong advocate during those difficult, uncer- trach procedure. The nurse anesthetist agreed and called tain times. This narrative is a wonderful example her attending and the intubation team. of relationship-based, patient- and family-centered As the anesthesiologist explained what was about to care. Katie was right — these situations don’t get happen, I looked at Mary, one of the strongest women I’ve easier with time, but her nursing practice becomes ever met, and she looked terrified. I ushered her out of the more informed with every patient she cares for. room and explained exactly what was happening. Thank-you, Katie.

September 1, 2016 — Caring Headlines — Page 11 Recognition

The Ben Corrao Clanon Memorial Scholarship — by Mary Ellin Smith, RN, professional development manager

he Ben Corrao Clanon Mem- 30th presentation of the scholarship that recognizes orial Scholarship was created excellence in primary nursing. In her comments, by Jeff Clanon and Regina NICU nursing director, Peggy Settle, RN, observed, Corrao as a tribute to their son, “When you walk in and see that Cheryl is working, Ben, who died in the NICU in you know that patients, families, and staff are being 1986. Corrao and Clanon es- well cared for. Her practice reflects primary nursing tablished the scholarship to at its absolute best.” recognize NICU nurses who Said one col- demonstrate exemplary practice, a commitment league of Slater, Tto primary nursing, and ongoing support and ad- “When it comes vocacy for patients and families. This year’s re- to advocating (L-r): Peggy Settle, RN; Sam Clanon; Regina cipient of the Ben Corrao Clanon Memorial for her patients, Corrao; Jeff Clanon, and Scholarship was NICU staff nurse, Cheryl Slater, Cheryl never scholarship recipient, RN. has a half-day Cheryl Slater, RN. On Tuesday August 2, 2016, Corrao, Clanon, day. She’s all in, At right: Slater and Settle. and their son, Sam, returned to MGH for the every day, all the time.” Said Clanon, “When your baby is brought to the NICU, it’s like be- ing dropped off on another planet. But you were always there for us, and for Ben. You helped and guided us with such compas- sion, the same way you’ve helped all the families who’ve come here for the past thirty years. Thank-you so much.” Slater acknowledged her colleagues say- ing, “You taught me how to be a better nurse. Primary nurses guide families through some of their most stressful times and help the team know and understand these newborns and their parents.” For more information about the Ben Corrao Clanon Memorial Scholarship, call Mary Ellin Smith, RN, at 617-724-5801.

Page 12 — Caring Headlines — September 1, 2016 New Leadership

Dwyer joins PCS leadership team ursing and Patient Care Ser- vices is pleased to welcome Dwyer came on Ann Marie Dwyer, RN, to the board, August 14, position of director of Clinical Informatics. Dwyer comes to 2016, and had an us with a wealth of experience throughout the Partners net- opportunity to work, most recently as the se- nior eCare nurse leading the team that dealt with work with outgoing Nclinical content and process re-design, biomedical de- vice-integration, clinical informatics, and quality and director, Van Hardison, safety during the highly successful launch of Partners eCare. RN, to ensure a Says Jeanette Ives Erickson, RN, senior vice presi- dent for Patient Care, “I’ve had the pleasure of work- smooth transition. ing with Ann Marie in her role as senior nurse for Ann Marie Dwyer, RN, new director, Nursing and PCS Clinical Informatics One of Dwyer’s Partners eCare, as co-leader of the Partners eCare Clinician Team, and when she served as chief nurse have two such accomplished informatics spe- first priorities was for the Spaulding Rehabilitation­ Network. Ann cialists guide us through these times of great Marie is also a key member of the Partners Chief technological change. Thank-you, Van. And attending a two-week Nurse Council’s Nursing Informatics Leaders Group.” welcome, Ann Marie.” Dwyer came on board, August 14, 2016, and had Says Dwyer, “I’m honored and excited to training program at an opportunity to work with outgoing director, Van be part of the Nursing and Patient Care Ser­ Hardison, RN, to ensure a smooth transition of lead- vices team. While at Partners eCare, I had Epic headquarters to ership. One of Dwyer’s first priorities as new director the pleasure of seeing first-hand the high was attending a two-week training program at Epic level of professionalism and engagement prepare for the eCare headquarters to learn and prepare for the eCare up- among the MGH team. It was both motivat- upgrade scheduled grade scheduled for this October. ing and inspiring. I look forward to working Says Ives Erickson, “I want to thank Van for his with all my new colleagues across the organi- for October. stellar leadership through the preparation and imple- zation on the evolution of clinical informa- mentation phases of MGH eCare. We’re fortunate to tion systems at MGH.”

September 1, 2016 — Caring Headlines — Page 13 Safety

Reducing the risk of needlesticks — by Georgia Peirce, project manager, and Andrew Gottlieb, director, Occupational Health Services

ary’ was a nurse who’d been do- • holding a hypodermic needle that has a safety ing administrative work. One device busy day, she stepped in to help a • disposing of a needle or cleaning up after a colleague who asked her to give procedure an injection to a patient. Using a • inserting or withdrawing a needle from a patient needle the patient had brought The total number of While sharps devices are ever-present and used ‘Mfrom home, Mary gave the injection then began to hundreds of thousands of times throughout the hos- needlesticks at MGH re-cap the needle. That’s when she felt the pinch. pital each year, the total number of needlesticks at Followed by panic. “I was terrified I might’ve just is relatively low. But MGH is relatively low. But for the person who ex- given myself HIV. I learned the hard way that you periences a sharps injury, one stick can change their for the person who never re-cap needles.” life. ‘John’ was an experienced nurse and role model. experiences a sharps When a needlestick or sharps injury occurs, the One day, after giving an injection, he began to source patient should be tested for hepatitis and injury, one stick can close the needle’s safety device. He knew he should HIV if their status is not known at the time of in- brace it against a hard surface, but he was in a hurry, change their life. jury. In cases where that testing cannot take place, so he pressed it against his forearm. The needle injured staff are assumed to have been exposed to slipped and penetrated his skin. HIV and/or hepatitis and need to make certain life- One staff member had trouble closing a sharps style changes until infection can be ruled out. Those bin in an ICU. When she gave the cover a quick changes can include delaying pregnancy or discon- push, she felt the pinch of a needle she hadn’t seen. tinuing breast-feeding for up to six months. The in- Another staff member felt a pinch when she was jured person should begin immediate prophylactic cleaning up after a procedure in a patient’s room. treatment for HIV and have their blood tested at She was unaware that an exposed needle had been regular intervals. left in the bedding. Needlestick injuries can be extremely stressful These are real examples from MGH safety re- and inconvenient with individuals sometimes hav- ports, and they’re compelling reminders of the ing to wait months to find out if/when their lives importance of ‘sticking’ to best practice when will return to normal. it comes to handling needles and other When handling sharps devices, to reduce your sharp instruments. risk of injury, stick to best practice. Sharps represent a hazard in virtually Needles: every setting. According to 2015 data • Always engage the needle safety device (hinged) gathered by MGH Occupational immediately after removing the needle from the Health Services, needlestick injuries patient most often happen when: continued on next page

Page 14 — Caring Headlines — September 1, 2016 Safety (continued)

• Always listen for or feel the click that tells you it’s activated Sharps bins: • Always activate the needle safety device (hinged) against a • Always dispose of a sharps device immediately after use, even if hard surface; never use your finger or other body part the safety device has been engaged • Always activate needle safety device (retracting) before remov- • Always request a new sharps bin as soon as the current one ing the needle from the patient starts to fill up; don’t let it get beyond ¾ full Hands: For more information or to register concerns or suggestions • Never re-cap a syringe related to needlestick safety, speak with your supervisor or unit or • Never put your hand near a needle/sharp device, including department leadership, contact MGH Occupational Health at during disposal 6-2217, or e-mail [email protected].

September 1, 2016 — Caring Headlines — Page 15 Fielding the Issues

Trauma-informed care what is it, and how does it affect my practice?

Question: I’ve been hearing the term, ‘trauma-informed care’ Question: How does trauma-informed care help our lately. What is this? colleagues? Jeanette: Trauma refers to the experience of abuse, neglect, vio- Jeanette: Trauma-informed care also means taking care of lence, or discrimination, especially in childhood. Trauma-informed ourselves and one another; recognizing when staff or colleagues care is based on our increasing understanding that many patients, experience stress due to trauma at home or secondary trauma at families, and colleagues have endured traumatic experiences that work. Hearing about the first-hand trauma of others can lead to have lasting impact. The landmark, Adverse Childhood­ Experi­ symptoms of fatigue, disturbing thoughts, poor concentration, ences study, and other research shows that exposure to trauma exhaustion, avoidance, absenteeism, and physical illness. Staff heightens health risks throughout the life span, including the risk experiencing these symptoms may struggle to provide high- of chronic lung, heart, and liver disease, depression, sexually quality care or experience burn-out. Preventing secondary trau- transmitted diseases, and substance-use disorders. matic stress can increase morale and allow staff to function at their best. Question: What is trauma-informed care? Jeanette: Trauma-informed care recognizes the prevalence of trauma and seeks to avoid re-traumatizing patients by inadver- Question: What are we doing to raise awareness? tently triggering reminders of traumatic experiences. Traumatic Ensuring we provide trauma-informed care is a memories can interfere with a patient’s ability to receive care or Jeanette: Partners-wide initiative. Later this month, MGH will host the cause emotional and biological stress. Trauma-informed care can 4th annual Partners Trauma-Informed Care Symposium. potentially improve patient engagement, adherence to treatment, Sponsored by the Knight Nursing Center, the MGH Social health outcomes, and reduce costs. Service Department, and Partners HealthCare, the symposium will be held September 26th in O’Keeffe Auditorium. Keynote Question: What does trauma-informed care look like? speaker, Carole Warshaw, MD, director of the National Center on Domestic Violence, Trauma & Mental Health, is a widely Jeanette: Patients may not reveal their trauma history for a va- recognized expert in the field. A panel discussion on integrat- riety of reasons, so experts recommend assuming everyone (pa- ing trauma-informed care into practice will be part of the sym- tients, families, and co-workers) may have a history of trauma. posium. All are welcome to attend; registration is required. Some strategies for making patients feel safe include giving them a choice, allowing them to have some control, avoiding surprises, informing them of what you’re going to do, and getting their per- Question: How can I learn more? mission before proceeding. Think about making your communica- To learn more about trauma-informed care, contact tion consistent, open, respectful, and compassionate. Jeanette: Debra Drumm, LICSW, director of HAVEN, at 617-724-0054. The physical environment is also important. Ensure that in- For more information about the symposium or to register, go door and outdoor spaces are well-lit, people aren’t loitering near to: http://www.cvent.com/d/dvqk26 Panel- http://www.cvent. entrances and exits, and patients have access to the door so they com/d/dvqk26 can exit easily if desired.

Page 16 — Caring Headlines — September 1, 2016 Announcements

SAFER Fair and MGH Nurses Blum Center Events Global Nursing: community outreach Alumnae Association focus on Recovery a Force for Change event fall reunion and Month Improving Health System Join collaborative governance educational program “Engaging Youth with Substance- Resilience champions to learn how they’re Use Disorders in Care and This year’s theme: October 14-15, 2016 working to make a SAFER “Nurse Leaders Making a Supporting their Parents” environment for patients, Thursday, September 1, 2016 9:00am–5:00pm Difference” at MGH families, and staff. Friday, September 23, 2016 11:00am–12:00pm O’Keeffe Auditorium This program will focus on Join nurse leaders, clinicians, and And bring socks! 8:00am–4:30pm current trends in youth substance educators to discuss the critical use, treatment, and strategies for Please bring a pair (or two) role of nursing in strengthening Sessions will include: “The engaging youth in treatment by health systems around the world. of new socks to be donated to a Development of the Nursing involving their parents. local community shelter. Leadership Academy,” “Doctor Abstract submission deadline is There will be games, refreshments, of Nursing Practice Program,” “Bridging the Gap: Meeting People September 1, 2016. Acceptance and prizes. “Global Nursing,” “Advancing Peer Where They Are” notifications will be sent via e-mail Review,” and more. Wednesday, September 7th by September 15, 2016. Wednesday, October 19, 2016 11:00am–12:00pm 12:00–2:00pm For more information or to For more information, or Learn about the MGH Bridge to submit an abstract, go to: Under the Bulfinch Tent register, call the MGH Nurses Clinic. Alumnae Association at http://www.massgeneral.org/ For information, call Mary Ellin 617-726-3144. globalhealth/ Smith, RN, at 4-5801. “Addiction, Recovery, and Quality of Life” Open to the public Wednesday, September 14th Submit an abstract 1:00–2:00pm ACLS Classes Hear the latest findings in Certification: for MGH Clinical addiction science. Collaborative (Two-day program Governance Research Day “Beyond Traditional Treatment Day one: lecture and review Call for applications Day two: stations and testing) On Thursday, October 6, 2016, Options: Innovations to Engage MGH will celebrate the 14th Patients” Applications are now being Day one: annual Clinical Research Day. Tuesday, September 20th accepted for Collaborative November 10, 2016 The Division of Clinical Research 1:00–2:00pm Governance, the decision-making 8:00am–3:00pm invites investigators to submit Providing patients with options body that places the authority, is the most effective form of Day two: abstracts by September 6th. responsibility, and accountability treatment. This program will for patient care with practicing November 11th Research must have been review this new treatment 8:00am–1:00pm conducted at MGH and may clinicians. philosophy. Committees seeking membership Re-certification (one-day class): include manuscripts published after September 1, 2015. include: October 12th “There is Treatment. Treatment • Diversity, 5:30–10:30pm Awards for best abstracts: Works” • Ethics in Clinical Practice $5,000 team award Thursday, September 29th Informatics Location to be announced. • 1:00pm–2:00pm • For information, send e-mail to: • $1,500 translational research • Patient Education award Providers from the MGH West Patient Experience [email protected], or call End Clinic will discuss treatment • 617-726-3905 • $1,000 individual award • Policy, Procedure, and • Departmental awards and recovery. A panel of patients Products To register, go to: will share their experiences. • Quality and Safety http://www.mgh.harvard.edu/ Clinical Research Day will begin • Research and Evidence- emergencymedicine/assets/ at 8:00am with a keynote address Programs are free and open to Based Practice Library/ACLS_registration%20 by Sandra Glucksmann, chief MGH staff and patients. Staff Nurse Advisory form.pdf. operating officer, Editas Medicine. No registration required. • For more information on the To submit an abstract, go to: All sessions held in the Blum Patient & Family Learning Center. committees or how to join, https://crp2016.abstractcentral. contact Mary Ellin Smith, RN com/ For more information, at 4-5801. For more information, call 4-3823. e-mail Jillian Tonelli or call 617-724-2900.

September 1, 2016 — Caring Headlines — Page 17 Professional Achievements

Folger presents Abreau certified Folger presents Penzias publishes Abby Folger, PT, physical therapist, Paige Abreau, RN, became certified Abby Folger, PT, physical therapist, Alexandra Penzias, RN, authored presented, “Clinical Integration,” in Medical Surgical Nursing by the presented, “Clinical Integration,” the article, “Speaking Up in Real at Northeastern University, American Nurses Credentialing at Northeastern University, Time: Skills for Education and July 5, 2016. Center, in June, 2016. in July 5, 2016. Safety,” in the Journal of Radiology, in June, 2016.

Brunelle honored Downing certified Arnstein publishes Cheryl Brunelle, PT, physical Catherine Downing, RN, became Paul Arnstein, RN; Katharine Koury; Rosa publishes therapist, received the One certified in Adult Medical Surgical Hang Lee; and Padma Gulur, MD, Katherine Rosa, RN, authored the Hundred award from the MGH Nursing by the American Nurses authored the article, “Morphine article, “Integrative Review on the Cancer Center, in May, 2016. Credentialing Center, in June, 2016. Before Hydromorphine — Results of Use of Newman Praxis Relationship a Quality Improvement Initiative,” in in Chronic Illness,” in Nursing Science Global Anesthesia and Perioperative Quarterly. Medicine. Foley honored Mulgrew presents Kimberly Foley, RN, staff nurse, Jackie Mulgrew, PT, physical received the SGNA Gabriele therapist, presented the webinar, Lipkis-Orlando honored Schindler Clinical Excellence “Physical Therapy Management Nurses present poster Robin Lipkis-Orlando, RN, director, Award, from the Society of of Patients with Heart Failure,” at Linda Caruso, RN; Sara Astarita, Office of Patient Advocacy, received Gastroenterology Nurses and Allied Health, Inc., March 14, 2016. RN; Anne Marie Barron, RN; and, the Cyrus C. Hopkins, MD, Patient Associates, in June, 2016. Patricia Rissmiller, RN; presented Safety Leadership Award, their poster, “Women’s Sexuality July 15, 2016. after Stem Cell Transplant,” at the Elien a panelist Oncology Nursing Society’s annual Sullivan honored Sandra Elien, domestic violence congress, in Austin, Texas, Caitlin Sullivan, RN, staff nurse, advocate, served as a panelist April 30, 2016. Keeney appointed received the Nursing Recognition discussing “The Role of a Hospital Tamra Keeney, PT, physical therapist, Award from the Internal Medicine DV Advocate” at the Health Care was appointed item writer, SACE Residency Program, June 9, 2016. Learning Forum at the Training (Specialization Academy of Content Institute of the Massachusetts Penzias presents poster Experts), for the Cardiovascular Medical Society in Waltham, Alexandra Penzias, RN, presented and Pulmonary Section of the June 3, 2016. her poster, “Perception of Nursing American Board of Physical Therapy Arnstein appointed Presence in Patients Experiencing Specialties. Paul Arnstein, RN, clinical nurse MRI-Guided Breast Biopsy,” at specialist, was appointed a member the annual conference of the of the Technical Advisory Panel of Keegan Argyropoulos International Association of The Joint Commission on presents Human Caring, in Boston, Scott presents June 29, 2016. Sarah Keegan Argyropoulos, RN, June 8-10, 2016. Katrina Scott, staff chaplain, presented, “Improving the Quality presented the, “End-of-Life Issues of Inpatient Bowel Preparation for Seminar,” at the Summer Institute in Colonoscopies with Active Nursing Siwy presents poster Bioethics at Yale University, Peterson re-elected Facilitation,” at the annual course June 16, 2016. Gayle Peterson, RN, staff nurse, of the Society of Gastroenterology Katherine Siwy, OTR/L, occupational Scott also presented, “Who Are was re-elected to the staff nurse Nurses and Associates, in Seattle, therapist, presented her poster, You? A Dignity Therapy Primer,” position of the Board of Directors Washington, May 23, 2016. “Fractionated CO2 Laser and Burn at the annual conference of of the American Nurses Association, Scar Contractures: Evaluation of the Association of Professional in June, 2016. Post-Treatment Scar Function and Chaplains in Orlando, Florida, Appearance: a Year Review,” at the June 24, 2016. annual meeting of the American Burn Association, in Las Vegas, May 4, 2016.

Page 18 — Caring Headlines — September 1, 2016 Published by Caring Headlines is published twice each month by the department of Nursing & Patient Care Services at Massachusetts General Hospital Siwy appointed Hunter honored Levin-Russman presents Publisher Jeanette Ives Erickson, RN Katherine Siwy, OTR/L, occupational Oncology nurse, Sara Hunter, RN, Elyse Levin-Russman, LICSW, social senior vice president therapist, was appointed co-chair of received a 2016 Massachusetts Care worker, presented, “Developing for Patient Care the Rehabilitation Committee for Award from Labouré College on and Sustaining a Family Advisory Managing Editor the American Burn Association, June 9, 2016, Committee in Pediatrics over Susan Sabia in July, 2016. Many Years,” at the annual Patient and Family Advisory Council Editorial Advisory Board Conference, in Norwood, Chaplaincy Kane certified June 23, 2016. Reverend John Polk Brooks certified Amanda Kane, RN, staff nurse, Disability Program Manager Sarah Brooks, RN, staff nurse, MICU, became certified as a Zary Amirhosseini became certified as a medical- critical care nurse by the American Editorial Support surgical nurse by the American Association of Critical Care Nurses Inter-disciplinary team Marianne Ditomassi, RN Mary Ellin Smith, RN Nurses Credentialing Center, Certification Corporation, publishes Maureen Schnider, RN in July, 2016. in July, 2016. Christopher Herndon; Paul Medical Interpreters Arnstein, RN; Beth Darnall; Craig Anabela Nunes Hartrick, MD; Keith Hecht; Mary Lyons, RN; Jahangir Maleki, MD; Materials Management Edward Raeke Nurses publish Nurses publish Renee Manworren, RN; Christine Virginia Capasso, RN, and Alicia Kevin Mary Callans, RN; Carolyn Miaskowski, RN; and Nalini Sehgal, Nutrition & Food Services Wierenga, RN, authored the chapter, Bleiler, RN; Jane Flanagan, RN; and MD, co-edited the 7th edition of Donna Belcher, RD Susan Doyle, RD “Carotid Stenosis,” in Primary Care: a Diane Carroll, RN, authored the Principles of Analgesic Use, Collaborative Practice, in June, 2016. article, “The Transitional Experience in July, 2016. Office of Patient Advocacy of Family Caring for their Child with Robin Lipkis-Orlando, RN a Tracheostomy,” in the July-August, Office of Quality & Safety 2016, Journal of Pediatric Nursing. Colleen Snydeman, RN Hebert certified Nurses present poster Orthotics & Prosthetics Jason Hebert, RN, staff nurse, Sheila Golden-Baker, RN, George Reardon became certified as a critical care professional development specialist, McDonald certified PCS Diversity nurse by the American Association and Mary McAdams, RN, clinical Deborah Washington, RN of Critical Care Nurses Certification Carolyn McDonald, RN, staff nurse, educator, presented their poster, Corporation, in July, 2016. became certified as a neuroscience Physical Therapy “Applying Nursing Peer Review Occupational Therapy nurse by the American Board of to the Nursing Professional Michael Sullivan, PT Neuroscience Nursing, in July, 2016. Development Role: Challenges Police, Security & Outside Services and Opportunities,” at the annual Joe Crowley Inter-disciplinary team conference of the Association of publishes Nursing Professional Development, Public Affairs MacKenzie presents Colleen Marshall Chantal Ferguson; Cheryl Brunelle, in Pittsburgh, July 20-21, 2016. PT; Meyha Swaroop; Nora Horick; Carole MacKenzie, RN, professional Respiratory Care Ed Burns, RRT Melissa Skolny; Cynthia Miller; development specialist, Lunder- Lauren Jammallo; Jean O’Toole, PT; Dineen Health Education Alliance Social Work Laura Salama, MD; Michelle Specht, of Maine, presented, “Best Practices Ellen Forman, LICSW MD; and Alphonse Taghian, MD, in Developing a Statewide Speech, Language & Swallowing authored the article, “Impact of Collaborative Practice Model Disorders and Reading Disabilities Ipsilateral Blood Draws, Injections, to Advance Nursing Preceptor Carmen Vega-Barachowitz, SLP Blood-Pressure Movements, and Air Education,” at the Maine Preceptor Training and Support Staff Travel on the Risk of Lymphedema Education Program, in Pittsburgh, Gino Chisari, RN July 20, 2016. for Patients Treated for Breast The Institute for Patient Care Cancer,” in the March, 2016, Journal Gaurdia Banister, RN of Clinical Oncology. Volunteer Services Jacqueline Nolan

Distribution Milton Calderon, 617-724-1755 Submissions All stories should be submitted to: [email protected] For more information, call: 617-724-1746 Next Publication September 15, 2016

September 1, 2016 — Caring Headlines — Page 19 HCAHPS

Inpatient HCAHPS Current data

The data is complete through June, 2016. We have partial data through August. MGH is performing well in our Overall Hospital Rating category.

All results reflect Top-Box (or ‘Always’ response) percentages

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Page 20 — Caring Headlines — September 1, 2016