Caring May 4, 2006 - Massachusetts General · PDF fileProject HOPE and the US Agency for ......

Inside:Speech-Language Pathology ..... 11111

Jeanette Ives Erickson .............. 22222The Journey of a Lifetime

Speech, Language & SwallowingDisorders ................................... 44444

Orren Carrere FoxAward .................................... 99999

GCRC ...................................... 1010101010

Clinical Narrative ..................... 1212121212Mary Sullivan, RN

Oncology Nursing Award ........ 1414141414

Bowditch Prize ........................ 1515151515

Occupational Therapy ............ 1616161616

The Beat Goes On .................. 1717171717

Quality & Safety ....................... 1818181818Hand Hygiene

Fielding the Issues .................. 1919191919Safety-Reporting System

Professional Achievements ..... 2020202020

Safety ...................................... 2222222222Medication Reconciliation

Educational Offerings .............. 2323232323

Blood Drive ............................. 2424242424

H E A D L I N E SCaringCaringMay 4, 2006

Working t

MGH P

A

ogether to shape the futureatient Care Services

bout five years ago, I hadthe privilege of being partof an ad hoc committee of

the American Speech-Language-Hearing Association to up-

date the scope of practice forSpeech-Language Pathology. Thefield had changed significantlysince the prior scope of practicehad been written more than two

decades earlier. Speech-languagepathologists representing variouspractice settings and areas of clin-ical practice from across the coun-try were invited to revise the scopeof practice and re-define the roleof speech-language pathologists.The resulting document, The Scopeof Practice in Speech-LanguagePathology, describes the breadth

of our professional practice, cap-turing the diversity of disorders,patient populations, practice set-tings, and professional roles andactivities encompassed by thefield. The objective of speech-language pathology is to optimizean individual’s ability to commu-nicate and/or swallow in natural

The meaning behind‘speech-language pathology’

—by Carmen Vega-Barachowitz, CCC-SLP,director, Speech, Language & Swallowing Disorders

continued on page 8

Speech-language pathologists, Danny Nunn, CCC-SLP (right), andRebecca Santos, CCC-SLP, perform Modified Barium Swallow exam with

patient, Eugene Foster, to determine the cause of his swallowing difficulties

May 4, 2006May 4, 2006Jeanette Ives EricksonJeanette Ives EricksonNursing, global health, and

the journey of a lifetimeor the past year,

I’ve had the plea-sure and privilege

of working withProject HOPE and

the US Agency for Inter-national Development assenior nurse consultanton a very special project.As you may know, thehealthcare system in Iraqhas deteriorated signi-ficantly over the past fewdecades, which has had adevastating impact onIraqi children who nowaccount for more than50% of the Iraqi popula-tion. Efforts are underway to build a much-needed, state-of-the artchildren’s hospital in thesouthern Iraqi city ofBasrah. I was asked to

F serve as senior nurseadvisor and consultant onthe creation of this 94-bed, pediatric oncologyhospital, scheduled toopen later this year.

I couldn’t have beenmore excited to acceptthis challenge, and I’menergized by the workthat lies ahead. But Imust admit, I didn’t fullyappreciate the enormityof the chasm that existsbetween the actual health-care-delivery system insouthern Iraq and thevision we have for theBasrah Children’s Hos-pital. This project will,indeed, be a challenge.

In my role as consult-ant, I’m responsible forensuring that Iraqi nurses

who will be staffing theBasrah Children’s Hos-pital are appropriatelytrained and prepared toprovide high-quality,specialized care to child-ren. This work began inearnest when I agreed tomentor Sukaina Matter,the nurse who was chos-en by the Iraqi Ministryof Health to be chiefnurse at Basrah Children’sHospital.

Sukaina is one ofonly a handful of bacca-laureate-prepared nursesin southern Iraq (only afew of these baccalaur-eate-prepared nurses willwork at Basrah Children’sHospital—Sukaina, aschief nurse, another asdirector of education.)

First training class of nursesfor Basrah Children’s HosptialFirst training class of nurses

for Basrah Children’s Hosptial

Sukaina made the longand arduous trip fromIraq to Boston, all byherself, to learn fromMGH nurses about mo-dern, western, nursingpractice and the role ofchief nurse. Sukaina ar-rived in September, 2005,and for three months wasprecepted by me and agroup of committed MGHnurses who quickly be-came her friends.

Despite cultural andlanguage differences,Sukaina was an excep-tional student. She quick-ly grasped unfamiliarconcepts, mastered ad-ministrative strategies,and showed great respectand interest in our ad-vanced technology andequipment. When Suk-aina left MGH in Novem-ber, she had a much moresophisticated understand- continued on next page

ing of the work that needsto be done and the chal-lenges that lie ahead.

In February, I traveledto Jordan and Oman tomeet with the first groupof Iraqi nurses beingtrained to work at BasrahChildren’s Hospital. Themore than 200 nurseswho will staff the hospi-tal are training at KingAbdullah Hospital inJordan and the RoyalHospital of Muscat inOman.

I had an opportunityto review the curriculum,talk with nurses, sharesome thoughts and ideas,and get a sense of theprogress being made interms of preparing thesenurses to practice in anew specialty. I wasstruck by the ‘thirst forknowledge’ I sensed in

May 4, 2006May 4, 2006

Clockwise from top left:

Senior vice president for Patient Care,

Jeanette Ives Erickson, RN, at early

orientation session with Sukaina

Visiting Iraqi chief nurse, Sukaina Matter

Ives Erickson with nurse educators in Oman

Basrah Children’s Hospital under

consturction

Members of the first nursing training class

at King Abdullah Hospital in Jordan

Jeanette Ives Ericksoncontinued from previous page

every member of thegroup. Currently in Iraq,nurses enter into practiceafter:

completing sixth gradeand three years of nurs-ing trainingcompleting ninth gradeand three years of nurs-ing trainingcompleting twelfthgrade and two years ofnursing training

Typically, higher edu-cated nurses are recruitedto teach in universities.

Cultural differencesadd another dimension totraining. In Iraq, mostnurses are male, and onlyfemale nurses can carefor female patients. It’scustomary for women,including nurses, to wearclothing that covers theirhead, neck, arms, andlegs. This presents count-less challenges to infec-tion-control and prevent-ion. But despite cultural,educational, and clinicaldifferences, there was anoverwhelming spirit of

unity and com-mitment amongtrainees.

I continue totalk to Sukainaevery week to dis-cuss important de-cisions and curric-ulum choices. Shewill return to MGHfor more training,and I plan to goback to Jordan and Omanto meet future trainingclasses.

When I accepted thisposition as senior nurseconsultant, I imagined itwould last through theconstruction and openingof Basrah Children’s

Hospital. I now feel itwill be a life-long jour-ney, one I will cherishforever.

I’m hopeful that theBasrah Children’s Hos-pital will be a source ofhealing and renewal forthe Iraqi people. I’ve

learned so much from thisexperience. It really is aprivilege to be part of aglobal effort to care forchildren and families,share knowledge andexpertise, and contributeto what I hope will be apeaceful future for all.

May 4, 2006May 4, 2006

What is executive func-tion?

Executive function is aterm used to describe theimportant set of skillsthat helps us be organiz-ed, get places on time,and feel in control of ourwork and life. Theseskills include the abilityto organize, prioritize,manage time, plan pro-jects, follow through ontasks, and monitor ourperformance. Most of usdon’t remember learningthese skills, yet we usethem all the time—weleave the house in themorning and arrive atwork on time, we knowhow to plan a birthdayparty, and even thoughit’s sometimes a chal-lenge, we know how toorganize our desk andfile our bills.

Children and adultswith executive-functiondisorder have a very dif-ferent experience whendealing with time, organ-izing their space, andplanning projects. Ima-gine the frustration ofconstantly being late, notbeing able to find impor-tant papers, or giving upon the science projectaltogether because itfeels too overwhelming.The difficulty is not alack of motivation orinterest. The person withexecutive-function dis-order fails to perceive theunderlying structure or

process inherent in time,space, and projects.

What does executive-function disorder looklike?

To understand the com-ponents of executivefunction, think of theresponsibilities of a chiefexecutive officer (CEO).To be successful, a CEOmust initiate tasks, inhi-bit distractions, monitorperformance, shift focus,plan, organize, prioritize,sequence, solve prob-lems, and communicateeffectively. As it turnsout, the business world isnot that different from

the classroom; our child-ren are required to per-form the same tasks.When they’re younger,parents and teachers helpstructure them. But asthey grow up, childrengain independence andare called upon to cleantheir rooms, be ready forthe bus, or write a bookreport. Children whointuitively use the impli-cit structure in life areable to get their workdone, often with enoughtime left over to play.Some children with exec-utive-function disorderspend their time trying to

figure out what they needto do instead of doing it;others impulsively jumpinto the task before creat-ing a plan that will letthem succeed. For thesechildren, homework as-signments and permis-sion slips may not makeit home. Because the daydemands frequent use ofexecutive function, child-ren with executive-func-tion disorder often feeloverwhelmed, frustrated,and ineffective. Theirintelligence and creati-vity is undermined bydisorganization as theystruggle to succeed athome and school.

Does executive-functiondisorder impact lang-uage?

There is a structure asso-ciated with the languageskills of listening, speak-ing, reading, and writing.

If a child doesn’t seestructure in space andtime, it can impact his/her ability to processlanguage. Children withexecutive-function dis-order may not perceivestructure in abstract lang-uage. They may havedifficulty understandingor telling a story becausethey don’t recognize thecritical components ofthe story (characters,setting, initiating event,plan, attempts, and reso-lution). They may havedifficulty comprehendingwhat they read or com-posing a paper if they’renot aware of the structureof exposition (topic, mainideas, details). Childrenwith deficits in executivefunction may have diffi-culty retrieving wordsand information when

The CEO in all of us: executive function and executive-

function disorder—by Kim Stewart, CCC-SLP

senior speech-language pathologist

continued on page 7

Speech-language pathologist, Kimberly Stewart, CCC-SLP (right),uses the Story Grammar Marker to help 11-year-old, Taylor Aspeslagh,

organize and communicate her thoughts

Speech, Language & SwallowingSpeech, Language & Swallowing

May 4, 2006May 4, 2006

atients who’vebeen diagnosedwith cancer of

the head and neckfrequently experience

difficulty with speechand swallowing. Changesin speech or voice qualityor trouble swallowingmay, in fact, be the rea-son patients seek medicaladvice in the first place.Treatment for cancer,such as surgery, radiationtherapy, or chemotherapycan also affect swallow-ing and communication.

Some of these effects arelong-lasting and can per-sist after treatment iscompleted. Patients withhead and neck canceraccount for a uniquepopulation served by theMGH department ofSpeech, Language &Swallowing Disorders.

Head and neck cancercan affect any part of theoral cavity, pharynx(throat) or larynx (voicebox). In some cases, thecancer spreads to thelymph nodes in the neck.

Typical speech disordersinclude impaired articu-lation or pronunciation ofcertain sounds—theexact nature of the dis-order depends on whichstructure has been affect-ed. For example, diffi-culty articulating ‘t’ or ‘s’sounds may indicate thatthe tip of the tongue hasbeen affected. Sometimesair escapes through thenose causing hypernasal-ity when the palate isinvolved. Difficulty speak-ing impacts a patient’s

ability to communicatewith loved ones, caregiv-ers, and community mem-bers. Speech impairmentdraws attention, causingpatients to feel embarras-sed. The role of a speechlanguage pathologist inthis instance is to try toimprove function throughexercise and teachingstrategies to slow the rateand increase the preci-sion of speech. Some-imes, we need the help ofa maxillofacial prosthe-dontist (someone whomakes artificial plates toimprove speech intelligi-bility).

Patients with cancersof the larynx or voice boxpresent with problems in

communication. In caseswhere the larynx hasbeen surgically removed,an artificial electrolarynxis needed to provide asource for speech. Lar-yngectomy patients mayalso be fitted with a one-way prosthesis in theirstoma to allow them touse a more natural sound-ing voice. In either case,patients need instructionfrom a speech-languagepathologist to be able touse their device optimal-ly.

Head and neck cancerpatients frequently havedifficulty swallowing.Typical complaints in-clude food getting caught

continued on page 7

P

Speech-language pathologyand head and neck cancer

—by Tessa Goldsmith, CCC-SLP, clinical specialist

Speech-language pathologists, Allison Holman, CCC-SLP (left)and Tessa Goldsmith, CCC-SLP (right), provide swallowing treatment

to patient, Roberta Brundrett, following head and neck surgery

May 4, 2006May 4, 2006

Helping babies eat safely—by Jean Ashland, CCC-SLP

peech-language pathologists assess and treat feed-

ing and swallowing disorders across the age spec-

trum from newborns to elders. Premature infants may

have trouble coordinating sucking and swallowing re-

sponses because of immature lung- and muscle-develop-

ment. Speech-language pathologists collaborate with nurses, phy-

sical and occupational therapists, physicians, and families to eval-

uate feeding and swallowing difficulties. The evaluation can in-

clude a fluoroscopy exam in Radiology, a test that examines the

swallow action to determine if aspiration is occurring (if liquid is

entering the airway). The Inpatient Feeding Team provides inter-

disciplinary evaluation and intervention for babies and children

with complex medical issues that affect their ability to feed and

swallow. Some techniques used to maximize safety while helping

babies feed include changing nipples on bottles to better control

the flow rate, supportive positioning, or alternative feeding meth-

ods during bottle- or

breast-feeding.

SS

Above: three-month-old, William, learns to feed in the NICU withthe help of speech-language pathologist, Jean Ashland, CCC-SLP.

Below, speech-language pathologist, Cheryl Hersh,CCC-SLP, works with 13-month old, Ben Kosty, to improve

his feeding and swallowing abilities.

(Pho

to p

rovi

ded

by s

taff)

Speech, Language & SwallowingSpeech, Language & Swallowing

May 4, 2006May 4, 2006

in their throat, coughingor choking on liquids, orliquids being regurgitatedthrough the nose. Sincemany patients require agastrostomy feeding tubeduring treatment, an im-portant post-treatmentgoal is to help wean pa-tients from their tube. Avideofluoroscopic swal-lowing study (video-x-ray of swallowing) isneeded to understand thenature of the patient’sswallowing problem. Inthis test, patients are ask-ed to drink or eat smallamounts of liquid or foodcoated with barium, anda video x-ray is taken.

Based on the findings ofthe test, swallowing stra-tegies are introduced thatmay improve swallowingefficiency and function.Often, simple strategies,such as alteration in headposture, make a substan-tial difference in the pa-tient’s ability to swallow.It is particularly helpfulfor patients to view thevideo-swallow study sothey can understand thenature of the problem andthe value of the therapeu-tic strategy.

Successful manage-ment of a patient withhead and neck cancerdemands the dynamic

and collaborative effortsof a multi-disciplinaryteam of specialists whofollow patients from diag-nosis through treatmentand beyond. Our Headand Neck Cancer Team iscomprised of practition-ers from MGH and theMassachusetts Eye andEar Infirmary, and in-cludes medical and radi-ation oncologists, otolar-yngologists, nurses, so-cial workers, and nutri-tionists. Speech-languagepathologists from MGHparticipate actively onthis team to provide pa-tient assessment, treat-ment, support, education,and advocacy. The focusof treatment is on assist-ing patients to return toeating and drinking as

normally as possiblewhen acute treatmenteffects have subsided.Since many patients arefearful of choking, ourgoal is to teach patientsto swallow safely and,where possible, weanpatients from their feed-ing tube.

Our focus is on help-ing patients recover fromtheir diagnosis and treat-ment and restore theirquality of life to thehighest level possible.Clear, open, and regularcommunication betweenpatients, caregivers, andfamily members helps usachieve our goals.

To contact the de-partment of Speech,Language & SwallowingDisorders, call:

Head and Neck Cancercontinued from page 5

Joey Buizon, 617-643-2902, SLP associate or617-726-2763

For information aboutspeech, language andswallowing disorders,call:

The American Speech,Language, and HearingAssociation (ASHA):www.asha.org

For information abouthead and neck cancer,call:

The MGH Cancer Re-source Room: 617-724-1822SPOHNC: Support forPeople with Oral andHead and Neck Can-cer:1-800-377-0928, orhttp://www.spohnc.orgThe Yul Brynner Foun-dation at www.yulbrynnerfoundation.org

they speak, write, or takea test. Just like a piece ofpaper in a filing cabinet,if new information isn’tstored in an organized

manner, it’s hard to findlater on.

Who can help?

Many things can cause

difficulty with organiza-tion and language. It’simportant to have anaccurate diagnosis todetermine the most ap-propriate treatment. Diag-nosis and treatment areavailable for children andadults.

Executive Functioncontinued from page 4

DiagnosisExecutive-function dis-order is diagnosed pri-marily by psychologists,psychiatrists, and neur-ologists. If comprehen-sion and expression oflanguage are in question,a language assessment bya speech-language path-ologist will be needed.

TreatmentTreatment for executive-function disorder with orwithout language dis-orders can be providedby speech-language path-ologists. Although treat-ment varies based on theindividual needs of theperson, skills are intro-duced to improve theability to organize, pri-oritize, estimate time,break down tasks intosteps, predict, and mon-itor performance. Treat-ment addressing lang-

uage may focus on im-proving effective storageand retrieval and provid-ing strategies for efficientlistening, speaking, read-ing, and writing.

For a speech-languageevaluation, contactSpeech, Language &Swallowing Disordersat 617-726-2763

For individual or grouptreatment and/or parenteducation sessions,contact Speech, Lang-uage & SwallowingDisorders at 617-726-2763

For services providedat the Chelsea andRevere HealthcareCenters, contact CarolDinnes at 617-887-3527 (Chelsea), orcall 781-485-6120(Revere)

Imagine a CEO...

InitiateInhibitMonitorShift focusPlan (toward a goal)OrganizePrioritizeSequenceProblem-solveCommunicateeffectively

Now imagine your child…

Initiate (homework)Inhibit (distracting thoughts)Monitor (performance while working on atask)Shift focus (between thoughts and thencome back!)Plan (how to do a science project)Organize (desk to be able to find things)Prioritize (what homework to do first)Sequence (steps in making a bird house)Problem-solve (to address unexpectedevents)Communicate effectively (with parents,teachers, and peers)

Consider executive function

May 4, 2006May 4, 2006

environments, therebyimproving his/her qualityof life.

Speech-languagepathologists practice in avariety of settings. Thegeneral public is probab-ly most familiar with ourrole as speech therapistsworking in the schoolsetting. Because so manypeople associate us withschools, there’s an as-sumption that we’re pri-marily involved withchildren. In reality, ourinvolvement with child-ren’s disorders such asarticulation (when a childhas difficulty pronounc-ing ‘s’ correctly) repre-sents a small part of ouroverall practice. In recentyears, we have becomemore involved with thecomplexities of languageand cognition and howthey impact communica-tion. A large part of ourcurrent practice address-es oral and written lang-uage and cognitive dis-orders. The evaluationand treatment of swal-lowing disorders in child-ren and adults are areasof specialty that havebecome common practicein our field, especially inthe healthcare setting.

At MGH, the depart-ment of Speech, Lang-uage & Swallowing Dis-orders provides servicesto inpatients and outpa-tients of all ages whopresent with the follow-ing disorders:

Language (phonology,morphology, syntax,semantics, pragmatics)

Comprehension oforal and written lang-uageExpression of oraland written languageLanguage processingPre-literacy and lang-uage-based literacyincluding phonolo-gical awareness

SpeechArticulationFluencyResonance

SwallowingInfant FeedingOral and pharyngealstages of swallowingin children and adults

CognitionAttentionMemoryExecutive Function

Like other healthcareprofessionals, speech-language pathologistsmake a profound impacton the individuals andfamilies they serve. Some-times this impact is relat-ed to body functions orstructures and how they

affect an individual’sability to actively partici-pate in society. A patientmay present with a de-generative disease thatmakes his tongue andface muscles weak. Thischange impairs the indi-vidual’s ability to eat. Italso impacts the individ-ual’s willingness andability to go to a restaur-ant for a meal with fami-ly and friends. The speech-language pathologist’sresponsibility in this caseis to assess the oral andpharyngeal stages of theswallow, determine thecause of the problem, andprovide recommenda-tions. When appropriate,speech-language patholo-gists provide treatmentand recommendations toimprove an individual’sability to eat by mouth.For some patients thatmeans working with aspeech-language patholo-gist toward the goal ofresuming the importantsocial activity of ‘goingout to eat,’ thereby posi-tively impacting qualityof life.

Sometimes speech-language pathologistsaddress contextual fac-tors, such as the environ-ment or personal factors,and how they act as bar-riers or facilitators tofunction. Environmentalfactors can include atti-tudes or physical barriers;personal factors mayinclude age, race, and/orgender. An adult whosuffers a stroke, whoselistening, speaking, read-ing, and writing skillsare impaired, can returnto work if certain jobmodifications are made.Accommodations andmodifications coupledwith an attitude of in-clusiveness and under-standing are environ-mental factors that couldfacilitate a positive im-pact on this individual’slife. Regardless of thedisability or disorder,contextual factors canfacilitate or challengeactivity and participationin society and in turnenhance or diminish thequality of an individual’slife.

Speech-Language Pathologycontinued from front cover

The Scope of Practicein Speech-Language Pa-thology encompasses allaspects of this model,including improvingquality of life by reduc-ing the impairment andhelping to increase acti-vity and participation.Our ability to influencesocial and attitudinalfactors while minimizingthe impact of personalfactors such as educa-tional background andlifestyle is key.

Individuals are refer-red to speech-languagepathologists for manyreasons, some of whichcan be confusing. “Whydo I have to see a speechpathologist when myproblem is swallowing?”Similar questions may beasked by patients in ourambulatory practice whohave impaired memory;or difficulty with readingcomprehension or writ-ing skills; or someonewho presents with poororganizational or studyskills. “Why do I have tosee a speech therapist?My speech is fine.” Orwhen a patient has a tra-cheostomy tube and needsa speaking valve; when apatient is admitted withaspiration pneumonia;when a patient is diag-nosed with throat cancerand undergoes radiationand chemotherapy. Speech-language pathologistscould be involved in allthese scenarios. Our scopeof practice is vast andcontinues to evolve. Hope-fully, in the coming years,our role and the impactwe have on improvingquality of life for child-ren, adults, and familieswill be well understood.

Inpatient:BedsideassessmentsTreatmentModifiedbarium swallowstudiesFibroscopicevaluation ofswallowing

Outpatient:Speech-languageevaluationsFeeding TeamevaluationsPediatric TherapyTeam evaluationsModified bariumswallow studiesSmall group andindividual treatment

Who We Help…Children and adults with:

AphasiaArticulation and phonologicaldisordersCleft palateCognitive impairmentsDyslexia and readingdisabilitiesExecutive-function disordersFeeding and swallowingdisordersFluency disordersLanguage learning disabilitiesMotor speech disordersNonverbal learning disabilitiesPervasive developmentaldisordersSpeech and language delaysTraumatic brain injuries

Scope of PracticeScope of Practice

May 4, 2006May 4, 2006

n March 23,2006, OrrenCarrere Fox

returned to theNewborn Intensive

Care Unit (NICU) withhis family and friends tocongratulate staff nurse,Anita Carew, RN, the2006 recipient of theaward that bears hisname. Orren’s parents,Elizabeth and Henry,established The OrrenCarrere Fox Award toacknowledge the compas-sionate care they receiv-

ed from the MGH com-munity during Orren’shospitalization when hewas an infant.

Today, Orren is ahealthy, athletic nine-year-old who sports thenickname, ‘Brown Po-tato,’ in deference to hisresemblance to Olympicsnowboarder, ShaunWhite, also known as the‘Flying Tomato.’

NICU nurse manager,Peggy Settle, RN, sharedthat clinicians from manyrole groups were nomi-

Orren Carrere FoxAward

—by Mary Ellin Smith, RN, professional development coordinator

nated for the award, dem-onstrating the importanceof the contributions of allmembers of the team. “Itreally does take a village,”said Settle, “to delivercomprehensive, expert,compassionate care.”

Acknowledging thisyear’s recipient, Settledescribed Carew, as anurse who epitomizes thehigh standards of thisaward. She’s an exception-al nurse and a role modelfor family-centered care.

Accepting the award,

OCarew thanked her NICUcolleagues and stressedthe importance of part-nering with families inthe care of newborns.Said Carew, “I alwaystell families, ‘We’re go-ing to get through thistogether. I’ll be by yourside no matter what.’ ”

Speaking for the fam-

ily, Orren’s father said,“Every time we drive byMGH, we look up at thethird floor and remem-ber what we all wentthrough, and what thefamilies of the childrencurrently in the NICU areexperiencing. We sendthem our good thoughtsand encouragement.”

New CRP websiteVisit the updated Clinical Recognition

Program web site.

See examples of portfolios, tips fromclinicians on how to develop your portfolioand prepare for your interview, and a listingof advanced clinicians and clinical scholars.

Visit: http://www.massgeneral.org/pcs/CCPD/Clinical_Recognition_Program/

abt_Clinical_Recognition.asp

RecognitionRecognition

(Photo by Abram Bekker)

Award recipient, Anita Carew, RN (second from right), with nurse manager,Peggy Settle, RN (right), and members of the Orren Carrere Fox family

May 4, 2006May 4, 2006

hat does HarryPotter have incommon with

research at MGH?In the late 1990s,

scientists in Great Britainengineered what theycalled, Harry Potter micethat didn’t experiencepuberty. At the same time,investigators at MGH’sMallinckrodt GeneralClinical Research Center(GCRC) were studyingpeople who never experi-enced puberty. Whenthese researchers got to-gether, they discovered agene that triggers puberty.

This is only one ofmany important accom-plishments of investigat-ors in the GCRC. EarlyMGH researchers wroteabout the physiology andtherapy of lead poisoningand treated many dis-eases of the thyroid. Sub-sequent scientists createdan immunoassay for di-goxin and explained theclinical role of calcitonin.Recent studies treateddiabetes with implant-able insulin pumps, stud-ied the brain during co-caine craving, and treat-ed HIV lipodystrophywith insulin-sensitizingagents.

The GCRC celebrat-ed its 80th anniversary

last year. It began as Ward4, was later re-namedMallinckrodt Ward IV,and is currently calledthe Mallinckrodt GeneralClinical Research Center.

In 1925, Ward 4 wasa research unit on thefirst floor of the BulfinchBuilding, complete withoutpatient beds, kitchen,nurses’ station, and twolaboratories. Accordingto early director, J. How-ard Means, “The ward’sprofessional people, de-voting their full time toits affairs and nothingelse, have been the headnurses and dieticians... Itis they who have kept theward going smoothly,always ready to serve thecause of research, yet atthe same time seeing thatthe nursing and dieteticcare of all patients satis-fied the diverse require-ments of several inves-tigators.”

Nurses play an essen-tial role on the GCRC.They are responsible forpatient safety, ensuringthe rights of the researchparticipant, and maintain-ing informed consentthroughout the study.GCRC nurses use clini-cal knowledge and skills

to assess participants.They educate participantsabout their medical needs,within and outside of thetrial. Nurses have regularcontact with participantsand are able to establishtrusting relationshipswith them.

Nurses assist withdata-collection for stud-ies and also do their ownresearch. One study foundnormal saline to be justas effective as heparin inblood sampling lines.GCRC nurses have com-pleted many evidence-based projects on topicssuch as ergonomics andquality-improvement. Aproject is currently underway to study the use ofcomplementary and alter-native medicine amongresearch participants.GCRC nurses are activeon the Nursing ResearchCommittee and havecreated posters for Nurs-ing Research Day andother venues.

Over time, bionutri-tion has contributed toexpertise in the designand implementation offeeding studies to assess

energy-expenditure, bone-mineral density and bodycomposition, anthropo-metrics, and a detailedquantification of nutrientintake from food diariesand questionnaires.

Scientific inquiryinitiated by bionutritionincludes a research studythat compared three me-thods to determine ener-gy-expenditure in over-weight and obese indi-viduals. A study to assessblood glucose responseto two insulin regimensin individuals with type 1diabetes has been propos-ed, designed, and funded,and will soon be imple-mented on the GCRC.

Today, metabolismand endocrinology re-search has expanded toinclude the fields of Neu-rology, Pediatrics, Psych-iatry, Infectious Disease,and Anesthesia. But thebasics have not changed:a dedicated staff of nurses,bionutritionists, lab as-sistants, administrators,and support staff provideresources to a large groupof investigators and co-ordinators conductingdiverse studies.

The GCRC has inpa-tient and outpatient rooms,a kitchen, research labor-atory, nutrition/metabolicassessment area, andoffice space for GCRCstaff. We also have loca-

tions at the CharlestownNavy Yard and MIT.

The GCRC has alwaysbeen at the forefront ofclinical research. It wasone of the first humansubjects research labora-tories in the country. Ward4 was the prototype for theclinical research center inBethesda and for the morethan 80 other clinical re-search centers in the Unit-ed States now supportedby the National Institutesof Health (NIH).

Soon, the NIH willconvert from GCRCs toClinical Translational Sci-ence Awards, which willdramatically change theface of clinical research.The new program is in-tended to break down bar-riers that currently existbetween bench and bed-side research. Each clini-cal and translational sci-ence entity will fall underthe umbrella of a medicalschool, allowing connec-tions between researchersand education and trainingof new investigators.

Throughout its history,the GCRC has led the waythrough periods of greatscientific evolution. Look-ing at the past helps guidethe future. As we celebrate80 years of research, ourcommitted team of nurses,researchers, volunteers,and others continues tolead in this time of transi-tion for clinical research.

ResearchResearchGCRC celebrates 80 years

of research—by Dayna Bradstreet, operations associate

W

1920s 1930s

J. Howard Means andDavid Edsall establishWard 4 laboratory forhuman investigationWard 4’s first study pub-lished, the first physiolog-ical and therapeutic studyof lead poisoning

National Institutes of Health(NIH) establishedAfter 17-month closureduring Great Depression,Ward 4 re-opens with grantfrom Hyams FoundationAlbright, the “father ofmodern endocrinology,”describes and treats hyper-parathyroidism

1940s

First use of radioactiveiodine for Graves’ disease(Hertz)During World War II, Ward4 used by Office of Scien-tific Research and Devel-opmentMetabolic aspects of con-valescence are studied(Reifenstein)Ward 4 re-named ‘Mallin-ckrodt Ward IV’ for Ed-ward Mallinckrodt, Jr.Nuremberg Code published

1950s

Ward 4 renovated to in-crease spaceFirst description of syn-drome of inappropriateanti-diuretic hormone se-cretion (Leaf and Bartter)Mallinckrodt starts endow-ment to ensure continuedoperation of Ward IVGCRC program estab-lished by NIH

1960s

Ward IV receives supportas a metabolic researchcenter from NIAMDDeclaration of HelsinkiDr. Henry K. Beecher’sarticle, “Ethics and Clini-cal Research,” publishedHoward receives PassanoAward for research oncalcium metabolism

May 4, 2006May 4, 2006

MGH GCRC renovatedResearch Subject Advocate (RSA) pro-gram foundedClinical Research Center at MIT be-comes satellite of MGH GCRCHuman Genome Project completedNIH Roadmap for Medical ResearchannouncedBioImaging Core established at Charles-town Navy YardAlternative way of blocking hormoneactivity in prostate cancer patients, withfewer side-effects and improved bonedensity (Smith)NIH launches Clinical TranslationalScience Awards (CTSAs)HIV lipodystrophy studied and asso-ciated metabolic disorder treated withmetformin (Grinspoon)Successful islet transplantation in kid-ney transplant recipients (Cagliero,Nathan)

he NationalGeneral ClinicalResearch Center

(GCRC) annualmeeting was held

March 15–18, 2006, inWashington DC. GCRCsare a network of 78 cen-ters across the countrythat provides an appropri-ate setting and nursingcare for safe clinical stu-dies involving adults andchildren. Each year, rep-resentatives from thesecenters, including nurses,physicians, bionutrition-ists, administrators, re-search advocates, andinformation-system man-agers, convene to discussadvances in clinical sci-ence and care of researchparticipants. This year,MGH GCRC nurses werea strong presence at themeeting with formal pre-sentations, interactivesessions, and poster pre-sentations.

A focus of this year’smeeting was the reorgan-ization of GCRCs toClinical TranslationalScience Award (CTSA)

centers over the next fewyears. CTSAs are aninitiative of the NationalInstitutes of Health toincorporatebasic medicalresearch intothe clinicalresearch are-na.

Six mem-bers of theMGH GCRCteam pre-sented at thisyear’s meet-ing, includingthe nursemanager,clinical nursespecialist,nurse practi-tioner, staffnurses, andoperationscoordinator.Bonnie Glass,RN, nursemanager andMary Sulli-van, NP, pre-sented, “Inte-grating Clinical ResearchNursing at MGH.” Thesession provided a forumfor discussion about therole of advanced practice

nurses in clinical research.Kim Smith, RN, pre-

sented posters on, “Theprotocol process and its

effect on data-collectionoutcomes,” and “Partici-pant reporting patternsfor side-effects of studymedications.” SharonMaginnis, RN, presentedposters on, “Complement-ary and Alternative Med-icine,” including one on,“Evidence-based practicerelated to acupuncture,”

and one in collaborationwith Jane Hubbard, RD,on a survey tool used tocollect information oncomplementary and alter-native therapies usedwith research participants.Gerry Cronin, operationscoordinator, presented aposter documenting mile-

MGH nurses present atNational General Clinical Research

Center annual meeting—by Karen Hopcia, RN, nurse practitioner, GCRC

T continued on page 18

1970s 1980s

Digitalis toxicity treatedwith antibodies (Haber)Physiology and clinicalrole of calcitonin describ-ed (Potts)National Advisory Councilfor Protection of Subjectsof Biomedical and Beha-vioral Research establish-edWard IV becomes NIHGeneral Clinical ResearchCenter (GCRC)National Commissionpublishes Belmont Report

GCRC re-locates to largerspace on White 13GnRH agonist treatmentof central precocious pu-berty established (Crowley)Glycoprotein secretion ofpituitary tumors studied(Klibanski, Ridgway)First treatment of type 1and type 2 diabetes withimplantable insulin pumps(Nathan, Blackshear)

1990s 2000s

Replacement therapy for Gaucher’s dis-ease (Mankin)First treatment of type 2 diabetes withglucagon-like peptide-1 (Nathan, Hab-ener)National Center for Research ResourcesformedParathyroid injection treatment to preventosteoporosis (Neer)MGH forms Partners Health Care withBrigham and Women’s HospitalElucidation of the physiology and patho-physiology of inhibins in women and menFunctional magnetic resonance imaging(fMRI) technology shows how specificareas of human brain react to cocaine andcocaine cravings (Breiter)rhIGF-1 used to treat bone loss in anorexianervosa (Klibanski)Pulsatile GnRH used for ovulation induc-tion in women with idiopathic hypogona-dotropism (Hall, Crowley)

(L-r): Karen Hopcia, RN; Gerry Cronin;Bonnie Glass, RN; and Mary Sullivan, RN,bring their expertise to the nation’s capital

(Pho

to p

rovi

ded

by s

taff)

May 4, 2006May 4, 2006

Mary Sullivan, RNnurse practitioner, GCRC

M

continued on next page

Nursing presence is powerfulintervention on GCRC

Clinical NarrativeClinical Narrative

y name is MarySullivan and I am anurse practitioner(NP) on the GCRC,

the General Clin-ical Research Center. Inmy role as nurse practi-tioner, I take histories,conduct physical exam-inations, formulate ap-propriate diagnoses, andidentify the needs of pa-tients and families basedon the data collected.

The goal of care forresearch patients includes:achieving optimal health,facilitating entry into thehealthcare system, pro-moting a safe environ-ment, and collaboratingin the provision of com-prehensive, holistic care.Most importantly, it’sabout being present withpatients.

Patients on the GCRCcan be healthy, under-served with many health-care needs, chronicallyill, or nearing the end oflife, presenting manychallenges to care. Thecaring interaction withinthe nurse-patient rela-tionship is the most cri-tical component and re-flects the true essence ofnursing.

I’d like to share thisstory about my relation-ship with ‘Eddie.’ Eddiewas a 74-year-old, Italianman, married, with fourgrown children and sev-eral grandchildren. Eddiehad been diagnosed withcongestive heart failure(CHF) about four yearsearlier. He had reachedend-stage disease and

had limited physical abi-lity.

Eddie enrolled in astudy that required intra-venous medication to beinfused once or twice aweek. Patients participat-ing in the study receivedactive study medicationor a placebo, a substancecontaining no medica-tion. For this study, pa-tients required one-on-one observation by anurse practitioner duringthe infusion due to a po-tential for hemodynamicinstability, frequent doseadjustments, and thepossibility of unexpectedadverse events.

As I read Eddie’smedical history, I realiz-ed how sick he was, notonly with heart disease,but several other medicalissues. I wondered whyhe’d want to enroll in aresearch study knowinghe might only get a pla-cebo? He was at the endof his life, and I question-ed why he’d want to spendhis remaining monthscoming to the hospitaltwice a week, hooked upto an infusion and moni-tor, not even knowing ifit would help. I realized Ineeded step back andlook at the situation fromhis point of view. It didn’tmatter what I thought,felt, wanted, or would dofor myself. This waswhat Eddie wanted. Ineeded to understand himand his needs, and sup-port his decision.

In our first meeting,as Eddie received his

infusions, he talked abouthis life, marriage, andfamily. As I monitoredhis hemodynamic mea-surements and potentialfor electrolyte imbalance,I listened to his storiesand came to know him.He talked about his ill-ness, how it impacted hislife, and how he was nolonger able to travel,which he loved to do. Hedescribed the feeling offreedom he felt when hedrove his car, and re-counted stories of cross-country family vacations.He was no longer able totravel and found it diffi-cult to lose his independ-ence. But he handled itgracefully, relying onmemories to fulfill him.

One day during hisvisit, I asked Eddie whyhe joined the study. Heresponded, “You know, Idon’t know.” He stoppedreading the paper, cockedhis head sideways, look-ed out the window andthought for a moment.Turning toward me hesaid, “I thought this med-ication might help me.”

I knew from our con-versations what he meant;he hoped it would let himspend more time with hisfamily and give him timeto get things in order. Hisfamily was his world,and he lived and breathedfor them.

After a while, thedisease began taking atoll on his body. He start-ed experiencing increas-ed shortness of breath,fatigue, and abdominal

girth. Emotionally, hewas sad and withdrawn.He required repeatedhospitalizations lastingfrom a few days to a cou-ple of weeks. His healthwas deteriorating, yet hestill came in for studyvisits.

At times during hisvisits, Eddie would ex-perience horrible bronch-ospasms that took hisbreath away and made itdifficult for him to speak.Despite these attacks, hestill wanted and neededto talk. Without saying it,we both knew his timewas limited, and he want-ed to be known. He want-ed to celebrate his storyof a simple, quiet, yetrich and full, family-centered life. He contin-ued to talk while I pro-vided an audience for hisstories, validating thefullness of his life.

As I listened, I knewthat advance care plan-ning had not been ad-dressed. Eddie was a fullcode (every effort wouldbe made to save him if hewent into cardiac arrest).Again, I had to respecthis wishes. But at the

same time, I knew I hadto address his diseaseprogression with him andthe team. Eddie wasn’tready to talk about end-ing treatment, hospice, orresuscitation, but thatdoor needed to be open-ed. I discussed his codestatus with the team.Eddie wanted to continuewith the medication be-cause it usually madehim feel better. A codestatus was not his priori-ty at this time. He wasn’tready to leave the studydespite fatigue, weight-gain, and failing health. Irespected his wishes, butI had opened the door,giving him permission tothink about possibilities.

Eddie’s wife and soncame with him to everyvisit. Most days theywent to a movie or sight-seeing around town. Itmight seem strange, butthis was what Eddie want-ed. He didn’t want toburden them. He tookthis time as an opportu-nity to sit back and talk.He was a planner whoneeded to know every-thing was going to be

May 4, 2006May 4, 2006

Narrativecontinued from page 12

okay. His plans includedcaring for his wife finan-cially, and also makingsure she was emotionallytaken care of. He plannedfor a good friend to watchover her after his death.

I remember one visitthat was extremely diffi-cult for both Eddie andme. He spoke openly andhonestly about his death.As he sat in the chairafter getting back fromthe bathroom, he wasshort of breath and ex-hausted. After he caughthis breath, with his headhung low, he looked upat me with tears in hiseyes. He told me histhoughts about dying,speaking about it openly.These visits provided anoutlet for him to say whathe felt. All I could dowas listen, give support,and cry with him. This

was the point in our rela-tionship when I felt Itruly knew Eddie theman.

One day, when Eddiewas scheduled to come infor an infusion, he waslate, which was unusual.I was paged for a phonecall. It was Eddie and hiswife. Eddie had decidedto end his participation inthe study, to stop all treat-ments for heart failure,and initiate hospice care.Eddie talked about whata difficult decision it hadbeen to accept death, andthen he started to chokeon his words. We bothknew his fight to live hadended. He had plannedall he could.

As I listened, my heartwas racing, my throattightened, and my eyesfilled with tears. I was sosad because I knew Iwouldn’t see him again. Iwasn’t really absorbingall he said.

I was choked up, but

somehow I was able tosay, “Eddie, this is yourtime to spend with yourfamily. You need to enjoythe time you have withthem.” I thanked him forthe pleasure of caring forhim and his family.

Amazingly, he hadwanted to call and thankme for all I had done forhim. We said good-byeand hung up. I knew hehad reached a point wherehe could stop fightingand accept death.

When I think of Eddie,two words come to mind—happiness and sadness.Happiness is what I feltwhen he came to the unitfor his infusion and whatI think when I reflect onour conversations. Sad-ness is what I felt know-ing he was nearing deathand now, knowing he hasdied. I miss him and whathe gave to me. As a nursepractitioner, I have theprivilege and honor tomeet patients, be presentwith them, hear theirstories, and come to knowthem in a way that ismeaningful. I recognizethat as my advanced nurs-ing practice continues togrow and evolve, thecollective stories of allmy patients guide mythinking in practice.

Comments by JeanetteIves Erickson, RN, MS,senior vice presidentfor Patient Care andchief nurse

Time and time again, wehear of the power of be-ing present to patients.Perhaps end-of-life carepresents one of the mostpowerful opportunities tomake a difference withour presence.

The Employee Assistance Program

Helping Kids Make HealthyChoices

Young people face many pressures anddecisions in today’s complex world. Whenyoung people talk openly with parents or

adults they trust, they tend to make betterchoices. Many parents need help initiating

these important conversations.

Join Jeanne Blake of Blake Works and PaulaRauch, MD, of MGH Psychiatry to learn

information, strategies, and skills that willhelp you raise kids who make smart choices.

Thursday, May 18, 200612:00–1:00pm

Thier Conference Room

For more information, contact theEmployee Assistance Program (EAP)

at 726-6976.

Blood: there’s life inevery drop

The MGH Blood Donor Center is locatedin the lobby of the Gray-Jackson Building

The MGH Blood Donor Center is openfor whole blood donations:

Tuesday, Wednesday, Thursday,7:30am–5:30pm

Friday, 8:30am–4:30pm(closed Monday)

Platelet donations:Monday, Tuesday, Wednesday, Thursday,

7:30am–5:00pmFriday, 8:30am–5:30pm

Appointments are available forblood or platelet donations

Call the MGH Blood Donor Centerto schedule an appointment

6-8177

At the outset, neitherEddie nor Mary knewwhat the study wouldbring. Mary wisely letEddie discover for him-self how coming to theGCRC could help him.Eddie used their timetogether to take stock ofhis life, share stories ofhis family, and ultimatelycome to grips with dying.

Mary’s constancy wasaffirming, comforting,and empowering. Herability to balance clinicalcare, important admini-strative concerns, andemotional support is thesign of a seasoned vet-eran. Eddie and Marywere lucky to find eachother.

Thank-you, Mary.

Quick Hits to improveyour writing!

Classes now scheduled for:

Tuesday, May 30, 11:00am–2:00pmMonday, June 12th, 10:00-1:00pmWednesday, July 19, 12:00-3:00Monday, August 14th, 10:00-1:00

All classes held in GRB-015Conference Room A

Pre-registration is required. Call 4-7840

A low-stress, high-yieldclass aimed at helpingdevelop your writing styleand eliminate some of theangst associated with writing

Offered by Susan Sabia,editor of Caring Headlines

May 4, 2006May 4, 2006

n Friday, April14, 2006, theOncology Nurs-

ing Career Devel-opment Award was

presented to this year’srecipient, oncology radi-ation staff nurse, GailUmphlett, RN.

The Oncology Nurs-ing Career DevelopmentAward, was establishedin 1989 to recognize astaff nurse who consist-ently demonstrates excel-lence in delivering careto patients with cancer,who serves as a role mo-del to others, and whoexemplifies a strong com-mitment to professionaldevelopment. The awardis funded by the Friendsof the MGH Cancer Cen-ter, an organization dedi-cated to providing com-fort, support, educationand amenities to cancerpatients and their fami-lies. The recipient is sel-ected by a multi-discipli-nary review board andreceives $1,000 to beapplied toward profes-sional development.

Umphlett has been afull-time nurse for 24years, joining the Radia-tion Oncology Team atMGH in April, 2003. Inletters of support accom-panying her nomination,Umphlett was character-ized as a caring, deter-mined self-starter whoalways gives her all toher patients.

Nurse manager, KatieMannix, RN, who nomi-

Oncology NursingCareer Development Award

RecognitionRecognition

Photos by Abram Bekker

O nated Umphlett, wrote,“Gail’s empathetic man-ner, assessment, and careencompass all the needsof the patient and family.She regularly presentsthe HOPES seminar,“Introduction to Radia-tion.” She mentors new

nursing staff, and hasbeen a preceptor for theCarol Ghiloni StudentNurse Oncology Fellow-ship Program.”

Colleague, LorraineDrapek, RN, wrote, “Gailhas been a clinical re-source and role model in

helping me ac-

cept the challenge ofcaring for patients withcancer. She is alwaysavailable and easily ap-proachable. And she hasexcellent teaching skillswhen working with ra-diation oncology resi-dents.”

Clinical nurse special-ist, Mimi Bartholomay,RN, said of Umphlett,“Gail has become one ofthe driving forces in thedevelopment of evidence-

based guidelines for thenursing management ofmucositis at MGH. Shehas also been an integralmember of the groupimplementing these guide-lines. She is committedto professional develop-ment, having obtainedher oncology nursingcertification, and she iscurrently working towardcompleting her master’sdegree.”

Other nomineesfor the OncologyNursing CareerDevelopment Aw-ard, were: TheresaHartman, RN; JohnOpolaski, RN; andPatricia Ostler, RN.

For more infor-mation about theOncology NursingCareer Develop-ment Award, con-tact Lin-Ti Chang,RN, at 4-7842.

Top left: Katie Mannix, RN; top right: recipient, Gail Umphlett, RN, with associate chief nurse,Jackie Somerville, RN; below: Umphlett with friends, colleagues, and fellow nominees

May 4, 2006May 4, 2006

Prestigious NathanielBowditch Prize shared by

nurse and physiciansn April 14, 2006,the sixth annualNathaniel Bow-

ditch Prize waspresented to the

team of Theresa Galli-van, RN, associate chiefnurse, and Hasan Bazari,MD, program director,department of MedicineTraining Program; a sep-arate award went to Wil-liam Dec, MD, chief ofCardiology. The BowditchPrize, established in 2000,recognizes significantcontributions that en-hance patient care whileat the same time reducecosts associated with care.

Gallivan and Bazariwere nominated for theirleadership of the Clinical

O Process Analysis Project,which sought to optimizebed utilization whileenhancing quality andefficiency of care. Theproject resulted in a newrounding model, a short-er (average)length of stayfor patients onBigelow 11, andan increase inthe number ofpre-noon dis-charges.

Said JeanetteIves Erickson,RN, senior vicepresident forPatient Care,“Theresa andHasan led byexample, involv-

ing clinicians and sup-port staff in every part ofthe process.”

Says Gallivan, “It’san honor to share thisaward with Hasan. I feelfortunate for the rich and

productive relationshipswe in Nursing have withour colleagues in Medi-cine. I also share thisaward with the exemp-lary nurses in GeneralMedicine. Their talent,ability, creativity, andcommitment have creat-ed an environment thatattracts the highest cali-ber nurses and supportstaff. It’s a privilege torepresent them.”

Andrew Warshaw,MD,chair ofthe sel-ectioncommit-

tee and surgeon-in-chief,compared the BowditchPrize to the People’sChoice Awards as nomi-nees and recipients arenominated by peers andcolleagues.

MGH president, PeterSlavin, MD, observed thatNathaniel Bowditch was apioneer of celestial naviga-tion in the 19th century.Said Slavin, “It’s fittingthat this award, given inhis name, celebrates theingenuity and creativity ofthose pioneering solutionsto health care’s greatestchallenges.”

Above left:Above left:Above left:Above left:Above left: Nathaniel Bowditch

Prize recipients, Theresa Gallivan,

RN, and Hasan Bazari, MD.

Above right:Above right:Above right:Above right:Above right: MGH president,

Peter Slavin, MD, speaks at

award presentation

At left:At left:At left:At left:At left: Andrew Warshaw, MD

(center), chair of the selection

committee, congratulates

Bazari and GallivanPhotos by Sam Riley

May 4, 2006May 4, 2006

his April, occu-pational therapistsacross the country

celebrated theirpractice as part of

National OccupationalTherapy Month. Inpatientand outpatient occupa-tional therapists at MGHtook advantage of theoccasion to reflect on andshare their practice.

Occupational thera-pists in inpatient and out-patient settings specializein hand therapy, neurolo-gy, pediatrics, medicallycomplex, acute-care, andpsychiatric populations.This eclectic group ofpractitioners mirrors thevariety of specialties thathave emerged within theprofession.

Occupational Thera-py (OT) originated in thelate 1800s and early 1900s,when it focused on themoral treatment of men-tally ill patients. Thera-pists advocated the use ofmusic, exercise, and oc-cupation for the treat-ment of mental illness.With the great number ofsoldiers who survivedWorld War I and WorldWar II, OT evolved intotreating the physicallywounded, with the focusshifting to physical disa-bilities impacting job-related activities. Theprofession began movingtoward specialization intwo distinct areas: physi-cal disability and psycho-social dysfunction.

Over the next century,

the profession continuedto change in response tothe political and socialclimate, technologicaladvances, and public-health issues. Most recent-ly, the MassachusettsDepartment of MentalHealth has ammended itsregulations around theuse of restraint and sec-lusion with agitated andaggressive clients. Thereis now a mandate for theuse of sensory tools tohelp clients manage emo-tions and behaviors thatcan typically lead to re-straint and seclusion.This has been an opportu-nity for occupationaltherapists to use a combi-nation of skills and know-ledge from our roots in

mental health with thespecialized practice thathas evolved over the lastcentury.

Using academic train-ing in mental health, sens-ory and neurologicalstimulation, and adaptiveenvironments, the MGHOccupational TherapyDepartment is workingwith the department ofPsychiatry to develop asensory room. A sensoryroom provides clientswith a safe space to ex-plore the use of senses(touch, smell, sight, etc.)as a means to cope withmental illness. Usingsensory-integration theor-ies developed and studiedby occupational therap-ists and creating a calm-

Occupational TherapyOccupational Therapy

T

ing environment (gliderchairs, a waterfall, relax-ing music and lighting)helps clients cope withthe stress of being hospi-talized. Aroma therapy,stress-relief balls, andweighted blankets giveclients access to newcoping mechanisms withthe goal of increasingtheir health and wellnessonce they return to work,home, and leisure activi-ties.

As the professionrevitalizes its roots inmental health, Occupa-tional Therapy contin-ues to bring a uniqueperspective to its prac-tice with a focus onparticipation in occu-pation. Regardless ofphysical or mental con-straints, the mind-bodyconnection continues tobe the foundation ofoccupational therapypractice.

Occupational Therapy getsin touch with its roots during

National OT Month—by Jessica McGuigan, OTR/L, occupational therapist

Occupational therapist, Jessica McGuigan,OTR/L, in the OT area (below) and the soon-to-be

completed sensory room (above) on Blake 11

May 4, 2006May 4, 2006

n Wednesday,March 22, 2006,the Cardiac Sur-

gical Nursing Ser-vice presented a day-

long workshop entitled,“The Beat Goes On: Ven-tricular Assist Devicesfor the Treatment ofHeart Failure.” Sixtynurses and other health-care professionals fromMGH and other Bostonhospitals attended.

A joint presentationof the Blake 8 CardiacSurgical Intensive CareUnit (CSICU) and theEllison 8 Cardiac Step-Down Unit, the workshopwas developed to shareinformation about thecare of patients with stageIV heart failure who re-quire mechanical assist-ance to support cardiacfunction. Some patientsgo on to receive a hearttransplant, others are‘destination’ patients,living with the permanentassistance of a ventric-ular assist device (VAD).

Presenters includedstaff nurses, a nurse prac-titioner, a cardiac sur-geon, and a multi-disci-plinary team involved inthe daily care of VADpatients. Some of thetopics included:

Historical Perspectiveand Evolution of VADTechnologyPatient Selection andInformed ConsentNursing Care in theProgressive Care Unit

Medical ManagementNursing Care in theImmediate Post-OpPeriodPreparation for HomeIt Takes A Village: theVAD Patient’s Multi-Disciplinary TeamRespiratory CareSocial ServicesOccupational TherapyPhysical TherapyCase ManagementFuture VAD Techno-logyA panel of VAD pa-

tients and family mem-bers shared their experi-

ences living with a VAD.They talked about thehighs and lows of living‘on a machine,’ trouble-shooting, modifying theirhomes and lives, battery-

The Beat Goes On:a closer look at ventricular

assist devices—by Kathy Sweezey, RN, staff nurse

Education/SupportEducation/Support

O

maintenance, and how itfeels to depend on friendsand family members formany of their day-to-dayneeds.

One patient in her40s, described how dif-ficult it was to relinquishher place as coordinatorof family activities andhow she missed gettingup early, getting her sonoff to school, and havingeverything done by break-fast. “Now,” she said, “Imove slowly and feeltired a lot of the time.”

One family memberdescribed an emergencysituation in which he hadto hand pump his broth-er’s VAD while in a heli-copter being transportedfrom another state.

Patients were effusivein their praise of nurses

and other providers. Oneyoung woman told howshe depended on nursesand looked forward toseeing them, even if theyweren’t assigned to her.“Just stopping by to say‘Hi’ made me feel likeeveryone cared aboutme.”

One patient was em-phatic that if it weren’tfor the nurses, “I think Iwould have given up.They made me exercise.Not with a chain or awhip, but with kindnessand understanding.”

Patients and familymembers spoke of hownurses had helped themmaintain hope throughtheir long and difficultjourneys.

Attendees agreed thathearing the patients’ per-spective was enlighten-ing and helped them real-ize that even the smallestefforts have an impact onpatients.

The Beat Goes Onwill be offered again onWednesday, September 6,2006. For more informa-tion, or to register, callThe Knight Nursing Cen-ter for Clinical & Pro-fessional Development at6-3111.

Beat Goes On

presenters include,

top: staff nurse,

Jennifer Carr, RN.

Left to right are:

Stephanie Ennis, ANP,

Jackie Mulgrew, PT,

and Kathy Schultz, RN.

Below, panel of patients

and family members

share their experiences

with attendees

May 4, 2006May 4, 2006

t MGH, we’re ona journey to make

hand hygieneroutine for every-

one. Hand hygiene is thesingle most importantfactor in preventing thetransmission of patho-gens (germs that causeinfection) and reducingthe risk of infection forpatients. It seems simple,but it’s so important thatJCAHO made it a Na-tional Patient Safety Goalto “comply with currentCenters for Disease Con-trol and Prevention (CDC)hand hygiene guidelines.”

Hand hygiene is re-quired before and aftercontact with patients orpatients’ environment.The preferred method ofhand hygiene is disinfec-tion with an alcohol-based, waterless handrub, such as Cal Stat.Hand-washing with soapand water is still neces-sary when hands are visi-bly soiled, after using thetoilet, before eating, and

after contact with a pa-tient on precautions forC difficile-associateddiarrhea. Hand-washingshould be followed by aCal Stat hand rub (exceptbefore eating because itcan leave a distastefulresidue).

Fingernails are includ-ed in the CDC’s hand-hygiene recommenda-tions. Evidence suggeststhat artificial and longnatural fingernails canaid the transmission ofinfections by healthcareworkers. MGH policy isthat artificial nails andnail jewelry may not beworn. Natural nails mustbe kept clean, and nolonger than 1/4 inch. Ifnail polish is worn, clearpolish is preferred toprovide better monitoringof nails (but colored po-lish is acceptable). Nailpolish must be well main-tained, not cracked, chip-ped, or scratched.

Gloves are not a sub-stitute for hand hygiene.

Cal Stat must be usedbefore and after gloveuse. Gloves should not beworn while transportingpatients unless an assist-ant is present to opendoors, press elevatorbuttons, or perform otheractivities that requiredirect contact with theenvironment.

The MGH Hand Hy-giene Program was de-veloped by the STOPTask Force to promotegood hand-hygiene prac-tice. The program is com-prised of education,awareness, unit-basedchampions, compliancesurveys, feedback to staffand managers, a posterseries featuring MGHstaff and physicians, anda rewards program. Pro-motional efforts haveincluded articles in Car-ing Headlines, the Hot-line, and Fruit StreetPhysician, a booklet de-signed for staff and visit-ors, and special eventsincluding a signature

poster campaign, hand-outs, contests, and pins.Compliance goals wereestablished, and unitsthat met them were re-warded with a pizza, ice-cream, or bagel party.

Since the inception ofthe Hand Hygiene Pro-gram, hand-hygiene com-pliance rates have im-proved from 8% to 61%before contact, and 47%to 78% after contact. Andmany units and role groupsachieved even highercompliance rates, such asthe staff of Blake 6 andPhysical and Occupa-tional Therapy, whoserates exceeded 90%. Asimprovements were made,there was a noticeabledecrease in infectionrates for MRSA and VRE,underscoring the impor-tance of hand hygiene foreveryone who comes intocontact with patients:staff, physicians, andvisitors.

The Hand HygieneProgram will be expand-ing to include other de-partments and ambulatorycare practices, and ef-forts will be made toinvolve patients and vis-itors. A video is being

Quality & SafetyQuality & SafetyThink clean with hand

hygiene—by Katie Farraher, senior project specialist, Office of Quality & Safety

A

developed to teach pa-tients and visitors aboutthe importance of handhygiene. Staff and phy-sicians are being encour-aged to use Cal Stat asthey approach every pa-tient and to expect thesame from everyone.Higher compliance goalshave been set for 2006.Units will be expected toachieve a minimum of80% compliance, and therewards goal will be90%, consistent withJCAHO standards. Unitsthat achieve 90% bothbefore and after contactwill be given a pizzaparty (or equivalent).The ultimate goal is toachieve 100% compli-ance, a goal that willrequire the effort andparticipation of everyoneat MGH.

Join us on our jour-ney to be the best. Toge-ther, we can make handhygiene routine at MGH.

For more informationon the MGH Hand Hy-giene Program or to be-come a hand hygienechampion on your unit,contact Judy Tarselli inthe Infection ControlUnit at 6-6330.

GCRCcontinued from page 11

stone events on the GCRCsince its inception in the1920s. Karen Hopcia,NP, presented a posteron, “Ergonomics in theresearch unit,” citingoptimal configurations ofoutpatient rooms andblood-sampling methods.

MGH nurses alsocontributed to the region-

al GCRC meeting. NewEngland GCRCs crafteda statement on the impor-tance of clinical researchnurses describing theunique role and special-ized knowledge requiredby clincal research nursesin safeguarding researchparticipants. Clinicalresearch nurses are act-ively involved in everyaspect of clinical research,from developing a pro-tocol implementation

plan, to providing patientcare, collecting data, andimplementing practicestandards based on thefindings of clinical re-search. The positionstatement was unanim-ously endorsed by theGCRC nursing group forfuture distribution.

In addition to attend-ing the annual meeting,GCRC nurses took advan-tage of being in the na-tion’s capital and visited

Massachusetts legislatorsto discuss the role ofclinical research nursesin the new Clinical Trans-lational Science Awards.With the guidance of theMGH department of Nurs-ing, a message was deliv-ered to the offices ofSenator Ted Kennedy,Senator John Kerry, Rep-resentative Stephen Lynchand Representative Mich-ael Capuano on the im-portance of nursing in

clinical research.Clinical research

nurses build trusting rela-tionships with researchparticipants; they are pri-mary caregivers and advo-cates in clinical research.Clinical research nursesare key to promoting excel-lence in clinical research,maintaining patient safety,and providing participantswith appropriate resourceswithin and outside theclinical study.

May 4, 2006May 4, 2006Fielding the IssuesFielding the IssuesNew on-line

safety-reporting systemQuestion: How is safety-reporting (formerly inci-dent-reporting) handledat MGH?

Jeanette: Incident-report-ing used to be a manualprocess, but on March22, 2006, the new on-linesafety-reporting systemwent live. You can nowaccess the safety-report-ing website from SafetyReporting MGH listedunder Partners Applica-tions on your Start but-ton.

Question: Why has thesafety-reporting systemmoved from paper to on-line?

Jeanette: Having a safe-ty-reporting system on-line makes it easier andmore efficient for staff.The hope is that more

staff will report safetyconcerns now that accessis so convenient. Web-based reporting is lesstime-consuming, andinformation is easier toanalyze, so communi-cation and feedback aremore timely.

Question: Why is it im-portant to report events?

Jeanette: Reporting ‘outof the ordinary’ events iscritical in identifying andaddressing systems is-sues. Reporting ‘nearmisses’ and close callshelps identify potentialrisks and hazards beforesomething serious hap-pens. Event-reportingallows us to explore thecauses of errors and weak-nesses in the system andunderstand why an errorhappened. If we know

why an error happened,we’re better equipped toprevent it and developnew systems to reducethe risk of it happeningagain.

Question: Won’t there benegative consequences ifI make an error and thenreport it?

Jeanette: No. We’re work-ing hard to establish aculture of safety, andsafety-reporting is criticalto any effective safetyinitiative. MGH promotesa ‘no-blame’ environ-ment. We want to knowabout errors so we candiscover contributingfactors and prevent fut-ure harm to patients andstaff. Error-reporting isessential in assessingsystem performance, notstaff performance.

Question: People areashamed when they makea mistake. Why wouldthey want to admit to it?

Jeanette: The culture ischanging. We don’t wantpeople to feel ashamed.We want people to feelgood about the fact thatreporting errors contrib-utes to a safer environ-ment. Disclosure of ad-verse events preventserrors in the future andensure that systems areworking the way theywere intended.

Question: How manyreports have been submit-ted on-line?

Jeanette: Almost 300reports have been filedsince March 22nd. Anaverage of 16 reports arereceived on-line everyday. The manual systemwill remain active untilstaff has been trained inthe new system.

Question: What cate-gory do most incidentreports fall into?

Jeanette: Since March22nd, the most frequent-ly reported events arerelated to: medication/IV safety; falls; generalemployee incidents; ID/documentation/consent;and safety/security/con-duct.

Question: How can I ar-range to be trained on thenew safety-reporting sys-tem?

Jeanette: Staff from theOffice of Quality & Safetyoffer training sessions inlarge, multi-disciplinaryforums or in small groupson units or in individualdepartments. Trainingtakes about 30 minutes.As of April 13, 2006,more than 2,000 staff and50% of department lead-ership and quality chairshad been trained.

If you would like to setup a training session, con-tact Deb Mulloy in theOffice of Quality & Safetyat 6-0167.

Be prepared for yourpatients’ questions

Learn more about HPV and genetictesting for women’s cancers

Topics:What’s new in genetic testing:understanding the implicationsfor breast and ovarian cancerCervical cancer screening:what’s the message behind HPV?

Thursday, May 18, 200611:00am–1:30 pm

Yawkey 10-660

sponsored by: Dana Farber/Partners Breastand Cervical Screening Collaborative and theMGH Women’s Health Coordinating Council

Pre-registration is required. To register,call 617-726-3111

Contact hours will be awarded

MESAC UpdateDid you know you can link directly to theIV Push Policy from the MESAC website?

Click your ‘Start’ button and scroll up to‘Partners Applications.’ Highlight ‘ClinicalReferences’ and click MESAC. From theMESAC website you can link directly to a

variety of resources to help you provide safeand effective care to your patients. When you

check out the MESAC website, use the‘Feedback’ option to let us know how we can

make the site more helpful to you.

Clinical Pastoral Educationfellowships for healthcare

providersThe Kenneth B. Schwartz Center

and the department of Nursing are offeringfellowships for the 2007 Clinical Pastoral

Education Program for Healthcare Providers

Clinicians from any discipline who workwith patients and families may apply

The program is part-time with groupsessions held Mondays from 8:30am–5:00pm

Additional hours are negotiatedfor the clinical component

Deadline for application:September 1, 2006

For more information call 6-4774 or 4-3227

May 4, 2006May 4, 2006

Kindman certifiedMary Kindman, RN, staff nurse, Ellison 11,became certified as a cardiovascular nurse

in March, 2006.

Pessina active in communityMonica Pessina, OTR/L,

occupational therapist, is a member of theAmericans with Disabilities Committee of

West Newbury, Massachusetts.

Moran, president-electPeter Moran, RN, case manager,

is the new president-elect of the CaseManagement Society of America,

2006–2007.

Macauley elected secretaryKelly Macauley, PT, physical therapist, was

elected secretary of Geriatric Special InterestGroups for the Massachusetts Chapter of the

American Physical Therapy Association,from 2006–2009.

Quinn on Nominating CommitteeThomas Quinn, RN, project director,

MGH Cares About Pain Relief, was electedto the Nominating Committee for the

American Society for Pain ManagementNursing in March, 2006.

Mylott receives awardLaura Mylott, RN, clinical nurse

specialist in The Knight Nursing Centerfor Clinical & Professional Development,

received the Academic Nursing Early CareerAward from the Massachusetts Association

of Colleges of Nursing, in March, 2006.

French receives NNSDOaward

Brian French, RN, professionaldevelopment coordinator, The Knight

Nursing Center for Clinical & ProfessionalDevelopment, received the 2006 Excellence

in the Role of Professional DevelopmentFacilitator, Change Agent, and ConsultantAward, from the National Nursing StaffDevelopment Organization (NNSDO),

in March, 2006.

Lavieri presentsMary Lavieri, RN, clinical nurse

specialist, presented, “Pulmonary CriticalCare,” at the Critical Care Registered Nurses

Review in Manchester, New Hampshire,March 30 and 31, 2006.

Lowe presentsColleen Lowe, OTR/L, occupationaltherapist, presented, “Sensation andSensibility,” at the Tufts University,

Fellowship ProgramMarch 27, 2006.

Akladiss presentsJoanne Akladiss, OTR/L, occupational

therapist, presented, “Introduction to UEEvaluation and Intervention,” “Splinting

Applications and Principles,” and“Introduction to Physical Agent

Modalities,” at the University of NewHampshire in March, 2006.

Fitzgerald presentsKaren A. Fitzgerald, RN, clinical

nurse specialist, Post Anesthesia Care Unit,presented, “Heart Failure and the SurgicalPatient: Implications for Peri-AnesthesiaNursing,” at the Massachusetts Society of

Peri-Anesthesia Nurses Spring Conference,March 12, 2006.

Jeffries presentsMarian Jeffries, RN, clinical nurse

specialist, Thoracic Surgery, presented,“Comparison of CNS Responses to aNational Survey on Common Patient

Problems with Responses from Staff Nursesand CNSs in a Large Boston MedicalCenter,” at the National Association

of Clinical Nurse Specialists Conventionin Salt Lake City, March 17, 2006.

Madigan featuredJanet Madigan, RN, project manager,

was featured in the March, 2006, NursingSpectrum, in the articles, “A Toolbox forSurvival: The Future of Nurse Leadership

Depends Upon an Intelligent Combination ofMentoring and True-to-Life Classroom

Experiences,” and, “Massachusetts HospitalsGo Public: Staffing Stats Now Public

Domain Throughout the State.”

Pazola presentsKathy Pazola, RN, staff nurse, clinicalscholar, presented her clinical narrativeto nursing students at the Massachusetts

College of Pharmacy in Worcester,April 3, 2006.

Pessina presentsMonica Pessina, OTR/L, occupational

therapist, presented, “Primate and HumanResearch Related to Upper ExtremityFunction,” at Tufts University School

of Occupational Therapy,February 25, 2006.

Quinn presentsThomas Quinn, RN, project director,

MGH Cares About Pain Relief, presented,“Respiratory Depression: Do We ReallyNeed to be so Nervous?” and, “Palliative

Sedation by Any Other Name,” at the annualmeeting of the American Society for Pain

Management Nursing in Orlando,Florida, March 31, 2006.

Snydeman presentsColleen Snydeman, RN, nurse manager,

RACU and CCU, presented, “InterceptingNear-Miss Adverse Events: the Critical

Care Nursing Safety Net,” at the Institutefor Nursing Healthcare Leadershipat Brigham and Women’s Hospital

March 28, 2006.

Coglianese reviewsDebra Coglianese, PT, physical therapist,reviewed the book, Muscles: Testing and

Function with Posture and Pain, by FlorencePeterson Kendall, Elizabeth Kendall

McCreary, and Patricia Guise Provance,for Physical Therapy, February, 2006.

Nurses presentColleen Snydeman, RN; Bessie

Manley, RN; Brenda Miller, RN; JohnMurphy, RN; Marita Prater, RN; Aileen

Tubridy, RN; Donna Perry, RN; and, TrishGibbons, RN, presented the poster, “Creating

a Culture of Leadership: the MGH NurseManager Leadership Development

Program,” at the MassachusettsOrganization of Nurse Executives,

March 10, 2006.

Professional AchievementsProfessional Achievements

May 4, 2006

May 4, 2006

Next Publication Date:

May 25, 2006

Published by:

Caring Headlines is published twice eachmonth by the department of Patient Care

Services at Massachusetts General Hospital.

Publisher

Jeanette Ives Erickson RN, MS,senior vice president for Patient Care

and chief nurse

Managing Editor

Susan Sabia

Editorial Advisory Board

ChaplaincyMichael McElhinny, MDiv

Development & Public Affairs LiaisonVictoria Brady

Editorial SupportMarianne Ditomassi, RN, MSN, MBAMary Ellin Smith, RN, MS

Materials ManagementEdward Raeke

Nutrition & Food ServicesMartha Lynch, MS, RD, CNSDSusan Doyle, MS, RD, LDN

Office of Patient AdvocacySally Millar, RN, MBA

Orthotics & ProstheticsMark Tlumacki

Patient Care Services, DiversityDeborah Washington, RN, MSN

Physical TherapyOccupational Therapy

Michael G. Sullivan, PT, MBA

Police, Security & Outside ServicesJoe Crowley

Reading Language DisordersCarolyn Horn, MEd

Respiratory CareEd Burns, RRT

Social ServicesEllen Forman, LICSW

Speech, Language & Swallowing DisordersCarmen Vega-Barachowitz, MS, SLP

Volunteer, Medical Interpreter, Ambassadorand LVC Retail Services

Pat Rowell

Distribution

Please contact Ursula Hoehl at 726-9057 forquestions related to distribution

Submission of Articles

Written contributions should besubmitted directly to Susan Sabia

as far in advance as possible.Caring Headlines cannot guarantee the

inclusion of any article.

Articles/ideas should be submittedby e-mail: [email protected]

For more information, call: 617-724-1746.

Please recycle

s you may be aware, a

large outbreak of mumps

has been reported in Iowa

and adjacent states, with a small-

er number of cases identified in

several other more distant states.

On April 26, 2006, the Boston

Public Health Commission is-

sued an alert stating that three

cases of mumps had been report-

ed in Boston since April 18th.

Investigations are on-going, and

it is anticipated that additional

cases will occur.

With that in mind, we want

to provide the following infor-

mation:

Diagnosing and managing

patients with mumps

Mumps should be suspected in

any patient who presents with

unilateral or bilateral pain and

swelling of the parotid salivary

gland (parotitis). Other symp-

toms, including low-grade fever,

malaise, headache, and muscle-

aching, may also occur.

For patients suspected of

having mumps:

Put the patient on Droplet

Precautions (move patient to a

private room, which doesn’t

need to have negative pres-

sure; healthcare workers wear

a surgical mask within three

feet of the patient; and patients

should wear a mask when

outside the room)

Notify Infection Control at

726-2036

Inquire about contact with

other people known or sus-

pected of having mumps

Inquire about a prior history of

mumps, prior mumps or meas-

les mumps rubella (MMR)

vaccination (how many doses

and when), and any prior tests

for mumps immunity (positive

answers to these questions do

not exclude a diagnosis of

mumps)

Draw one red-top tube of

blood for mumps virus anti-

body (IgM and IgG) and send

to Clinical Microbiology Lab-

oratory

Promptly collect a clean-catch

urine sample 5-10ml in a screw-

top sterile container and send

to the Clinical Microbiology

Laboratory on ice for mumps

culture/PCR

Collect a sterile dacron swab

from the buccal mucosa of the

upper rear molars 30 seconds

after massage of the parotid

gland on the same side. Prompt-

ly place the swab in viral trans-

port and send on ice to the

Clinical Microbiology Labo-

ratory for mumps culture/PCR

Protection from mumps

The Boston Public Health Com-

mission and the Massachusetts

Department of Public Health

recommend documentation of

immunity for healthcare workers

involved in patient contact and

at risk for exposure to patients

with mumps by either:

a positive test for antibody

(IgG) to mumps virus

or documented receipt of two

doses of MMR vaccine

Unprotected exposure (with-

out droplet precautions) to a

patient with mumps by a health-

care worker without documented

immunity could result in a fur-

lough from work from day 12 to

day 25 after exposure (the incu-

bation period between exposure

and onset of clinical symptoms).

To ensure immunity for at-

risk healthcare workers, Occu-

pational Health will provide

mumps antibody testing. MMR

vaccine will be offered to staff

who have no contra-indications,

whose tests are negative, or who

have received one or fewer prior

doses of MMR vaccine.

Staff in ambulatory and emer-

gency areas, those most likely to

encounter mumps cases, will be

a priority for testing and vacci-

nation if needed and not contra-

indicated. Information about this

process will be/has been pro-

vided to ambulatory and emer-

gency managers.

For more information about

mumps or managing patients

with mumps, contact the Infec-

tion Control Unit at 6-2036.

Infection ControlInfection ControlA message from Infection Control:diagnosing and managing patients

with mumps—by David Hooper, MD, chief, Infection Control Unit,

and Stephen Calderwood, MD, chief, Division of Infectious Diseases

A

May 4, 2006May 4, 2006

o help reducethe risk of medi-cation errors

and comply withJCAHO’s National

Patient Safety Goal to,“accurately and complete-ly reconcile medicationsacross the continuum ofcare,” MGH is launchingan electronic medication-reconciliation initiativeto help clinicians trackthe medications beingtaken by inpatients andoutpatients. Medicationreconciliation involvesobtaining a complete listof the medications a pa-tient is currently taking(including the name,dosage, frequency, androute) and comparing itto admission, transfer,and discharge medicationorders. The goal is toreduce the risk of omis-sions, dosage errors, du-plication of drug classes,or other types of discrep-ancies as patients travelthrough what can be a

complex path of care.The electronic medi-

cation-reconciliationinitiative began on someunits on April 25, 2006,when a new module wasintroduced in ProviderOrder Entry (POE) tosupport the new process.The new module is calledthe Pre-Admission Med-ication List (PAML).

The list, which in-cludes all prescription,over-the-counter, andherbal medications, canbe accessed in an out-patient setting, such as aphysician’s office, andmust be reconciled attime of admission anddischarge. The admittingclinician (physician, phy-sician assistant, or nursepractitioner) is respon-sible for documentingpre-admission medica-tions in PAML, indicat-ing the planned action foreach pre-admission med-ication on admission,

accurately entering medi-cation orders into POE,and collaborating withmembers of Pharmacyand/or Nursing within 24hours of admission toresolve uncertainties.

Key components ofthe initiative:

The nurse is responsi-ble for reviewing andverifying the PAML atadmission when thePAML icon appears onthe Unit Census Mon-itorThe PAML should beprinted and used as aworksheet to reviewwith the patient, familyand/or the patient’scaregiverIf discrepancies areidentified, the nurse isresponsible for commu-nicating discrepanciesto the admitting clini-cian and updating theinformation in PAMLso that the physiciancan update POE ordersif appropriate

If medication informa-tion cannot be con-firmed with the pa-tient, family, and/orcaregiver, the nursemust make a notationin the Comment sec-tion of PAMLThe nurse must elec-tronically sign the mo-dified PAML as thePAML reviewer anddiscard the paperPAML in the recyclebinThe pharmacist thenreconciles the admis-sion POE orders withthe PAML based onthe admitting clini-cian’s planned actionfor each medication. Ifthere are discrepancies,the pharmacist con-tacts the physician toresolve the discrepan-cies

If the patient is trans-ferred within the hospi-tal:

At transfer, the physi-cian enters medicationorders in POE by alsoreferring to the PAMLThe nurse must reviewthe PAML to ensurethat medication orderswritten on transfer areconsistent with thePAMLThe pharmacist recon-ciles orders against thePAML

Upon discharge, thedischarging prescriber(MD, NP, PA) is respon-sible for reconciling thedischarge medicationswith the PAML. Thenurse must compare thedischarge medicationswith the PAML and noti-fy the provider who dis-charged the patient ofany discrepancies sodischarge medications

can be adjusted by the pro-vider if appropriate.

Once the PAML and dis-charge medications havebeen reviewed, the nurseclicks the, ‘Check here ifPAML has been review-ed’ button in the NursingDischarge Note sectionDischarge medicationsmust be reviewed withthe patient, family and/orcaregiver, and the patientmust receive a copy ofthe completed dischargemedications from thePost-Hospital Care Plan.The patient should not begiven a copy of the PAML

Says senior vice presi-dent for Patient Care, Jean-ette Ives Erickson, RN,“This initiative represents avital partnership betweenour patients and caregivers.It is essential that everymember of the care teamworks together to keep thePAML accurate. We’reconfident this new systemwill streamline the processmaking it easier for all clin-icians to keep our patientssafe.”

A patient awarenesscampaign called, ‘Be MedSmart,’ is being launchedalong with the medication-reconciliation initiativeencouraging patients andfamilies to maintain anaccurate list of medicationsand bring that list withthem to all appointments,hospitals admissions, andED visits.

The Medication Recon-ciliation Committee ischaired by Chris Coley,MD; Sally Millar, RN; andMeg Clapp, RPh. For moreinformation about the med-ication-reconciliation ini-tiative, contact Joanne Em-politi at 6-3254 or Rose-mary O’Malley at 6-9663.

Medication-reconciliationinitiative: ‘Be Med Smart’

—by Janet Madigan, RN, project manager

T

Medication-Reconciliation Roll-Out

General Medicine: White 8, 9, and 10, Ellison 16 April 25

General Medicine, Oncology: Bigelow 9, Blake 7, Ellison 14 May 1

Pediatrics: Ellison 17, 18 and PICU May 8

Cardiology and Psychiatry: Ellison 9, 10, 11, Blake 11 May 15

Neurology and Burn Unit: Bigelow 12, White 12,Ellison 12, Bigelow 13 May 29

General Surgery, Vascular Surgery: SICU, Ellison 7,White 7, SICU, Bigelow 14 June 5

Orthopaedics, Gynecology and Transplant: Ellison 6,White 6, Bigelow 7, Blake 6 June 12

Medicine: Phillips 20, 21, Bigelow 11, White 11 June 19

General Surgery, Cardiac Surgery: Ellison 8, 19, 22and Blake 8 June 26

Obstetrics: Ellison 13, Blake 13, 14, and NICU July 10

SafetySafety

Educational OfferingsEducational Offerings May 4, 2006May 4, 2006

2006

2006

For detailed information about educational offerings, visit our web calendar at http://pcs.mgh.harvard.edu. To register, call (617)726-3111.For information about Risk Management Foundation programs, check the Internet at http://www.hrm.harvard.edu.

Contact HoursDescriptionWhen/WhereNew Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0(for mentors only)

May 108:00am–2:00pm

- - -Advanced Cardiac Life Support (ACLS)—Provider CourseDay 1: O’Keeffe Auditorium. Day 2: Thier Conference Room

May 12 and 228:00am–5:00pm

Post-Operative Care: the Challenge of the First 24 HoursThier Conference Room

TBAMay 158:00am–4:30pm

CPR—American Heart Association BLS Re-CertificationVBK401

- - -May 177:30–11:00am/12:00–3:30pm

CPR—Age-Specific Mannequin Demonstration of BLS SkillsVBK401 (No BLS card given)

- - -May 228:00am and 12:00pm (Adult)10:00am and 2:00pm (Pediatric)

BLS Certification for Healthcare ProvidersVBK601

- - -May 238:00am–2:00pm

Psychological Type & Personal Style: Maximizing YourEffectivenessTraining Department, Charles River Plaza

8.1May 248:00am–4:00pm

New Graduate Nurse Development Seminar IITraining Department, Charles River Plaza

5.4 (for mentors only)May 248:00am–2:30pm

Basic Respiratory Nursing CareSweet Conference Room

- - -May 2512:00–3:30pm

Nursing Grand Rounds“PICC Your Lines: the Inside Story.” O’Keeffe Auditorium

1.2May 251:30–2:30pm

Pediatric Advanced Life Support (PALS) Re-Certification ProgramTraining Department, Charles River Plaza

- - -May 318:00am–12:30pm

Be Prepared to Answer your Patients’ Questions: HPV and GeneticTesting for Women’s CancersYawkey 10-660

TBAMay 1811:00am–1:30pm

CPR—American Heart Association BLS Re-CertificationVBK401

- - -June 17:30–11:00am/12:00–3:30pm

Intermediate Respiratory CareO’Keeffe Auditorium

TBAJune 28:00am–4:30pm

Intermediate ArrhythmiasHaber Conference Room

3.9June 78:00–11:30am

Pacing ConceptsHaber Conference Room

4.5June 712:15–4:30pm

Wound Care Education: Phase IITraining Department, Charles River Plaza

TBAJune 7 and 148:00am–4:30pm

New Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0(for mentors only)

June 148:00am–2:00pm

Chaplaincy Grand Rounds“Providing Spiritual Care for Kids and Families.” Sweet Conference Room

- - -May 1611:00am–12:00pm

Chaplaincy Grand Rounds“Providing Care to Jehovah’s Witnesses.” Sweet Conference Room

- - -June 1311:00am–12:00pm

Nursing Grand RoundsHaber Conference Room

1.2June 1411:00am–12:00pm

May 4, 2006May 4, 2006

CaringCaringH E A D L I N E S

Send returns only to Bigelow 10Nursing Office, MGH

55 Fruit StreetBoston, MA 02114-2696

First ClassUS Postage Paid

Permit #57416Boston MA

urses and physi-cians in the MGHMedical Service

are engaging in afriendly competition dur-

ing the month of May. Toencourage donations tothe MGH Blood DonorCenter, doctors (interns,junior and senior resi-

What’s a little friendlycompetition among colleagues?

SupportSupport

dents, and attending phy-sicians), have challengednurses from the medicalunits (White 8, 9, 10, and11, Bigelow 9 and 11,

Ellison 16, Phillips 20and 21, and the MedicalIntensive Care Unit) tosee who can donate themost blood. All donorswill receive a T-shirt; thewinning team will enjoya pizza party to celebratetheir victory.

Some people thinkblood shortages only oc-cur during the winter hol-idays. That’s not the case.Every summer there is astate-wide shortage ofblood due to donors goingon vacation, companiesshutting down, and a lackof donorship from schoolsand colleges that are clos-ed for the season.

Blood drives like theone the Medical Serviceis holding help increasethe amount of blood wehave on hand and urgent-ly need for our patients.You can help. Blood do-nors make many life-saving treatments possi-ble. All blood given to ourpatients is donated bygenerous strangers likeyou.

Got an idea for ablood-donor challenge? Itcould save a life. For moreinformation, call KathrynDeCoste, marketing spe-cialist, in the Blood Do-nor Center at 4-9699.

N

Nurse manager, Susan Morash, RN, and resident, Allan Moore, MD,kick off the Medical Service Blood Donor Challenge with the first donation.

Gail Fennessy, LPN, performs the blood-draw.

Caring May 4, 2006 - Massachusetts General · PDF fileProject HOPE and the US Agency for ......

Documents

Transcript of Caring May 4, 2006 - Massachusetts General · PDF fileProject HOPE and the US Agency for ......