From the President, June 2017

Posted on Jun 5, 2017 in President's Message | 0 comments

Dear Medical Staff Colleagues,

You may have noticed the following renovations that are now occurring at the medical center:

Administration has now moved to the 5th floor of the Merritt Building – The Physician Lounge on the ground floor is now undergoing construction which is projected to last roughly 18 months. The interim location will be the physician dining area on the first floor. It is a work in progress so your patience is appreciated. – If you are interested in learning more about the new Physician’s Lounge, please swing by the Medical Staff Office, a blueprint for the floor plan is available for review. The new area will house a physician dining area, work station, exercise equipment (stationary bike, treadmill). – An in house MRI is also planned for the ground floor.

The first floor cath labs are still in the process of being updated in a sequential staged fashion.

Call Rooms Update– There is a call room corridor on the 4th floor Merritt Building, adjacent to the EKG dept. We have four two existing call rooms – one for the in house hospitalist, and one for in house intensivist. The two additional call rooms are assigned to 1) one for surgery, and 2)one “extra” room for anyone on call needing a place to sleep. Please contact the Medical Staff office for details. The House Supervisor will have the code lock passcode for entry.

Cardiac Arrhythmia (Telemetry) Monitoring Bed Assignment- you may have noticed the roll out several weeks ago for cardiac monitored bed assignment based on set defined clinical criteria. The goal is to decrease unnecessary telemetry over usage which impacts on patient flow throughout the hospital.  Please review the guidelines included in the newsletter. You may receive a query if you are the attending physician for a patient on telemetry/cardiac monitored bed who does not meet the guideline criteria. By familiarizing yourself with the information, you will improve communications with the charge nurse and house supervisor.

Have a great month and Happy Father’s Day for all dads.

Until next time, Be well

Donna D. Tigno, M.D.
President of Summit Medical Staff
Co-Director of Critical Care at Summit Medical Center

 

Medication Safety Alert: BID Order in EPIC

Posted on Jun 5, 2017 in Announcements | 0 comments

Event details:
An order for Lantus was placed at midnight as a BID dose, with the dosing schedule of 2100 and 0900. The patient received Lantus at 01:30 and 08:00 and was scheduled to receive again at 2100. 

Situation:
Potential risk of long acting Insulin overdose when placing BID order in EPIC.

Background:
Medications orders for twice a day dosing include: BID, q12 and q12hrs.
When ordering a medication BID there are multiple choices to select from, depending on the category chosen. This is of particular concern with high alert medications such as long acting insulin or an anti-coagulant.

Assessment:
Medications can be ordered with the intent of twice a day dosing with the potential for being administered 3x within 24 hours depending on the time a medication is ordered and the dosing interval selected.

The same scenario can occur with any dosing schedules where there may be an extra dose calculated due to the 50% rule (i.e. QD, TID, and QID dosing) within the initial 24 hours.

Recommendation:

  • Pay attention to the dosing times.
  • Pay particular attention to the designated times that EPIC designates for administration times.
    • These times will show up in your order.  
    • EPIC cannot calculate the administration times per your intent.
  • Be aware of the EPIC 50% rule
    • To prevent medications from being administered too closely together, there are standard administration times. 
      • If the next scheduled dose is more than 50% of the time interval between doses, the medication will be given at the next schedule time after ordered is placed.
      • If the medication is ordered in less than 50% of the time interval between scheduled doses, the medication will not be given “now.”

A request was made at the system level to create an alert to prevent this from happening but this may take some time. In the interim, we need to be aware of this potential problem and pay attention when placing orders, especially with high alert medications.

Lois Wong, MSN, FNP
Risk Officer

Cardiac Monitoring Performance Improvement Team

Posted on Jun 5, 2017 in Announcements | 0 comments

For several months a team has been meeting to improve the use of cardiac telemetry monitoring. This is important because appropriate use of cardiac monitoring leads to improved patient flow (from the ED, ICU, and PACU), patient safety (improved mobility, less noise), and cost (to the patient and hospital).

The interdisciplinary, cross campus team of physicians, nurse managers, nursing supervisors and charge nurses from ICU, cardiac monitoring units and ED first came together on April 24, 2017 to review evidence based practices and cardiac monitoring criteria. The practices and criteria discussed that day had previously been reviewed by our hospitalists, intensivists, cardiologists, neurologists, and surgeons and were developed from national guidelines. The team also formalized a process for downgrading with the goal of empowering nursing to ask the question daily about the need for continued monitoring.

The ABSMC Indications for Cardiac Monitoring process went live on May 16, 2017, both for admission or transfer to a cardiac monitor and for downgrading off the monitor.

As part of their standard work, the nursing supervisors and charge nurses will be looking for the indication for cardiac monitoring for their patients. At times there may be a phone call made to the physician if the indication is unclear or to request discontinuation based on the criteria.

Many thanks to the team members for their time and engagement in this great (and ongoing) process!

Denise Navellier, Chief Nursing Executive, Summit
Ursula Boynton, Administrative Medical Director

 

Doctor’s Lounge Relocation

Posted on Jun 5, 2017 in Announcements | 0 comments

Some of the Lounge furniture, refrigerator, and coffee machine along with additional furniture, PC’s stations and additional seating will be RELOCATED to the temporary Doctor’s Lounge located at the end of the cafeteria on the 1st floor (currently the Doctor’s Cafeteria).

Food Services will continue stocking the two refrigerators with snack and cold drinks as well as providing breakfast and lunch in the Doctor’s Cafeteria area.

Additional patio furniture will be placed outside the Cafeteria area for any physician that may like to take outdoor lunch.

John Ramirez
Administrative Director Support Services & Facilities

EHR Upgrades

Posted on Jun 5, 2017 in EHR Updates | 0 comments

  • Leave of Absence (LOA) (to transfer a patient to another campus, when then patient is expected to return to the sending facility)
  • Order Context (new function to add clarifying contextual information when associating orders to release with procedures)
  • ICU Liberation – ABCDEF Bundle (new bundle in the VS/Vent report and ICU Summary Report)
  • Haiku/Canto Secure Chat (Functionality in EPIC Haiku to send secure messages) NOTE: At this time there will be no change to SPOK, which will continue to be offered to providers as an option.

For assistance, contact your EHR Physician Liaison, Patty Fitzgibbons, at 510-325-9618

Health Information Management

Posted on Jun 5, 2017 in Health Information Management | 0 comments

Did you know you can request a change to your deficiency notification letter preference?

The following deficiency notification letter preferences are available:

  • Inbasket (default)
  • Fax
  • Email

If you current preference is not meeting your needs, please reach out to your Health Information Manager. Contact information below:

Alisa Stinn, RHIT
Health Information Manager / HIM Leader
Alta Bates Summit Medical Center-Oakland Campus
stinnal@sutterhealth.org
(Office) 510-869-8741
(Fax) 510-869-8856

Welcome, New Physicians

Posted on Jun 5, 2017 in New Physicians | 0 comments

Bradley C. Ching, MD
Berkeley Emergency Medical Group
2450 Ashby Ave.
Berkeley, CA 94705
(510) 204-4723

Matthew W. Diehl, MD
Hospitalist, Medical
350 Hawthorne Ave., Room 2346
Oakland, CA 94609
(510) 869-6883

Charlene S. Emmanuel, MD
Obstetrics and Gynecology
Ob / Gyn Partners for Health
365 Hawthorne Ave Ste 301
Oakland, CA 94609-3113
(510) 893-1700

Stephen M. Knox, MD
East Bay AIDS Center
3100 Summit St., 2nd Floor
Oakland, CA 94609
(510) 869-8400

Allison G. Pollock, MD
Phys. Medicine and Rehab.
350 Hawthorne Ave
Oakland, CA 94609-3108
(510) 869-6325

From the Medical Staff Office

From the President, May 2017

Posted on May 2, 2017 in President's Message | 0 comments

Dear Medical Staff Colleagues,

Thanks to all for your work on co-signing verbal orders which is a Joint Commission requirement. Overall we are now 85 percent compliant with co-signing within 48 hours. Cheers to the Anesthesia and Emergency Departments for reaching more than 90 percent compliance.

C diff– Our hospital as many hospitals in the Sutter system is working on decreasing our C difficile infection rate. On PCU 7 & 4E, there is a process being piloted where a floor mat reminds you as you enter the patient room to properly gown up and wash your hands before you leave.

Call rooms– currently we have call rooms for overnight hospitalists and intensivists. For those of you that are taking call overnight and require a place to rest, we will soon have two additional call rooms on the 4th floor of the Merritt building to utilize. Thank you to our administration for making this possible. For questions on access to the call room and for assistance please contact the Med Staff office.

Ethics Committee– Beginning June 2017, new Co-Chairs for the Ethics Committee will be Dr. Leif Hass and Lucia Tanassi. Special thanks to the outgoing Co-Chairs Dr. Janice Manjuck and Dr. Andrea Green for your dedication and hard work.

Our Annual Hospital Week BBQ will be held on May 12th at Summit and May 8th at Alta Bates.

Happy Memorial Day and Mother’s Day.

Until next time

Be well,

Donna

Donna D. Tigno, M.D.
President of Summit Medical Staff
Co-Director of Critical Care at Summit Medical Center.

 

Patient Satisfaction Survey

Posted on May 2, 2017 in Announcements | 0 comments

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a “national, standardized, publicly reported survey of patients’ perspectives of hospital care” (Ketelsen, L, et al. The HCAHPS Handbook, 2014).  National Research Corporation (NRC) is Sutter Health’s vendor for mailing this CMS required survey to a random sample of ABSMC inpatients that meet the surveying criteria.  Surveys are mailed in English and Spanish.  A minimum of 300 returned surveys is required for each of our inpatient campuses. Last year we had 3,288 surveys returned for both campuses combined.

The HCAHPS domains/questions differ from a patient satisfaction survey as they are designed to measure the frequency with which the patient experienced specific behaviors. Responses are rated as -“Did the patient experienced a behavior Always, Usually, Sometimes, Never? “ The top box score or percent “Always” is what is publically reported, counts and is accessible to consumers.

One of the eight domains is Doctor Communication. It has three questions that roll up into the domain as a composite score:

– During this hospital stay, how often did doctors treat you with courtesy and respect?
– During this hospital stay, how often did the doctors listen carefully to you?
– During this hospital stay, how often did doctors explain things in a way you could understand?

How are we scoring? The minimum ABSMC dashboard target (P50) is 80.3% and by campus we are trending YTD 76.8% (Alta Bates) and 77.6% (Summit).

The question to ask yourself is: “Do I use all of these tactics with every patient every time?”

– Use AIDET (Acknowledge, Introduce, Duration Explain, and Thank)
– Use every day language or words the patient/family can understand when explaining
– Sit down when talking to the patient.
– Use reflective listening and empathy skills

We are proud of our physicians and staff and believe that ABSMC is the best place to receive care. We appreciate the help of our physicians as we work to develop a culture of Always in the way we communicate with our patients. Please contact Leslie Costa at costal@sutterhealth.org for any questions.

Working together to Create a culture of Always by Leslie Costa, RN, PhD, Director Patient Experience

Update from The Well-Being Committee

Posted on May 2, 2017 in Committee Briefings | 0 comments

There might be a few spots still open for the event at Green Gulch in Marin sponsored by Stresscare on 5/6. visit: www.stresscaretraining.org/special-events. This retreat introduces mindfulness to physicians who are facing burnout.

The weekly Mindfulness and Mediation Group run by John Mouratoff, MD and Scott Lee, MD is still meeting Wednesday at 5 pm typically in the Oak room on the first floor.

We are looking for people who are interested in being involved in our Peer Support Program that we hope to start in the fall. Sutter is supporting our efforts to have physicians here trained to offer support to our colleagues feeling stressed by work or feeling bad about challenging cases or case that went poorly. If you are interested in being involved, let me know.

Thanks,
Leif Hass, MD