care provider collaborative efforts toreduce transmission of hospital-acquired Methicillin resistant staphy-lococcus aureus (MRSA) and to reducethe occurrence of pressure ulcers.

Our participation in the CMS 9thScope of Work is a great example ofhow we learn as a system to improvepatient care in a collaborative strategywith other providers throughout theState of Delaware and our region.

MRSA safety initiativeThe QID-run, statewide collaborativeproject to reduce MRSA took placefrom August 2008 to July 2011.

Wilmington Hospital Intensive Care,or WICU, became the chosen battle-ground for implementing MRSA pre-vention strategies.

“WICU submitted MRSA data fromthe Infection Prevention department tothe Center's for Disease Control's

Inside

Christiana Care ranks amongstate’s Top Work Places 2

Christiana Care nurses earnstatewide honors 4

Transforming Leadership Forum 5

Surgeon Jay Luft, M.D.,’s missionto Ethiopia 6

New CPR guidelines 8

Community Clinical OnclogyProgram leads patient accruals 10

Caring for Yourself- See your dentist regularly 17 - Get help controlling asthma 19

VOLUME 22, NUMBER 11

A publication from

Christiana Care Health System

External Affairs

P.O. Box 1668

Wilmington, DE 19899-1668

www.christianacare.org

F O C U SFocusing on the people and initiatives that distinguish Christiana Care Health System

Christiana Care Health Systemreceived Certificates of Excellence

from the Centers for Medicare &Medicaid Services (CMS) for collabo-rating in hospital-acquired infectionand pressure ulcer prevention projectsconducted by Quality Insights ofDelaware (QID) in the CMS 9th Scopeof Work period.

A Scope of Work refers to a three-yearperiod during which CMS enterscontracts with quality improvementorganizations such as QID across thenation to conduct quality improve-ment projects. The 9th scope pertainsto the contract that started July 1, 2008and ended June 30, 2011. The themewas patient safety.

As part of a larger group encompass-ing West Virginia, Pennsylvania andDelaware, QID won CMS’ approvalfor two project proposals to gatherdata and measure results in health

Christiana Care embraces CMS campaign to improve patient safety

Accepting certificates of excellence from Quality Insights of Delaware representativeKathy Rivard (center) are, from left: Janet Cunningham, Michelle Kane, SharonAnderson, Beth Donovan, Carol Briody, Patty Resnik and Michelle Collins.

C O N T I N U E D , P. 2

F O C U S O N E X C E L L E N C E

teams, policies and protocols, account-ability and staff education.

n Risk assessment of patients uponadmission and daily.

n Pressure ulcer prevention throughdaily skin inspection, moisture man-agement, optimal nutrition and hydra-tion and minimizing pressure.

n Treatment and documentation.

Participating hospitals administeredpatient safety surveys at baseline andremeasurement. These survey instru-ments included the Agency forHealthcare Research and Quality’sHospital Survey on Patient SafetyCulture and the Hospital Leadershipand Quality Assessment Tool(HLQAT).*

Focused on managing incontinenceBeth Donovan, MSN, RN, CWOCN,wound ostomy continence nurse, saysQID’s data collection tool helpedChristiana Care define an opportunityfor improvement in moisture manage-ment. Moisture is a significant cause ofpressure ulcers in patients whose con-dition includes incontinence.

The pressure ulcer prevention projectteam focused on improving moisturemanagement on one unit (4 E/W atWilmington Hospital) with a view toimprove systemwide learning basedon the results. Systemwide learningafter the 4 E/W experience helpedimprove pressure ulcer preventionthroughout the health system.

* The HLQAT is the result of a public-pri-vate collaboration of national organiza-tions interested in helping hospitals maxi-mize their reimbursement on value-basedpurchasing quality measure sets.

CMS patient safety themeempowers quality improvement

National Healthcare Safety Network,”says Kathleen Wroten, RN, InfectionPrevention manager. InfectionPrevention and the WICU collaboratedon various initiatives to reduce therisk of MRSA transmission, such ashand hygiene education and monitor-ing, educational sessions with staffand new isolation signs, she explains.

Educational seminars and statewidesharing sessions allowed hospitals toshare successful strategies and barriersstatewide. “At Christiana Care, WICUreported no MRSA transmissions dur-ing several months of the project,”Wroten says.

Preventing pressure ulcersPressure ulcers occur when pressureagainst the skin reduces blood supplyto that area and the affected tissuedies. This can happen when you stayin one position for too long withoutshifting your weight. You might get apressure ulcer if you use a wheelchairor are confined to a bed, even for ashort period of time (for example,after surgery or an injury).

Christiana Care participated in theCMS Pressure Ulcer Reduction Project,joining a community of practiceorganized by QID that included nurs-ing homes and other stakeholders toshare tools, successes and learnings.

The project timeframe was August2008 to January 2010.

To begin, Christiana Care completed ahospital baseline self-assessment sur-vey for pressure ulcers reduction.

Initial project strategies consisted of:

n Organizational commitment,reflected by the interdisciplinary

P A T I E N T S A F E T Y, C O N T I N U E D

2 ● F O C U S A u g . 1 9 , 2 0 1 1

For the eighth consecutive year, theNews Journal has named

Christiana Care a Top Workplaceemployer, ranking the health system6th in the large workplace categoryand best in career opportunities.

The newspaper bases the honor onemployee surveys from 100 compa-nies in the Delaware region.

More than 700 Christiana Careemployees completed a survey inMay, voting Christiana Care the topworkplace for career opportunities.

Only 50 companies made the bestplace to work list this year. The publi-cation featured the rankings in TopWorkplaces 2011 insert in the NewsJournal on Sunday, Aug 14.

Christiana Careranked best instate for careeropportunities

n Companies that invest in workers’ health with com-prehensive worksite wellness programs and healthywork environments have less absenteeism, greater pro-ductivity and lower health care costs.

n Initiating a nationwide plan to cut the salt in the foodsupply to support an average intake of 1,500 mg per daymay reduce high blood pressure in the country by 25percent, saving $26 billion in health care costs annually.

As a call to action, the statement puts an equal amountof responsibility on individuals and on society — specifi-cally federal, state and local policy-makers.

“People often don’t realize the power to stay healthy isin their own hands,” said Dr. Weintraub in a pressrelease from the American Heart Association. “But it’snot something many individuals or families can doalone. It takes fundamental changes from society as awhole.”

Center for Heart & Vascular Healthand across the entire Christiana CareHealth System,” added MitchellSaltzberg, M.D., medical director ofthe Heart Failure Program.

“Our program continues to strive todo the right things for congestiveheart failure patients and to define ourprogram as a regional and nationalcenter of excellence. This certificationis a major step toward maintainingexcellence and continually improvingthe care we provide.”

Before receiving certification,Christiana Care underwent a rigorouson-site survey. A team of JointCommission expert surveyors evaluat-ed Christiana Care for compliancewith standards of care specific to theneeds of patients and families withheart failure, recognizing its progres-sive care models, levels of staffengagement and collaboration amongproviders.

Christiana Care Health System’sCenter for Heart & Vascular

Health has earned the JointCommission’s Gold Seal of Approval.

Christiana Care is the only hospital inDelaware and one of just 33 in theUnited States to demonstrate com-pliance with The Joint Commission’snational standards for health care qual-ity and safety in disease-specific care.

The award recognizes ChristianaCare’s dedication to continuous adher-ence to The Joint Commission’s state-of-the-art standards.

High-quality treatment“This certification is a testament to thehigh-quality treatment we provide topatients with heart failure,” saysTimothy J. Gardner, M.D., medicaldirector of the Center for Heart &Vascular Health and past nationalpresident of the American HeartAssociation. “It signifies that our serv-ices have met the requirements needed

Heart Failure Program called ‘one of the best’ in U.S.

to achieve long-term success inimproving outcomes. It’s also a signalto the community that we can effec-tively manage the unique and special-ized needs of heart failure patients,and that there is no need for them toleave the state to find the highest levelof care.”

“Disease-specific advanced certifica-tion in heart failure is the culminationof a tremendous team effort within the

C E N T E R F O R H E A R T & V A S C U L A R H E A L T H

William Weintraub, M.D., the JohnH. Ammon Chair of Cardiology

at Christiana Care, is the lead authorof a policy statement published in theprint edition of the July 26 issue ofCirculation: Journal of the AmericanHeart Association that says preventingheart disease before it starts is a goodlong-term investment.

The statement summarizes years ofresearch on the value of investing inprevention, particularly through

community-based changes to make it easier to live a healthylifestyle:

n Every dollar spent on building trails for walking or bikingsaves $3 in medical costs.

Dr. Weintraub writes AHA policy statement on prevention

William Weintraub, M.D.

A u g . 1 9 , 2 0 11 F O C U S ● 3

The Advance Practice Award winner and distinguished finalists honored atthe 2011 Delaware Excellence in Nursing Practice Award Celebration deserve

additional recognition for demonstrating the following Forces of Magnet traits asoutlined by the ANCC Magnet Nursing program:

In addition to Seckel, Christiana Carehad 10 other finalists in Delaware’sforemost nursing award celebration:

Acute Care Non-Criticaln Marsha Babb, RN

n Jessey Jennings, RN

n Cheryl Swift, RN

Community Basedn Jessica Marvel, RN

Nursing Excellence Awardscorrespond to Forces of Magnet

4 ● F O C U S A u g . 1 9 , 2 0 1 1

T R A N S F O R M A T I O N

Maureen A. Seckel, RN, APN,Medical Critical Care

Pulmonary CNS, received theAdvance Practice Award at the 2011Delaware Excellence in NursingPractice Award Celebration July 14.

The Delaware Nurses Association andthe Delaware Organization of NurseExecutives coordinate the awards. Theevent recognizes nursing professionalswho consistently promote, excel andbring a positive approach to their areaof nursing practice.

From left, Dana Estrada,RN, Marsha Babb, MS,BSN, RNII, CNOR, LindaLewis, MSN, RN, NE-BC,Jessica Marvel, RN, JesseyJennings, RN, MSN, PCCN,FNP-BC, Maureen Seckel,RN, APN, MSN, ACNS-BC,CCNS, CCRN, BethRathmanner, RN-BC, CherylSwift, BS, RNC, MSN,Susan Siano, MSN, RN-BC,RNII, Carolyn Arnold, BSN,CCRN, Paula Smallwood,RN, MSN, NE-BC.

Award Forces of Magnet

Christiana Care nurses earn statewide honors

Structural Empowerment

Acute Care Non-Critical

Community based

Exemplary Professional Practice

Nurse Leader

Outpatient

Transformational Leadership

New Knowledge, Innovationsand Improvements

n Dana Estrada, RN

Nurse Leadern Paula Smallwood, RN

n Linda Lewis, RN

n Beth Rathmanner, RN

Outpatientn Susan Siano, RN

n Carolyn Arnold, RN.

hand held devices at the forum.

The Aug. 10 event drew a full house atthe John H. Ammon MedicalEducation Center. The forum objectivewas to provide “a framework to seizeopportunities to transform the organi-zation,” said moderator BarbaraMonegan, director of TalentManagement, System Learning.

Such shared beliefs and behaviors pro-vide “a baseline to use opportunitiesto change and transform,” she said.

For a more detailed accounting of theQ & A component and the featured speak-ers, including comments by Dr. Laskowskion a recent Value Institute analysis ofrobotic surgery, log on to Yammer andjoin the Leadership Forum network. Not amember? Visit www.yammer.com to join.

A u g . 1 9 , 2 0 11 F O C U S ● 5

T R A N S F O R M I N G L E A D E R S H I P

Value Institute leaders formed a panel to answer questions at the forum. From left,William Weintraub, M.D., director of the Christiana Center for Outcomes Research;Richard Derman, M.D., director of the Center for Health System Design Research;Sharon Anderson, RN, MS, director of the Center for Quality and Safety; and VernonAlders, corporate director of Operational Excellence and director of the Center forOperational Excellence.

Delivering value is basis for fulfilling our mission to community

“In this volatile world,we still must fulfill

our mission, deliveringservices that are valuable toour community,” ChristianaCare president and CEO,Robert J. Laskowski, M.D.,told physicians and staff atthe Aug. 10 Forum forLeadership Behaviors.

“Our strategy is about pro-viding value as profession-als and value for those weserve.”

Strategy for delivering valueDr. Laskowski praisedChristiana Care’s perform-ance in terms of quality andcost and dramatic improve-ments in patient safety aswell. “We should feel goodabout that,” he said.

Following Dr. Laskowski’s presenta-tion the audience viewed a videotapedlecture by the vacationing JamesNewman, M.D., FACP, senior vicepresident and executive director of theChristiana Care Value Institute.

“We've done a great job with qualityand safety,” Dr. Newman said. But,“how do we use our resources in aresponsible way when we're beingpaid less than cost?"

Dr. Newman called the expectationsthat we will do better for less, contin-ue to push drivers of quality and safe-ty, and figure out how to extract over-use and misuse out of the health sys-tem “daunting tasks.”

“But Christiana Care understands andcommits to this challenge,” he said.

Following Dr. Newman’s dialog, lead-ers of the four Value Institute Centersformed a panel that fielded manyquestions, submitted both verballyand through smart phones and other

HUMAN RESOURCES FREQUENTLY CALLEDNUMBERS

health care the condition usuallywould be addressed on the day ofbirth.

Dr. Luft said he learned how the pro-cedure is done without hightech instruments, such as theVTI/CT Scan available atWilmington Hospital, whichwould enable the surgeon tonavigate easily to the blockageand use other high-tech equip-ment to remove it.

“They don’t have that,” hesays. “They do a great job withwhat they have. But there’s nofinesse. The surgeon at BlackLion, Abebe Melaku, M.D.,showed me how they do itwith very little equipment. Hegot it done quickly, because hehad to. You do what you haveto do.”

Otolaryngologists, anesthesiolo-gists and others interested in join-ing future missions are welcome toe-mail Dr. Luft, jay.luft@aol.com,for help and information.

Healing the Children’s mission, asalways, was two-fold: to treat as manychildren as they could handle; and toimprove medical education. “The teach-ing is more beneficial in the long termthan doing the work ourselves,” Dr.Luft says. “We taught a soft tissuecourse, using pigs feet to show their res-idents how to do local skin flaps.” Helearned a lot about practicing medicinewithout the tools and support to whichhe is accustomed, too.

For example, at Black Lion Hospital hetook part in a surgical procedure on a12-year-old girl to correct bilateralcholanal atresia, a birth defect markedby bone growth blocking the nasal pas-sageways that prevented the girl frombreathing through her nose.

“Throughout her life, this girl had beenbreathing only through her mouth,” Dr.Luft reports. In countries with advanced

Jay Luft, M.D., journeys to Addis-Ababba, Ethiopiato heal children and teach surgical skills

Imagine having a painful ear infec-tion and no access to medical care

within many miles. Imaging strug-gline to find transportation across thelong distance and rough terrain to oneof only two large, overcrowded hospi-tals in your nation.

“In all of Ethiopia,” says Jay Luft,M.D., “where 88 million people live,there are not as many doctors practic-ing as there are in Delaware, home toless than a million people.”

Dr. Luft, former chief of theDepartment of Surgery’sOtolaryngology section at ChristianaCare Health System, says a colleaguecalled on him late last year to join anOtolaryngology team heading forBlack Lion Hospital, in Addis-Ababa,Ethiopia, on a 2011 spring mission forthe Philadelphia area chapter ofHealing the Children, a non-profithumanitarian organization.

Christiana Care’s OR atWilmington Hospitalhelped support the missionwith donations of surgicalinstrument trays and softmaterials, such asbandages.

The lack of health careproviders in Ethiopiaenables the advance ofmany diseases that proba-bly would be corrected inearly childhood in theUnited States, Dr. Luftsays. “The majority of thesurgeries we performedwere done to help children hear betterand decrease infection by closingchronic perforations, which are causedby recurrent ear disease without treat-ment,” Dr. Luft says.

F O C U S O N E X C E L L E N C E

Jay Luft, M.D.

Otolaryngologic surgeon Jay Luft, M.D., center,instructs Ethiopian doctors how to perform anasal septal reconstruction, a common procedurein America that the African surgeons had onlyread about and never before seen.

6 ● F O C U S A u g . 1 9 , 2 0 1 1

them migraine treatment and most ofthem responded.”

Many patients were never diagnosedOn average, these patients had been

suffering with ear pain for at least fiveyears. Many of them had never beendiagnosed with migraine. Once Dr.Teixido initiated migraine therapies,patients began to feel relief within twoto three weeks.

Using rigorous scientific standards toaccount for placebo effect and the pos-sibility his patients were improvingspontaneously, Dr. Teixido came to theconclusion that he had identified anew clinical entity he calls migraine-associated otalgia.

The findings could have life-changingimplications for those patients wholive with atypical migraine symptomsfor years without receiving a diagnosisor finding effective treatment.

Physicians also should take note of thestudy’s results, Dr. Teixido says.Primary care physicians and otolaryn-gologists, who normally considermigraine to be the provenance of neu-rologists, likely see patients every daywith unexplained ear pain, dizzinessor other symptoms that could be relat-ed to migraine, even if the patient isn’texperiencing the typical headachepain.

“In my specialty, every doctor knowsthese patients,” Dr. Teixido says.“We’ve done CT scans and MRIs andlooked at their throats and ears andwhen we can’t figure out the cause oftheir symptoms, we should treat formigraine.”

Doctor finds unsolved ear pain is often migraine

Most people don’t go to their ENTfor a migraine. Then again, most

people may be unaware that headachepain is only one of many symptoms ofmigraine, which can present as dizzi-

Michael Teixido, M.D.

Christiana Care’s Compliance Hotline canbe used to report a violation of any regu-

lation, law or legal requirement as itrelates to billing or documentation,

24 hours a day, 7 days a week.

All reports go directly to Compliance Officer Ronald B. Sherman.

Callers may remain anonymous.

The toll-free number is:877-REPORT-0 (877-737-6780).

at 302-623-2873.

F O C U S O N E X C E L L E N C E

When ear pain doesn’t seem tohave a cause, it might be migraine.

ness, chronic sinus pain, tinnitus, sensi-tivity to sound and earache, amongothers symptoms.

“A lot of people who have migraine areundertreated,” said MichaelTeixido, M.D., an otolaryn-gologist and director of theBalance and Mobility Centerof Christiana Care. “Of allthe people with migraine,only about half of themknow they have it. And only about 30percent of people with diagnosedmigraine are satisfied with treatment.There is a lot of room for improvementin migraine therapy.”

Dr. Teixido has spent 15 years learningabout and treating atypical migrainesymptoms. Earlier this year, he pub-lished an article describing a seven-year study showing that unexplainedear pain can be a symptom of migraineand alleviated by migraine therapy.The paper, titled “Otalgia Associatedwith Migraine,” appeared in theFebruary issue of the journal Otology &Neurotology.

“Over a seven-year period, I treatedmany patients with ear pain, and in 50I could not discover the cause of theirpain,” Dr. Teixido said. “I offered all of

“Of all the people with migraine,only about half know they have it.”

Michael Teixido, M.D.

A u g . 1 9 , 2 0 11 F O C U S ● 7

reached the ED. Then we had a goodhandoff. It was as synchronous of ateam event as we could ever have.”

Neurologically, Brian survived the har-rowing event intact, his doctors say.He is now an honor student. On July15, Brian and his parents returned toChristiana Care to celebrate his lifeand survival with the people whocared for him in his direst hour and arepresentative from the AmericanHeart Association, who called theiractions a textbook case of how thingsare supposed to happen.

View more photos at http://www.flickr.com/photos/christianacare

Did you know that AmericanHeart Association (AHA) car-

diopulmonary resuscitation (CPR)guidelines changed last fall?

The AHA rearranged the three steps ofCPR. What used to be A-B-C — forairway, breathing, compressions isnow C-A-B — for compressions, air-way, breathing.

Here is a step-by-step guide fromChristiana Care Training Center, basedon the new American HeartAssociation-recommended CPRmethod:

1. Make sure the scene is safe. Yell forhelp.

2. Look for no breathing or only gasp-ing. Try to get the victim to respond; ifthe person doesn't respond, roll theperson onto his or her back.

3. Send someone to call 9-1-1 and tofind the nearest Automated ExternalDefibrillator (AED) if one is available.(If you are by yourself you make thecall and get the AED yourself.)

F O C U S O N E X C E L L E N C E

Brian Atkins, a seemingly robustand healthy 15-year-old Delaware

teen, went into cardiac arrest, experi-encing “sudden death” on Sundaymorning, May 2, 2010.

He had gone to visit a friend’s home,where a family gathering was underway. He collapsed shortly after arriv-ing there. Someone attending theparty, Betty Foster, a retired nurse,started cardiopulmonary resuscitation(CPR) on the spot. On the way to theChristiana Hospital EmergencyDepartment and for more than anhour after arrival, emergency respon-ders continued CPR until Brianregained a pulse.

Melissa Ivey, RN, CEN, says in her 20years of experience in the EmergencyDepartment, it has become difficultsometimes to feel optimistic aboutcases like Brian’s. Ivey, who is often

part of the critical-care transport team,was instead “floating” as a nurse inthe Emergency Department and readyto jump in when Brian arrived. Shewas shocked when she recognizedBrian’s father, who had been herfriend in high school.

“This case strengthened my faith inGod and my confidence in the careerpath I chose,” Ivey says. “But after werevived Brian we still didn’t feel thejoy as much as the worry about thepossible outcome, which is far betterthan we imagined that day.”

Paul R. Sierzenski, M.D., the attendingphysician, praised the way everyoneinvolved performed that morning.“Resuscitation is like a relay thatbegins with an all-out sprint,” Dr.Sierzenski says. “It starts with abystander performing CPR — that isthe most critical component before he

A year after sudden-death eventDelaware teen celebrates life

8 ● F O C U S A u g . 1 9 , 2 0 1 1

Brian Atkins, seated, was surrounded by his life-saving team of providers, including,back row, from left, Blaine Zumar, Meg Salter, NREMT, Gary Bollinger, RN, OksanaIwaskiw, RN, Mike McMichael, NREMT, E.J. Castagna, NREMT, Tom Shoemaker,NREMT. Front row, from left: Mitchell Saltzberg, M.D., Jennifer Henry, RN, PaulSierzenski, M.D., Betsy Foster, RN, Melissa Ivey, RN, Marla Sanabria, RN. BrianAtkins is seated.

Cardiopulmonaryresuscitationguidelines changed

breaths. If you choose not to do this,go to Step 8

6. Resume chest compressions (30compressions)

7. 30 compressions to 2 breaths for 5cycles, about 2 minutes. After the 5thcycle of CPR, reassess and if neededcontinue with CPR.

8. Resume or continue giving com-pressions at a rate of 100 per minute,same depth. After each push, makesure the chest comes back to itsnormal position.

C P R G U I D E L I N E S , C O N T I N U E D When the AED arrives, interruptperforming CPR, turn the AED on andfollow the prompts.

Continue with this sequence of CPRand the use of the AED until EMSarrives.

Bristow, who works every weekendand has weekdays off, says he hadtime to reflect on what happenedbefore returning to work July 16.

“At 42, I thought I might be tooyoung for this kind of deal,” he says.“If it wasn’t for them caring….

“But I was in the right place at theright time. I feel like they saved mylife.”

OR Tech Bryan Bristow says caring colleagues saved his life

Bryan Bristow, a certified surgicaltechnologist (CST) assigned to

Christiana Hospital’s main OR, sayshe feels like his OR coworkers savedhis life.

After experiencing discomfortthroughout one day at work in JulyBristow felt chest pain. “I kind ofignored it thinking it would go away,”he recalls. But after Bristow returnedfrom an errand to the Labor &Delivery unit some distance from theOR, he “felt like something wasn’tright.”

Bristow spoke to OR colleague AngelaThomas, RN, who told Bristow not toignore the symptoms. Together withDenise Shearon, RN, Thomas ledBristow to the adjacent post-anesthesiacare unit where they knew they coulduse an available EKG monitor.

“My heart rhythm was not right andmy blood pressure was “off the scale,”Bristow reports. “I went downstairs tothe ED where they have a moresophisticated EKG machine,” he says.The EKG showed a right bundlebranch block — a defect in his heart'selectrical conduction system.

Doctors admitted Bristow and ordered

a stress test. The test results showedthree coronary blockages requiringintervention in the cath lab. The cathlab physician cleared the blockagesand placed stents to support thereopened arteries before discharginghim.

“I feel better than I have in 10 years,”he declares. “It’s amazing what flowof blood will do for you.”

F O C U S O N E X C E L L E N C E

From left, Denise Shearon, RN, Bryan Bristow and Angela Thomas, RN.

4. Start chest compressions:

- Place the heel of your hand on thecenter of the victim's chest.

- Put your other hand on top of thefirst with your fingers interlaced.

- Push straight down on the chest(lower half of the breastbone), to atleast 2 inches depth at a rate of at least100 pushes a minute. (That's about thesame rhythm as the beat of the BeeGee's song "Stayin' Alive.")

5. Open the airway and give 2

Portableautomatedexternaldefibrillators(AEDs) areavailable inmany publicplaces.

A u g . 1 9 , 2 0 11 F O C U S ● 9

1 0 ● F O C U S A u g . 1 9 , 2 0 1 1

Employees of the Marble SlabCreamery, a neighbor of

Christiana Care’s Helen F. GrahamCancer Center, have started a pro-gram at the ice cream maker’s shopacross Delaware Route 58 to supportthe Cancer Center. The employeesdonate tips collected on Wednesdayto a fund for periodic donations.

“Part of our business philosophy is togive back to the community; this isjust one way we do so,” say MarbleSlab owners Mark and RhondaQuinlan.

“The Marble Slab Creamery-Christiana, is an example of the con-tinued community support that theHelen F. Graham Cancer Center hasreceived over the last nine years,”says Nicholas J. Petrelli, M.D., Bank ofAmerica endowed medical director of theHelen F. Graham Cancer Center.“Without community support, we wouldnot have a cutting-edge cancerprogram.”

H E L E N F . G R A H A M C A N C E R C E N T E R

What a sweet thing to do! Christiana CareCCOP is patientaccrual champion

The Cancer and Leukemia GroupB, known as CALGB, places

Christiana Care’s CommunityClinical Oncology Program (CCOP)at the top for recruiting patients forclinical trials for the period from May1, 2010 to April 30, 2011. ChristianaCare was fifth overall out of 45participating organizations, and firstamong non-university cancer centers.

Christiana Care’s accrual rate is 23percent of all patients, far above thenational average of 4 percent. In part,that is because of recruiting commu-nity physicians to CCOP and makingnurses available to the offices ofoncology practices at the Helen F.Graham Cancer Center to providepatients with information aboutclinical trials. Clinical trials play anessential role in cancer research.

Top five accrual rankingn Dana-Farber - 623

n University of North Carolina-Chapel Hill - 431

n Washington University School ofMedicine - 431

n The Ohio State University - 394

n Christiana Care Health System,Helen F. Graham Cancer Center –359 patients.

To learn more about Christiana Care’sCommunity Clinical Oncology Program, goto: christianacare.org/communitycancerprogram.

Nicholas J. Petrelli, M.D. (right), ,receives a check from Mark andRhonda Quinlan, proprietors of theMarble Slab Creamery, on behalf ofthe ice cream vendors’ generousemployees.

UD student earns research fellowship atCenter for Translational Cancer Research

researchers at the Center forTranslational Cancer Research at theHelen F. Graham Cancer Center,describes his project as part of aneffort to effectively target the elusivecancer stem-cell while giving a lethalblow to a drug-resistant and tumor-generating subset of cells. Ralston’srole is to help determine whether twodrugs for treating high cholesterol,Lovastatin and/or Simvastatin, cankill the drug-resistant cells.

“It is a great honor to be immersed inthe challenging, supportive, and inspi-rational atmosphere that permeatesthe CTCR lab,” Ralston says.

University ofDelaware

undergraduateresearcherMatthew Ralstonreceived a fellow-ship award tosponsor his thesisproject titled“RhodependentApoptosis

Mechanism Induced by StatinTreatment.”

Ralston, who is mentored by BruceBoman, M.D., Ph.D., director of CancerGenetics and Stem Cell Biology, and

Matthew Ralston

tions. They also may benefit fromcognitive behavioral therapy.Unless neighbors or relatives alertsocial service agencies to the problem,hoarding will continue indefinitely,putting the hoarder at risk for injuryfrom falling objects, fire and reactionsfrom taking expired medications orthe wrong drugs. That is why it isespecially important to identify hoard-ers so they can receive treatment. “Hoarders do not voluntarily ask forhelp,” Dr. Gupta says. “They do notthink they have a problem.”The phenomenon of hoarding wasfirst identified in 1947, when theCollyer brothers of New York Citywere found dead in their brownstoneamong 130 tons of refuse, includingthe chassis of a Model-T Ford, 14pianos and hundreds of bundles ofdecades-old newspapers.Disorder often rooted in childhoodThe disorder is frequently rooted inchildhood and has been observed infoster children who hoard food tomake certain they will have enough toeat, Janney says.“Shopping online gives hoarders moreopportunities to buy things,”Symonds says. “Extreme couponinggives them a rational reason to buylarge quantities of things they willultimately never use.”Treatment of hoarding requires a com-prehensive effort. Janney andSymonds are compiling a list of com-munity resources, such as animal res-cue groups and housing agencies thatcan help hoarders through the difficultprocess of decluttering their lives. InNovember, they will give a presenta-tion on hoarding to the DelawareEmergency Nurses Association.“Hoarding is a difficult problem,”Janney says. “Education is the firststep toward a solution.”

Christiana Care nurses explore complex ‘hoarding’ behavior

For years, hoarding was a secretobsession that grew out of control

for millions of Americans.

“Today, reality TV shows put drama inthe hoarding phenomenon — but thatdoesn’t really educatethe public,” says AnitaSymonds, RN, forensicnurse examiner coordi-nator at ChristianaHospital.

Symonds and JeannieJanney, RN, a psychiatricnurse, are workingtogether to explore thecomplex condition,which impacts an esti-mated 10.6 millionAmericans. Their goal isto bring hoarding intothe open so that morepeople who have thecondition can be treated.

They are sharing threenon-confrontational questions that willhelp nurses identify hoarders:

n Do you notice yourself collectingitems that other people might notthink of as valuable?

n Are areas in your home clutteredwith your collections?

n Do you experience difficulty or findit impossible to discard any of yourcollection items?

In the hospital, hoarders often will

keep items from their food trays,including paper napkins and condi-ments, Janney explains. Or they mightask for extra dressings to take home.

Symonds and Janney wrote an article,“53 Reasons Why Mary Needed OurUnderstanding and Compassion,” acomposite portrait of a patient whowas admitted through the ED as aresult of behavior connected to hoard-ing. The article will be published inNursing 2011.

Mary, the fictional patient, trippedover one of the dozens of cats in herhome and broke her hip.

Hoarding can contribute to varioushealth problems, says Sandeep Gupta,M.D., Christiana Care director ofPsychiatric Emergency Services.

Health risks of hoardingThe stove might be covered withdebris, so the hoarder can no longercook and becomes malnourished. Ifthe bathtub is filled with litter, thehoarder cannot bathe and hygienesuffers. If hoarders share their homeswith many pets, animals and theirwaste can contribute to disease.

Treating people with hoarding issuescan take an inpatient and outpatientapproach, depending on the severityof the condition. Dr. Gupta says med-ications for obsessive compulsive dis-order and depression can help hoard-ers who have those underlying condi-

F O C U S O N E X C E L L E N C E

Hoarding is abehavioraldisorder thatcan contributeto a host ofhealth andsafe typroblems.

Regina Janney, RN

AnitaSymonds, RN

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The 20th American Heart Association Annual HeartWalk will be here in just a few short weeks. The

Heart Walk, scheduled for Sunday, Sept. 11 at theWilmington Riverfront, promotes awareness aboutheart disease and stroke while raising funds to fight thediseases. Each year, Christiana Care employees, fami-lies and friends turn out to support this great event.

You can register a walking team at www.heartwalk.kintera.org/wilmingtonde. Individualscan join one of the several teams from Christiana Carealready listed on the site. Or call your co-workers,friends and family and start your own team. On-siteregistration begins at 8 a.m.

Register today to receive a special Annual Heart WalkT-shirt.

Upcoming Events

Register now to join American Heart Association annual walk

C E N T E R F O R H E A R T & V A S C U L A R H E A L T H

This year’s Christiana Care Heart Walk T-shirt is fun and colorful.The first 1,000 employees and their team members to registerreceive this special, free T-shirt.

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Front Back

Co-Ed soccerChristiana Care’s NewCastle County SoccerLeague team for women18 and older, men 30 andolder, starts play the firstweek in September, con-tinuing through earlyDecember. Interested play-ers should contact TepKang via Outlook or call733-6333.

Congratulations to MelissaDonovan, M.D., the July 2011

Resident of the Month. Donovan, afifth-year Surgery resident, receivednominations from other residents andnursing staff, which included suchcomments as “She is honestly one ofthe most compassionate and attentiveresidents I've ever worked with."Other residents reported having “thegood fortune of working with her onnight float and other assignments,where she has proven herself time andtime again to be a significant resourceto all who work with her.”

Another co-worker described her as“resourceful, strong, intelligent and apleasure to work with, especially inhighly stressful situations."

Melissa Donovan, M.D., named July 2011 Resident of the Month

Melissa Donovan, M.D.

Sherry A. Monson appointed vice presidentWomen’s and Children’s Services

Sherry A. Monson, RN, MBA, MSN,has been appointed vice president,

Christiana Care Women’s andChildren’s Services.

Monson joined Christiana Care afterserving as director of Nursing atLancaster General Health’s Womenand Babies Hospital. Previously, shewas vice president of Women andChildren’s Service at Rose MedicalCenter in Denver. She has more than18 years’ experience in hospital leader-ship, with the last 10 dedicated towomen’s and children’s health servic-es. Her clinical and administrativecareer includes previous work inemergency medicine, behavioral

health, strategic planning, processredesign, project management andhealth information systems.

Monson has been a registered nursesince 1980 and lived and practiced inUtah until 2008. She is certified inexecutive nursing practice through theAmerican Organization of NurseExecutives.

She received an MS degree in Nursingfrom the University of Phoenix,Arizona, an MBA from the Universityof Utah, and a BS in Health ServicesAdministration from Weber StateUniversity, Ogden, Utah.

To contact Monson call 733-1286.

Sherry A. Monson, RN, MBA, MSN

Blood Bank of Delmarva’s 9thannual Summer BloodChallenge ends on September

11. There is still time to earn pointsfor Christiana Care and help us takehome the title of the “Top LifesavingEmployer.”

Christiana Care's next on site blooddrive is Monday, Aug. 29 in theAuditorium of the John H. AmmonMedical Education Center. We need100 donors in order to hold our onsite blood drives…we need you!

It only takes about an hour from startto finish.

Call 737-8400 today to schedule yourappointment.

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Annual blood drivelooking for big finish

ly ask patients whether they are usingdietary supplements. Providing exam-ples may be helpful in understandingwhat is being asked.

Christiana Care supports the use ofselect dietary supplements. Requestsfor the addition or deletion of agentsto the formulary may be submitted tothe Pharmacy and TherapeuticsCommittee. If the agent is on the for-mulary, it will be provided by phar-macy services or the dietary depart-ment. Dietary supplements not on theformulary may be used if the physi-cian enters an order for the patient to“use their own dietary supplement”and the dietary supplement is consid-ered safe by Pharmacy andTherapeutic Committee.

The following supplements havebeen determined to be safe for use bypatients of Christiana Care:

Bilberry, black tea, black cohosh,black pepper, cascara, cayenne,chamomile, chondroitin, cranberry,echinacea, garlic, ginger, ginkgo,ginseng, panex and Siberianglucosamine, grape seed extract,hawthorn, milk thistle, passionflower, SAMe, saw palmetto, soy, St.John’s wort.

Dietary supplements are defined bythe Dietary Supplement Health andEducation Act of 1994 as products“intended to supplement the diet” thatcontain vitamins, minerals, herbs, orother botanicals. Familiar examples ofherbals include: St. John’s Wort, echi-nacea, ginkgo biloba, saw palmetto,and black cohosh. Consumers areoften attracted to these products sec-ondary to the belief that they are effec-tive and natural, hence, safe.

However, the safety and efficacy ofthese agents have not been proven tothe Food and Drug Administration(FDA), because these agents are classi-fied under food products and not drugtherapy. Opposite of the drugapproval process, the proof of efficacyor safety does not have to be demon-strated to the FDA prior to marketingof agent. With regard to efficacy, mar-keting of dietary supplements cannotclaim activity in the specific treatmentof a specific disease or condition, how-ever, claims can be made that suggestan effect on the function of the bodywithout the burden of proof to theFDA. The differentiation of these two

claims may lead to patient misinter-pretation. For example, dietary sup-plements containing ginkgo bilobacannot be labeled as treating memoryloss or Alzheimer’s disease, but, canbe labeled to enhance brain functionand cognition in patients. A consumermay interpret these two claims as onein the same.

The popularity of dietary supplementshas grown steadily in the UnitedStates. It is estimated that more 38million adults in the United States usedietary supplements. However, it isestimated that only 1/3 to 1/2 ofpatients will share with their providerthat they are utilizing these supple-ments.This lack of reporting is of con-cern because of the potential forserious drug-herb interactions. Forexample, decreased anticoagulantactivity with the combination of gin-seng and warfarin, increased risk ofbleeding when ginkgo biloba is com-bined with antithrombotics, or apotentially fatal result of serotoninsyndrome from the use of St. John’swort in combination with selectiveserotonin reuptake inhibitors, to namea few. To prevent the omission of thisinformation, providers should routine-

Therapeutic notesDietary Supplements By Cynthia Barlow, Pharm. D., BCOP

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C H R I S T I A N A C A R E P H A R M A C Y

Trent A.Beach,

Pharm.D.,MBA, MHA,FASHP,received anappointment

from the U.S. Department ofCommerce’ National Institute ofStandards and Technology (NIST) toserve on the 2011 Board of Examiners

for the Malcolm Baldrige NationalQuality Award.

The Baldridge Award, created bypublic law in 1987, is the highest levelof national recognition for perform-ance excellence that a U.S. organiza-tion can receive.

As an examiner, Beach is responsiblefor reviewing and evaluating applica-tions submitted for the Award. Theboard is composed of approximately

Trent Beach appointed Baldridge award examiner

500 leading expertsselected fromindustry, profes-sional and tradeorganizations, edu-cation and healthcare organizations,and nonprofits(including govern-ment).

Trent A. Beach, Pharm.D

Formulary update - July-August, 2011

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United Way of Delaware supports First State School

Adelegation from the United Way ofDelaware delivered much-appreciated

books and backpacks in August to help outstudents at First State School. United Way’smessage: One of our primary focuses is edu-cation, because a solid education is critical fora good quality of life.

United Way supports many programs thatpromote reading and education in general forpreschool children through high school ages,as well as a variety of health and income ini-tiatives to promote physical health andfinancial stability.”

United Way representa-tives (from left) SarahKenney, Jeff Haas,Gerald Rocha, KananiHines and ReggieCoston visited the FirstState School (FSS) atWilmington Hospital,bearing gifts. From left,FSS students Henia,Madison, Kiara,Samsan, Zie and Maurareceived the specialUnited Way backpacksfilled with summerreading selections, justa few of the 4,000 bagsdistributed throughoutDelaware.

retain and recruit oral and maxillofa-cial surgery faculty.

Dr. Meara is one of only four 2011national award recipients.

“Dr. Meara is our rising star andbrings a new dimension and expertiseto our training program for oral andmaxillofacial surgery in the full scopeof surgical procedures,” says Edwin L.Granite, D.M.D., Chair and programdirector of the Department of Oral andMaxillofacial Surgery and HospitalDentistry. “I can think of no one betterqualified to teach the teachers and sur-geons of tomorrow who are learninghere in our highly advanced, nation-ally recognized training program.”

Christiana Care’s Department ofOral and Maxillofacial Surgery

Director of Training and ResearchDaniel J. Meara, M.D., D.M.D., hasreceived the American Association ofOral and Maxillofacial Surgeons/Oraland Maxillofacial Surgery Foundation,Faculty Educator DevelopmentAward.

Disbursed over three years, the finan-cial award is used to encourage andsupport promising young oral andmaxillofacial surgeons and their aca-demic careers in the specialty. It alsoprovides an incentive to Commissionon Dental Accreditation (CODA)accredited residency programs to

Daniel J. Meara, M.D., D.M.D.

Dr. Meara receives grant to promote academic careers among oral-maxillofacial surgeons

F O C U S O N E X C E L L E N C E

Nov. 4, 2011 ... Nov. 4, 2011 ... Nov. 4, 2011 ... Nov. 4, 2011 ... Nov.

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By getting dental checkups every sixmonths, you can take care of concernssuch as cavities, broken fillings andgum disease before they become large,expensive and painful problems.

Poor oral hygiene also can contributeto bone loss and increase your risk ofheart disease and stroke. The dentistalso will examine your mouth forsigns of oral cancer, which is highlycurable if it is diagnosed in the earlystages.

So, if it’s time for a checkup, don’tignore that reminder from your den-tist. Make an appointment — andsmile!

Set yourself up for success by stockinggrab-and-go items you can toss inyour lunch when you are pressed fortime, such as low-fat yogurt cups,bananas, apples and pre-measured100-calorie snack packets of almonds.

Steer clear of soda, which is packedwith sodium, sugar and calories.Instead, go for water, no-fat milk or asugar-free soft drink. It’s better foryour waistline — and eliminatingsugar also lessens your odds of toothdecay. (Tip: Adding a frozen bottle ofwater to your sack will keep yourlunch cold. And when it thaws, youcan drink it.)

C A R I N G F O R Y O U R S E L F

An apple for the teacher, the dentist—and you

The approaching school year is areminder to educate ourselves on

ways we can help to keep ourselveshealthy.

Think of an apple for the teacher toremind yourself of two good habits:packing nutritious brown bag lunchesand scheduling regular dental check-ups, the better to bite into that crispfruit.

Healthy lunches are a great way to getyour kids on the path to nutritionbecause the help eliminate opportun-ities for youngsters to make poor foodchoices on impulse. Because you con-trol what goes into the bag, you dic-tate the fat content and calorie count.

That also goes for grownups.

You might start by rethinking thesandwich, that brown bag staple.Whole-grain breads, such as rye andwheat, are typically more nutritiousthan white bread. They also hold upbetter in the lunch box and are lesslikely to get limp and soggy.

Choose lean meats, such as turkey.Eliminate the cheese or try a low-fatalternative, such as part-skim moz-zarella. Hold the mayo. Try a littlehummus, instead. It’s spreadable,tasty and much lower in fat.

To keep brown bag boredom at bay,mix things up by trying new comboson vegetarian sandwiches, such as bellpeppers, arugula and spinach, withlow-fat cheese. Or make a green saladtopped with lean protein, perhapsgrilled chicken breast. (Tip: Save timeby grilling a few extra chicken por-tions when you make dinner and usethe extra for lunches.)

By getting dental checkups every six months, you can take care of concerns such ascavities, broken fillings and gum disease before they become large, expensive andpainful problems.

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Publishing, presentations, appointments, awardsPublishing

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Service milestones adding upto 60,000 hours called for a cele-bration June 29 at the Universityand Whist Club in Wilmington.From left are some of the latestmilestone achievers, including vol-unteers Anna Marie Brown, MaryMcCready Diane Margolin, GirijaParameswaran, James Dugar, JackCooney, Philip Faix Jr., Janet Buell,Judy Vassar, Joanne Patchak, andJanet Sashihara.

Evaluating diabetes programMore than 330 people with diabetesenrolled in a disease managementprogram that provides diabetes edu-cation and nutrition counseling.Individuals who are compliant withthe program receive medications andsupplies at no charge. Enrollment iscurrently closed to new participantswhile the program is being evaluated,but preliminary results indicate thatenrollees show significant improve-ment in their cholesterol values andblood sugar control.

Two dynamic initiatives, part ofChristiana Care’s commitment to

improving employee health, are help-ing workers with two chronic diseasesto keep their conditions under control.

More than 90 people signed up for aprogram designed to help adults 18and older with asthma, says KarenAnthony, MS, CHES, program manag-er, Preventive Health Services.

The goal is to reach as manyChristiana Care employees anddependents with asthma as possibleby providing education and medica-tion at a convenient location at nocost. Anthony says an estimated 1,200workers, spouses and dependentsover 18 suffer from asthma.

“From our results so far, we are hear-ing that people are ecstatic about howmuch better they feel,” she says. “Wehope to help many more to under-stand and better manage their asth-ma.”

When asthma is under control, peoplefeel better and need to take fewer sickdays.

Asthma affects ability to work“Asthma definitely impacts whether

people can come to work or how theyfeel after they get to work,” she says.

At the beginning of the asthma pro-gram, more than half the participantsreported their asthma was uncon-trolled or poorly controlled.

After three months, only 22 percentreported their asthma was uncotrolled.

In the program, participants meet witha nurse manager, who educates themabout their asthma and how to prop-erly use their various medications tothat they can better understand theirconditions and adhere to their asthmaaction plans.

Enrollees also have self-managementgoals and benchmarks. They cangauge their improvement at follow-upappointments after three months, sixmonths and nine months.

“A lot of people don’t think they haveasthma unless they are having anattack,” Anthony says. “In the pro-gram, they learn about the importanceof maintenance medications and areeducated about asthma triggers, suchas allergy season.”

Preventive Health Services is a part-nership between The Eugene DuPontPreventive Medicine & RehabilitationInstitute, the Department of Familyand Community Medicine andEmployee Health Services, created toimprove and promote employeehealth and wellness.

In addition to helping employees, theprograms also have the potential to

C A R I N G F O R Y O U R S E L F

Preventive Health Services wants to help you control asthma

benefit the entire health care systemby reducing medical costs.

To learn more about the asthmaprogram, call Preventive Health Servicesat 302-661-3050.

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It’s never too early to read Focus!Little Siya Edupuganti takes an interest in FOCUS. Reading FOCUS is part of Siya'searly childhood education, says her mother, Kavitha Edupuganti, injury preventioneducator with the Christiana Care PEEPS team.

When Deborah Buenaga saw a photo of a boy with mito-chondrial disease riding a specially made bike, she wanted

one for her 12-year-old son, Preston, who has the developmentaldisease, too. Excited, she posted a picture of the bike on herFacebook profile and asked her friends if they knew anythingabout the company that made it.

A friend saw the post and sent Buenaga a message telling hershe was going to start a “Facebook Event” page to raise enoughmoney to buy Preston the $2,200 bike.

Her friend created a page named “Pay It Forward for Preston'sLove Bike,” and invited their friends to participate. Within fivedays they collected more than they needed in pledges forPreston's bike. Now Buenaga plans to use money left over to buyanother custom-made bike for another child in need.

PRSRT STD

U.S. POSTAGE

PAID

WILMINGTON DE

PERMIT NO. 357

External Affairs

P.O. Box 1668

Wilmington, DE 19899-1668

www.christianacare.org

P R I N T E D O N

R E C Y C L E D P A P E R

How Preston’s dream of bike-riding became reality

Preston Buenaga received his custom-made orange bike Aug.11. Withhim in the photo are his Christiana Care Physical Therapy PLUSrehabilitation team, from left, Exercise Tech Allison Siple, MicheleJones, OTR/L, Lisa Ross PT, DPT, PCS, Travis Ross PT, DPT; and hisparents, Deborah and Stephen Buenaga.