headlines the mgh protech inside: program: opening doors€¦ · september 7, 2006 headlines...

Inside:

ProTech Graduation ................ 1

Jeanette Ives Erickson ............ 2Collaborative Governance

Survey 2006

Fielding the Issues .................. 3Staffing Ratios

Patient Education .................... 4

Clinical Narrative .................... 6Marissa Legare, RN

New Leadership ...................... 8Eileen Flaherty, RN

New Policy .............................. 9Emergency Discharge

Prescriptions

Educational Offerings ........... 11

Quality & Safety ................... 12Fall Reduction Program

CaringCaringSeptember 7, 2006

H E A D L I N E S

Working t

MGH

StanCherlin

School PaSeated:

ogether to shape the futurePatient Care Services

The MGH ProTechProgram: opening doors

to new opportunities—by Galia Wise, manager, MGH-East Boston High School Partnership

n Wednesday, Aug-ust 16, 2006, tenbright, talented,

and motivated EastBoston High School

students graduated from the Pro-Tech Program, a structured intern-

ship that combines classroominstruction with work-based learn-ing experiences. The two-year,paid internship introduces stu-dents to a variety of professionsand opportunities as an educa-tional stepping stone to careers in

health care. MGH has been a lead-er in the ProTech Program since1991.

Thier Conference room wasabuzz with MGH staff, guests,and family members who had

continued on page 10

O

(Photo by Abram Bekker)

ding (l-r):ProTech graduates, Jesse Hernandez; Marc Fleury; Mireille Kamanzi;e Gene; Dominica Campbell; Galia Wise, manager of the MGH-East Boston Highrtnership; and Candace Burns, director, MGH-Boston Public Schools Partnerships

Graduates, Felicia Sorrentino; Kristen Chianca; John Nichols; and Gina Nardone

September 7, 2006September 7, 2006Jeanette Ives EricksonJeanette Ives Erickson

Jeanette Ives Erickson, RN, MSsenior vice president for Patient

Care and chief nurse

Collaborative governance:an essential part of the professional

practice models with all success-ful programs, reg-

ular monitoringand evaluation are

needed to ensure theyremain relevant and re-sponsive in a dynamic,perpetually changing,healthcare environment.Toward that end, I askedclinical nurse specialist,Susan Lee, RN, of theInstitute for Patient Care,and senior nurse scientist,Dorothy Jones, RN, ofthe Yvonne Munn Center

A for Nursing Research, toconduct an evaluation ofcollaborative governanceas we enter our tenthyear in operation.

In April, a survey wassent to all (251) membersof collaborative govern-ance committees; to arandom sampling of(590) Patient Care Ser-vices professional staff;and to (161) members ofthe PCS leadership team,including associate chiefnurses, directors, mana-

gers, and supervisors.The survey was similarto those used in pastyears, and recipientswere asked to return com-pleted surveys by mailwithin two weeks.

More than 250 sur-veys were returned: 95from collaborative-gov-ernance participants; 125from non-collaborative-governance participants;and 36 from PCS lead-ership, providing mean-ingful feedback from allsample groups. Respond-ents represented Nursing,Occupational Therapy,Physical Therapy, SocialServices, Speech-Lang-uage & Swallowing Dis-orders, Chaplaincy, andPharmacy, and ranged inexperience from threemonths to 42 years.

The survey sought toidentify trends in em-powerment between col-laborative-governanceand non-collaborative-governance participants.It looked at formal, infor-mal, structural, and psy-chological empowermentwith an underlying as-sumption that staff whofeel empowered are moreeffective in the work-place. Those who feelempowered report a senseof increased autonomy,higher job satisfaction,greater commitment, andlower stress.

I’m happy to reportthat 94.6% of those who

completed surveys sup-port collaborative gov-ernance; and empower-ment scores have contin-ued in an upward trendsince 2000. Those whoserve on collaborativegovernance committeesreported a greater percep-tion of access to oppor-tunity, information, sup-port, and resources thantheir non-collaborative-governance counterparts.

Some of the com-ments received in thesurvey include:

“Collaborative govern-ance has helped meclarify my position onissues, increased byconfidence, and mademe less intimidated tooffer an opinion.”“I’ve learned that is-sues facing my unit arenot necessarily isolatedissues.”“Through collaborativegovernance, I’ve estab-lished relationshipswith other membersthat have evolved intoresources.”

“I was able to bring astaff-led initiative fromconcept to institutionalchange.”“Knowing that admini-stration values inputfrom staff to positivelychange and improvethe care of our patientsis empowering andgratifying.”

It’s rewarding to knowthat staff and leadershipalike feel collaborativegovernance gives clini-cians the opportunity tocontribute to the profes-sional practice environ-ment, make decisionsabout their practice, andhave an impact on theoverall organization.

Based on feedbackobtained by the survey,we will be:

exploring mechanismsto advance inter-disci-plinary research andeducationaddressing some oper-ational issues such as:term limits, arrangingcoverage to allow com-

continued on next page

Collaborativegovernance

membership driveOpen enrollment

September 1–October 15, 2006

Collaborative governance is theformal, multi-disciplinary, decision-making

structure of Patient Care Services.Its mission is to stimulate, facilitate, andgenerate knowledge to improve patientcare and enhance the environment in

which clinicians practice

Open HouseAttend a committee meeting any timeduring the month of September to see

collaborative governance in action(please notify a co-chair beforehand)

Ice Cream SocialCome get the ‘scoop’ on collaborative

governance!

Tuesday, September 26, 200611:00am–3:00pm

Under the Bulfinch Tent

legislation. tives (MONE). being provided. Gover-

Advanced Clinicians:Maryalyce Romano, RN, SurgeryChristine Perino, RRT, RespiratoryCareEileen Collins, PT, Physical TherapyMelanie Struzzi, PT, Physical TherapyJennifer Hovsepian, RN, CardiacSurgeryMarissa Legare, RN, Transplant UnitTracey Zachary, RN, EmergencyDepartmentNoel DuPlessis, RN, NeurologyKatherine O’Meara, RN, MedicineCheryl Hersh, SLP, Speech, Language& Swallowing DisordersKathleen Mortimer, RN, Surgery

Clinical Scholars:Robert Larocque, RN, RadiologyAnn Hession, RN, Obstetrics

Jeanette Ives Ericksoncontinued from previous page

mittee members timeaway, etc.establishing ways forformer collaborativegovernance membersto continue to contrib-ute after their terms areup

Collaborative govern-ance is an essential partof our professional prac-tice model, and the col-laborative governancesurvey is an instructivetool as we continuallystrive to keep our com-mittee structure vital and

responsive. As always, Iwelcome your commentsand feedback. Don’t feelyou have to wait for thenext survey to contact mewith your suggestions.

I’d like to leave youwith this quote from staffnurse, Ann Eastman, RN,who said, “Collaborativegovernance means op-portunity to me: oppor-tunity to learn about thework of other disciplines;opportunity to under-stand the perspective ofother clinicians; oppor-

tunity to look at systemsand see why ‘the bestlaid plans’ sometimesfail. But most of all, it’san opportunity for prob-lem-solving with pa-tients at the center andstakeholders having anopportunity to see howour work can help orhinder each other in ach-ieving excellent patientcare.”

Thank-you, Ann.

UpdatePaul Arnstein, RN, is thenew clinical nurse spe-cialist for Pain Relief.He is located on White 6and can be reached at4-8517.

September 7, 2006September 7, 2006Fielding the IssuesFielding the IssuesWhat’s the latest on mandatory

staffing ratios?Question: The state legi-slature ended its sessionin July. What happenedwith the nurse staffingissue?

Jeanette: A final conclu-sion wasn’t reached.Although the House ofRepresentatives adopteda mandatory staffingratios bill, the Senate didnot complete its workbefore the end of theirformal session (July 31st).The legislature may beback in session to ad-dress other matters in thecoming months, but it’sunlikely that staffingratios will be consideredagain this year. The en-tire process may startagain next year if pro-ponents of ratios file

Question: Did our lettersmake a difference?

Jeanette: Yes. It’s impor-tant for legislators to heardirectly from the peoplethey represent, and hun-dreds of MGH nursestook the time to let elect-ed officials know howthey felt. I invited a num-ber of legislators to visitMGH to see first-handhow important flexibilityin staffing is. When theywere unable to come, Iwent to the State Houseto make our case. Staffnurses like Meg Soriano,RN, and others spoke onbehalf of clinicians at thebedside. And Janet Mad-igan, RN, represented theMassachusetts Organi-zation of Nurse Execu-

Question: Why wouldanyone support manda-tory staffing ratios?

Jeanette: Mandatorystaffing ratios offer aneasy answer to a complexproblem. Proponents ofmandatory ratios make itsound as if a ‘simple’government mandate willmagically produce morenurses and improve pa-tient care. We know it’snot that simple.

Mandated, one-size-fits-all staffing ratioswould require every med-ical-surgical unit in thestate to set the number ofpatients a nurse can carefor, regardless of thepatient’s individual needs,the nurse’s experience, orthe time of day care is

nment should not bemaking those decisions.Nurses should.

Mandated staffingratios would compro-mise patient safety andquality of care by takingflexibility, individual-ized care, and decision-making away fromnurses. And the man-datory staffing bill doesnothing to address thenursing shortage.

Question: Why is thePatient Safety Act bet-ter?

Jeanette: The PatientSafety Act holds hospi-tals accountable for

staffing decisions, ex-pands nurse-trainingprograms, and invests innew nursing faculty. Itstrikes the right balancebetween public account-ability and flexibilityand lets caregivers makethe decisions aboutwhat’s best for patients.

Question: Is this debateover?

Jeanette: Probably not.Mandatory staffing ra-tios will no doubt be anissue in the upcomingelections, so proponentsare likely to re-introducethis legislation againnext year.

Clinician RecognitionProgram

Advanced clinicians and clinicalscholars recognized June–August,

2006

September 7, 2006September 7, 2006

ew members of thePatient EducationCommittee have

been surprised tolearn about the work thecommittee is doing tosupport clinical staff indeveloping patient-edu-cation activities. Lastfall, the Patient Educa-tion Committee set out toassess the current needs,knowledge, and practicesof clinical staff in rela-tion to teaching patients.Committee memberscreated a survey to helpidentify current patient-education practices andidentify future goals toimprove access, ease ofuse, and documentationof patient education forhealthcare providers.

The Patient Educa-

tion Committee created a26-question survey, in-corporating a patient-education model thatincludes: education-plan-ning, assessment, evalu-ation, resources, inter-ventions, teaching, anddocumentation. The sur-vey was divided into fivemain areas that address-ed the following ques-tions:

Do clinicians assesspatients’ learning needs?Do clinicians use MGHpatient-education re-sources?Do clinicians haveadequate skills andconfidence to teachpatients?

What documentationdo clinicians use forpatient-teaching?

Do clinicians use a‘teach back’ method toassess patients’ under-standing of new mater-ials?The survey was design-

ed using a four-pointLikert scale that rates theresponders’ level of con-fidence and frequency ofuse.

The Patient Educa-tion Committee distrib-uted the survey to allmembers of collaborativegovernance committees.The 105surveys thatwere return-ed represent52 patientcare unitsand 17 dis-ciplines.Nurses rep-

resented 80% of the re-spondents; 16% wereregistered dieticians,occupational therapists;nurse practitioners; phar-macists, physical thera-pists, social workers, andspeech-language patholo-gists; and the remaining4% were from non-clini-cal committee members.The average clinical ex-perience for all respond-ents was 19.5 years, theaverage work experienceat MGH was ten years.

Results of the surveysuggest that more than80% of staff incorporatepatient education intotheir clinical practice.This includes involvingfamily members in theeducation process, assess-ing learning barriers,

evaluating patients’ read-iness to learn, and beingsensitive to patients’ cul-tural backgrounds whileteaching. Of those sur-veyed, 80% felt confi-dent with their clinicalskill and ability to teachpatients.

Interestingly, an aver-age of 66% felt they haveadequate computer skills,easy access to dischargedocuments, and easyaccess to patient-educa-tion resources. However,less than 36% of staffactually use availablepatient-education re-sources, such as the Pa-tient & Family LearningCenter, the Cancer Re-source Room, on-lineresources (the MGH In-

Patient EducationPatient EducationPatient education:

current practices and futuredirection

—by Janet King, RN; Carol Harmon Mahony, OTR/L; and Elizabeth West, RN

N



tranet or the Internet), thePatient Education On-Demand Video Channel,Lexi-Comp, CareNotes,or DrugNotes. Thoughstaff believe they haveadequate access to re-sources, there is remark-ably low utilization ofavailable tools for patientteaching and documenta-tion. Some possible rea-sons for infrequent use ofresources surfaced in thesurvey’s ‘Comments’sections. They includelack of time, lack of avail-able computers, and thecomplex process involv-ed in finding educationalresources.

Most clinicians feelthat they’re providingadequate patient educa-tion, but less than 50%are documenting patient

education using the dis-charge summaries inCAS or in the Interdisci-plinary Inpatient Teach-ing Form. Sixty percentof survey respondentsreport including patienteducation in their dailynotes.

Upon reviewing thesurvey results, the com-mittee proposed several2006-2007 goals to try toaddress the discrepancybetween clinicians’ know-ledge of patient-educa-tion resources and theiractual use of those re-sources. The Patient Edu-cation Committee is de-veloping a patient educa-tion website, will conti-nue to publish quarterlyarticles in Caring Head-lines, and will develop2007 nursing competen-

Patient Educationcontinued from previous page

cies in the area of patienteducation. The commit-tee recently hosted ahallway display of on-line, patient-educationresources and demonstra-tions of the on-demandTV channels. In Novem-ber, the committee willhost a patient-educationprogram for cliniciansfeaturing Fran London,entitled, “The Essence ofPatient Education.”

The Patient Educa-tion Committee strives todevelop the role that clin-ical staff play in provid-ing patient education.The patient-educationsurvey generated cleargoals for how the com-mittee can help staff ex-pand their familiaritywith educational resourc-es and improve their clin-ical practice. For moreinformation, call CarolHarmon Mahony, OTR/Lat 4-8162.

Far left: The Patient

Education Committee’s

research poster describ-

ing their recent survey

of current patient-teach-

ing practices and

future goals.

Center and right:

Members of the Patient

Education Committee

staff display tables in

the Main Lobby dissem-

inating information on

patient-education and

on-line resources

at MGH.

(Photos by Michelle Rose)

Blood:there’s life-savingpower in every

dropThe 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–3:00pm

Appointments are available forblood or platelet donations

Call the MGH Blood Donor Centerto schedule an appointment

6-8177


Marissa Legare, RNstaff nurse, Blake 6 Transplant Unit

M


From discharge planningto end-of-life care: a challenging

and rewarding experience Marissa Legare is an advanced clinician

Clinical NarrativeClinical Narrative

Some portions of this text may have been altered to make the story more understandable to non-clinicians.

y name is MarissaLegare, and I havebeen a staff nurseon the Transplant

Unit for fouryears. I began workingon the Transplant Unitright out of nursing schoolbecause I was drawn tothe many opportunities itoffered for growth andlearning. In my time onBlake 6, I’ve grown froma novice to an experienc-ed ICU nurse. I’ve caredfor the simplest of pa-tients and the most com-plex. Coming to workevery day presents a newchallenge, which I love.

One of the greatestand most rewarding chal-lenges occurred this pastJanuary. Mr. G was aman in his 50s who’drecently undergone aliver transplant for hepa-tocellular cancer andHepatitis C. He did wellafter surgery. He ‘flew’through the recoveryphase, and soon his dis-charge planning was infull swing. During thisinitial phase I was notone of Mr. G’s nurses. I’dsay “Hi” in passing. Iknew he and his wife hadbeen married for 25 yearsand had no children. Theywere inseparable and soin love. It was nice tosee.

The fifth night afterMr. G’s transplant, hespiked a temperature of103o. Things spiraleddownward after that. Thefollowing morning his

liver-function readingstripled and his kidneybegan to shut down. Hewent for an immediateCT scan and returned tothe unit in respiratorydistress. He was intubat-ed and placed on contin-uous veno-venous hemo-filtration (CVVH), amechanical blood-filter-ing system that runs 24hours a day to filter outtoxins when a patient isin kidney failure. Withina matter of 20 hours Mr.G had gone from being asoon-to-be-dischargedpatient to an ICU patient.

Mrs. G, who’d beenby her husband’s sideduring his entire hospital-ization, went home thatmorning before he wasintubated because shecouldn’t handle it. Shedidn’t want her husbandto see her upset, but shewas terrified, so shethought it would be bestfor her to go home andlet the transplant team doits job.

My shift had startedat 3:00pm that day. Theevening was busy be-cause Mr. G’s conditionhad become so complicat-ed. His biggest issueswere that he was severe-ly fluid-overloaded andhad low blood pressure. Iworked closely with thenephrology team and ourtransplant team. Ourgoals were to relieve Mr.G of some fluid throughCVVH and get his bloodpressure up to a safer

level. Initially, the neph-rology team wanted totake out 100cc of fluid anhour, but Mr. G could nottolerate that dramatic afluid shift. When I tried,his blood pressure woulddrop to an unsafe level.So I began by taking off50cc of fluid an hour,and Mr. G’s blood pres-sure tolerated this well. Iwent back to the nephro-logists and let them knowI was taking fluid out at arate of 50cc an hour. Theywere comfortable withthis and let me run themachine as needed to getas much fluid off Mr. Gas was safely possible. Itfelt like a balancing act.By the end of my shift,he had stabilized slightly,but still had a ways to go.

About four days afterMr. G had decompansat-ed, I was again his nurse.He was still critically ill,on a ventilator, and re-ceiving CVVH. Mrs. Gdecided she was ready tocome in and see him forthe first time that after-noon. I talked with heron the phone that morn-ing, and she let me knowwhat time she’d be in. Iplanned my day aroundthis, because I knew she’dneed a lot of time andsupport when she arriv-ed. When she came in,we sat together in thevisitor’s lounge. I tried tomentally prepare her forwhat she would see. Iexplained what each ofthe tubes, lines, and ma-

chines did; I tried to giveher a good mental picturebefore she went into herhusband’s room. I knewshe didn’t want to getupset in front of him, sothe less shock she felt,the better the visit wouldbe for both of them. Afterexplaining things, I walk-ed Mrs. G to her hus-band’s room. She wentover to the bed and start-ed talking to him. Sheasked me if he could hearher. I told her I wasn’tsure, but I talked to himall the time, and he’dprobably rather hear hervoice than mine. For therest of the evening, shesat by his side, held hishand, and spoke to him.From that day on, shecame in every day, andwe developed a trustingrelationship.

Over the next threeweeks, I cared for Mr. Galmost every shift I work-ed. He remained very ill,and in fact, his conditiongot worse instead of bet-ter. Mr. G’s liver wasdying, his kidneys hadfailed, and he had con-tracted an infection thatdidn’t respond to any of

the antibiotics. Each dayour team would round,and there would seem tobe fewer and fewer treat-ment options.

One Wednesday after-noon, after another CTscan, it was decided thatthe source of the infec-tion could be the spleen,so it was decided that itshould be removed. Theteam was hesitant to putMr. G through the ordealof moving him to theoperating room (OR) butthey felt it was his lasthope. The following day,Mrs. G gave her consent,and Mr. G was taken tothe OR for a splenectomy.

Friday afternoon, Icame in and took care ofMr. G again. When I gotreport, I knew he wasdying. He was on maxi-mum support, 100% oxy-gen on the ventilator, anextremely high rate onthe CVVH machine, andhe was getting a lot ofphenylepherine to keephis blood pressure at alow but safe level. Withinthe first hour of my shift,I had to increase his phen-ylepherine because his


Clinical Narrativecontinued from previous page

blood pressure had drop-ped again. It occurred tome that this shift wasgoing to be just as chal-lenging as my first shiftcaring Mr. G, but in avery different way. Now,instead of trying to saveMr. G, we were going tohave to let him die thebest way we knew how. Ibegan to think about howI could make this aspeaceful as possible forboth Mr. and Mrs. G.During evening rounds,the teams concluded thatnothing more could bedone. They were going totalk to Mrs. G. There hadbeen other meetings withMrs. G in the past fewweeks, but those hadinvolved exploring op-tions to save Mr. G’s life.This meeting was goingto be hard for everyone.As a team, we broughtMrs. G and her familyinto the visitors’ loungefor this end-of-life dis-cussion.

The doctors explainedthat nothing more couldbe done and broached thesubject of a DNR (a do-not-resuscitate order).Until this point Mr. Ghad been a ‘full code.’Mrs. G listened, thenasked about the possibi-lity of withdrawing careif there was no hope. Shedidn’t want her husbandto suffer a second longerthan he had to. She ex-pressed concern aboutturning off his sedationmedications.

I explained exactlywhat would happen ifshe decided to withdraw

care. I explained that wewould take Mr. G off theCVVH machine, turndown the ventilator, andthen turn off the blood-pressure medications. Istressed the fact that wewouldn’t turn off, or evendecrease, his sedationmedications.

After the meeting,team members offeredtheir condolences andleft. I was the last staffmember in the room. Iwent up to Mrs. G andtold her she should beproud of herself and herhusband. We both startedto cry, then I left to letthe family make a deci-sion about how they’dlike to proceed.

Twenty minutes later,Mrs. G came to me in herhusband’s room and ask-ed to speak to me in thehall. They had decided towithdraw care and letMr. G go. I asked her togive me five minutes toprepare the room for herand her family. The trans-plant fellow, anothernurse, and I went into theroom. I took Mr. G offthe CVVH machine andmoved it out of the roomwhile my co-workersremoved the IV medica-tions and placed chairsaround the bed so every-one could be close. Wecombed Mr. G’s hair (hewas very particular abouthis hair) and told thefamily they could comein. When everyone wassettled, I left the room sothe family could havesome time alone withhim.

Mr. G died about 30minutes later. I let thefamily know they couldstay as long as they need-ed, but they were readyto go. I helped Mrs. Gpack up her husband’sbelongings and she saidone final good-bye to Mr.G. Out in the hall, Mr.G’s family thanked stafffor all they had done.Mrs. G thanked us all andhugged us. She came tome last and thanked mefor taking such good careof her husband. I told herI wished we could havedone more.

I left that night feel-ing I had helped Mr. Gdie peacefully and helpedMrs. G feel at peace withhis death. This was re-

warding, but left me feel-ing helpless. Getting atransplant is supposed tobe the start of a new lifenot the end of one. Al-though this is somethingI don’t want to go throughagain any time soon, Iwas glad I was there andable to help Mr. and Mrs.G through this tryingtime in their lives.

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

This is a wonderful, in-structive narrative. In amatter of days, Mr. G’scondition went from sta-ble to gravely ill. At eachjuncture, Marissa waspresent to Mr. G and

sensitive to his wife’sneeds as she came togrips with her husband’schanging prognosis. Ledby compassion and em-pathy, Marissa usheredMr. and Mrs. G throughfrightening, unfamiliartimes with strength andfocus. She collaboratedwith other team mem-bers, made herself avail-able to Mr. G’s family,and tended to the small-est details to ensure Mr.G had a peaceful death.Explaining how carewould be withdrawn,stressing that Mr. G’ssedation medicationswould not be changed,gave Mrs. G peace ofmind.

Thank-you, Marissa.

MGH: improvinghand hygieneGlove Safety:When should gloves be worn?

Gloves are used to protect healthcareworkers and patients, and reduce thecross-contamination between patients,workers, and the environment.

Standard precautions: used for all patients

Glove use is recommended when contact is anticipated withnon-intact skin, mucous membranes, bodily fluids, or items con-taminated with bodily fluids or excretions.

Is there a correct way to put gloves on and take them off?

Yes. If you’re unsure of the proper technique, contact your nursemanager or the Infection Control Unit for a demonstration.

Special precautions: for patients on airborne, contact, drop-let, neutropenic, or other precautions

Gloves may be required for all contact with patients on the above-mentioned precautions (including intact skin) and/or contact withitems in the patients’ environment.

See posted signs or the Infection Control Manual for further infor-mation on the specific precaution requirements for your patient.

Stop the Transmissionof Pathogens

Infection Control UnitClinics 131726-2036

September 7, 2006September 7, 2006New LeadershipNew LeadershipPCS executive teamwelcomes Flaherty

n February, 2006,Christina M. Graf,RN, announcedher intention to

retire as directorof Patient Care Ser-

vices Financial Manage-ment Systems and assumea part-time position fo-cusing on health servicesadministrative researchand other projects. Asanyone in Patient CareServices will tell you,Graf’s departure leftsome very big shoes tofill. After an extensivenational search, it wasannounced on August 29,

I 2006, that Eileen Flaher-ty, RN, nurse manager ofthe Bigelow 11 MedicalUnit, would become thenew director of PCSFinancial ManagementSystems.

Responsible for co-ordinating, analyzing,and implementing keyfinancial systems andensuring optimal utiliza-tion of human, fiscal, andmaterial resources, therole calls for a highlyspecialized blend of stra-tegic-planning, opera-tional, and financial ex-pertise. Flaherty, who has

been at MGH since 1997serving as assistant pro-ject manager, staff spe-cialist, and most recently,nurse manager, brings awealth of essential know-ledge and experience tothe role.

Says senior vice pres-ident for Patient CareServices, Jeanette IvesErickson, RN, “I’m thrill-ed that Eileen chose topursue this opportunityto expand her influencein the MGH community.Her accomplishments asa nurse manager, her suc-cess in ensuring high-

quality care, exploringflexible staffing options,and promoting operation-al efficiency made herthe perfect choice, dis-tinguishing her from afield of many other high-ly qualified candidates.”

As a nurse manager,Flaherty has workedclosely with many of thesystems and programsdesigned by her prede-cessor. In January, 2005,a project team under theleadership of Graf, imple-mented the Unit-BasedDashboard, a quality-assurance tool developedto provide unit leadershipwith relevant informationabout their operations,clinical outcomes, staff-ing, and financial prac-

tices. The dashboardcombines informationfrom workload producti-vity reports, quality out-come reports, fiscal re-ports, and many othersources to help nursemanagers, associate chiefnurses, and operationscoordinators make in-formed decisions aboutissues that impact theirunits.

As an end-user of theUnit-Based Dashboard,Flaherty has had first-hand experience usingthe tool to monitor, eval-uate, and implement im-provements on Bigelow11. She’s in a uniqueposition to be able tobuild on the success ofthis and other initiatives,using her skill and ex-perience to help othersuse the data in a mean-ingful way.

Teamwork and col-laboration have alwaysbeen hallmarks of Fla-herty’s leadership style,fueling her efforts todevelop strong commu-nication skills in herselfand others.

Says Flaherty, “I’mthrilled to be joiningsuch a dynamic leader-ship team during such anexciting time in healthcare. While my heart willalways be with the staffof Bigelow 11, I’m proudto be able to build on theskills and experiences weshared to influence pa-tient care in new ways.I’m grateful for my yearsas a nurse manager andlook forward to this won-derful opportunity tobroaden my commitmentto Patient Care Services.”

Eileen Flaherty, RN, new director,PCS Financial Management Systems

September 7, 2006

September 7, 2006

Next Publication Date:

September 21, 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 McCandless

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

New PolicyNew Policy

Question: I understand there’s anew policy around the dispens-ing of emergency discharge med-ications for free-care patients.What is the new policy?

Answer: The new policy ap-plies to medications prescribedafter the MGH Outpatient Phar-macy is closed. In those in-stances, the MGH InpatientPharmacy will dispense an em-ergency supply of medication(s)to patients who have been pre-approved for free care. The In-patient Pharmacy will providean emergency supply of medi-cation(s) that will last the pa-tient until the remainder of theprescription can be obtainedfrom the Outpatient Pharmacy.Patients will be given up to atwo-day supply. The policy mayalso be used when patients needmedication(s) not available atoutside pharmacies due to ex-tenuating circumstances.

Question: What are the hours ofthe Outpatient Pharmacy?

Answer: The Outpatient Phar-macy, located on the first floorof the Wang Building, is openMonday–Friday: 9:00am–5:30pm;Saturdays, Sundays, and Holi-days: 9:00am–12:30pm.

Question: How does the policywork?

Answer: When a patient is iden-tified as someone who is receiv-ing free care and needs to bedischarged with medicationswhen the Outpatient Pharmacyis closed, the nurse will page thecase manager on call to obtainapproval. The case manager willcontact the Pharmacy for author-ization.

The nurse or case managerwill fax the prescription(s) to theInpatient Pharmacy. It should benoted on the cover sheet that theprescription(s) are for an emer-

gency discharge patient. (Pre-scriptions must be faxed; thePharmacy will not accept verbalorders.)

The Inpatient Pharmacy willhand deliver an emergency sup-ply of the medication(s) to theunit and give them to the nursecaring for the patient.

Prescription(s) will be sent tothe Outpatient Pharmacy thefollowing day for the remainderof the prescription to be filled.

Question: Why was this policyenacted?

Answer: The policy was devel-oped to improve the care, safety,and overall hospital experienceof patients pre-approved for freecare. By establishing a meansfor free-care patients to obtaindischarge medications any timeof the day or night, we can dis-charge patients in a more timelymanner and improve their hos-pital experience.

Question: When did this policygo into effect?

Answer: The policy was devel-oped by the Pharmacy in March,approved by the Clinical Policyand Record Committee in April,and approved by the MedicalPolicy Committee in August.

Question: Whom can I call if Ihave questions about the policy?

Answer: You can call the Inpa-tient Pharmacy at 6-2503, orpage the pharmacist for yourpatient care unit. Alternatively,you can look up ‘Pharmacy’ inthe Partners Directory and selectthe pager for the appropriateunit.

Emergency discharge prescriptionswhen Outpatient Pharmacy is closed

Improve your English!Enroll in an English for speakers of

other languages classTen classes range from Beginner to High Interme-diateClasses meet from 2:00–3:30pm or 3:30–5:00pmMondays and Wednesdays, or Tuesdays andThursdaysFall classes begin September 11, 2006Classes are geared for support staff

Améliorer votre Anglais!Melhore o seu Inglês!

Mejore su Inglés!For more information, or to enroll, contact Beth Butterfoss

at 6-2388 or by e-mail

!


ProTech Graduationcontinued from front cover

come together to honorthe ProTech graduates.Galia Wise, manager,MGH-East Boston HighSchool Partnership; Can-dace Burns, director,MGH-Boston PublicSchools Partnerships;and MGH president,Peter Slavin, MD, addres-sed the gathering withwords of wisdom andhopes for a bright futureas students embark ontheir new journey. All tengraduates will attendcollege in the fall.

Guest speaker, Melis-

sa Diaz, a 2004 ProTechgraduate, gave a heart-felt speech about howProTech continued toprovided her with op-portunities even after shegraduated.

Said Diaz, “Being inthe ProTech Program andworking at MGH helpedme be more focused onmy academics and gotme really thinking aboutmy future. MGH staffand ProTech staff tookthe time to talk with mewhen I had doubts aboutmy thoughts and deci-

sions... I came to theUnited States from theDominican Republic atage 14 without knowinganyone or speaking aword of English. I justhad the American dreamin my head. I wanted toaccomplish everythingmy family had not beenable to. I wanted to finishhigh school and go tocollege, something mymother had not been ableto do because she neededto work to support herfamily. When my mothercame to this country she

worked two jobs to pro-vide for four children. Iremember as a teenagerseeing my mom wake upat 4:00 every morningand not return home untilmidnight. It made mesad, but at the same time,it started a fire inside ofme. That fire gave me thedetermination to achieveand succeed.”

Diaz is currently work-ing as a medical assistantat the MGH Cancer Cen-ter and will be startingher junior year of nursingschool at the University

of Massachusetts in thefall.

Speaker, DominicaCampbell, a 2006 Pro-Tech graduate, spokeabout the lessons shelearned during her Pro-Tech experience. Origin-ally from Nigeria, Camp-bell spoke passionatelyabout her past, present,and future.

Said Campbell, “TheProTech program hasdefinitely made a differ-ence in my life. It hashelped me grow in manyways. I understand themeaning of responsibilityand compassion morethan I ever did before. Inow firmly believe thatpeople can make a dif-ference in other people’slives, and that is what Iwant to spend my lifedoing. I have alwayswanted to work in themedical field because Iwant to belong to thatspecial group of peoplewho have compassion forothers and do everythingthey can to help those inneed.”

Campbell is one ofthree recipients of thisyear’s MGH Edward M.Kennedy Health CareerScholarship and will beattending the Universityof Massachusetts, Am-herst, in the fall whereshe plans to enroll in thePre-Med program.

The ProTech Programis a School Partnershipinitiative of the MGHCommunity Benefit Pro-gram funded by PartnersHuman Resources. Formore information aboutthe ProTech Program, callGalia Wise at 4-8326.

(Pho

to b

y Ab

ram

Bek

ker)

Photos clockwise from top left: Galia Wise, manager,MGH-East Boston High School Partnership; 2004 Pro-Tech graduate, Melissa Diaz; 2006 ProTech graduate,Dominica Campbell; and Candace Burns, director,MGH-Boston Public Schools Partnerships

Education/SupportEducation/Support

Educational OfferingsEducational Offerings September 7, 2006September 7, 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/WhereTBANeuroscience Nursing Review Course

Day 1: O’Keeffe Auditorium. Day 2: Thier Conference RoomSeptember 15 and 188:00am–4:15pm

BLS Certification for Healthcare ProvidersVBK601

- - -September 208:00am–2:00pm

Building Relationships in the Diverse Hospital Community:Understanding Our Patients, Ourselves, and Each OtherTraining Department, Charles River Plaza

7.2September 208:00am–4:30pm

Medical-Surgical Nursing Certification Prep CourseYawkey 10-660

TBASeptember 208:00am–4:30pm

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

- - -September 218:00am and 12:00pm (Adult)10:00am and 2:00pm (Pediatric)

Preceptor Development ProgramTraining Department, Charles River Plaza

7September 218:00am–4:30pm

Chaplaincy Grand Rounds“An Introduction to Hinduism.” Yawkey 2-220

- - -September 2111:00am–12:30pm

CPR—American Heart Association BLS Re-CertificationVBK401

- - -September 267:30–11:00am/12:00–3:30pm

New Graduate Nurse Development Seminar IITraining Department, Charles River Plaza

5.4 (for mentors only)September 278:00am–2:00pm

Basic Respiratory Nursing CareSweet Conference Room

- - -September 2812:00–4:00pm

Nursing Grand Rounds“Anticoagulation.” O’Keeffe Auditorium

1.2September 281:30–2:30pm

MGH School of Nursing Alumni Homecoming ProgramO’Keeffe Auditorium

TBASeptember 298:00am–4:30pm

BLS Certification for Healthcare ProvidersVBK601

- - -October 38:00am–2:00pm

CPR—American Heart Association BLS Re-CertificationVBK401

- - -October 47:30–11:00am/12:00–3:30pm

TBASpecial Procedures and Diagnostic Tests: What You Need to KnowO’Keeffe Auditorium

October 68:00am–4:00pm

End-of-Life Nursing Education ProgramBurr 6 Conference Room

TBAOctober 10 and 138:00am–4:30pm

Congenital Heart DiseaseYawkey 2220

4.5October 107:30am–2:00pm

New Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0(for mentors only)

October 118:00am–2:00pm

Intermediate ArrhythmiasHaber Conference Room

3.9October 118:00–11:30am

Pacing ConceptsHaber Conference Room

4.5October 1112:15–4:30pm

OA/PCA/USA ConnectionsBigelow 4 Amphitheater

- - -October 111:30–2:30pm

16.8for completing both days

Oncology Nursing Society Chemotherapy-Biotherapy CourseYawkey 2220

October 12 and 198:00am–4:00pm


Send returns only to Bigelow 10Nursing Office, MGH

55 Fruit StreetBoston, MA 02114-2696

First ClassUS Postage Paid

Permit #57416Boston MA

CaringCaringH E A D L I N E S

very patientis at risk forfalling. Some

patients, be-cause of med-

ical or cognitive issues,are at greater risk thanothers. Falling presentssuch a safety risk that in2005, the Joint Commis-sion on Accreditation ofHealthcare Organizations(JCAHO) introduced anew National PatientSafety Goal related tofalls and patient harm.The goal says: “Reducethe risk of patient harmresulting from falls; im-plement a fall-reductionprogram including anevaluation of the effec-tiveness of the program.”

Our existing Fall Pre-vention Program includes

an evaluation of currentstandards, practice, relat-ed policies, and guide-lines. The Patient CareServices (PCS) PatientsAt Risk for Injury Com-mittee continuously mon-itors and analyzes falldata gathered through theMGH Safety ReportingSystem. The committeereviews all fall data quar-terly and reports theiranalysis to Patient CareServices leadership.

The Patients at Riskfor Injury Committeecollaborates with othergroups and committeesto introduce improve-ments such as a review ofcurrent standards or theintroduction of safetyequipment. The recentrevision of the Nursing

Assessment Form to in-clude the use of theMorse Fall Scale is oneexample. Nurses assesspatients upon admission,every 24 hours thereafter,or whenever the patient’scondition changes. Thescale quantifies the pa-tient’s risk for falling byevaluating his/her historyof falls, secondary diag-noses, mobility aids,reliance on equipment,gait, and mental status.The assessment is docu-mented on the PatientCare Flow Sheet. Nursesmatch interventions topatients’ specific risksand document them onthe Intervention Sheet.The policy, “Risk forInjury: Falls,” in the Nurs-ing Practice Manual

Quality & SafetyQuality & SafetyThe MGH Fall Reduction

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

E

provides guidelines forthe assessment/interven-tion process.

Another example isthe introduction of newhospital beds. One fea-ture of the bed is a tri-level alarm system thatcan be set based on eachpatient’s individual riskfactors. Strategies are inplace to prevent falls andidentify opportunities forimprovement. Guidelineshave been establishedthat target the safety is-sues of specific patientpopulations (such as theon-line Problem/Out-come/Intervention Sheetand clinical pathways forManaging Patients withDelirium, Dementia andAlcohol Withdrawal).Guidelines have alsobeen established for pa-tients who require re-straints for medical-sur-gical or behavioral rea-sons. The Patients atRisk for Injury Survey

was developed for use inclinical areas and imple-mented to help identifyopportunities for im-provement.

Hospital administra-tors and clinical leader-ship ensure that MGHpolicies are consistentwith JCAHO standards,but every clinician isresponsible for assess-ing and re-assessingpatients’ risk for fallingand adhering to MGHpolicies and procedures.

For more informa-tion on the MGH FallReduction Program orrelated policies and pro-cedures, go to the on-line Clinical Policy andProcedure Manual, theNursing Policy Manual,the Nursing ClinicalPractice Manual orClinical Pathways: Pro-blem/Outcome/Inter-vention Sheets. Or con-tact Katie Farraher at6-4709.

headlines the mgh protech inside: program: opening doors€¦ · september 7, 2006 headlines...

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