Inside

Addictions outreachhelps save lives 2

Quick response revivedmarathoner 3

Zohra Ali-Khan Catts promotesstate professional standards 4

Volunteers help ensurethat ‘no one dies alone’ 5

Publishing, Presentations,Appointments, Awards 7

VNA offers private dutynurse training program 8

People in national spotlight 9

New OB/GYNs in Greenville 10

F O C U SChristiana Care earns value award

Christiana Care has been recognizedas one of the top 100 hospitals for

community value in the nation byCleverley + Associates® as part of its"Community ValueLeadership Awards."

Cleverley ranks thetop 100 hospitals eachyear based on itsCommunity ValueIndex (CVI), whichconsiders financial via-bility and plant rein-vestment, hospital costand charge structureand quality perform-ance.

Christiana Care also earnedrecognition as one of Cleverley’s

“Community Value Five-Star Hospitals”for 2010 for placing in the top 20 percentof all hospitals nationwide based on the

CVI. Cleverley+ Associates is aColumbus, Ohio-

based health care dataand consulting ser-

vices firm specializingin custom data analy-ses and reporting forhealthcare providers,

consultants, andvendors.

Learn more aboutthe Community ValueIndex and Community

Value Five-Star Hospital awards online at www.cleverleyassociates.com.

To determine which organizations earn awards, Cleverley+Associa tes considersfinancial viability and plant reinvestment, hospital cost and charge structure, andquality performance.

“When you include drug abuse, thenumber is even higher,” Dr. Hortonsays.

Bolstered by the success of the pro-gram at Wilmington Hospital,Christiana Care hopes to expand theinitiative to Christiana Hospital.

“We’re working with the state to try tosecure federal funding,” Dr. Hortonsays. “We think we have come up withan effective method that saves bothlives and money.”

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More patients with substanceabuse issues are receiving

potentially life-saving treatment foraddictions thanks to an innovativepeer-to-peer counseling program.

An embedded, on-site outreach coun-selor at Wilmington Hospital is engag-ing patients with drug and alcoholproblems at times when studies showintervention efforts most often findsuccess.

Christiana Care launched the programSept. 1, 2008 in partnership with

Brandywine Counseling Inc.Since then the program has produceddramatic results that could ultimatelyreduce serious illnesses associatedwith addiction, such as pancreatitis,heart disease, kidney failure, cirrhosisand pneumonia.

More than a third enter treatmentAs of June 10, 2010, 35 percent of the313 individuals who received peer-to-peer counseling have participated in alicensed inpatient or outpatient treat-ment program, says Terry Horton,M.D., an internist on the faculty of theDepartment of Medicine.

“These numbers are exceedinglyrobust,” Dr. Horton says. “Before, theonly option available to engagepatients in community-based drugtreatment was to hand them a phonenumber and a few, if any, would fol-low through.”

The program’s impressive success rateattracted the attention of DelawarePhysicians Care, an Aetna Medicaidplan. In tracking 18 patients whoreceived peer-to-peer counseling, thegroup found that individuals weretaking better care of their health andrelying less on emergency care.

Hospital admissions declined by athird and there were 38 percent fewervisits to the Emergency Department.Meanwhile, visits to primary careproviders increased 88 percent.

Patients who receive treat-ment for their addictionsand routine care from theirprimary care physiciansare less likely to developmore serious diseases.

“Care for substanceabusers can be exceedinglyexpensive,” Dr. Hortonsays. “By getting them

treatment, we can reduce their suffer-ing and benefit society as well.”

Brandywine Counseling’s BobbieDillard works directly and intenselywith patients at Wilmington Hospitalwho have been identified as beingaddicted to drugs or alcohol.

Outreach for patients at bedside“Bobbie comes to the bedside or theclinic or the Emergency Departmentand talks with the patients,” Dr.Horton says. “It’s a low-tech methodthat is having a positive impact onhealth care costs.”

Finding ways to channel people intotreatment for their addictions couldhave a sweeping effect on the healthcare system. Currently, 7 percent of theadults in Delaware are consideredproblem drinkers, according to thestate Department of Health and SocialServices, Division of Public Health.

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

Addictions outreach counseling helps save lives

Brandywine Counseling, Inc. counselorBobbie Dillard meets with patients withalcohol and drug abuse problems afterthey arrive at Wilmington Hospital.

“I t ’s a low-tech method thati s hav ing a pos i t ive impacton hea l th care cos ts .”

Terry Horton, M.D.

Force 14: Community andthe health care organization

In an annual foot race that wasall about endurance and indi-

vidual finish times, the mostimportant result at the May 16Delaware Marathon was thespeedy response of a medicalteam.

Seconds after crossing the finishline, Scott Stanley, a 50-year-oldfather of three from Drexel Hill,Pa., collapsed.

Fortuitously, Julie Sullivan, M.D.,a PGY-3 Emergency Medicineresident, two visiting residentsfrom Abington Family Medicine,several Emergency Departmentnurses and a paramedic weremonitoring the event andresponded within seconds.

He had no pulseStanley had no pulse. The teamimmediately began CPR and calledfor an ambulance, which isequipped with an automated exter-nal defibrillator or AED, a portableelectronic device that automaticallydiagnoses cardiac arrhythmias anddelivers an electric shock to the heartso that it can reestablish its rhythm.

“I woke up in the ambulance,” herecalls. “Before that, all I remember iscrossing the finish line and feelingfaint.

“I probably wouldn’t have made it ifthis had happened to me on a lonelystreet at 6 o’clock in the morning ordriving in my car,” he says. “Hats offto all the people at Christiana Carewho took such wonderful care of me.”

No history of heart diseaseStanley, who had no history of heartdisease, had suffered sudden death,which occurs when plaque, alreadybuilt up inside the artery, suddenly

Quick response revived marathoner

ruptures and immediately forms aclot, completely blocking the arteryand causing a heart attack.

“Without that shock to get the heartback on track, the patient dies,” saysEhsanur Rahman, M.D., FACC, associ-ate chief of Cardiology, the interven-tional cardiologist who treated him.

Stanley had finished his marathon. Butthe race to the cardiac cath lab was infull stride.

Every second counts“When a patient has a blocked arteryin the early stages of a heart attack,heart muscle damage continues andevery second counts,” Dr. Rahman says.

Stanley was rushed to the hospital foremergency cardiac catheterization toremove the blood clot, restore blood

flow through the artery and insert astent to keep the blood vessel open.

Less than a month later, he was backat his law practice and playing kick-ball with his son.

“It was very fortunate that skilled peo-ple at the scene began to treat himimmediately,” Dr. Rahman says.“Their timely and professionalresponse made all the difference. Afterhis resuscitation in the field and evenbefore he arrived in the hospital, thehighly efficient, hospital-wide multi-disciplinary system was in full swingto get the patient to the cardiac cathlab as expeditiously as possible.”

A day to rememberThroughout the day, nurses respondedto a variety of conditions, including amarathoner with chest pains, a volun-teer with labor pains and a runnerwho broke his leg as he crossed thefinish line.

“I can't say enough about how well itall worked out with our team,” saysLinda Laskowski Jones, RN, MS,ACNS-BC, CCRN, CEN, VicePresident: Emergency, Trauma &Aeromedical Services. “They trulyperformed with the highest possiblestandards.”

Robert Laskowski, M.D., MBA,Christiana Care CEO and a participantin the day’s races, commended thevolunteers.

“They showed their commitment tocaring for our neighbors every step ofthe way,” he says. “They did a magnif-icent job taking care of the athletesand race volunteers.”

For Delaware Marathon photos, visitwww.flickr.com/photos/christianacare

Drexel Hill attorney Scott Stanley, 50, sur-vived a sudden death experience at theDelaware Marathon finish line thanks toquick action by emergency responders. Wthhim, from left, are his wife, Rebecca, andchildren Ellie and Olivia, and Nathan.

On June 30th, Ali-Khan Catts and herfellow genetic counselors joined Gov.Jack Markell in a bill signing ceremo-ny in Dover at Legislative Hall.

In Delaware, screening for cancer haslead to a significant drop in state can-cer rates and the work of geneticcounselors, including Ali-Khan Catts,has been instrumental in the leader-ship and patient care demonstrated bythe Helen F. Graham Cancer Center.

Genetic counselor helps establish state standards for licenses

Even before she came to the HelenF. Graham Cancer Center in 2002,

certified genetic counselor Zohra Ali-Khan Catts, MS, was motivated to getinvolved.

New to the state, she saw a greatopportunity to establish the licensingrequirements in Delaware as a way tocontribute to her profession.

Genetic counselors work at majorhospital and facilities throughoutDelaware helping patients understandinformation and results from screen-ing tests.

In a meeting with the other 13 geneticcounselors in Delaware, Ali-KhanCatts introduced the idea of licensinglaws for genetic counseling inDelaware. The counselors, along withmedical geneticists, discussed the prosand cons of licensure and decided topursue legislation.

Their proposal outlined standards foreducation and set the regulations forlicensure of genetic counselors as wellas penalties for failure to comply. Itprotects the public by identifyinghealth care providers who have theappropriate training and expertise in

genetic counseling. It also setup a genetic counseling coun-cil under the Board ofMedical Practice.

Why have licensing standards?As genetics and regularscreening becomes more inte-grated in health care, patientsneed access to those whohave proper training inassessing family history anddiscussing genetic test results.Whether you are being testedfor a certain cancer, pediatricgenetic condition, or undergo-ing prenatal screenings, youneed a consultation with a

genetic counselor or medical geneticistto best understand the results of yourspecific test as it pertains to your fami-ly history.

Whether you are being tested for acertain cancer or undergoing prenatalscreenings, you need a consultationwith a genetic counselor or medicalgeneticist to best understand theresults of your specific test.

The coalition needed a legislativechampion and Senator Bethany Hall-Long was a natural choice. As a nurseand educator, Senator Hall-Longquickly recognized the benefit thiswould provide to the public and wasvery motivated to introduce licensurelegislation.

Ali-Khan Catts and the other geneticcounselors worked closely withSenator Hall-Long to get the bill to cir-culate to the Board of ProfessionalRegulations, Board of MedicalPractice, and the National Society ofGenetic Counselors for review beforeit was introduced in the state Senateon May 6, 2010 and passed by theSenate and House on June 3 and 23,respectively.

Zohra Ali-Khan Catts (left) joins Delaware Gov.Jack Markell in announcing new laws governinglicensing of genetics counselors.

Clinical trials play an essentialrole in cancer research.

The Cancer and Leukemia Group B,known as CALGB, places ChristianaCare’s Community Clinical OncologyProgram (CCOP) at the top forrecruiting patients for clinical trialsfor the period May 1, 2009 to April30, 2010.

Christiana Care was fifth overall outof 45 participating organizations,with an accrual rate of 26 percent, farabove the national average of 4 percent.

That is due, in part, to recruitingcommunity physicians to CCOP andmaking nurses readily available toenroll patients in the offices of oncol-ogy practices at the Helen F. GrahamCancer Center.

Top five accrual rankings for theyear, in number of patients, include:

Ohio State University - 518University of North Carolina - 454

Washington University - 437

University of California atSan Francisco - 374 Christiana Care’s Helen F. GrahamCancer Center - 341.

CCOP is cancer trialsaccrual champion

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Volunteers help patients through final hours

Isabel Hendrixson had never met theelderly man at Christiana Hospital

who was near death.

But she knew it was important to bewith him at the end, so she hurried tohis bedside. She held his hand andread him poetry.

“I hope that when my time comessomeone is there for me if my familycannot be there,” she says.

Offering comfort to dying patientsHendrixson is one of more than 20Vigil Volunteers in a program thatoffers comfort and compassion todying patients who do not have aloved one nearby. It’s called No OneDies Alone.

“We did a lot of research into bestpractices to come up with what wethink is an excellent system to helppatients who are near the end die withdignity,” says Lily Tanverdi, VolunteerCoordinator at Wilmington Hospital.

Program established systemwideThe pilot program was introduced atChristiana Care in March 2009, basedon a group founded by a nurse atSacred Heart Medical Center inEugene, Ore. After a year of testing atseveral units at Christiana Hospitaland Wilmington Hospital, No OneDies Alone has been launched system-wide.

Although precise statistics are notavailable, patients at Christiana Caredie each year who do not have lovedones at their side, says MargaritaRodriguez-Duffy, MSW CAVS,Manager, Volunteer & StudentAdministration.

“Perhaps they may not have family inthe area or no family at all,” she says.“Volunteers are willing to serve as

surrogate family members during thislast journey.”

Years ago, when she was a volunteerin the Medical Intensive Care Unit,Sandy Krett sat with a dying patient.

“His family could not bear to be withhim when he died, so I volunteered,”she recalls.

Now a Vigil Volunteer, she is gratefulto see a system in place for patientswho are alone.

Volunteers are trained and equippedEach volunteer carries a bag equippedwith reading materials, recordings ofsoothing music and a journal. If thepatient is dying from an infectious dis-ease, the volunteers are outfitted withmasks, gloves and protective clothing.

During her vigil with a patient, volun-

Thirteen Christiana Care Vigil Volunteers assembled above include (standing, from left)David Hayward, Andrew DelGenio, Darren Cowgill, Isabel Hendrixson, TheresaBrainard, Charles White, Elayne Tomb, Andrew Fairchild, Laura Lagana, Sandra Krett,Mariana Oratorio. Seated from left are Shirley Williams and Mary Frederick.

teer Bonnie Haines read psalms fromvarious religions and spoke to theman as if he were an old friend.

“He wasn’t conscious but I talkedwith him as if he was,” she recalls. “Itold him about my family and mygrandchildren.”

Soon after, Haines sat with her 93-year-old father, who was in hospicecare.

“As my father died, Andrea Bocelliwas singing in the background, whichwas quite beautiful,” she recalls.“Being with someone at the end is areal privilege.”

Volunteers undergo training sessionsbefore they begin their work. To learnmore, call 302 733-1284 or go towww.christianacare.org/volunteer.

Consistent with our strategies for engaging staff in continuous improvement and best practices, we regularly review important top-ics in Focus to help reinforce safe-practice behaviors. These tips reinforce information and enable staff to better articulate our safe-ty practices during an unannounced survey.

Look Alike/Sound Alike MedicationsQ. What Actions should be taken to avoid confusion of Look-Alike / Sound-Alike

Medications (LASAs)?

A. Actions: Along with the 5 Rights and 2 Patient Identifiers

n Look up all Medications in Formulary, Drug Reference Book, Micromedix or call the pharmacist.

n Always check the brand name and generic name of medications.

n List both names on the MAR for redundancy and communication to all team members.

n Be knowledgeable of the purpose/indication for use of each medication. (In most cases LASA medications are

used for different purposes.)

Q. How does Christiana Care Health System help prevent confusion of LASA medications? A. Pharmacy:

n Assesses each new Formulary addition for LASA potential. n Separates LASA medications within the Acudose cabinets.n Utilizes alert stickers, labels and tall man lettering. n Includes individual LASA reminders within the drug information monographs of the Christiana Care Health

System formulary.Systemwide:n Implemented Bar Coded Medication Administration to assist in checking the 5 –Rights.n Posted the LASA list on the Nursing portal in the Staff References section.n Placed viewable product notes in EMAR/CPOE to alert a LASA potential.

Well-informed Caregivers and Patients are the Vital Link in the Safety Chain to Prevent Errors

Focus on Excellence - Best Practice Review

Academic Affairs, in partnershipwith Quality and Patient Safety,

offers the next Achieving CompetencyToday (ACT) course, Issues in HealthCare Cost, Quality, Systems andSafety, for physicians, residents, nurs-es, pharmacists and allied health pro-fessionals.

The ACT course takes place onWednesday evenings Sept. 8 through

Dec. 1, from 4-7:30 p.m. Enrollment islimited to 28. Applications, due byAug. 6, are available through theAcademic Affairs Office, ChristianaHospital, MAP 2, Suite 2114, or by e-mailing Theresa Fields, administrativeassistant, at tfields@christianacare.org.

Course descriptionAchieving Competency Today (ACT) isa graduate level, interdisciplinary 12-

Next ACT course starts Sept. 8week course that includes modules onperformance improvement, patientsafety, measurement and outcomesanalysis in quality improvement, inter-disciplinary team concepts, the U.S.health care system, a brief history andcomparison with other models, healthcare economics and legislation, changetheory, and budgets and approvalprocesses as they relate to conductinga performance improvement project.

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Publishing, Presenting, Appointments, AwardsEvents

be relevant to the world of work and toprepare registered nurses for positionsof leadership in the multi-facetedmodern health-care industry.

are considered LPN IIs. Current regis-tered nurses are now categorized asRN I. VNA will begin accepting appli-cations for LPN II and LPN III thisOctober to enable nurses to meet crite-ria requirements. RN II designationsbegin June 2011.

To learn more about the PDN careerpath or to request an application contact acase management supervisor at 1-800-322-4428, visit the VNA homepage via theemployee portal or visit www.chris-tianacare.org/vna/privatedutynursing.

VNA launches private duty nursing career path

The Visiting Nurse Association’s(VNA) career path for private

duty nurses (PDNs) supportsChristiana Care’s Magnet designation.

It also enhances VNA’s education andpreceptor support program, “TheJourney From Novice to Expert”created in 2007 to increase the numberof qualified PDNs caring for medicallycomplex patients, including those withtracheostomy and ventilator depend-ency.

“This career path recognizes nursesfor their experience, skill level, educa-tion, and leadership behaviors; andprovides clearly defined steps foradvancement from LPN I to RN IIwithin the private duty specialty,”says program director ClevelandCartwright, RN.

Statewide private duty nursing ser-vices grew by 18 percent at VNA from2007 to 2009 as a result of the pro-gram, which serves adult and pedi-atric patients in the home and schoolenvironment.

Creates career growth potentialVNA is the first home care agency inDelaware to offer this type of advance-ment opportunity for private dutynurses, according to Case Manage-ment Supervisor JoEllen Workman,RN, MSN/HSA. “VNA can continue

hiring new graduates, while also offer-ing growth potential for current staffand experienced nurses joining theagency,” she says.

Career paths are available for licensedpractical nurses and registered nurses.Designations include LPN I, LPN II,LPN III, RN I and RN II.

VNA places all new hires in the PDNcareer path according to their skillsand experience. Current VNA LPNswho meet the required qualifications

Immaculata University is startingnew accelerated RN to BSN classes at

Christiana Hospital in the fall.Students attend class once a week on-site and are able to complete degreerequirements within a reasonable timeframe. Courses have been designed to

E D U C A T I O N

Qualified VNA private duty nurses care for medically complex patients, includingthose with tracheostomy and ventilator dependency.

There will be two cohorts during thefall semester:

Monday evenings, starting Sept. 27.

Thursday evenings, starting Sept. 23.

For more information, contactMadeleine Keyes atmkeyes@immaculata.edu or call 610-647-4400, ext. 3173.

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Sherrill Mullenix won the EmergencyMedicine Residency Association's 2010

Residency Coordinator of the Year Award,presented in June in Phoenix, Ariz.

Fifth-year EM/IM resident ChristianColetti, M.D., now an attending physicianwith Doctors for Emergency Services, pre-sented the award.

Albert A. Rizzo, M.D.

Gerard Fulda, M.D., has been appointedby the U.S. Department of Health &

Human Services (HHS) to serve as chair ofthe Scientific Knowledge Subcommittee (taskforce) for the Organ Donor Management TaskForce.

Sponsored by HHS, the Health Resourcesand Services Administration (HRSA) and theOrgan Donation and TransplantationAlliance, the task force addresses opportuni-ties to improve outcomes of and decreasevariation in donor management practices.

The task force will advise the sponsoringagencies about:

n Gaps between what is known and whatneeds to be known about hemodynamicmanagement of the deceased organ donor.

n The assets or capabilities needed toimprove the quality/quantity of research tobetter identify optimal organ donor manage-ment procedures or protocols.

n Research studies that should be consideredthat would have the greatest impact on organdonation outcomes.

n Research studies that can be conducted atthe DSA level, regional level and/or nationallevel.

Albert Rizzo, M.D., named chairman-elect of American Lung Association

Delaware pulmonologist AlbertA. Rizzo, M.D., was elected

chair of the National Board ofDirectors for the American LungAssociation. He just completedserving a two-year term as theAssociation’s highly visibleNationwide Assembly Speaker.

In March of 2010, Dr. Rizzo testifiedon Capitol Hill, at the request ofSen. Tom Carper, in support of SB2995, the Clean Air ActAmendments of 2010, which aimedto strengthen the Clean Air Act bycleaning up sulfur dioxide, nitrogenoxides and mercury from powerplants.

Dr. Rizzo has served as a volunteerfor the American Lung Associationin Delaware for more than 20 years,including two terms as the statechapter Chairman of the Board ofDirectors.

He was responsible for starting theDelaware Asthma Consortium,which now includes more than 60members from the community,

Gerard Fulda, M.D.,to lead task force

Gerard Fulda, M.D.

Sherrill Mullenix

N A T I O N A L R E C O G N I T I O N

pharmaceutical companies andbusinesses, to address manage-ment and care of individualswith asthma.

Dr. Rizzo is chief of thePulmonary and Critical CareMedicine section at ChristianaCare and a managing partner ofPulmonary Associates, PA.

Mullenix receives topcoordinator award

Gretchen Makai, M.D., now seespatients at her office in MAP 2 on

Christiana Hospital campus, in addi-tion to her Greenville Medical Centeroffice hours. Her practice is in Suite2103.

Dr. Makai performs minimally inva-sive gynecologic surgical proceduresthat address a variety of women'shealth concerns, including irregularbleeding, fibroids, pelvic pain,endometriosis and ovarian cysts.These minimally invasive proceduresrequire very small incisions or no inci-sions at all. They often can provide analternative to a hysterectomy.

A new, state-of-the-science OR wasinstalled this year in MAP 2, provid-ing patients with access to a high-techfacility equipped with miniature cam-eras, fiber optics and high-definitionmonitors.

She also has regular hours at theChristiana Care Center for Women'sHealth, 3706 Kennett Pike inGreenville.

For an appointment, call 302-623-4410.

The Department of Obstetrics & Gynecology and the MedicalGroup of Christiana Care announced the opening of a new

OB/GYN practice at the Greenville Medical Office - Center forWomen's Health, at 3706 Kennett Pike in Greenville.

Kirsten Smith, M.D., and Julia Powell, M.D., are now acceptingobstetrics and gynecology patients at their new women’s health prac-tice. Each offers experienced care for women, from family planning,obstetrical care and contraception to treatment of the symptoms ofmenopause and more.

To learn more about our women's health services or to find a doctor, call302-623-2273.

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Greenville Medical Office welcomesDr. Smith and Dr. Powell, OB/Gyns

would be required to determine if useof these can significantly reduce mor-bidity and mortality.

Ensuring safe prescribing practices forour patients is a key factor in provid-ing optimal patient care. Using avail-able tools can offer guidance for pre-scribers facing challenges whenchoosing medications for their elderlypatients. Along with these tools, eval-uating a patient’s medication historycombined with the medication recon-ciliation process provides an opportu-nity to match each medication withan appropriate indication. Theseefforts combined can help us providehigh quality patient care.

Welcome New Medical-Dental Staff

Emergency Medicine

Emergency Medicine/ Internal Medicine

Obstetrics/Gynecology

Pediatrics/Pediatric Nephrology

Surgery - General

Surgery - Neurologic

Therapeutic Notes

Some of the challenges faced whenprescribing for the elderly populationinclude avoiding overuse of medica-tions and avoiding the use of medica-tions that may be poorly tolerated.Suboptimal use of medications, includ-ing the omission of indicated medica-tions may also be a concern.

These can be associated with anincreased risk of adverse drug events,morbidity and mortality. Screening toolsare available to help guide prescribersin selecting medications that may besafer options for elderly patients. Beers’criteria, which have been widely cited,contains two lists of medications thatare recommended to avoid in adultsover 65 years of age, one independentof and one dependent of disease state.

A newer screening tool, STOPP(Screening Tool of Older Persons’Potentially inappropriate Prescriptions)has been developed according to physi-ological systems. Examples of poten-tially inappropriate prescriptions asdetermined by STOPP criteria includedigoxin dosed at >125 mcg/day inpatients with impaired renal function,or the use of tricyclic anti-depressantsin patients with dementia. Othersinclude NSAID use along with warfarin,proton pump inhibitors for peptic ulcerdisease at full dose for >8 weeks, anddrugs that adversely affect those proneto falls such as benzodiazepines orvasodilator use with postural hypotension.

STOPP criteria should be used in con-junction with START (Screening Tool toAlert doctors to Right Treatment) toevaluate errors of omission, which isfailing to prescribe drugs with an indi-cation that could benefit a patient.Barry et al. evaluated 600 communitydwelling patients (>65 years of age)

admitted to a hospital with acute ill-ness, and found one or more appropri-ate medications were omitted in 57.8%of the patients.

The most frequently omitted includestatins for atherosclerotic cardiovascu-lar disease, warfarin in chronic atrialfibrillation, ACE inhibitors for conges-tive cardiac failure, aspirin for stenoticarterial disease, and calcium supple-mentation for osteoporosis. Some rea-sons may include the attempt to avoidpolypharmacy or focusing on palliationof symptoms rather than secondary dis-ease prevention.

Overall, STOPP and START may beuseful tools to help guide prescribing,although randomized controlled trials

Antonio Valle, Jr., a nurse assistant in PACU, says it feelsnatural to play the grand piano at Christiana Hospital for

the people sitting in or traversing the main lobby.

“I have had so many people say such nice things and evenleave notes thanking me for giving them a time of peace insuch a hard time in their lives … I’m so happy that I couldgive back a little by doing something that I hadn't put toomuch thought into.”

Valle, who has been playing the piano in the lobby since May2010, started learning music at age 4.

Listeners can often find Valle playing in the main lobbyTuesdays and Fridays from 12:30-1 p.m.

Pianist fills main lobby with soothing melodies