focusfaulkner evans
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
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
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
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
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.
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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