CBSN | Junaid Khan, MD: Safe to Seek Critical & Preventative Care

Posted on Aug 5, 2020 in Announcements, Uncategorized | 0 comments

Dr. Junaid Khan, from Alta Bates Summit Medical Center, talks to CBSN Bay Area about why patients are delaying their medical needs due to the coronavirus.

https://news.yahoo.com/delaying-medical-care-due-covid-220000551.html

Sutter Community Connect

Posted on Aug 5, 2020 in Announcements | 0 comments

Guidance on Treatment of Enterococcal Infections

Posted on Aug 5, 2020 in Announcements | 0 comments

Guidance on Treatment of Enterococcal Infections

Enterococcal species can cause a variety of infections, including urinary tract infections, bacteremia, endocarditis, and intra-abdominal infections. The species of greatest clinical importance are Enterococcus faecalis and Enterococcus faecium, with E. faecium emerging as a leading cause of multidrug-resistant enterococcal infection (e.g. VRE, vancomycin-resistant enterococcus). Prudent use of vancomycin is recommended to decrease the risk of conferring vancomycin resistance. In addition, considerations should be made to decrease the use of antibiotics with no activity against enterococci, particularly, enterococci are intrinsically resistant to all cephalosporins, clindamycin, and trimethoprim-sulfamethoxazole.

Most E. faecalis strains remain susceptible to ampicillin. Based on Alta Bates Summit Medical Center’s 2019 antibiogram, ampicillin susceptibility is better than vancomycin for E. faecalis (98-100% with ampicillin vs. 92-97% with vancomycin). With the higher susceptibility rate and the benefit of narrower spectrum of activity and reduced renal toxicity, ampicillin is recommended over vancomycin for all E. faecalis infections, even if susceptibilities are still pending, unless patient has severe penicillin allergy. For uncomplicated enterococcal urinary tract infections, ampicillin or amoxicillin is the empiric drug of choice until further speciation, unless patient has severe penicillin allergy, in which case nitrofurantoin or levofloxacin can be used as an alternative based on susceptibilities. In suspected systemic infections, such as bacteremia and endocarditis, vancomycin can be used for empiric therapy until species identification. For VRE infections that are not susceptible to ampicillin, linezolid is the preferred drug of choice. An additional clinical pearl based on Clinical and Laboratory Standards Institute (CLSI) is that ampicillin susceptibility may be used to predict piperacillin and meropenem susceptibility for polymicrobial infections. In general, if ampicillin-susceptible, piperacillin (i.e. Zosyn) can be used to cover for all enterococcus species, whereas meropenem can be used for ampicillin-susceptible E. faecalis only.

Key points:

  • Ampicillin preferred over Vancomycin for all E. faecalis infections even if susceptibilities pending
  • Enterococci are intrinsically resistant to all Cephalosporins, Clindamycin, Bactrim
  • For polymicrobial infections, if Ampicillin-susceptible Enterococcus, Zosyn can also be used; if Ampicillin-susceptible E. faecalis, Meropenem can also be used

References

  • Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals from the American Heart Association. Circulation 132(15):1435-1486.
  • Murray BE, & Miller WR. (2019). Treatment of enterococcal infections. In EL Baron (Ed.), UpToDate. Retrieved July 28, 2020, from https://www.uptodate.com/contents/treatment-of-enterococcalinfections
  • Weinstein MP, Kim TJ, Lewis II JS et al. Clinical and Laboratory Standards Institute M100-ED30: 2020 Performance Standards for Antimicrobial Susceptibility Testing, 30th Edition. Jan 2020. 

Justin J. Roth, Pharm.D., BCPS, BCCCP
Clinical Pharmacy Manager/PIC
Alta Bates Summit Medical Center
rothj@sutterhealth.org

Love and Loss – Coping with Our Emotions in the Era of Covid-19

Posted on Aug 5, 2020 in Wellness Committee | 0 comments

Love and Loss – Coping with Our Emotions in the Era of Covid

For those of us who work on the nursing units at ABSMC, the death of Janine Paiste-Ponder was a body blow.  An amazing nurse, teammate, human being gone suddenly, and she died in our ED. Wow, still shocks me as I see it in print now.  

“Feelings” are feelings because they are an embodied phenomenon.  Emotions are not just in our heads they are in our hearts and bodies.  The loss of Janine has felt like a body blow because I felt so many powerful emotions – some at the same time, sometimes different ones in waves.

Covid continues to turn the world upside down.  Previously, death for me has meant grief. With Janine’s tragic death from Covid, I imagine that many of you felt many more emotions: shock, anger, fear, love and awe in addition to grief. Understanding this might help us cope with our emotions.  In doing so, move forward and heal ourselves with the help of those in our community.  Perhaps, we will be stronger as a result.

Why all these emotions? I am not typically a fan of war analogies, but emotionally this might be the best one we have for facing Covid. We didn’t just loose a friend or co-worker.  We lost someone who was living by her values, putting her life on the line to protect others and our way of life. 

The emotions we are feeling? We are angry at the appalling response of the federal government.  Angry that those who think Covid is just a Democratic Party conspiracy.  Angry at those in this country who are not masking and then want us to put our lives on the line to care for them when they get sick!

We are feeling fear. Her death has moved the virus’s virulence from the abstract to the real. Everyone is more afraid for themselves, for their teammates and families.  Coming to work now is harder as a result.   The virus doesn’t feel “out in the community” now with our PPE to keep it at bay; it has penetrated us.  I know my risk remains small with proper PPE, yet even with my scientific self in the driver’s seat, I admit to quick moments of near panic as I doff and don.

We are feeling compassion.  Our hearts went out to our nursing colleagues who showed up to work last Friday, learned of Janine’s death and then set about doing their job: comforting, medicating, feeding and bathing those under our care. And of feeling of compassion flow each time we step on a nursing unit.  This type of expansive concern is the gift that loss brings and offers us a way forward.  We have lost a sister in the struggle and have a stronger sense of commitment for those still taking on the risk to serve.

It can be overwhelming; we are being buffeted between fear, grief, frustration, anger and compassion – anxious and ruminating all the while.

What I have learned about the “Science of Happiness” is that many of our ideas about a happy life are misguided.  A meaningful life is not one where we avoid negative emotions, but one where we learn to properly take them in as part of an emotionally rich life.  Few things make you feel more alive than profound grief – not a joyful sensation but one is certainly not numb!  We need to take in the negative emotions; we need to sit with them, at first without searching for someone to blame or for solutions, and then we come together to make meaning that takes us forward.

At Summit, now our job is to feel all these emotions.  Sit with them individually as we treasure our loved ones at home. And we need to experience them collectively at work with one-on-one conversations and larger memorializing events. This is how we build stronger relationships, how we create a more connected community and a shared sense of purpose. Then we can work together with open hearts to better face the continued challenge of this virus.  Those of us who knew Janine understand this is how she would have wanted us to move forward.

Leif Hass, MD
Summit Wellness Committee – Chair

2020 Medical Staff Reminders for Medical Records

Posted on Aug 5, 2020 in Announcements | 0 comments

2020 Medical Staff Reminders for Medical Records

Verbal/Telephone Orders:

Please remember to sign your Verbal/Telephone Orders. Our Medical Staff Rules and Regulations state that Verbal and Telephone Orders must be signed within 48 hours.

Here are some handy tips:

  1. Hardwire signing your Verbal/Telephone Orders. Make signing deficiencies the first and last thing you do daily.
  2. Sign all Verbal/Telephone orders including Discontinued and Canceled orders.
  3. Work with your group to sign orders for each other. Inform your team when going off service and ask that your orders be signed.  E HR Physician Liaisons are happy to work with you and your group to make it easy to sign each other’s verbal orders.
  4. Utilize tools such as email reminders and Haiku on your personal cell phone (tip sheets attached). You can contact your campus E HR Physician Liaison for assistance

Summit:  Patty Fitzgibbon -510-325-9618, Ashby: Shala Thomas -510-495-5254

Vacation Reminders:

Inform Health Information Management (HIM) when going on vacation so deficiencies can be placed on hold and out of office while you are out.

In order to place a hold on any potential medical record deficiencies, you have 3 options:

  1. Call the local HIM/Medical Records Department, Chart Completion Team at Summit:  510-869-6545, option 2 (Summit Campus only).
  2. Call or email the S3 physician line (Summit and/or Alta Bates Campus) 855-398-1641, Option 1, or email S3Chart CompletionTeam@Sutterhealth.org.
  3. Call or email the HIM Manager (Summit and/or Alta Bates Campus) Summit:  510-869-8741, or Email Stinnal@sutterhealth.org.

Deficiency notification preference:
Use the attached form to change or update your deficiency notification preference to one of three options (Inbasket/Fax/Email).
Email completed form to HIM Manager stinnal@sutterhealth.org or fax to number listed on the form.

Content Requirements for Operative Report and Immediate Post OP (IPON) Note:

  1. Audits over the last 6 months revealed some providers are missing required content elements in dictated Operative Reports.
  2. Whether you dictate or document your Operative and/or IPON, all elements below are required.
  3. Most common content elements missed in Operative report are Specimens Removed and EBL.
  4. Per the Medical Staff R&R, the content of the IPON and the OP/Procedure report must include the following elements:

Operative / Procedure Report Content:

Full operative/procedure reports must be completed immediately following the procedure and must include the following information:

  1. Preoperative diagnosis
  2. Postoperative diagnosis
  3. Name of the operation performed
  4. Names of the surgeon and assistant(s)
  5. Description of the findings at surgery
  6. Description of the technique uses
  7. Tissue removed or altered
  8. Estimated blood loss
  9. Date of Procedure

Immediate Post Op Note Content:

  1. If the practitioner dictates the full operative report, s/he is still obligated to prepare an operative note and enter it in the record immediately following the procedure. This note shall summarize the procedure in sufficient detail and contain such additional information to assure that there is adequate information in the medical record for purposes of providing care, pending the transcription and entry of the full dictated operative report. At a minimum, it must contain the name(s) of the primary surgeon(s) and his/her assistant(s), procedure performed and a description of each procedure finding, estimated blood loss, specimens removed, postoperative diagnosis, and date of procedure.
    Immediate is defines as before the patient is discharged to next level of care.

EPIC CORNER

Posted on Aug 5, 2020 in Uncategorized | 0 comments

New Physicians

Posted on Aug 5, 2020 in New Physicians | 0 comments

President’s Message

Posted on Jul 7, 2020 in President's Message | 0 comments

The death of George Floyd was shocking and horrifying. As the nation has reeled with massive social unrest for weeks, it is clear that there is a need for dramatic change in how black people are treated in this country. While it would be easy to assign some bad actors to systemic racism within law enforcement, we all have a duty to understand our part in the injustice.

It is imperative as health care providers that we examine and challenge our own implicit biases. This is not to say that all bias is intrinsically wrong, some of it may be informative and predictive. But bias influences how we make decisions for our patients, how we perceive their underlying medical problems, and most importantly, their outcomes.

Studies, including one within Sutter’s own population of patients, have shown that significant health disparities in both exposure and outcomes, as well as access to care, are disproportionate in communities of color. Please see link below for more information.

https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00598

Oakland is among the most ethnically diverse cities in the country; we have a duty to be both culturally sensitive and aware of the structural inequalities that have shaped the experiences of our patients.

On June 8, physicians and nurses took a knee for George Floyd to show solidarity with peaceful protests (see below).

I implore each of you to examine your own implicit biases and to do as much as you can to help balance the scales.

Jeff Chen, MD, MPH
Chief of Staff ABSMC Summit Campus

Alta Bates Summit Comprehensive Cancer Center Now Providing Superficial Radiotherapy for Skin Cancer Patients

Posted on Jul 7, 2020 in Announcements | 0 comments

EHR Education for Providers

Posted on Jul 7, 2020 in EHR Updates | 0 comments