Providing Quality Health Care Half-Way Around the World

aringAugust 17, 2006 CCaringHEADLINES Inside: Providing quality

An Update from the Durant Fellows ...... 1 health care half-way around Jeanette Ives Erickson ...... 2 the world z Global Thinking (See page 6) Fielding the Issues ...... 3 z Service Improvement Initiatives

Physical Therapy ...... 4 z The Boston Lobsters

Clinical Narrative ...... 8 z Katherine O’Meara, RN

ENCARE Teaches Safety and Prevention ...... 10

Staff Perceptions of the Profes- sional Practice Environment Survey ...... 11

Clinical Nurse Specialist ...... 12 z Marion Phipps, RN

Food & Nutrition Services .... 14 z Nutrition Screening

Educational Offerings ...... 15

Bigelow 11 staff nurse and Durant Refugee Medicine fellow, Chanda Plong, RN, with some of her young patients aboard the USNS Mercy, currently deployed in southeast Asia

(Photo provided by staff)

MGH Patient Care Services Working together to shape the future Jeanette Ives Erickson August 17, 2006 Citizens of the world: a shift to global thinking hese are diffi- pendent and our thinking rural Rwanda delivering cult times. Sever- more global. Our ‘com- primary care and HIV al personal inter- munity’ is no longer that treatment. Chanda Plong, actions recently little neighborhood along RN, is aboard the USNS Thave reminded me the Charles; our commu- Mercy in Cambodia and how closely connected nity is the world. And Indonesia bringing much- we are to international MGH is a microcosm of needed care in the after- events. that world with patients, math of catastrophic I was having dinner visitors, and employees natural disasters (see with friends one evening, from states and countries story on page 6). friends whose company I around the globe. Karen Holland, RN,

value and enjoy. Our I’m proud that MGH and Joy Williams, RN, Jeanette Ives Erickson, RN, MS time together is usually is a leader in providing are also aboard the Mercy senior vice president for Patient carefree and relaxed; but humanitarian aid to troub- for three-month intern- Care and chief nurse on this occasion, some- led nations. I’m proud ships under the auspices thing was different. There that MGH is a leader in of the Durant Fellowship Center for Global Health able to, ‘Extend MGH to was an uneasiness in the global health, education, Program. and Disaster Response. the World,’ by: air. and research. I’m proud Karen and physician The mission of this new z establishing rapidly “Is your family safe?” that so many of our em- colleague, Larry Ronan, center is to, “improve the deployable, multi- I asked. ployees feel empowered MD, have been named health of the world’s disciplinary teams to My friends are of most vulnerable and cri- respond to humanitar- Lebanese decent and sis-affected populations ian emergencies “Responsibility does not only lie have family living in through care-delivery, z designing standards of Lebanon. education, and research.” care-delivery and edu- with the leaders of our countries Earlier in the day, I Our goals include: cational programs for had sent an e-mail to z serving as a resource populations in need or with those who have been another friend with a for MGH constituents z designing strategies to similar inquiry. “Have working in the field of educate all disciplines appointed or elected to do a you heard from your fa- humanitarian aid around global-health mily in Israel?” z serving as a resource issues and disaster particular job. It lies with each of These are difficult for governmental and preparedness times. We are members non-governmental z offering multi-disci- us individually. Peace, for example, of an international com- agencies plinary consultation on munity. Our interests and z studying the impact of establishing infrastruc- starts within each one of us.” relationships transcend natural disasters and tures for providing physical borders. And as war on healthcare sys- global-health services —the Dalai Lama healthcare providers, tems and populations and disaster response we’re committed to car- z planning for and creat- z studying the impact ing for and about people to look beyond our walls recipients of this year’s ing an operational in- and outcomes of glo- from all cultures and and share our resources Boston Business Journ- frastructure for rapid- bal-health and disaster- backgrounds. with those who have al’s Champions in Health response teams response initiatives I feel blessed to work such great need. Care Awards. They will z extending MGH exper- We’re in the process at MGH with people who As I write this, two of be honored along with tise in improving the of recruiting a director share my passion for our nurses are bringing other local recipients at a health of the world’s for the Center for Global patient care and my de- their knowledge and skill special breakfast recep- vulnerable and crisis- Health and Disaster Re- sire to be part of a di- to struggling countries in tion in September. conflicted populations sponse and securing phy- verse and compassionate Africa and southeast Perhaps one of the This is exciting work. sical space to house staff. community. Our defini- Asia. Thomas Durant most important initia- With the creation of a I’ll keep you informed as tion of community has Refugee Medicine fel- tives on which we’re formal Center for Global we move forward with changed as the world has low, Lucinda Langen- embarking is the launch- Health and Disaster Re- this important initiative. become more interde- camp, RN, is working in ing of the new MGH sponse we will truly be continued on next page

Page 2 Fielding the Issues August 17, 2006 Jeanette: LEAN is a improving their turn- An update on some service- collaborative program around time, as well. between Patient Care Staff need to remember improvement initiatives at MGH Services, Materials Man- to tag broken equipment agement, and Biomedical properly so Biomedical Question: We’ve had Can you give us an up- fall. I’ll keep you updat- Engineering designed to Engineering can quickly problems with out-dated date on when these new ed on our progress. improve the flow of equip- diagnose and repair faul- morgue stretchers? Is pumps will be put into ment throughout the hos- ty equipment. The plan is Question: The black there any way to get new circulation? pital. Members of all to implement LEAN on boxes used to store pre- ones? three departments came all patient care units over Jeanette: The Bedside caution supplies outside together and looked at the next six months. Jeanette: Yes. I’m pleas- Technology Task Force, of patients’ rooms aren’t ed to report that new co-chaired by associate ways to make the process very attractive. Can we Question: I’ve noticed morgue stretchers have chief nurse, Dawn Ten- ‘leaner’ by eliminating find a better solution? some units have new been ordered. After re- ney, RN, and director of wasted steps. The pro- room-separating curtains, viewing several different Systems Improvement, Jeanette: Yes. We’ll be gram has been up and signage, and art in pa- models, a task force George Reardon, is lead- piloting a new precau- running since February tients’ rooms and hall- unanimously selected a ing the effort to replace tion cart on several units on Ellison 12, White 12, ways. Will all units be new stretcher, which will all our old pumps with in the coming weeks, Blake 12, and Bigelow getting these upgrades? improve the transporting new, ‘smart’ pumps. Sy- and I want to hear your 14. White 11 and Ellison process and provide erg- ringe pumps in the ICUs feedback. We’re confi- 11 came on board in April. Jeanette: New room- onomic relief to staff were replaced with smart dent a solution will be And Bigelow 7, Bigelow separating curtains have nurses and pathologists. pumps last fall, and PCA forthcoming in the near 11, Bigelow 13, Ellison been ordered for all in- The new stretchers should pumps are next on the future. 17, and Ellison 18 will patient units. We antici- arrive in October. list. We’ve been waiting begin this month. The pate installation will be Question: I’ve heard for a PCA pump that program has been very completed by late fall. colleagues talking about Question: At a recent meets our needs to come successful with positive New art and signage is ‘COWs.’ What are they? Staff Nurse Advisory on the market, and we’ve feedback from PCS staff being ordered on a unit- about how accessible Committee meeting, we identified a promising Jeanette: (No, we’re not by-unit basis. This is a equipment is now. heard a presentation on one we hope to pilot in opening a farm.) COWs time-consuming effort; Frequently requested replacement PCA pumps. five clinical areas in the is an acronym for, ‘com- our goal is to ensure all items such as Propaqs, puters on wheels,’ laptop units receive new art (and 3M pumps, PCA pumps, computers on carts that signage as necessary) in feeding pumps, and Sig- Jeanette Ives Erickson can be wheeled around the coming year. ma pumps are kept on continued from previous page the unit and used by staff units on a LEAN cart. in various locations. All Question: My unit has Par levels are established lost some of its unit- Updates inpatient units now have These may be troub- through unit-based sur- based equipment. Is there I’m happy to announce the wireless technology led times, but they are veys. After being used, anything we can do to that Jim McCarthy has to support the use of times rife with oppor- equipment is placed on a keep this equipment? accepted the position of COWs. Pilots are under- tunity to help our fellow soiled utility cart, and a operations coordinator way on Blake 7, White 8, Jeanette: Maintaining man, to forge interna- (Materials Management) for the new Emergency White 9, White 10, and unit-based equipment is tional relationships, and LEAN associate cleans it Department Observa- White 11. We’ll be ex- an on-going challenge. to lead by example. on the unit and puts it tion Unit. Jim has long panding the pilot to in- George Reardon and We’re fortunate to be back on the cart. This supported Patient Care clude a variety of carts senior project specialist, part of an organization minimizes the amount of Services with his work so we can generate feed- Dan Kerls, are organiz- whose mission is one of time the equipment is in Materials Manage- back on which carts best ing a multi-disciplinary altruism and good will. away from the unit. LEAN ment. Please join me in meet our needs. task force to look at how As we shift our perspec- associates are trained by welcoming him to the inpatient units can pre- tive toward global think- Question: I’ve heard Biomedical Engineering PCS team. vent the loss of much ing and international, some of my colleagues to do certain quick fixes Joanne Ferguson, needed equipment. This humanitarian assist- talking about an equip- on equipment that’s not RN, has accepted the is a pressing patient-care ance, I’m thrilled to ment-management sys- working. And Biomed- position of staff special- issue as well as a finan- have the chance to share tem called, LEAN. What ical Engineering has re- ist for the Perioperative cial issue. I will keep you our mission with the is that? worked their process for Service, effective Sep- informed of their pro- world. repairing equipment, tember 10, 2006. gress.

Page 3 Physical Therapy August 17, 2006

MGH supports whatever care players z Thomas Gill, MD, co- may need to recover and director, MGH Sports the Boston Lobsters get ready to play again. Medicine Staff is available to assist z Kai Mithoefer, MD, —by James Zachazewski, PT, clinical director, MGH Sports Medicine all members of World orthopedic surgeon GH is proud to be country. Our primary players warm-up, stretch, Team Tennis whenever z Michelle Connolly, a sponsor and responsibility in this ca- and provide any other they’re in Boston. massage therapist partner of the pacity is to ensure that services necessary to The MGH Lobsters During home matches Boston Lobsters, a some of the world’s great- prepare them for com- Sports Medicine staff MGH sponsored an edu- M pre-eminent est tennis players (wheth- petitive play. During consists of: cational booth to promote member of the World er members of the Lob- matches, should an in- z Jim Zachazewski, PT, various services offered Team Tennis league. The sters, or members of vi- jury occur, physicians, physical therapist and by the hospital, includ- MGH Sports Medicine siting teams) receive the therapists, and trainers clinical director for ing: Service and the MGH best health care possible respond immediately to MGH Sports Medicine z the MGH Vascular department of Physical while in Boston. provide emergency care, z Anne Viser, PT, physi- Center Therapy have teamed up The MGH Lobsters and ensure that follow-up cal therapist z Physical Therapy and to provide the Lobsters Sports Medicine staff diagnostic, medical, or z Jean Jonah, PT, physi- MGH Sports Medicine with access to the best provide on-site coverage surgical care is received cal therapist z Womens Health and sports-medicine physi- and services for players if required. Players have z Bruce Price, MD, med- Dermatology cians, physical therapists, before, during, and after access to the entire MGH ical director z the MGH Cancer Cen- athletic trainers, and mas- matches. Before matches, medical staff. Following z Peter Asnis, MD, orth- ter sage therapists in the staff is available to help matches, staff provide opedic surgeon continued on next page

Staffing the educational booth at a recent World Team Tennis match at Harvard University’s Bright Arena (home of the Boston Lobsters), are (l-r): Anne Viser, PT, physical therapist; Suzanne Curley, OTR/L, occupational therapist; Jessica Nadraga, physical therapy student; Theresa Jacobs, PT, physical therapist; Abby Folger, PT, physical therapist; and Robert Ratcliffe, PT, physical therapist. Staff fielded sports- related questions and offered instruction to fans on how to have a safe and healthy tennis season.

Page 4 August 17, 2006

MGH Supports the Boston z Food &Nutrition Ser- Physical therapists who found on the MGH Phy- Lobsters vices staffed the educational sical Therapy website at: continued from previous page z the MassGeneral Hos- booth included: http://www.massgeneral. pital for Children z Jennifer Miraglia, PT org/pcs/heal_phys.asp; or Staff fielded sports- z Lisa Duncombe, PT the MGH Sports Medi- related questions and z Jean Jonah, PT cine website at: http:// offered instruction to z Stephanie Gallup, PT www.massgeneral. org/ fans on how to have a z Marie Brownrigg, PT ortho/Boston_ Lobsters_ safe and healthy tennis z Abby Folger, PT Tennis_Tips.htm. season. Brochures pre- z Jessica Nadraga, PT For more information pared by MGH staff de- z Theresa Jacobs, PT about any of the services scribing general stretch- z Robert Ratcliffe, PT offered by the Physical ing and flexibility exer- Copies of pamphlets Therapy Department, call cises were available. and instructions can be 4-0125.

Photos, clockwise from top left: Boston Lobster and long-time international tennis super-star, Martina Navratilova. Enjoying the match, court-side, are (l-r): Anne Viser, PT, physical therapist; Jim Zachazewski, PT, clinical director for MGH Sports Medicine; and Bruce Price, MD, medical director, MGH Lobsters Sports Medicine. Before a match, Viser tapes the ankle of Boston Lobster, Kristen Schlukebir.

Page 5 Humanitarian Aid August 17, 2006 immunizations at the hos- Providing quality health care: images from pital in Gunungstatoli. We were given a small room with no windows or air Rwanda and southeast Asia conditioning. After five On June 7, 2006, Lucinda Langencamp, RN, of the MassGeneral Hospital for Children, and Chanda Plong, RN, minutes we were drench- of Bigelow 11, became this year’s recipients of the Thomas S. Durant, MD, Fellowship in Refugee Medicine. Langencamp ed with sweat. We saw is working in an under-served area of Rwanda; Plong is aboard the USNS Mercy in Indonesia and Cambodia. Both are more than 70 people of all sharing their experiences via on-line blogs (to view blogs directly, go to: http://chanda-durantfellowship.blogspot.com/ ages. It was so rewarding or http://www.rwandahealthjournal.blogspot.com/) Below are excerpts from their on-line journals. to be with patients and gery. I’m so glad to be shoes. The hospital was families in their own en- part of this mission. just recently re-built after vironment. being ruined by earth- The hospital is still Friday, July 14th (Plong) quakes in 2005. being re-built. We set up We arrived at the Indo- We’re performing stations in the fairly new nesian island of Simeulue minor surgeries on board main building. Each de- on Tuesday after a five- and will finish up with partment had a room: day voyage from Bangla- primary care on Satur- Physical Therapy, Immu- desh. While en route, we day, doing immuniza- nization, OB/GYN, In- kept ourselves busy by tions, physicals, teach- ternal Medicine, Dental, preparing lectures for ing, etc. Optical, Pharmarcy, and teaching opportunities. Surgery. We picked up about 20 Sunday, July 23 (Plong) The rest of the week, I Indonesian interpreters We left the island of Nias worked back on the ship. but only a few of them yesterday, and arrived in Patients were a mix of speak English. Banda Ache last night. adults and children await- Once in Simeulue we The mission began with ing some type of surgical used speed boats to travel patients being brought procedure. Procedures to and from the ship. The aboard via boats and ranged from simple cata- hospital is amazingly helocopters. I had the ract surgeries to hysterec- clean. Before anyone opportunity to go ashore tomies, cyst-removals and Monday, July 3 (Plong) back, it must have been enters, we take off our and give vaccines and amputations. Saturday was the first scary for them to have day of Operation Smile. I been in such an unfamil- was assigned to work in iar environment with Casualty & Receiving, or different sounds, smells, their Emergency Depart- and tastes. ment. Before I knew it, Tuesday, July 4 (Plong) we were consumed with work—vital signs, x-rays, The past few days have labs, call reports. It was been pretty busy getting interesting to see the patients prepped for sur- mesh of cultures immers- gery. We’re working with ed together. Women’s many patients who have brightly colored sari’s cleft lips and palates. against the drab military It’s amazing to see uniforms . such drastic results on Happiness, anger, these patients. A cleft lip sadness, anxiety, frustra- only takes an hour and a tion, and relief filled the half to repair. When pa- air. Some women were tients come out of the crying. Some sat quietly, PACU, they’re brought to afraid to say anything. the Post-Op Ward where Some laughed and play- discharge teaching starts ed, amazed at where they immediately. It’s wonder- were. It was a hectic day, ful to see the looks on but we eventually worked parents’ faces when they out the logistics. Looking see their child after sur- (Photos provided by staff)

Page 6 August 17, 2006

Humanitarian Aid continued from previous page

Tuesday, July 4 (Langen- I knew many children camp) died of it in poor coun- It’s malaria season. To- tries, but it was a ‘text- ward the end of May book’ understanding. when wet season ends Like most people in the and dry season begins, United States, I had nev- p.falciparum rears its er been exposed to these ugly head. The majority things. I’ve always had of children in the pediat- the luxury of a wealthier ric ward have been admit- life. I’ve always known ted for malaria. They are the world isn’t fair. I so sick, I can’t fathom guess that’s why I’m how their parents walked here—to try to make it a for hours to get them to little more fair. It’s a the hospital. drop more than not doing Prior to coming here, anything. But who knows, I didn’t know there was a maybe we can figure out malaria season. Nor did I a way to fight this dis- feel the tragedy of it. Yes, ease, drop by drop.

Tuesday, August 3 (Lang- be little—one person at a dom of speech or free- encamp) time, one family at a dom of assembly they It’s been weeks since I time—but I can do some- struggle for here. It’s last wrote. It’s amazing thing every day. I can be access to food and water how the time escapes me. present to the moments at and education and medi- I don’t even know where hand. cal care. July went. We had two I like being here am- Until the country can important visitors recent- ong the rural poor. We figure out how to pro- ly. Bill Clinton and Bill are as close to the medi- vide for the common Gates each came to Rwa- cal, social, and economic good of its people, we nda to get a sense of the issues of this area as any- provide the best medical situation here. It was one in the country. What care we can to one of the reassuring to see care- I’m seeing as I work in poorest areas in the givers advocate for the the hospital and out in world. And that, in truth, poorest of the poor here. the community, is that is the most a non-govern- Clinton and Gates were access to medical care, ment organization can greeted as VIPs, but there water, land, food, and do—relieve human suf- was no question that our education are tantamount fering with support, med- primary mission was to to a fair and just life. ical aid, and compassion. advocate for our patients. Children die here every We can make things bet- The children who get week. These children ter here. And yes, despite better from malnutrition would not die in the Unit- the hardships that exist are as wonderful and ed States or Europe or every day, there is hope darling as any children Japan; these deaths are for the poor. But not with- can be. My efforts may preventable. It’s not free- out our help.

Photos in this spread (l-r): Cleft-palate patient and a family member after surgery aboard the USNS Mercy. Plong with Hirschsprung’s disease patient. Young Rwandan girl “looks fantastic” after treatment. At one of the Rwandan health centers, Langenkamp assesses baby with a suspected ventricular defect. (Photos provided by staff)

Page 7 Clinical Narrative August 17, 2006 Sometimes comfort comes in the form of trust, respect, and compassion Katherine O’Meara is an advanced clinician y name is Kather- learned that the best plan no one cared about his ine O’Meara, and of action was to tend to pain, and he was going to I am a staff nurse his needs early. I gather- die in misery if someone on White 10. As a ed his 8:00pm medica- didn’t address the throb- M three-year veter- tions, grabbed some pea- bing in his jaw! Seeing an of a medical unit, I’ve nut-butter crackers and my distress, the intern on encountered many pa- ginger ale (his favorites), call came immediately to tients who choose not to and headed straight to his my aid. He told Mr. K Katherine O’Meara, RN cooperate with the plan room. Patients with as that he’d consider adjust- staff nurse, White 10 of care. This particular many psycho-social is- ing his pain medicine if patient proved to be one sues as Mr. K don’t like Mr. K would go back to cared about him because he’d been diagnosed with of the most difficult. Mr. to wait, and I’ve realized his room and let me check he was a drunken bum bladder cancer at the age K was well known to that it’s better to head off his vital signs. Mr. K and all we wanted to do of 20 and had lived with staff on our unit. He was problems before they continued to yell as he was throw him back out a urostomy ever since. a homeless man who was comes looking for you. walked back to his room. on the streets. I tried to He hadn’t been able to admitted frequently to Unfortunately, before He reluctantly allowed get a few words in, but have children due to the White 10 for alcohol- I made it to Mr. K’s room, me to close his door to finally gave up because surgery (something he’d withdrawal. At the time I was intercepted by an- spare other patients from he just wouldn’t listen. always dreamed of.) He of this admission, he had other patient’s family his tirade. I had cared for He went on and on about had lost two wives to been seen in the Emer- member. As I stood in the Mr. K often enough to how sick and frustrated cancer, was divorced by gency Department 26 hallway talking, I smell- know that, although he he was and how unfair a third, and estranged times in the past two ed the odor of stale urine was upset, he wouldn’t his life had been. I knew from his fourth because months. He had been and heard the grumbling harm me. I knew I was he wasn’t mad at the of his drinking. His fam- admitted 15 times and of an angry Mr. K ap- safe alone with him in doctors, or me; he was ily lives in Texas and left against medical ad- proaching from behind. I his room. Furthermore, I mad at the world. And I “didn’t bother with him.” vice (AMA) all but three quickly excused myself knew that what he really knew the best thing I As if that weren’t bad of those times. In my and went to head him off. needed was some one- could do for him right enough, he’d just been past experiences with Mr. I was prepared for his on-one attention. then was sit and listen. diagnosed with cancer K, he had been rude and usual behavior, but some- As I took his blood With patients like Mr. again, in three places on verbally abusive toward thing was slightly differ- pressure and heart rate, I K, my ability to listen his face, including his staff and other patients. ent. Although he’d only confirmed what I already and facilitate healthy jaw (which explained the He paid little attention to been admitted that after- suspected. Mr. K was in a communication is often pain he was experienc- personal hygiene, allow- noon, he wasn’t confused good deal of pain. His my most important skill ing). Doctors told him ing his urostomy bag to or heavily sedated. He systolic blood pressure as a nurse. I pulled a he’d probably need a overflow, giving him a actually seemed to know was close to 200, and his chair up next to Mr. K’s steel plate in his jaw, and potent, unpleasant smell. what he was doing. He heart rate was in the bed and sat down. I re- another round of chemo- His typical course on walked straight for the 120s. I knew his base- moved my gloves and put therapy, which he said he White 10 consisted of nurses’ station with a lines were much lower. the thermometer and wouldn’t wish on his heavy doses of Valium steady gait. He was on a Alcohol-withdrawal can oxygen-saturation moni- worst enemy. starting at 15-minute mission. present with many of the tor down. He looked sur- As Mr. K continued intervals, a number of I tried my best to re- same symptoms as pain, prised that I’d actually to talk, I noticed that, al- upsetting interactions direct him, wanting to but it was easy to see the stuck around to hear what though he was still upset, with staff, and piles of avoid a confrontation in difference. Mr. K had he had to say, but he kept his voice had changed. dirty linen. And usually, the hallway, but he walk- been admitted that after- talking. What had begun He was no longer yelling, after disrupting opera- ed right past me, went to noon, which meant it was as a yelling tirade turned he was lamenting. By the tions, Mr. K would leave the desk, and demanded too soon to be seeing into a baring of his soul. end of our conversation, AMA. to speak to a doctor. He such severe signs of with- He poured his heart out he was actually weeping. From previous exper- started screaming that he drawal. He continued to about how hard his life continued on next page ience with Mr. K, I had was being neglected, that rant about how no one had been. He told me

Page 8 August 17, 2006

Clinical Narrative I agreed to explain taking his medication, with an open mind and continued from previous page that to the social worker. his heart rate went to the give him the respect he After leaving Mr. K’s 70s and stayed there for deserved. I wanted my room, I went straight to the rest of the night. I fellow nurses to experi- For a long time, I just few days.” He asked me the intern on call. We was satisfied that the ence the same sense of sat by the bed with my to ask the medical team discussed my conversa- medication had worked. reward and satisfaction I hand on his and let him if he could start taking tion with Mr. K and I At 6:00 the next mor- had felt caring for Mr. K. cry. I told him how sorry two Percocets instead of told him I thought in- ning, I peeked into his Mr. K stayed with us I was, and how I couldn’t one. He said he didn’t creasing his Percocet was room to see if he needed for more than a week imagine what it must be want IV pain medication; a reasonable request. He anything before I left. He during that admission. like for him. For the first he didn’t want Oxycon- was glad Mr. K had calm- politely asked if I’d help Although I had advocat- time in months, I felt like tin. Percocet worked for ed down but leery about him into the shower. He ed for an adjustment in I was giving Mr. K exact- him, he just needed a prescribing more Perco- thought a shower would his pain medication, I ly what he needed. I was larger dose. He knew he cet in case Mr. K was make him feel better and knew the more important able to show him that I didn’t have much time ‘med-seeking.’ I told him he realized how offensive intervention was an even recognized he wasn’t just left, and he wanted to be I felt strongly that Mr. K he smelled. When he got stronger dose of trust, a patient in need of med- comfortable. was demonstrating actual out, he combed his hair, respect, and compassion. ical attention. He was a I told him I’d talk to pain. His vital signs sup- shaved, and brushed his Comments by Jeanette person who should be the team about increasing ported that assessment, teeth. He told me how Ives Erickson, RN, MS, treated like one. He wip- his Percocet, and I got and according to report, much he appreciated senior vice president ed his nose and actually him to agree to a pain he hadn’t been able to eat what I’d done for him the for Patient Care and cracked a smile. He told consult. Finally, I asked much, a direct result of night before. He said it chief nurse me I was the first person if I could have a social the pain in his jaw. I went had been a long time This narrative is eloquent in months who’d touched worker check on him. I on to say that, in my ex- since he’d been treated in its simplicity. What him without gloves. knew he’d be resistant to perience, patients who like a human being and could be more basic than “I know I’m homeless this, because he ada- are med-seeking ask for he felt ‘changed.’ Mr. K treating people with trust, and need a shower,” he mantly insisted he was stronger medications not admitted that he owed a respect, and compassion? said. “But my illness is managing on his own. As higher doses of Percocet. lot of people an apology When Katherine took the cancer and that ain’t con- is often the case with I reminded the intern that for being so rude. He time to listen to Mr. K, tagious. Sometimes I feel homeless patients, he I knew this patient very said his behavior had simply listen, it changed like I’m treated like a didn’t want to accept well and that Percocet been an emotional re- everything. Katherine rabid dog.” He said it outside support. I remind- had worked for him in sponse to the stress he’d was willing to look be- jokingly, but I knew he ed myself that, although I the past. He said he’d been under. It was easier yond the ‘homeless’ label was serious. may not understand or write a prescription for to drink and be rude to and see the person. She I asked Mr. K what agree with his choices in the increased dose and people than deal with his took off her gloves and we could do for him. He life, it wasn’t my job to we’d see what the Pain problems. He had decid- held his hand, a gesture laughed and said he ap- judge. I was there to sup- Service recommended the ed to give up on the world so powerful, Mr. K was preciated my asking. port him. But it had be- next day. because the world had moved to tears. “Usually I just get come clear to me that Mr. I immediately return- given up on him. Katherine’s experi- Valium and shoved back K was not currently able ed with the Percocet for “But last night,” he ence and intuition told out on the street.” to manage on his own. I Mr. K. I re-checked his said, “I realized you were her that Mr. K was tell- He went on to tell me wanted him to talk with vital signs, knowing that only trying to help. It’s ing the truth when he that he didn’t want to be someone about his social he’d calmed down. His not your fault I’m the asked for a higher dose treated for the cancer. and emotional needs. I blood pressure and heart way I am—the drinking, of Percoset. She advocat- He’d gone through that knew a social worker rate had improved with the cancer, none of it. I ed for him with the intern before and didn’t feel he could introduce him to a his mood, but they were know I’m never going to on call. She shared the had the fight left in him. number of resources and still higher than his base- get better, but I’d like to night’s events with the He understood he was help him choose the one(s) line. This reinforced my work together to make nurse coming on duty to living his life because of he felt comfortable with. belief that he was still in the time I have left a little ensure continuity of care. his own choices, and he He said it would be okay pain. He took the pills, less painful.” In short, Katherine gave didn’t want to be in pain as long as they didn’t thanked me, and asked In report at the end of Mr. K the same individ- anymore. make him go to a shelter. me to close his door. I my shift, I took a lot of ualized, high-quality care “I’ve been in so much “I live on the streets checked on Mr. K through- time explaining to the she would have given pain lately,” he said, “I because that’s where I’m out the night; he seemed incoming nurse what had any other patient. haven’t been able to stay happiest. You might not to be sleeping comfort- happened overnight. I Thank-you, Kath- out of the Emergency understand, but it’s my ably. Within an hour of wanted her to be able to erine. Room for more than a choice to make.” continue caring for Mr. K

Page 9 Education/Support August 17, 2006

ENCARE: educating safety, and helmet safety. difference in the commu- ENCARE is active in all nity. Informing people the public about safety and 50 states and Canada. about the choices they Today, ENCARE reaches have and the potential prevention approximately 300,000 outcomes of their de- youths and 150,000 older cisions can prevent un- —by Ines Luciani-Mcgillivray, RN; Karen Celentano, RN; Americans annually with told catastrophes. The and Sabrina Fedrico, RN its injury prevention pro- ENCARE program fo- NCARE is a alcohol-related tragedies, als world-wide, with grams. cuses on real people not group of trau- these nurses looked at almost 23,000 members. Nurses and healthcare just statistics. Presenta- ma nurses that each and said, “If people ENCARE has trained professionals who parti- tions are meaningful, and uses its consid- could see what we see, more than 8,000 health- cipate in these programs people relate closely to E erable know- maybe they’d think twice care professionals (regi- say the rewards are price- the stories. Using actual ledge and exper- before drinking and driv- stered nurses, emergency less. Being able to influ- case scenarios, re-enact- ience to try to educate ing.” So they set about medical technicians, and ence public opinion about ments show what hap- communities about health bringing that message to paramedics). These indi- injury-prevention is a pens when people make risks and prevention. the people who need it viduals volunteer their powerful thing. Said one different choices about ENCARE, (Emergency the most. time to educate the pub- ENCARE volunteer, “As drinking, driving, seat Nurses Care) was created ENCARE is the In- lic about injury-preven- parents ourselves, we belts, etc. There’s a para- in the 1980s by two Em- jury Prevention Institute tion, the dangers of under- have many teachable ble that goes along with ergency Department staff of the Emergency Nurses age drinking, the impor- moments and many stor- this program that speaks nurses. After a partic- Association (ENA). ENA tance of using safety ies to share.” to how one person can ularly busy weekend that is comprised of emergen- belts, gun safety, ped- Being an ENCARE make a difference in the involved a number of cy healthcare profession- estrian safety, bicycle volunteer can make a real lives of others: Once upon a time, there was a little girl stand- ing on the beach. As she stood on the shore, waves threw starfish onto the sand. As that happened, she threw them back, one after another. A man walked by and watched the little girl throwing the starfish into the water one at a time. After watching for a few minutes, he said, “What you’re doing continued on next page

During a recent ENCARE presentation at a local school, trauma nurses, Karen Celentano, RN (left) and Ines McGillivray, RN, demonstrate various pieces of equipment used to save lives in the Emer- gency Department

Page 10 Feedback August 17, 2006 for social workers; even Staff Perceptions of the Professional the question-and-answer column in Caring Head- Practice Environment Survey lines is the result of feedback from this survey. Senior vice president for Patient Care, Jeanette Ives Erickson, RN, answers questions about the Staff Perceptions of the Professional Practice Environment Survery Question: Are my re- Question: What is the sional practice. The sur- providers within Patient Jeanette: Since 2003, sponses confidential? purpose of the Staff Per- vey is a ‘report card’ that Care Services because I clinicians have reported a Jeanette: Yes. All survey ceptions of the Profes- I take very seriously. The want to hear what every desire to be able to com- answers are completely sional Practice Environ- Patient Care Services person has to say. Every plete the survey on-line. confidential. Each survey ment Survey? leadership team uses this year, I hope for a high This year, for the first is tagged with a random- feedback to identify op- response rate, and this time, the survey will be Jeanette: The survey was ly generated ID number. portunities to improve year, I’m looking for- available on-line. The developed to obtain feed- That number is used only the practice environment ward to the best response Institute for Health Poli- back from staff about the to allow clinicians to for clinicians. rate yet. cy at MGH, will inde- environment of practice complete the on-line sur- pendently distribute the at MGH. We know that vey over several sessions Question: Who receives Question: I know there survey and analyze re- in order to enhance the (if they’re unable to com- the survey? have been changes in the sponses. They will col- quality of care, it’s im- plete it in one sitting) and survey in past years. Is laborate with Dorothy portant for staff to feel Jeanette: The survey is to prevent multiple sur- there anything new this Jones, RN, senior nurse supported in their profes- mailed to all direct-care veys from being submit- year? scientist, in preparing the ted by the same individ- final report. If the on-line ual. Neither the ID num- injury-prevention, response is as strong as ENCARE: Educating the Public ber nor survey answers bicycle- and helmet- anticipated, the survey continued from previous page will be shared with any- may be distributed on- safety, and an intro- one within Patient Care line exclusively in sub- duction to the dan- Services. Responses are sequent years. During makes no sense. You as MGH Emergency De- gers of drug and not linked to individual this year of transition, can’t possibly keep up partment nurses. As emer- alcohol use. It is an names. staff may choose to com- with the waves. What gency healthcare profes- interactive program plete the survey on-line you’re doing will make sionals, we have an obli- with games, J-ello Question: Who sees the or by hard copy to ensure no difference at all.” gation to educate people molds, and role play- results? that everyone’s voice is As the little girl look- about how they can live ing heard. The on-line survey Jeanette: Data from the ed at the man, another healthy, safe life styles. z TAKE CARE, is will be distributed on survey is reported at three wave threw a starfish Our mission is to reduce geared toward older September 7, 2006; the organizational levels: my onto the beach. She preventable injuries and adults, and it focus- hard-copy version will be executive team, discipline- picked it up and threw death through education. es on the effects of distributed on September specific leadership of the it back into the water. ENCARE nurses alcohol use, the 11th. departments comprising She looked at the man provide injury-prevention interaction of alco- Patient Care Services, and said, “It made a education to young peo- hol and prescription Question: Does my parti- and at the unit level. At difference to that one.” ple, parents, older adults, (and non-prescrip- cipation really matter? each level there should and the general public. be discussion about what We see and care for tion) drugs, safe Jeanette: Yes. If you the survey tells us and victims of many trage- Our programs include: medication use, have comments or sug- how we can use the infor- dies. We have special z DARE to CARE, aim- doctor/patient rela- gestions about our prac- mation to improve our skills and knowledge and ed at middle schools tionships, and high- tice environment, this is environment. This survey a credibility that only and high schools. The way and pedestrian one of the best ways to is an effective vehicle for emergency healthcare program graphically safety make your opinions capturing feedback, but professionals can bring show the consequences heard. Many programs For more informa- it’s only as effective as of drug use, under-age and initiatives have been to the community. We tion about any of the the people who respond. implemented based on tailor our programs to drinking, drinking and ENCARE programs, I hope you’ll help me to feedback from this sur- specific age groups, start- driving, and driving call Ines Luciani-Mc- make sure that MGH vey, including, the Cul- ing as early as fifth grade. without a safety belt gillivray at 617-548- continues to be the “em- turally Competent Care Collectively, the authors z LEARNING to CARE, 0096, or by e-mail: ployer of choice” for the Lecture Series, the Mater- of this article have more targets elementary ilucianimcgillivray@ best and the brightest ials Management Nurs- than 60 years experience partners.org. clinicians and caregivers. schools, focusing on ing Task Force, pagers

Page 11 Clinical Nurse Specialists August 17, 2006 The meaning of food and nutrition: a complex issue at the end of life —by Marion Phipps, RN, clinical nurse specialist roviding end- unit, he was comatose ly starved during those of-life nursing and had a nasal feeding years, and the importance care for individ- tube because he’d lost that having enough food uals after a severe the ability to swallow. had taken on for his fam- Pstroke is an important Though he couldn’t move, ily. With the onset of his part of patient care on the he seemed quite distress- blindness, he had become neuroscience units. As ed. His family was ex- frightened and began to one of the clinical nurse hausted and anxious. Mr. imagine he was back in specialist on this service, Marion Phipps, RN J’s daughter described the camp. He became clinical nurse specialist I know that we learn her 86-year-old father as paranoid and required a much from every one of having been in a period psychiatric evaluation. our patients and their of declining health. Two Mr. J was able to return he survive a concentra- there is decreased ability families. From the exper- years before, he had de- home with the support of tion camp only to starve to manage excess bodily iences we’ve gained car- veloped sudden blindness his family and commu- at the end of his life?” fluids, which can cause ing for these patients, and become confused nity agencies. she said. pulmonary congestion we’ve built a repertoire and agitated, eventually Throughout the first But she felt strongly and suffering. In caring of approaches that has requiring a psychiatric day of Mr. J’s hospital that the naso-gastric tube for Mr. J, the inter-disci- improved care to all our hospitalization. She told stay, his daughter was was causing her father to plinary team knew that patients. In doing this, me her father was a Hol- very anxious. She told suffer. The team suggest- his family could not tol- we’ve established a rich ocaust survivor who’d staff she couldn’t stand ed placing a gastric tube, erate the discontinuation narrative source to assist spent several years in a seeing her father suffer. and she agreed. His nurses of nutritional support. us in recognizing the concentration camp. She felt the nasal feeding removed the tube in the The team supported this complexities inherent in When he was released at tube was causing him family’s presence, and approach because it was this practice. The fol- the end of the war, he distress. But she said he Mr. J immediately seem- appropriate given Mr. J’s lowing story demonstrates met his wife who was couldn’t be without nu- ed more comfortable and history. The care plan how difficult end-of-life also a camp survivor, and trition. She stressed the relaxed. The family felt was developed recogniz- care can be for families together they emmigrated fact that both her parents great relief that he no ing that there is no one and clinicians. to the United States. Af- had nearly starved to longer appeared to be approach for all patients In December of last ter the war, her father death in concentration suffering. at the end of life. The year, an elderly man, I’ll talked very little about camps and that food was Together with our inter-disciplinary team call him ‘Mr. J,’ was his experience in the one of the most impor- social worker, staff dis- was informed and guided admitted after sustaining concentration camp. One tant aspects of life in cussed the possibility of by the wishes of Mr. J’s a devastating stroke. exception was when he their family. a Palliative Care consult- family who wanted the Upon admission to the described how he’d near- The next morning, the ation. The team agreed best for an honored and neurology team informed with this decision. Mr. cherished loved one. As the family that they be- J’s daughter met with the physician and author, lieved Mr. J’s potential palliative care team and Robert Coles, has told us, for recovery was limited. felt totally supported in “The people who come aringaring His daughter told the the decisions she’d made. to us bring us their stor- HEADLINES CC team that her goal was to Two days later, Mr. J had ies. They hope they will Back issues of Caring Headlines are take her father home to a gastric tube placed and tell them well enough so die with supportive care. went home the next day that we understand the available on-line at the Patient Care Services The team agreed with with 24-hour care. truth of their lives. They website: http://pcs.mgh.harvard.edu/ this decision and asked Often in end-of-life hope we know how to her about feeding options. care, there is a recom- interpret their stories For assistance in searching back issues, She reiterated that her mendation to discontinue correctly. We have to contact Jess Beaham, at 6-3193 father could not be with- fluids and nutrition be- remember what we hear out nutrition. “How could cause at the end of life is their story.”

Page 12 Published by: Caring Headlines is published twice each month by the department of Patient Care Services at Massachusetts General Hospital. August 17, 2006 Publisher Jeanette Ives Erickson RN, MS, senior vice president for Patient Care and chief nurse

Managing Editor MGH is committed to Susan Sabia improving hand hygiene Editorial Advisory Board Chaplaincy Your mother was right… Michael McElhinny, MDiv Development & Public Affairs Liaison z Hand-washing is one of the most important Victoria Brady McCandless actions you can take to clean your hands and Stop the Transmission Editorial Support reduce the spread of germs of Pathogens Marianne Ditomassi, RN, MSN, MBA Infection Control Unit Mary Ellin Smith, RN, MS z Healthcare workers must also disinfect their hands Clinics 131 726-2036 to stop the spread of pathogens (germs that cause Materials Management Edward Raeke disease), and use a hand moisturizer to keep their skin healthy and intact Nutrition & Food Services Martha Lynch, MS, RD, CNSD Susan Doyle, MS, RD, LDN When should hands be washed? Office of Patient Advocacy Sally Millar, RN, MBA z When visible or known soiling occurs Orthotics & Prosthetics z After using the bathroom Mark Tlumacki Patient Care Services, Diversity z Before eating Deborah Washington, RN, MSN z After any contact with patients known to be infected with C. difficile or Physical Therapy their environment Occupational Therapy Michael G. Sullivan, PT, MBA z Hands should also be washed if they feel sticky from build-up of residue Police, Security & Outside Services after repeated applications of Cal Stat or lotion Joe Crowley z Remember to dry hands well and use Cal Stat after washing (don’t use Reading Language Disorders Carolyn Horn, MEd Cal Stat before eating) Respiratory Care z Hand-washing removes build-up of dirt, soil, or Cal Stat residue, but Ed Burns, RRT germs can remain on the skin. After hand-washing, dry hands thoroughly Social Services and apply Cal Stat to kill remaining germs Ellen Forman, LICSW z Wash hands but do not apply Cal Stat before eating. Cal Stat evaporates Speech, Language & Swallowing Disorders Carmen Vega-Barachowitz, MS, SLP quickly, but it can leave a residue on your hands that could affect the fla- Volunteer, Medical Interpreter, Ambassador vor of your food and LVC Retail Services Pat Rowell

Glove Safety Distribution Please contact Ursula Hoehl at 726-9057 for z Gloves should never be worn from patient to patient, or from a dirty to a questions related to distribution clean environment. Doing so can: z spread pathogens Submission of Articles z cause infections Written contributions should be submitted directly to Susan Sabia z Don’t let your gloves become a launching pad for germs. When gloves as far in advance as possible. are removed, microscopic spatter may contaminate hands and/or the Caring Headlines cannot guarantee the environment inclusion of any article. Articles/ideas should be submitted z Gloves should be removed carefully, following proper removal procedure, by e-mail: [email protected] not with a stretch and snap For more information, call: 617-724-1746. z After removal, dispose of used gloves immediately in the nearest appropriate receptacle Next Publication Date: September 7, 2006

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Please recycle Food & Nutrition August 17, 2006 A closer look at the nutrition screening process —by Tiash Sinha, RD, clinical nutrition specialist

ur current nutri- ter sense of how well the sion, and the presence of tion screening process is working, and chronic disease. This process was what, if anything we can helps identify patients introduced in do to improve it. with characteristics or O1997 in accordance Currently, nurses risk factors associated with JCAHO regulations screen all patients admit- with nutrition problems that required a nutrition ted to inpatient units at who may benefit from screening for every pa- MGH. Nutrition screen- nutritional care. Malnu- Tiash Sinha, RD tient within 24 hours of ings are part of the nurs- trition remains largely clinical nutrition specialist admission. The depart- ing assessment. This is a unrecognized in hospitals ment of Food & Nutrition crucial component in and is linked closely to a the information in physi- need to be made. The Services will soon be identifying patients who higher likelihood of com- cians’ admission notes. study will help us answer conducting a study to may be at nutritional plications, longer lengths How closely do the two questions such as: Are look at this screening risk. Nurses ask a series of stay, and higher hos- agree in terms of identi- there ways to improve process in a critical way. of questions about the pital costs. Nutrition fying nutritional risk and patient care? Are there We hope to answer sever- patient’s weight, gastro- screenings upon admis- the presence of disease? ways to improve the time- al questions that will intestinal issues (such as sion can help detect mal- Do we need to modify liness with which pa- give Nursing and Food & nausea/vomiting/diar- nutrition as well as many the questions to better tients are seen by an RD? Nutrition Services a bet- rhea), diet prior to admis- other nutritional issues. capture the patient’s nu- Do RDs need to explain How do dietitians use tritional concerns? Does in more detail the ques- the information collected the form reflect physi- tions on the nursing as- Blood: there’s life in in the nursing assess- cians’ concerns for pa- sessment form? Does the ment? When a patient tients? form need to be revised? every drop meets the criteria for a The data will be ag- We hope to be able to The MGH Blood Donor Center is located nutrition trigger, the reg- gregated by service to answer these questions in the lobby of the Gray-Jackson Building istered dietitian (RD) determine whether there and many others once the assesses the patient’s are differences from one study is completed. The MGH Blood Donor Center is open nutritional needs, estab- service to another. The We thank nurses for for whole blood donations: lishes priorities, sets goals information will be col- working with us to iden- Tuesday, Wednesday, Thursday, lected from a review of tify patients at nutritional 7:30am–5:30pm and objectives to meet medical records of adult risk and for referring Friday, 8:30am–4:30pm the nutritional needs, and (closed Monday) implements a plan of patients previously ad- them to an RD in a time- care. Patients are moni- mitted to MGH. The ly manner. Please take a Platelet donations: tored, and changes are study will begin in the moment to review the Monday, Tuesday, Wednesday, Thursday, introduced based on the fall pending approval nutrition/metabolic sec- 7:30am–5:00pm patient’s response. from the Institutional tion of the nursing assess- Friday, 8:30am–3:00pm The study we will be Review Board. ment form and let us Appointments are available for conducting will evaluate Once the study is know how we can make blood or platelet donations the nutrition screening completed and the data this study as useful as process. We will compare analyzed, our department possible. If you have Call the MGH Blood Donor Center the nutrition screening will share the results questions or comments, to schedule an appointment with Nursing and collab- please contact Tiash Sin- 6-8177 information on the nursing assessment form with orate on any changes that ha via e-mail.

666666 Page 14 Educational Offerings August 17, 2006 When/Where Description Contact Hours September 6 The Beat Goes On: Ventricular Devices for Treatment of Heart Failure TBA 8:00am–4:00pm O’Keeffe Auditorium

September 7 CPR—American Heart Association BLS Re-Certification - - - 7:30–11:00am/12:00–3:30pm VBK401

September 7 Oncology Nursing Concepts: Advancing Clinical Practice TBA 8:00–4:00pm Yawkey 2210 September 7 CVVH Core Program TBA 8:00am–12:00pm Training Department, Charles River Plaza September 8 and 13 Phase II: Wound Care Education TBA 8:00am–4:00pm Training Department, Charles River Plaza

September 8 On-Line Patient-Education Resources 2.4 8:00–10:00am FND626

September 8 and 25 Advanced Cardiac Life Support (ACLS)—Provider Course - - - 8:00am–5:00pm Day 1: O’Keeffe Auditorium. Day 2: Thier Conference Room

September 11, 13, 20, 22, 28, 29 Greater Boston ICU Consortium CORE Program 44.8 7:30am–4:30pm (check for locations) for completing all six days

September 13 New Graduate Nurse Development Seminar I 6.0 8:00am–2:00pm Training Department, Charles River Plaza (for mentors only) September 13 Nursing Grand Rounds 1.2 11:00am–12:00pm “Mucositis.” Haber Conference Room September 13 OA/PCA/USA Connections - - - 1:30–2:30pm Haber Conference Room September 13 More than Just a Journal Club 1.2 4:00–5:00pm Yawkey 2210

September 15 and 18 Neuroscience Nursing Review Course TBA 8:00am–4:15pm Day 1: O’Keeffe Auditorium. Day 2: Thier Conference Room

September 20 BLS Certification for Healthcare Providers - - - 8:00am–2:00pm VBK601

September 20 Building Relationships in the Diverse Hospital Community: 7.2 8:00am–4:30pm Understanding Our Patients, Ourselves, and Each Other Training Department, Charles River Plaza

September 20 Medical-Surgical Nursing Certification Prep Course TBA 8:00am–4:30pm Yawkey 10-660 September 21 CPR—Age-Specific Mannequin Demonstration of BLS Skills - - - 8:00am and 12:00pm (Adult) VBK401 (No BLS card given) 10:00am and 2:00pm (Pediatric)

September 21 Preceptor Development Program 7 8:00am–4:30pm Training Department, Charles River Plaza

September 21 Chaplaincy Grand Rounds - - - 11:00am–12:30pm “An Introduction to Hinduism.” Yawkey 2-220

September 26 CPR—American Heart Association BLS Re-Certification - - - 7:30–11:00am/12:00–3:30pm VBK401

September 27 New Graduate Nurse Development Seminar II 5.4 (for mentors only) 8:00am–2:00pm Training Department, Charles River Plaza

September 28 Basic Respiratory Nursing Care - - - 12:00–4:00pm Sweet Conference Room

For detailed information about educational offerings, visit our web calendar at http://pcs.mgh.harvard.edu. To register, call (617)726-3111. For information about Risk Management Foundation programs, check the Internet at http://www.hrm.harvard.edu. 2006 2006 Page 15 Giving August 17, 2006 You don’t need a Call for Nominations reason to give blood... Stephanie M. Macaluso, RN, Excellence In But if you did... Clinical Practice Award The Stephanie M. Macaluso, RN, Excellence in Clinical z When you give blood, your donation is separated into three parts: Practice Award recognizes direct-care providers through- z red cells can be used to treat trauma and surgical patients out Patient Care Services whose practice exemplifies the z platelets are used to care for cancer patients expert application of values reflected in our vision. z plasma helps burn and hemophilia patients Nominations are now being accepted for the 2006 awards. Staff nurses, occupational therapists, physical therapists, z One donation can potentially help three people respiratory therapists, speech-language pathologists, z Sickle-cell-anemia patients can use up to five pints of blood per social workers and chaplains are eligible. month z Direct-care providers may nominate one another. Nurse z The need for blood increases with advances in medical technology managers, directors, clinical leaders, health professionals, patients, and families may nominate a direct-care z MGH is the largest transfuser of blood in Massachusetts, and one of provider the largest in the nation z Nominations can be made by completing a brief form z Every two seconds, someone needs blood which is available on patient care units, in department offices, and at the Gray information desk. z Only 5% of eligible donors donate blood z Nominations are due by October 9th z The number-one use of blood is treating cancer z Nominees will receive a letter informing them of their z There’s a 97% chance you’ll need blood in your lifetime nomination and requesting they submit a professional portfolio. Written materials on resume-writing, narrative- z One out of every ten hospital patients needs blood writing, and endorsement letters will be enclosed z Treatment for cancer, organ transplants, and surgery depends on the z The review board that selects recipients is comprised availability of blood of previous award recipients, administrators, and MGH volunteers z The nations blood supply has decreased by 3% per year since 1987 Award recipients will receive $1,500 to be used toward a z When you donate blood, your blood pressure, pulse, temperature professional conference or course of their choosing. and iron level are checked, and you’ll be notified if any abnormal- Recipients will be recognized at a reception in their honor, ities are found and their names will be added to the plaque z Giving blood is safe, simple, and satisfying honoring Macaluso award recipients. z Type O is the most common blood type. Type O can safely be trans- For more information or assistance with fused to patients with any other blood type and is frequently used in the nomination process, contact Mary Ellin Smith, RN, emergencies. Because of its compatibility with other blood types, professional development coordinator, at 4-5801 type O is the most widely used and frequently needed blood type

First Class US Postage Paid aringaring Permit #57416 HEADLINES CC Boston MA Send returns only to Bigelow 10 Nursing Office, MGH 55 Fruit Street Boston, MA 02114-2696

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