focusfaulkner evans

16
Focus on Faulkner 1 IN THIS ISSUE P3: Bariatric Improvement Team creates welcoming environment P6: Physician group expands to meet growing needs P9: Dear Faulkner Hospital P11: Professionalism and the Culture of Safety P12: Citizenship classes offered at Faulkner P15: Faulkner Hospital receives stroke award Health Care Unseen By Joe O’Day, Director or Faulkner Hospital’s Pharmacy A friend of mine from college, knowing I had decided to transfer to pharmacy school, would goad me, saying “I heard pharmacists take pills from big bottles and put them into little bottles,” and start laughing. He’d been admitted to dental school. “I may have to count pills,” I’d respond, “but you’ll be staring down throats the rest of your life.” Dispensing medications – “counting pills” – is a fundamental activity in pharmacy. Patients need correct medications, need them promptly, and require appropriate education. But there are other parts to the job, just as important. Pharmacists help patients every day by intervening in their medication orders, discovering and correcting drug interactions and therapeutic duplications, educating other health care workers and patients, and helping to ensure the best outcomes. From an outsider’s perspective, most of these actions are under the radar. A few years ago I received an urgent phone call from a medical resident covering the intensive care unit at my community teaching hospital in the Boston area. His patient had attempted suicide by drinking an extremely poisonous substance. The conventional treatment for such a poison was to administer intravenous ethyl alcohol in amounts to keep the patient intoxicated. By competing with the substance’s metabolism, the alcohol prevents toxic metabolites from forming, avoiding renal failure and metabolic abnormalities and allowing time for it to be removed by dialysis. I had encountered an identical situation years earlier at a different hospital. At that time, Poison Control helped us determine the concentration of the ethyl alcohol needed and how to prepare and filter these infusions. That patient survived with no permanent adverse effects, and when the physician on the case called days later to thank us, it felt great. Ten years later, the same poisoning had occurred, but there was a new antidote with fewer side effects than alcohol. Working with two other pharmacists, we acquired enough of the antidote to get the patient through this crisis, conferred with FAULKNER FOCUS ON News for and about Faulkner Hospital Employees C.A.R.E. STANDARDS C. Communicate your commitment to providing high quality service A. Appear and act as a professional R. Respect all individuals E. Extend yourself Remember to plan for language needs (interpretation, translation and assistive devices) for all patients that may require this extra service. continued on P4

Upload: davidjgoldberg

Post on 24-Apr-2015

37 views

Category:

Documents


3 download

TRANSCRIPT

Focus on Faulkner 1

IN THIS ISSUEP3: Bariatric Improvement Team

creates welcoming environment

P6: Physician group expands to meet

growing needs

P9: Dear Faulkner Hospital

P11: Professionalism and the Culture

of Safety

P12: Citizenship classes offered at

Faulkner

P15: Faulkner Hospital receives

stroke award

Health Care UnseenBy Joe O’Day, Director or Faulkner Hospital’s Pharmacy

A friend of mine from college, knowing I

had decided to transfer to pharmacy school,

would goad me, saying “I heard pharmacists

take pills from big bottles and put them

into little bottles,” and start laughing. He’d

been admitted to dental school. “I may have

to count pills,” I’d respond, “but you’ll be

staring down throats the rest of your life.”

Dispensing medications – “counting pills”

– is a fundamental activity in pharmacy.

Patients need correct medications, need

them promptly, and require appropriate

education. But there are other parts to the

job, just as important.

Pharmacists help patients every day by

intervening in their medication orders,

discovering and correcting drug interactions

and therapeutic duplications, educating

other health care workers and patients, and

helping to ensure the best outcomes. From

an outsider’s perspective, most of these

actions are under the radar.

A few years ago I received an urgent phone

call from a medical resident covering

the intensive care unit at my community

teaching hospital in the Boston area. His

patient had attempted suicide by drinking

an extremely poisonous substance.

The conventional treatment for such a

poison was to administer intravenous

ethyl alcohol in amounts to keep the

patient intoxicated. By competing with

the substance’s metabolism, the alcohol

prevents toxic metabolites from forming,

avoiding renal failure and metabolic

abnormalities and allowing time for it to be

removed by dialysis.

I had encountered an identical situation

years earlier at a different hospital. At that

time, Poison Control helped us determine

the concentration of the ethyl alcohol

needed and how to prepare and fi lter these

infusions. That patient survived with no

permanent adverse effects, and when the

physician on the case called days later to

thank us, it felt great.

Ten years later, the same poisoning had

occurred, but there was a new antidote with

fewer side effects than alcohol. Working

with two other pharmacists, we acquired

enough of the antidote to get the patient

through this crisis, conferred with

FAULKNERFOCUS ONNews for and about Faulkner Hospital Employees

C.A.R.E. STANDARDS

C. Communicate your commitment

to providing high quality service

A. Appear and act as a professional

R. Respect all individuals

E. Extend yourself

Remember to plan for language needs

(interpretation, translation and assistive

devices) for all patients that may require

this extra service.

continued on P4

Focus on Faulkner2

Published by Marketing and Public Affairs

(617) 983-7588 / [email protected]

We welcome your feedback and suggestions for future issues.

Partners HealthCare Strategic Initiative: What Happens Next?

Over the course of the past few months, we hope you have heard

about the “Case for Change” across the Partners system and the

strategic efforts underway to redesign the delivery of health care

while making it more affordable for our patients. In the coming

weeks, some of the best ideas from experts at Partners hospitals will

be introduced at Faulkner Hospital.

On the Care Redesign front, teams have been focused on specifi c

disease conditions including stroke, diabetes, colon cancer and

coronary disease (including heart attack care and coronary bypass).

A separate group examining Patient Affordability has examined

ways to reduce overall costs across the system. Both teams have

assembled a list of preliminary recommendations as well as risks and

challenges that need to be considered.

Senior leaders from hospitals across the system are now in the

process of reviewing and organizing these recommendations.

Liaisons from all Partners institutions will begin to consider these

ideas and how they will work at their hospitals. At Faulkner Hospital,

senior physicians and our leadership team will lead this process.

They will collaborate with clinical and administrative leadership

from across the hospital to start tailoring these efforts to meet the

needs of our patients. During this phase – being dubbed the “Test

Fit” phase – hospitals across the Partners system will really begin to

determine how change will work best at their individual institutions.

Also during this phase of the strategic initiative, you may have

noticed that the Reputation/Communications Group has unveiled

a public education campaign, consisting of several newspaper ads

and a television commercial with a message that underscores the

quality of care delivered across our Partners hospitals. If you have

not yet seen the TV ad, you can view it on the Partners website. It

is being aired on local stations, CNN, ESPN, and MSNBC. You

can even fi nd the Partners ad during shows like 60 Minutes and

30 Rock. Tied to the advertising campaign is a website: www.

connectwithpartners.org. This platform provides Partners with an

external voice in the ongoing conversation about today’s health care

issues. We invite you to connect with the site.

In the next few weeks, there will be additional updates and a report

on how the “Test Fit” process unfolded here at Faulkner Hospital.

This is an opportunity for you to get involved too by thinking of

new and better ways to deliver care. If you see a process that can

be done more effectively and effi ciently, please let your manager/

supervisor know.

As you may have heard, the Federal govern-

ment has mandated changes to the 4010 HIPAA

transaction standards (claims and eligibility) and

the International Classifi cation of Diseases (ICD)

coding system. All covered entities, includ-

ing health care providers, must convert from

ICD-9 to ICD-10-CM (diagnosis) and ICD-10-PCS

(procedure) codes by the compliance date of

October 1, 2013.

How will this change impact Faulkner Hospital,

Partners HealthCare, the health care industry

and you? Working with Partners, Faulkner Hos-

pital has a project plan in place for this mandat-

ed change. In the weeks and months ahead, you

will be receiving more formal communication

about this project as it relates to your depart-

ment, including an initial training survey that you

will receive by the end of March.

If you have any questions, please contact Debra

Torosian at 617-983-7458.

IMPLEMENTATION OF HIPAA 5010/ICD-10

Focus on Faulkner 3

Faulkner Hospital has played a leadership

role in caring for bariatric patients for many

years. Bariatrics is the fi eld of medicine

that deals with the causes, prevention

and treatment of obesity. Obesity is

defi ned as a body mass index (BMI) of 30

or greater. During the past 20 years there

has been a dramatic increase in obesity in

the United States and is a major risk factor

for cardiovascular disease, certain types

of cancer and Type 2 diabetes. Faulkner

Hospital has been designated as a Bariatric

Center of Excellence by the American

College of Surgeons, which ensures we

abide by certain standards of care. As part

of Faulkner’s commitment to best practices

in the care of this population, the hospital

has established a Bariatric Improvement

Team (BIT).

Who we are:

The Faulkner Hospital has successfully

recruited a new surgeon for Bariatrics

who is scheduled to arrive later this year.

While waiting for the new surgeon’s arrival

the BIT has been created and meets

monthly. The group consists of members

from various disciplines of the hospital

including Nutrition, Psychiatry, Nursing,

Social Work, Education, Quality, PACU, Peri-

operative, OR and Physical Therapy. This

interdisciplinary approach assures care of

the total patient.

What we have done:

The Team has been working on hospital-

wide improvements to address the needs

of bariatric patients, their families and staff.

For example, modifi ed furniture, including

beds, wheelchairs and toilet seats have been

purchased for patient comfort and safety.

An important added component of care

developed by this committee is the

establishment of a specialized bariatric

exercise program which can be used

pre- and post-operatively by creating

an environment that offers privacy and

support. It is hoped that bariatric patients

will feel more comfortable in developing an

exercise regime to enhance their weight loss

program.

Perhaps the most important work of the BIT

is its sensitivity to the emotional diffi culties

that many patients experience due to their

size. Our team initiated a campaign to raise

public awareness of attitudes about bariatric

patients during the last year’s Safety Fair.

A poster was presented that explained the

diffi culties that patients experience on a

daily basis due to their size. The awareness

campaign is now focused on developing

Faulkner Hospital as a leader in providing

exceptional care to our bariatric patients in a

sensitive and encouraging environment.

Where we are going:

The BIT intends to educate the hospital

community and to gain its support in

creating a welcoming environment for

everyone. We believe our efforts will benefi t

all our patients and family members, not just

the bariatric patients. Based on the growing

number of statistics about obesity in the

United States, and the health problems

associated with it, we will continue to work

with our patients who may have weight

concerns, as well as family members visiting

that need some consideration or resources

due to their weight.

What can you do?

We appreciate staff input as we move

forward and take the next steps. Be on the

lookout this spring for a survey where you

can tell us what improvements you think

would further develop Faulkner Hospital

as an exceptional center of care for the

bariatric patient.

To read more about what is available in

bariatrics go to Faulkner411.org under

Departments and Services. If you have

information that you would like added to

this section you can contact Carol Shea at

617-983-7980.

Bariatric Improvement Team: creating a welcoming environment By Carol Shea, RN, Quality Improvement Department

Focus on Faulkner4

the resident to ensure correct dosing and

appropriate duration of treatment, and

prepared and delivered it to the patient’s

nurse, describing its mechanism of action

and side effects. Over the next few days,

we delighted in the fact that our patient

survived with no permanent physical injury.

I once sprinted up four fl ights of stairs

carrying – gingerly – the life-saving clot

buster Alteplase (TPA) in order to get it into

the nurse’s hands so she could administer

it to a patient suffering a heart attack.

The sooner it gets infused, the greater

the amount of heart muscle saved, and

the better the chances are of a successful

outcome. After handing it over, I relaxed

and caught my breath, then walked past the

nurses’ station towards the elevator. The

cardiologist who ordered it looked up from

the patient’s chart and smiled, a silent thank

you crossing his lips.

I remember an anesthesiologist once ask-

ing me to mix a new type of preparation, an

infusion to be administered into the epidural

space. He wanted to use it on an inpatient

with terminal cancer who, despite receiv-

ing high doses of narcotics intravenously,

had intractable pain. Epidural analgesia is

a technique where the tissue space around

the spinal cord is injected or infused with

an analgesic. Benefi ts include enhanced

pain relief (the drug is administered directly

to the central nervous system), and fewer

side effects (the amount needed is small so

less drug gets into the systemic circulation).

The preparation in this case would be a

mixture of a local anesthetic and a narcotic.

We fi gured out the amounts of each drug

in the mix, ensuring compatibility, stability,

and correct dose. It was administered to the

patient with great pain-relieving results. Our

epidural analgesia program had begun and

quickly spread to include many other pa-

tients. Epidural analgesia would become an

important tool in the world of pain relief.

Several months later, while checking medi-

cation stock on the intensive care unit, the

chief of anesthesia pulled me into a patient’s

room and introduced me as “the guy re-

sponsible for relieving your pain.” I thought

it a kind – and overstated – gesture by a nice

guy, but I’ve remembered it through the

years.

A few years ago there was a patient admit-

ted to a surgical fl oor with an exceptionally

confusing drug regimen. She claimed to

have allergies to the excipients (inactive in-

gredients) in medications, was on more than

ten different drugs, took them throughout

the day, and had set up a fi nicky system of

self-medication. This patient requested to

take her own medications. Hospitals have a

policy requiring that only those medications

purchased and stocked by that hospital can

be used while the patient is under its care.

Health Care Unseen, continued from P1

. . . After handing it over, I relaxed and caught my breath, then walked past the nurses’ station towards the elevator. The cardiologist who ordered it looked up from the patient’s chart and smiled, a silent thank you crossing his lips.

Dr. Raymond Murphy, former Chief of Faulkner

Hospital’s Division of Pulmonary Care, recently

donated fi ve original pieces of his artwork to

Faulkner Hospital’s Patient/Family Resource

Center.

Dr. Murphy’s donated artwork is of birds, fl owers

and other things found in nature, which he has

recreated using pastels and watercolors. The

paintings were done over the last fi ve years and

donated to the hospital in 2010.

“I donated them as an expression of my thanks

to the wonderful people I’ve worked with, as

well as to the patients and their families who

have benefi ted from the excellent care they

received at Faulkner Hospital,” says Dr. Murphy.

It is Dr. Murphy’s hope that viewers of his

artwork are able to see the beauty in the world

despite the many problems life throws at them.

FAULKNER PHYSICIAN DONATES ORIGINAL ARTWORK

Focus on Faulkner 5

This makes certain the drugs have been

obtained from a reputable supplier, have

been stored properly, and are still in date.

However, sometimes an exception is made,

and only if the patient’s medications are

properly labeled, can be identifi ed by the

pharmacy, and will be administered by the

patient’s nurse.

This patient’s physician said that her certain-

ty of reacting badly to the hospital’s drugs

(many identical to the one’s she had brought

in) was causing her great angst. We acqui-

esced and picked up the patient’s Tupper-

ware container with her medications inside.

They were a mess, mixed together in various

prescription bottles. Another pharmacist

and I spent hours sorting through, organiz-

ing, and identifying as many as we could.

As we fi nished up, I noted the time: 6 pm. I

hoped to make my hospital’s medical book

club meeting that night. We were to discuss

Anne Fadiman’s book “The Spirit Catches

You and You Fall Down.” It tells a harrowing

story of a Hmong family in California, how a

lack of cultural understanding contributes

to the tragic death of a child to seizures, and

highlights the importance of understanding

the patient’s side of an interaction, of the

role of empathy in the healing process. The

group was to meet at 6:30 pm.

My assistant had to leave, so I brought the

patient’s reorganized medications to the

nursing unit to review them with the nurse

and physician. I needed something clarifi ed

and asked the medical resident if I could

see the patient. As we entered the room

and the resident introduced me as “The

Pharmacist,” the patient became agitated,

pointed at me and shrieked, “that’s the guy

who’s screwing me up!” I had the impulse to

say I just wasted three hours fi guring out the

meds just to make her happy. But there was

nothing to fi ght against. My job was to help.

When I gently reassured her that she could

take her own medications and that I only

needed one question answered, she settled

down.

Arriving at the book club at 7:30 pm, I men-

tioned the irony of having read a book about

the dangers of miscommunication between

patients and caregivers and what I had just

experienced. I was upset, but had respected

her fear about someone tampering with her

“system.” The book had done its job.

One evening I got a call that a patient had

refractory thrombocytopenia (abnormally

low platelet level), a potentially life-threaten-

ing condition, and that the physician wanted

to try a seldom used medication. We worked

out the dose with the patient’s resident and

consulting hematologist, and prepared it

and educated the nursing staff about its ad-

ministration. This, of course, occurred at the

end of the day, making a long day longer.

Finishing up afterwards, I thought of the

stressful hours the process took, how the

pharmacy had reacted quickly and success-

fully, and as I threw on my coat and walked

outside into the damp, cold, winter night to-

ward my car, I clenched my fi st and punched

the air in victory.

The drug was administered with good re-

sults: the patient’s platelets rose to safe

levels. Days later, I asked our two pharmacy

students, who rounded with the residents,

about the patient. “She’s a professional

singer,” they said. “She sang ‘O Danny Boy’

for St. Patrick’s Day, to thank everyone.” I

felt a wave of resentment. Surely we also

deserved to receive this gift of thanks. No

one knew that three of us had stayed hours

after our shift to ensure her treatment went

perfectly. Then I caught myself: We don’t

work for accolades; we work to get our pa-

tients well.

Faulkner Hospital’s Patient/Family Resource

Center (PFRC) recently received a digital

talking book player on permanent loan from

the Perkins Braille and Talking Book Library.

The player utilizes book cartridges and

downloads from the Library of Congress

digital book collection. Each month, the

Perkins Library will send the PFRC a new

cartridge for their collection.

“With this player, we are now able to expand

our offerings to patients who can’t see or

have diffi culties reading print,” says Cara

Marcus, Director of the P/FRC.

RESOURCE CENTER OFFERS NEW DIGITAL BOOK PLAYER

Focus on Faulkner6

Faulkner Community Physicians recently

added three new primary care physicians

to their offi ces in Hyde Park, Roslindale and

West Roxbury to meet the growing need for

PCPs in the area.

Dr. Naureen Raja-Shafi q has joined the staff

of the Hyde Park offi ce. Dr. Glenn Allison

has joined the staff of the Roslindale offi ce

and Dr. Khang Vinh Nguyen has joined the

staff of the West Roxbury offi ce.

All three are currently accepting new

patients.

“I enjoy working with diverse patient

populations in terms of different medical

issues, ethnicities, ages and socioeconomic

backgrounds,” says Dr. Nguyen.

“It’s a great privilege to be able to practice

in an area I’m so familiar with,” states Dr.

Allison. “What I enjoy about primary care

is getting to know patients and striving to

form a trusting relationship that will allow me

to accurately diagnose any health problems

they encounter.”

“With the training they’ve received and

the collective experiences they bring to

our medical group all three of these new

primary care physicians will be an asset to

this community for years to come,” states

Dr. John Lewis, Medical Director of the

Faulkner Community Physicians practice in

West Roxbury. “While access to primary

care physicians has continued to decline

in recent years, we’re proud to be able to

expand our services to meet the needs of

our surrounding communities.”

Faulkner Community Physicians is a group of

10 physicians with offi ces in 3 communities.

“Being involved in primary care allows me

to get to know patients and their families

on a long-term basis,” says Dr. Raja-Shafi q.

“For me, helping people from all walks of

life is what makes primary care medicine so

fascinating.”

For more information or to make an

appointment, please call 617-983-7500.

From left: Dr. Naureen Raja-Shafi q, Dr. Glenn Allison and Dr. Khang Vinh Nguyen

Faulkner Community Physicians group expands to meet growing needs

Patient’s granddaughter donates artwork

Inspired by her

grandmothers

survival from breast

cancer, 12 year-

old Hanna Serena

Kaye donated

11 inspirational

drawings to Faulkner

Hospital’s Sagoff

Breast Imaging and

Diagnostic Centre.

Each drawing has a different theme which

offers words of encouragement to patients

currently undergoing various types of

treatments. One of the drawings is of a

mermaid with the message “just keep

swimming,” shown below. Others include

animals and stars.

When asked why she decided to make the

donation, Kaye said “I wanted to bring joy to

the people and help them take their minds

off of getting breast cancer treatment.”

She began drawing at age two and continues

to create artwork as a student at the Carroll

School in Lincoln, MA.

Hannah Kaye

Focus on Faulkner 7

Powerful Tools for Caregivers

Faulkner Hospital recently hosted a

program, Powerful Tools for Caregivers

which is sponsored by AgeWell West

Roxbury. The program is a six-week event

that incorporates learning the skills to

cope with caring for someone with a

chronic illness or for an elderly relative or

friend which can be stressful physically,

emotionally and fi nancially.

For more information contact:

Tracy Sylven in the Community Health

Department

[email protected]

617-983-7451

Fall Prevention and Fitness for Seniors

Faulkner Hospital sponsors two exciting

programs for seniors. The programs are in

conjunction with the West Roxbury YMCA

and AgeWell West Roxbury. The classes

provide opportunities for seniors to explore

various modalities of exercise, balance,

fl exibility, and relaxation. They are designed

to increase strength, balance, fl exibility and

endurance. Balancing Mind, Body and More

and Tai Chi are free of charge and offered

several times a year. For more information

on next sessions contact:

Tracy Sylven in the Community Health

Department

[email protected]

617-983-7451

Walk for Life

Faulkner Hospital’s community walking

program, Walk for Life, will resume after a

long winter. The program is free and open

to everyone in the community. Start walking

to reduce your risk of heart disease. We

will meet every Wednesday starting April

6 - November 16 at 2pm at the Arnold

Arboretum’s Hunnewell Building. Everyone

is encouraged to check with their physician

before starting any new fi tness routine and

you are always instructed to walk at your

own pace.

Note: We will not meet if there is rain or

extreme heat.

For more information contact:

Tracy Sylven in the Community Health

Department

[email protected]

617-983-7451

Manning Elementary School

Stacey Miller and Ania Fusiek from the

Community Health Department taught

a lesson with the K0 and K1 class on the

spread of germs and germ prevention. The

children participated in activities that taught

them how to sneeze into their sleeves and

they also learned a song on the proper way

of hand washing.

Tracy Sylven and Ania Fusiek from the

Community Health Department held a

Coconut Tasting offering coconuts and

coconut water. Whole fresh coconuts were

cracked open and the kids got to sample

the fruit along with various fl avors of

coconut water.

Brooke Staats, RD from the Food and

Nutrition Department worked with the 1st

and 2nd grade Manning School classes

on lessons for healthy foods and nutrition.

Each grade had both a visit from Brooke to

the school, as well as to the hospital, where

during their lesson, they made healthy

snacks.

Curley Middle School Job Shadow

In February, the following staff hosted 8th

grade students from Faulkner Hospital’s

newly established school partnership with

the Curley Middle School, in Jamaica Plain:

Mike Cacioppo

Madeline Gervasey

Ellen McKenna

Shannon Vukosa

Flu Vaccine Clinics

The following staff contributed to the

successful community infl uenza vaccine

clinics:

Ninon Bastien

Anne Marie Birmingham

Sheila Delamere

Candy Eggers Dow

Helen Driscoll

Karen Fuller

Carol Garcia

Lillian Go

Nancy Harrington

Judy Hayes

Stacey Miller

Amanda Nasson

Paula O’Brien

Digi Rojas

Rosemarie Shortt

Paula Whalen

Healthy Conversations

In November, Dr. Derrick Todd presented on

the topic of “Arthritis” to a local community

group, comprised of retired senior citizens.

Faulkner Hospital’s Healthy Conversations

program is organized through the

Community Health Department, which

connects clinical staff with local community

groups, to offer free educational

presentations.

For more information about how to

participate contact:

Stacey Miller in the Community Health

Department

[email protected]

617-983-7907

Community Corner

Focus on Faulkner8

Dr. Stephen Wright, Chief of Medicine and Dr. Nina Chalfi n, MRCP,

Hospitalist, recently attended the Clinical Process Improvement

Program (CPIP) which is a part of the High Performance Medicine

Initiatives at Partners Healthcare.

The program, adapted from Intermountain Healthcare in Salt Lake

City, UT, focused on educating doctors and other health care

providers to identify and improve their clinical processes. The

program also took them through completing an original project

from start to implementation. The course met on six days over a

four month period.

“We are always looking to improve and this program gave us

the tools necessary to help facilitate improvements at Faulkner

Hospital,” says Dr. Wright. Their group, along with other clinical

leaders, looked at various data collected by the High Performance

2.4 group at Partners in order to identify a subject for their project.

This data looks at quality measures and the hospital’s adherence

to those standards. For the group project, they decided to take a

closer look at hospital discharge documentation.

In order to facilitate change, the group had to fi rst determine

which missing data elements were causing lower than expected

scores. The fi elds that they found were being left off the discharge

documents were:

1. the hospital’s contact phone number

2. condition of admission diagnosis at discharge (what happened

after treatment) and

3. complete information about the prescription of Coumadin

With the errors identifi ed, the group began searching for strategies

to eliminate them. One solution they came up with was to modify

the template physician’s were using to fi ll out the summaries in the

hospital’s clinical system, Meditech.

With input from residents, PA/NPs, and Information Systems, the

group developed additional fi elds for this information that were

either automatically populated or required before they could move

on. The hospital contact number was set to auto populate like the

patient’s name and other identifying information. The condition of

admission diagnosis at discharge and Coumadin prescription fi elds

were marked as required, and prompts were put in to alert the

document preparer what needed to be done in order to move on.

“By changing the way we create discharge documents at Faulkner,

we are able to give patients and their physicians/caregivers a

detailed explanation of what happened during their stay,” says

Dr. Chalfi n. “By doing this, we ensure that both patients and their

physician/caregivers understand their medical issues as they move

out of the hospital to their next care environment.”

Process improvement helps discharge process

Dr. Stephen Wright and Dr. Nina Chalfi n show off their certifi cates of

completion for the Clinical Process Improvement Program.

GET THE LATEST PROGRAM INFOR-MATION, HEALTH TIPS AND EVENTS IN ONE OF THREE EASY WAYS:

1Become a fan ofFaulkner Hospital:

http://www.facebook.

com/faulknerhospital

2Follow Faulkner

Hospital on Twitter:

http://twitter.com/

faulknerhosp

3Sign up for online news

delivered right to your inbox:

http://www.faulknerhospital.org/

enews.html

Focus on Faulkner 9

My father suffered a horrible fall and I immediately brought

him to Faulkner Hospital’s Emergency Room for evaluation and

treatment. From the moment we entered the hospital to the

time we left every staff member we encountered treated us with

genuine kindness and compassion. Beth Gangemi greeted us

as we walked in and she immediately took our information and

called for someone to get ice for his injuries. Lorraine Traft, RN

immediately assessed my father’s condition and was very kind

and warm to him while treating him. My father was immedi-

ately brought into an exam room and Anthony Paglia, PA was

very thoughtful and caring while treating my father and made

him feel very comfortable. There was a sweet nurse named

Karen White that came in and sat next to my father on the

stretcher and talked to him and made him feel cared for. Our

fi nal encounter was with Kelly Mastroianni, RN who cleaned and

treated my father’s wounds. Kelly communicated with my father

before she treated him just so he was aware of what was going

to be done and she was very gentle and sweet with him.

It was a diffi cult situation to be in with my father and the treat-

ment that he received at Faulkner Hospital made a bad situa-

tion more endurable. We are very grateful that we can count on

Faulkner Hospital to treat our valued family members with re-

spect, kindness and compassion. I am happy to tell you that my

father is recovering very quickly and feeling much better. Thank

you all for being there when we really needed you.

Dear Faulkner Hospital,

I am writing to thank you for the wonderful care of my mother

while she was hospitalized at Faulkner Hospital. Most of the

staff was helpful and measured up to expectations of a world

class hospital, however, there were certain staff members on 6

south who were exceptional.

Dr. Chalfi n was quite impressive not only as a skilled physician,

but also as a leader and teacher. She advocated for her patient,

managed the care team and listened to the concerns of the

family and responded as quickly as possible. Her competence

and awareness of cultural differences was outstanding. Not

only was she respectful and kind to all involved, she did this

with ease.

There was also a nurse whose name I do not recall. She

attempted to meet my mother’s every need, making her feel as

if she was her only patient. The nursing supervisor whom I had

the opportunity to meet was also a superb employee. She was

competent, caring and very professional.

My family and I are truly grateful for the treatment received at

your hospital.

Dear Faulkner Hospital,

My father was recently hospitalized at Faulkner Hospital and I

am writing to commend the staff on the expert, compassionate

care that they provided. From the nurse in the ED to the

nursing staff and PCSs on 6 South, the care provided was

outstanding. I would also be remiss if I did not mention the

high level of customer service provided by transport, dietary

and phlebotomy staff.

Staff was respectful and welcomed the input of family members

in my father’s care. Two residents, Katherine Rose and Michelle

Morse, exemplifi ed the essence of patient- and family-centered

care in their interactions with my father and his family.

Your staff exceeded my expectations in the high quality and

safe patient care provided and, as such, should be recognized

for their efforts.

Dear Faulkner Hospital,

Focus on Faulkner10

Faulkner Hospital’s Process Improvement Department,

led by Senior Consultant Sherman Zemler Wu has been

working with staff members from multiple departments to

help reduce the turn around time on robotic surgery cases.

When the process fi rst began, it took staff 44 minutes

from the time one robotic surgery patient was taken out

of the OR to the time the next patient entered. With a

goal of getting the turn around time to consistently be 20

minutes, the hospital is not only aiming to increase patient

satisfaction but also looking to add more cases.

“If we can cut down on the time it

takes between cases then there’s

the potential to have more surgeons

utilizing our robot,” states Zemler

Wu. “Not only will this enhance our

ability to start and end on time, but

it will facilitate the ability to grow

Brigham and Women’s Center for

Robotic Surgery at Faulkner Hospital by enhancing our

reputation of having the most effi cient Robotic Surgery

team in Boston.”

In the fi rst quarter of fi scal year 2011, the OR team has been

able to take the turn around time from 44 minutes down to

33 minutes. They were able to do this by developing new

OR supply packs and implementing new parallel processes

where nurses, OR scrub techs, and anesthesia are working

in parallel to speed up the turn over time. Patients are now

brought into the room while it is fi nishing being set up,

which has already proven to cut valuable minutes off of the

turn around time.

“On a regular basis, patients relay to me the wonderful

care that they receive at Faulkner, and I am grateful to

nursing, anesthesia, housekeeping, administration and my

team for their signifi cant contributions,” says Dr. Jim Hu.

“Patients who’ve been treated here in the past are loyal

to continued treatment here and those new to Faulkner

marvel at the world class care they receive. I’m delighted at

the 25 percent reduction in turnover time, and look forward

to working with Sherman and others to improve the quality

of care that we deliver.”

NEW TECHNOLOGY ALLOWS RADIOLOGISTS TO OPTIMIZE IMAGES

Faulkner Hospital’s Radiology Department recently

began using an eight-channel wrist coil in their MRI

service to optimize both the patient experience and the

images produced.

The wrist coil utilizes eight channels, or frequencies, to

provide more specifi c, high resolution images of the wrist

and its components, as well as to maximize the comfort

of the patient throughout the imaging process.

These optimized images provide physicians with a

more detailed view of the wrist, allowing them to better

diagnose and treat the symptoms more accurately. The

noise, or motion some images show, is also greatly

reduced.

“Since we have implemented the coil we have seen a

reduction in test time and patient satisfaction,” says

Catherine Brockington, RTRMR, Staff Technologist.

Turn around time for robotic cases decreases

Focus on Faulkner 11

Professional behavior is a central component for a successful

patient safety program and is necessary to truly establish a “Culture

of Safety.” A Culture of Safety is one in which an organization’s

beliefs, attitudes, values and actions are evident through its strong

teamwork, clear communication, and transparency about reporting

errors and adverse events. An effective Culture of Safety assumes

an institutional commitment to learn from mistakes in a non-blaming

way. There must be recognition by the institution that while human

error is inevitable, secure systems can be implemented to safeguard

patients from harm. As part of Faulkner Hospital’s commitment to

patient safety, it has convened a multidisciplinary steering committee

to promote professional behavior throughout the Faulkner

community.

While there is universal agreement that our hospital endorses the

principles of professionalism and respectful communication, this

is not enough. Faulkner Hospital is also committed to creating

an infrastructure that sets clear expectations about behaviors

and consequences for non-compliance. According to the Joint

Commission, “positive collaborative behaviors can be embedded

in hospital culture, but clear policies, including sanctions, must be

developed that address these behaviors.” The Joint Commission’s

Sentinel Event Alert in July 2008 acknowledged a “history of

tolerance to unprofessional and disruptive behavior in health care.”

The Sentinel Alert required hospitals to combat this history by

creating a Code of Professional Conduct that specifi cally defi nes

“acceptable, unacceptable, and disruptive behavior,” and to develop

a fair and equitable process for addressing these behaviors. With

this mandate, the hospital’s steering committee has begun the

process of establishing such a program at Faulkner Hospital.

Disruptive behavior is known to pose a clear threat to patient safety

and has been reported widely in several studies in medical literature,

including a 2005 study, entitled, “Silence Kills.” This study found

that more than 20 percent of respondents reported actual harm to a

patient as a result of disruptive behavior by members of the health

care team. Faulkner Hospital began its efforts to respond to this

serious issue by examining baseline perceptions of our own clinical

staff about the prevalence of unprofessional and disruptive behavior

within this hospital.

The departments of Patient Safety, Risk Management and Quality

Improvement distributed an anonymous and confi dential survey

to the hospital community in August 2010. The response rate was

greater than 40 percent, representing more than a dozen disciplines

from a wide variety of departments. Seventy six percent of the

respondents reported having witnessed disruptive behavior, which

was higher than expected but in keeping with other published

surveys. Unfortunately, of those respondents who had either

witnessed or experienced disruptive behavior, only 52 percent had

reported this to their supervisor, director or department head.

After establishing our baseline, which will be used to gauge the

effect of the new initiative and policies on expected improvements,

the group drafted a code of professional conduct that meets

Joint Commission requirements, and the steering committee is

now considering how the institution will address non-compliant

behaviors. When completed, there will be a hospital-wide

educational roll-out of the code and related policies. The hospital

encourages all staff to report unprofessional and disruptive

behavior directly to appropriate individuals, or by utilizing the rL

Safety Reporting system – which now contains a specifi c fi eld for

unprofessional behavior. It is hoped that the hospital’s commitment

to this important element of patient safety will continue to improve

the high quality of care provided at Faulkner.

Professionalism and the Culture of SafetyMaureen Fischer, RN, MSN

Faulkner Hospital offerstwo options to pre-register:Please have your insurance card availablewhen pre-registering.

If you have pre-registered for your visit, please reportdirectly to your appointment location.

If you are not pre-registered or unsure if you are, pleasestop at the Information Desk upon arrival. They will directyou to your appointment or to registration as needed.

Online:

www.FaulknerHospital.org(24 hours a day)

Telephone:BREAST IMAGING

617-983-7068Monday - Thursday, 7 am - 8 pm

Friday from 7 am - 3:30 pmSaturday from 8 am - 3 pm

ALL OTHER SERVICES617-983-7010

Monday - Friday from 6 am - 8 pm

Focus on Faulkner12

Faulkner Hospital’s Volunteer Coordinator, Alphonso

Westley, has been named a YMCA Achiever for

2011. He is one of only three recipients throughout

Brigham and Women’s/Faulkner Hospital to receive

this year’s award.

The criteria for the award looked at a candidate’s

contribution to Partners and their willingness to

impact the lives of minority youths in the Greater

Boston area. Westley was nominated by Rosemarie

Shortt, Director of Patient/Family Relations and

Volunteer Services.

“Throughout Alphonso’s recruitment and retention work, our

diverse volunteer workforce now more closely resembles the

communities we serve and refl ects the multiplicity of ages, cultures

and other demographics of our patient population,” Shortt writes

in her nomination letter. Many of these volunteers are students

and their volunteer work at Faulkner provides them an opportunity

to view the healthcare environment fi rst hand, often

infl uencing them in their educational and career

choices.

Outside of his work at Faulkner Hospital, Westley

is a youth mentor at the Greater Boston Vineyard

R.E.A.C.H. program and is also pursuing a Masters of

Healthcare Management from Cambridge College.

Westley was quick to point out that this award isn’t

just about recognizing him. “This award recognizes

my department and the work we do to improve the

overall patient experience by providing them with resources and

other requests they may have.”

Along with this award, Westley must also complete 40 hours of

community service the program sets forth. In April, he, along with

other winners across the city, will be formally recognized at the

YMCA’s Annual Recognition Gala.

Volunteer Coordinator wins YMCA award

Alphonso Westley

Faulkner Hospital is now offering free citizenship classes to its employees and their immediate families who wish to become US citizens.

Through a grant from Jewish Vocational Services (JVS), participants

will be provided with the following services:

History and civics lessons•

Assistance completing the N400 application•

Interview preparation for the meeting with a USCIS offi cial•

Follow- up sessions and tutorials•

In addition to these services, participants will also have access

to referrals for additional support services, including fi nancial

assistance with the application fee if needed. Classes will be run in

eight week blocks that consist of meeting one day per week for two

hours at the hospital.

Mary Duggan, Education Coordinator

here at the hospital, is excited to see this

program become part of the long line of

classes offered to hospital employees.

“When we found out about this class

being offered and knowing we had

employees interested in something like

this, we jumped at the chance to bring

these classes to the hospital.”

In order to participate in this class, employees must have:

a green card or equivalent•

be a permanent resident for at least fi ve years•

be moderately profi cient in English •

Prior to taking the class, a prospective participant will be

administered a pre-class assessment by a JVS representative.

To inquire about participating in the class or for more information,

contact Mary Duggan at 617-983-4634 or [email protected].

Citizenship classes come to Faulkner

Focus on Faulkner 13

With the adoptions of prospective payment

methodologies under various types of

Medicare facilities, the submission of cost

report data has taken on a compliance

focus instead of a direct reimbursement

concentration. There are still categories of

Medicare reimbursement that are impacted

by various components of the Medicare

cost report, such as, Nursing and Allied

Health programs, Medicare DSH and direct

and indirect Graduate Medical Education.

Outside the areas of direct Medicare

reimbursement, the remaining portion of

the cost report is completed accurately in

order to comply with Federal regulations

and statutes from a compliance perspective

only.

The link of the cost report to Medicare

reimbursement goes beyond the direct

reimbursement areas previously mentioned.

The Centers for Medicare and Medicaid

Services (CMS) has been steadily increasing

the use of the Medicare Cost Report for

Medicare rate setting purposes by adding

Inpatient Prospective Payment System (IPPS)

to the list of PPS methodologies which rely

upon submitted cost report data to estimate

and set rates for Medicare. Therefore, the

submission of each Medicare Cost Report

contributes indirectly to the Medicare rates

which a facility receives.

Given the fact that the cost report data

will impact the IPPS rates (and Outpatient

Prospective Payment System as well),

concern has been raised by the hospital

industry as to whether or not the cost report

data is compatible for use in estimating

rates at the DRG level. The hospital industry

has communicated this concern to CMS

in numerous Federal Register comment

periods. CMS has acknowledged the need

to modify the cost report to improve the

data used in calculating the cost-based

weights. One of the fi rst components of

the cost report to be changed is Medical

Supplies. CMS intends to correct for charge

compression for devices and implants.

CMS implemented a new cost center titled

“Implantable Devices Charged to Patients,”

which is effective for cost reports beginning

on or after May 1, 2009.

It is extremely important for hospitals

to properly submit cost report data for

this new cost center as it could increase

or decrease reimbursement for devices

depending on the collective data submitted

by all of the hospitals. Currently, there

are approximately 3,400 IPPS acute care

hospitals included in the IPPS rate setting

methodology. Although, our facility is one

of 3,400, it is the collective nature of the

cost report data that all hospitals should

focus on. If all 3,400 hospitals have the

mindset that their cost report data alone

will not impact the rate setting process, the

approach may have an impact on the rate

setting approach adopted by CMS.

The hospital industry must ensure that

the gross revenue on Worksheet C of the

cost report is linked to revenue codes: 275

(Pacemaker), 278 (Intraocular lens), 278

(Other Implants) and 624 (Investigational

devices). In turn, the expenses on

Worksheet A of the cost report for

“Implantable Devices Charged to Patients”

cost center must only include those related

to the aforementioned revenue codes.

The assumption will be that all hospitals

are coding the supplies correctly in their

respective revenue codes. If facilities

are not properly coding the supplies

then the reported data could be skewed.

The respective expenses related to the

implantable devices must be separately

identifi ed in order to accurately refl ect the

expenses in this cost center.

CMS has made it clear in the IPPS fi nal

rules that hospitals are responsible for

submitting accurate cost report data and

that reliance should not be placed on a

Medicare Administrative Contractor (MAC)

to determine if the amounts are reported

correctly. Therefore, it does not appear that

there will be much oversight by CMS or their

contacted agents to oversee the submission

of this data.

Hospitals must make a concerted effort

to assure that data submitted for the new

“Implantable Devices Charged to Patients”

cost center is accurate based on the fact

that each hospital’s cost report data will

indirectly impact hospital Medicare rate

setting. Hospitals must not only focus on

the direct areas of Medicare reimbursement

that the cost report impacts, but also realize

the indirect impact for which the cost report

has.

Questions or comments regarding this

article can be address to Patrick V. Cerce,

Director of Compliance at (617) 983-7470.

Medicare cost report submission indirect impact on Medicare rate setting

Focus on Faulkner14

FOR WALK

LIFE

Lace up your sneakers and join us!Walking group open to all those interested

Wednesdays at 2 pmApril 6 - November 16 (weather permitting)

Meet at the Arnold Arboretum’s Hunnewell Building.

Heart disease is the number one killer in the United States and

physical inactivity doubles the risk. Start walking and reduce

your risk.

For questions or more information, please call Tracy in

Faulkner Hospital’s Community Health Department at

617-983-7451 or email [email protected] program is a collaboration of Faulkner Hospital, the West Roxbury/Roslindale YMCA and AgeWell West Roxbury.

Faulkner Hospital has begun offering pre-college classes to

employees to assist them with the college admissions process.

The classes are part of a grant the hospital received from the

Massachusetts Department of Elementary and Secondary

Education, Executive offi ces of Labor and Workforce Development,

Commonwealth and Jewish Vocational Services.

For four hours a week, participants study English, math and reading

to prepare for the required entrance exam all colleges require

before a student is admitted to their program. The classes run until

all participants have passed their exams or up to 47 weeks. Class size

ranges from seven to nine participants per session.

Along with academic preparation, participants meet with an

academic coach one-on-one throughout the session. The advisor

makes sure the students understand the materials and are on the

right track that will help them succeed. The coach also assists them

with the overall admissions process.

“This program gave me the opportunity to explore my education

further which then allows me to be successful in life,” says student

Norbely Bustillo of the Sagoff Centre.

The fi rst class of the program ran from May 25 – December 20, 2010.

The class had nine participants and out of the nine, seven enrolled in

college and the remaining two plan to enroll this fall.

Pre-college classes offered at Faulkner Hospital

From left: pre-college class participants Lillian Riley, Ava Peeples,

Rosalyn Gonzalez, Margaret McPartland, Debra Gladden and

Norbelly Bustillo.

Focus on Faulkner 15

Faulkner Hospital has received the

2010 American Heart Association/

American Stroke Association’s Get

With The Guidelines® Stroke Gold

Plus Performance Achievement

Award. The award recognizes Faulkner

Hospital’s commitment and success in

implementing excellent care for stroke

patients, according to evidence-based

guidelines.

To receive the award, Faulkner achieved of 85 percent

or higher adherence to all Get With The Guidelines-

Stroke Performance Achievement indicators for two or

more consecutive 12-month intervals and achieved 75

percent or higher compliance with six of 10 Get With

The Guidelines-Stroke Quality Measures, which are

reporting initiatives to measure quality of care.

These measures include aggressive use of

medications, such as tPA, antithrombotics,

anticoagulation therapy, DVT prophylaxis, cholesterol

reducing drugs and smoking cessation, all aimed at

reducing death and disability and improving the lives

of stroke patients.

“With a stroke, time lost is brain lost, and the Get

With The Guidelines–Stroke Gold Plus Performance

Achievement Award demonstrates Faulkner Hospital’s

commitment to being one of the top hospitals in the

country for providing aggressive, proven stroke care,”

said Linda Bresette, NP, Stroke Program Manager.

“We will continue with our focus on providing care that

has been shown in the scientifi c literature to quickly

and effi ciently treat stroke patients with evidence-

based protocols.”

“Faulkner is to be commended for its commitment

to implementing standards of care and protocols for

treating stroke patients,” said Lee H. Schwamm, MD,

chair of the Get With The Guidelines National Steering

Committee and director of the TeleStroke and Acute

Stroke Services at Massachusetts General Hospital in

Boston. “The full implementation of acute care and

secondary prevention recommendations

and guidelines is a critical step in saving

the lives and improving outcomes of

stroke patients.”

Get With The Guidelines–Stroke uses

the “teachable moment,” the time soon

after a patient has had a stroke, when

they are most likely to listen to and follow

their healthcare professionals’ guidance.

Studies demonstrate that patients who are taught how

to manage their risk factors while still in the hospital

reduce their risk of a second heart attack or stroke.

Through Get With The Guidelines–Stroke, customized

patient education materials are made available at the

point of discharge, based on patients’ individual risk

profi les. The take-away materials are written in an

easy-to-understand format and are available in English

and Spanish. In addition, the Get With The Guidelines

Patient Management Tool gives healthcare providers

access to up-to-date cardiovascular and stroke science

at the point of care.

“The time is right for Faulkner Hospital to be

focused on improving the quality of stroke care by

implementing Get With The Guidelines–Stroke. The

number of acute ischemic stroke patients eligible for

treatment is expected to grow over the next decade

due to increasing stroke incidence and a large aging

population,” said Bresette.

According to the American Heart Association/

American Stroke Association, stroke is the third

leading cause of death in the United States and

a leading cause of serious, long-term disability. On

average, someone suffers a stroke every 45 seconds;

someone dies of a stroke every three minutes; and

795,000 people suffer a new or recurrent stroke

each year. “This level of care requires an amazing

collaboration between physicians, nurses, CT staff, and

rehab professionals. We have a great team dedicated

to providing the best stroke care possible,” stated

Bresette.

Faulkner Hospital receives Get With The Guidelines Gold Plus Performance Achievement Award Award demonstrates Faulkner Hospital’s commitment to

quality care for stroke patients