Download July 2006 - GwinnettMD

July 2006
Improving Cardiac Evidence-Based Care
“Thorough documentation plays a key role
in demonstrating the quality of care provided to cardiac patients at GHS,” according to Manfred Sandler,
MD, physician champion of the Cardiac Team. Data is
publicly reported at the Hospital Compare Web site at
http://www.hospitalcompare.hhs.gov/. Critical-related
measures and documentation components include:
CHF - LVF Assessment – documentation of:
• LVF assessment prior to arrival, during hospitalization, or planned after discharge and documented in the
medical record.
• Any reason documented by a physician/NP/PA for not
assessing LVEF, such as “Echo done last March shows
severe LV dysfunction.” “Terminal care – will not do
any further evaluation.” “Pt. refusing Echo.” “Will measure EF after discharge.” CHF and AMI - ACEI or ARB for LVSD – documentation of ACEI or ARB prescribed at discharge or documented contraindication to both:
• ACE inhibitor allergy and ARB allergy
• Moderate or severe aortic stenosis
• Physician/NP/PA documentation of reasons for contraindications for both, such as “No ACE/ARB due to
hypotension,” “No ACE/ARB due to hyperkalemia,”
“Comfort care only – no medications” or documentation on Heart Failure Admission Order Set or Pharmacy
ACE Inhibitor/ARB Progress Note.
AMI Aspirin at Discharge – patient prescribed aspirin
at discharge or contraindication documented:
• Active bleeding on arrival or any time during hospital
stay
• Aspirin allergy
• Coumadin/warfarin prescribed
• Other reasons documented by physician/NP/PA, such
as “GI bleeding with aspirin in the past,” “No aspirin
– hx of PUD,” or “Chronic hepatitis -- no aspirin.”
AMI Beta Blocker at Discharge – patient prescribed
beta blocker at discharge or contraindication documented:
• Beta blocker allergy
• Bradycardia (< 60 min) on day of discharge or day
prior to discharge while not on beta blocker
• Second or third degree heart block on EKG and patient does not have a pacemaker
• Other reasons documented by physician/NP/PA, such
as “severe hypotension with beta blockers in the past,”
“complaint of drowsiness – discontinue beta blocker,”
or “patient refusing all medications.”
For more information, contact Mary Ann
Ferguson, RN, CAPA, clinical data abstractor,
Quality Resources, at 678-442-4534.
Glancy Rehab Center’s Stroke Program Earns Accreditation
Glancy Rehabilitation Center (GRC) has been awarded three-year accreditation and a designation as a Stroke
Specialty Program from the Commission on Accreditation of Rehabilitation Facilities (CARF). ““This accreditation is evidence of dedication and commitment to improving the quality of the lives of those who have suffered a stroke. Services,
personnel and documentation clearly indicate an established pattern of practicing excellence,“ said Brian J. Boon, PhD,
president and CEO of CARF.
With this special accreditation for inpatient rehabilitation services, GHS becomes the first and only healthcare
system in Georgia to have a fully accredited continuum of acute stroke care. In 2005, GMC and Joan Glancy Memorial Hospital earned the Gold Seal of Approval™ for stroke care when the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) awarded “Primary Stroke Center Certification” to these two hospitals.
“We’re proud to achieve this distinction,” says Sunil Bhole, MD, medical director of GRC. “While we have always
provided excellent care to stroke patients, the CARF designation as a Stroke Specialty Program recognizes our Center’s
commitment to providing the highest quality rehabilitation services.”
E verything Y ou N eed to
K now A bout R x P rofile
On Wednesday, June 28, 2006, Rx Profile became available through the GHS physician portal. The addition of the Rx Profile will
make it possible for staff physicians and clinicians to view a patient’s medication profile on
any computer, home or office, that has access
to the GHS physician portal. Since Rx Profile is
a module inside the portal, it will not be necessary to sign into another application or to download and install a viewer to see the information. Viewing a medication profile during your
portal session is easy. Begin by identifying and selecting the patient you would like to view. Click on
the Rx Profile tab and the module will open. The Rx
Profile includes the name, dose, frequency, start
date, stop date and status of all the medications
ordered on a patient. It is also possible to view the
scheduled administration times for medications
for patients. For patients at Joan Glancy, you will
be able to view the actual administration times.
User’s guides will be placed at each nursing unit and will be available on GwinnettMD.
If you need help using Rx Profile, please
call the Physician Response Line at 678442-4496 and a portal analyst will assist you. Diabetes Care Committee
• More and more areas in our hospital are
pursuing better blood glucose management
through special initiatives. In the Perioperative
area, the Surgical Care Improvement Project
(SCIP) conducted a pilot to check blood glucose levels on patients with diabetes and all
patients of one surgeon in Pre-op, OR and
PACU. The outcome: a Perioperative Glucose
Control Protocol. All diabetes patients will now
have blood glucose levels checked in Pre-op,
OR and PACU. Patients with a blood glucose
level over 150 mg/dl are treated with IV correction dose insulin. • JCAHO has published the final requirements
for the Certificate of Distinction for Inpatient Diabetes Care. These “critical elements” include
identifying any patient with a history of diabetes
upon admission, an A1C level must be documented on all diabetes patients, formal protocols in place that address blood glucose monitoring, hypoglycemia and hyperglycemia, and
specific diabetes education for all staff managing patients with diabetes. The Diabetes Care
Committee will be working to address these requirements with the ultimate goal of submitting
an application for the Certification.
Know Your Collaboratives -- An Update
Critical Care Collaborative - The Critical Care Collaborative is now beginning its fourth year as a team. Work
continues on the Surviving Sepsis Campaign through the use of order sets, chart reviews and daily monitoring
of sepsis patient care. Drs. McGann and Siore and their groups are testing a Suspected VAP order set, and
Respiratory Care is developing a complementary Mini-BAL Policy.
The Medical Response Team continues to do great work, with a total of 344 MRT calls resulting in the stabilization
of 172 patients to remain on the floors. Thus far, the team has only had to call for a hospitalist back-up 12 times.
The average time for a call is 43 minutes.
Flow Collaborative - Current work in the Flow Collaborative involves changing the Admissions Unit to a Medical
Short Stay Unit and implementing a Bed Management System (BMS).
z The Medical Short Stay Unit is a 24-hour nursing care unit seven days a week. Patients must be 18
or older who require skilled medical nursing care for up to 48 hours. Patient diagnosis will be related to diabetes,
DVT, blood transfusions and post cardiac catheterization, pending discharge in four to six hours. All physicians
should receive notification in the mail regarding the scope of patient care/services, admission criteria, guidelines,
exclusion criteria and goals. Contact the unit manager with questions at 678-442-2319.
z The Bed Management System is an upgrade to the current Tele-Tracking system that provides a real
time electronic bedboard, replacing the existing manual bedboards. Vickie Mewborn-Waits, Patient Flow Manager,
has been very busy managing the implementation and training of this new system. If you are interested in seeing
this new product, please feel free to join a bed-huddle meeting any day at 9 a.m. in the Nursing Administration
Conference Room.
Mon., July 17, 8:30 a.m. - 2 p.m.
Organizational Improvement Department
P.A.L.S. Recertification
Kim Smith, RN, MSN, Coordinator, Organizational Improvement Department
Approved for 5.0 CME credits GHS Resource Center, 665 Duluth Hwy, Lawrenceville
To register, call Tina Gavorsky at 678-442-4338 or e-mail
Joanie Blaney at [email protected]
Registration required.
Tues., July 25, 12 noon
Department of Medicine
Grand Rounds - Redefining Insomnia: State-of-theScience Insomnia Management
Dipak V. Vashi, MD, Assistant Professor of Medicine, Department of Medicine, Emory University School of Medicine
Approved for 1.0 CME credit
Supported by an educational grant from Sanofi-Aventis
Education Center, GMC
To register, call Sue Vogel at 678-442-4644.
Registration required for all associates.
Wed., July 26, 4 p.m.
Department of Emergency Medicine
Clinical Effectiveness of Six Benign ED Diagnoses
Roy E. Gilbreath, MD, FACP, Vice President and Chief
Medical Officer, Gwinnett Hospital System
Approved for 1.0 CME credit
Education Center, GMC
To register, call Nellie Awbrey at 678-442-3317.
Registration required for all associates.
Mon., July 31, 9 a.m., 12 noon or 2 p.m.
CME/Medical Library
Hands-On Computer Training with Medical Library
Databases: Health & Wellness Resource Center and
Health Reference Center
Mary Ellen Nolan, MLS, Medical Librarian, CME/Medical
Library, Gwinnett Hospital System
Approved for 1.0 CME credit
Medical Office Building, Learning Center, Suite 115, PC
Training Room
9 - 10 a.m., noon - 1 p.m. (physicians only) or 2 - 3 p.m.
To register, call Lavinia Bullock at 678-442-4337. Registration required for all associates. Limited seating.
Wed., August 2, 12 noon
Department of OB/GYN
Reproductive Surgery in the Era of Assisted
Reproductive Technologies
G. Wright Bates, Jr., MD, Reproductive Endocrinology
Approved for 1.0 CME credit
Education Center, GMC
To register, call Patty Key at 678-442-4700. Registration
required for all associates.
Thurs., August 3, 8 a.m.
Trauma Services
Trauma Rounds - Rehabilitation of the Trauma Patient:
Part 1
Kelly Moore, MEd, CCC-SLP
Martha VanDam, MS, CCC-SLP
Speech Pathology/Rehab, Gwinnett Hospital System
Approved for 1.0 CME credit
Education Center, GMC
For more information, call Deb Battle at 678-442-3742.
Thurs., August 10, 12:30 p.m. Department of Pediatrics
Menstrual Function and Dysfunction in
the Adolescent Girl
Kristi M. Mulchahey, MD, FACOG; Pediatric, Adolescent
and Adult Gynecology, Atlanta GYN Associates
Approved for 1.0 CME credit Rose & Azalea Rooms, GWP
To register, call Patty Key at 678-442-4700.
Registration required for all associates.
Tues., August 15, 12:30 p.m.
Diabetes/Endocrinology
Achieving Total Glycemic Control: The Transition from
Oral Agents to Insulin in Patients with Type 2 Diabetes
Alan J. Garber, MD, PhD, Professor of Medicine, Biochemistry and Cell Biology; Chief of Endocrinology, Diabetes and
Metabolism, The Methodist Hospital, Houston, Texas
Approved for 1.0 CME credit
Supported by an educational grant from Novo Nordisk
Education Center, GMC To register, call Sue Vogel at 678442-4644.
Registration required for all associates.
Grapevine e-mail:
Physician Hotline:
[email protected]
678-442-3455
Gwinnett Hospital System is accredited by the Medical Association of Georgia to offer continuing medical
education to physicians. Gwinnett Hospital System
designates each of these educational activities for
the specified hours in AMA PRA Category I Credits™.
Physicians should only claim credit commensurate
with the extent of their participation in the activity. CME Program Information Online!
To view specific CME program information, log on
to Gwinnett Hospital System’s online physician Web
site at http://www.gwinnettmd.org and click on “CME
Offerings.” This site also features links to the “Results
CIS” (Clinical Information System) and the Medical
Library Web page with links to many online full-text
databases, medical textbooks and over 3,000 full-text
medical journals. For additional information, contact
Anne Kramer, RN, BC, MN, Director, Medical Education/Medical Library, at 678-442-4341.
Old Man Winter Blows in Disease
Prevention This Cold and Flu Season
By Loretta Jackson Brown, MSN, RN
As we continue to strive adult vaccination recommendations include pneumo-
toward clinical excellence,
GHS has adopted a Standing Order Nurse Protocol
for pneumococcal and influenza vaccination. Vaccination has always been a critical link in disease prevention. The Centers for Medicare and Medicaid Services,
as well as the Joint Commission for Accreditation of
Healthcare Organizations, have earmarked pneumococcal and influenza as indicators of hospital quality
for patients admitted with pneumonia and congestive
heart failure. The Center for Disease Control (CDC)
GMC - Duluth Update
By Lea Bay, VP-Operations
* Paving is 90 percent complete. Striping is
also complete.
* Millwork is 90 percent complete.
* R.J. Griffin has developed an internal punch
list and is working on it.
* Construction trailer removal is underway.
* Terrazo work will be complete next week.
* Inpatient care units sheet vinyl is complete.
* Landscaping irrigation is underway.
* Carpet installation is almost complete.
* Punch list schedule was revised and distributed to teams.
* GOC Endoscopy renovation is on schedule
for completion on August 8, 2006.
* All defibrillators will be LP20s at both
GMC - Duluth and at GOC.
Questions? Call Lea Bay at 678-584-7300.
coccal vaccination for patients 65 years and older, and
influenza for patients 50 years and older. Pneumococcal and influenza vaccinations are also indicated for
adults who do not meet the age requirements but have
chronic disease conditions which may make them more
likely to contract pneumonia or influenza.
Traditionally, adult vaccination was carried out
in physician offices or public health departments. We
now recognize the importance of vaccinating patients
whenever they come into contact with a healthcare provider -- making acute care hospitals a perfect venue! All adult non-maternity patients admitted to
GHS will be screened for pneumococcal and influenza
vaccination. Nurses will use established criteria based
on CDC guidelines to determine a patient’s appropriateness for vaccination. If the patient meets vaccination criteria and desires to be vaccinated, the vaccine
will be administered the next day at 2100. Patients
admitted to the intensive care unit will be vaccinated
upon discharge from the unit. A vaccination order will
be placed in the physician order section of the medical
record notifying the physician of the intent to vaccinate. A physician will have until 2100 the following day to
use the form to override the order when medically appropriate. Once the patient is discharged, the vaccination order will be subtitled vaccination in the electronic
discharge record for future reference.
While the aim is to offer vaccination to all medically appropriate patients, we do not want to unnecessarily immunize patients who are up-to-date with their
vaccinations. One way to help avoid re-vaccination is
for physicians to write an order “Do Not Vaccinate – patient is current on pneumococcal and/or influenza vaccines” for those patients who they know are up-to-date
with their vaccinations.
For comments or additional questions, please contact
Loretta Jackson Brown, MSN, RN, at 678-442-3222.
July 26 Is Moving Day!
On July 26, 2006, Respiratory Care outpatient services, Cardiac Rehabilitation and Pulmonary Rehabilitation will move to a new location just off the GMC
lobby. The entrance to the department will be on the right side of the connecting
hallway to Gwinnett Women’s Pavilion. An open house for the medical staff will be held on August 8 from 6:30 8:30 a.m. An open house for all associates is planned for August 9 from 2 - 4 p.m. Come check out our new home!