heart of the matter - summer issue vol 1

THE HEART OF THE MATTER The Official Newsletter of the Heart & Vascular Institute of New York

Summer Issue Volume 1

l h h e a r t o f t h e m a t t e r @ g m a i l . c o m

Interdisciplinary Care

& Collaboration By: Travis Baird, MS, NP, RN, CCRN

Assistant Nurse Manager- 5 Uris

“Individual commitment to a group effort -

that is what makes a team work, a company

work, a society work, a civilization work.”-

Vince Lombardi

The increasingly complex healthcare

environment encourages active and dynamic

collaboration among healthcare providers.

With changes in the delivery of care and the

introduction of the Affordable Care Act, many

people will be able to afford insurance; this in

turn will create opportunities for quality of

care to be provided to millions of Americans

who were previously uninsured. With reform,

healthcare systems will compete to offer the

best patient and family centered services,

the most current medical innovations, and

positive outcomes found on evidence-based

practice. Reimbursement from government

and insurance payments will rely on positive

outcomes, transparency, and quality of care

from healthcare systems. Achieving positive

outcomes will depend on the dynamic,

coordinated, and interdisciplinary efforts of

its healthcare participants. Many

organizations such as Kaiser Permanente

and the Robert Wood Johnson foundation

have been looking at ways to improve the

communication and coordination of care

among healthcare professionals, developing

successful models of interdisciplinary

collaborations that have gained admiration

and support from the Institute of Medicine.

Ideally, all healthcare systems should work in

synchrony and provide care that is superb

and patient centered. However, many

healthcare professionals and some

institutions continue to operate in virtually

separate domains. An atmosphere of

isolation and lack of communication

continues, and is affecting efficient delivery

of care for patients and their families. At the

North Shore-LIJ -Heart and Vascular

institute, the vision of the future emphasizes

teamwork and collaboration in which,

interdisciplinary teams work together to

ensure that all our patients receive care that

is individualized, coordinated, and tailored

using the most innovative methods to

achieve superior patient care results. The

first issue of this nurse-driven cardiovascular

newsletter focuses on the collaboration,

teamwork, and interdisciplinary care that

exist among our healthcare team members.

Cardiovascular services embody complex

and often dynamic sub specialties designed

to improve heart and vascular care and

outcomes. The importance of working as a

team is directly correlated to patient

satisfaction and overall quality of care.

Working together towards a common goal

enhances better outcomes and increases

patient and family satisfaction, and gives the

provider, and allied healthcare team

members the commitment and joy of

performing at their best with each patient

they touch.

In this issue

Editorial staff

Travis Baird, MS, NP, RN, CCRN

Editor in Chief

Kae Dian Long, RN, MSN, MHA, FCCS

Editor

Lauren Woods, BSN, RN, CCRN, TNCC

Editor

Fredda S Pearlson, RN, BA

Editor

Meet our team

Success stories

Forum of knowledge

New faces and MD forum

Person of interest

Congratulations to Christine Reid, RN

from 5 East / CCU who submitted the

winning title for our newsletter:

“The Heart of the Matter “




CTICU By: Ashley Dorfman, RN, BSN Assistant Nurse Manager 9E/L CTICU

Paula Christensen RN, BSN, CCRN

Assistant Nurse Manager 9E/L CTICU

Binky Uy RN, MSN

Nurse Manager 9E/L CTICU

9East/9Lachman is a CTICU and step-down

telemetry unit that specializes in a wide

variety of innovative and groundbreaking

open heart, thoracic and structural heart

procedures. As a division of The Lenox Hill

Heart and Vascular Institute; we take pride in

being at the forefront of new advances in

cardiac surgery and minimally invasive

cardiac and thoracic procedures. The care

we provide to our patients postoperatively is

equally specialized and innovative. A unique

aspect of 9East/9Lachman is that the CTICU

and the step-down unit essentially function

as one. All RN's, PA's, Physicians, Nursing

leadership, case managers, social workers,

and physical therapists rotate through both

units; providing continuity of care for our

patients, as well as unity among all

disciplines. Having a cross-trained team

guarantees the highest level of critical

thinking skills and ensures optimal patient

care. We collaborate as an interdisciplinary

team in our daily 9am and 6pm rounds;

where each team member's role is integral to

providing extraordinary patient care. One of

the unit-based projects that exemplify how

we strive for excellence is the Quality

Ambassador initiative. This project was

developed to promote awareness,

motivation, and ownership of quality and

core measures among the frontline staff. In

this ongoing project, we have selected

certain quality metrics and core measures to

focus on; and designated 2-4 of our RN's

and PA's to spearhead a certain area of

quality. Physicians participate by leading our

interdisciplinary rounds and ensuring core

measures were addressed on each patient.

This creates a great sense of cohesiveness

and teamwork, in which all members are

working towards a shared goal. The

contributions and hard work of each team

member has enabled us to maintain

compliance with a majority of our quality

metrics (zero CLABSI for 2 years, zero

CAUTI for 9 months, and zero VAP for 9

months). This in turn, translates into the

highest quality of care for our patients.

Binky Uy , MSN, RN

Ashley Dorfman, BSN, RN

Paula Christensen, BSN, RN, CCRN

EPS By: Christine Brown, RN

Nurse Manager, EPS

Electrophysiology is experiencing increased

growth within the cardiology department.

Advancements in technology enable us to do

procedures in less time and with more

accuracy. The Electrophysiology Lab

performs many procedures and diagnostic

tests including: Atrial Flutter and Fibrillation

Ablation, Ventricular Tachycardia Ablation,

SVT Ablation, Permanent Pacemaker

Implantation, Implantable Cardiovertor,

Biventricular Implants, Tilt Table Test,

Cardioversion, and Loop Recorder Implant.

The Electrophysiology team includes;

Electrophysiologists, RNs, Nurse

Practitioners, PAs, Clinical Nurse Specialist,

Cardiovascular Techs, and House Keeping.

Electrophysiology will soon start the process

of building a new lab in order to

accommodate anticipated increased growth.

We use the shared mental model approach

in non-invasive cardiology in which, the

patient is at center of our model and each

patient’s experience is enhanced by our

team approach.

What is a Cabrera’s sign? By: Kae Dian Long, RN, MSN, MHA, FCCS

Nurse Manager- 5 Uris

Is a notch of the S-wave in leads V3 and V4

and used to diagnose Acute Myocardial

infarction in the presence of left bundle

branch block- EMS12lead




PCU By: Lauren Woods, RN, BSN, CCRN, TNCC

& Elizabeth Renaud, RN, MHA, PCCN

Assistant Nurse Managers- 5 Uris

5 Uris or the progressive care unit (PCU) is a

37-bed unit consisting of cases ranging from

cardiac post- operative percutaneous

coronary interventions, diagnostic

catherizations, to vascular cases such as

endovascular aneurysm repair, femoral

popliteal bypass, and amputations. PCU has

undergone a profound process of transition,

in which the unit now is able to absorb a

dynamic population of surgical, cardiac, and

medicine patients. Our staff consists of

critically trained nurses, PAs, fellows, social

workers, case managers and private

physicians who work collaboratively to

provide the best care for our patients.

According to the American Association of

Critical Care Nurses, the number of

progressive care units will be significantly

higher in the years to come to provide care

for a wide variety of patients in need of high-

intensity nursing care and increased need for

surveillance. To able to work in PCU, nurses

must possess certain levels of competencies

and specialized education to provide care for

a diverse and multifaceted population.

Lenox Hill’s PCU was originally developed to

care for patients with cardiac diseases who

required constant cardiac monitoring. But

with the changes of healthcare reform and

the increasingly complex patient population,

PCUs are now designed to be eclectic and

provide an array of services to adapt to the

widely varied patient population. It can be

thought of as a bridge between an intensive

care unit and a medical surgical unit. Our

nurses are specifically trained in basic and

advanced cardiac life support, as well as

other related cardiac, surgical, and vascular

services all designed to provide the best care

possible for our patients. The collaborative

care model is evidenced by the daily

interactions among all healthcare team

members. Frequent rounds occur throughout

the day, whereby nurses, physicians, social

workers, case managers, physical therapy,

and nursing leadership are intimately aware

of each patient’s medical condition and

disposition of care. This method of working

collaboratively ensures clarity of information

and better quality of care. The collaborative

care council is working concurrently on two

projects for 2014; first, improving the

communication between midlevel providers

and nurses, and second, reduce the amount

of time a patient is kept without food before

and after surgery. Our co-chairs are Nicole

Lamoureux, RN, Sarah Linhares, RN, and

Amelia Moodie-Thomas, RN.

Lauren Woods, BSN, RN, CCRN, TNCC

Elizabeth Renaud, MHA, RN, PCCN

Accelerated Idioventricular Rhythm or

AIVR is one of the most common rhythm post cardiac arrest and reperfusion, following

resolution of infarct, commonly seen in the cath lab setting following PCI. – EMS12Lead

What is a collaborative care council? By: Nicole Lamoureux, RN and Amelia Moodie-Thomas, RN- 5Uris

The main focus is collaboration and

participation from all interdisciplinary teams

with the singular goal of enhancing and

improving overall patient care and

satisfaction. One of 5 Uris’ projects for 2014

is improving the communication and

dissemination of information between

physician assistants and nurses by engaging

in active patient-centered daily bedside

rounds.

From left to right: Nicole Lamoureux, RN,

Anthony Evangelista, RN, Olga Verbitskaia,

RN, and Amelia Moodie-Thomas, RN




Patient Care Services

for Cardiology

Paulina Flores, RN, MSN Director,

I’ve been at Lenox Hill for more than five

years, and have been with the Cardiology

Department for more than two years. During

my nineteen years in leadership I have been

a Nurse Manager, Clinical Leader, and have

completed the NSLIJ High Potential

Program. I am currently enrolled in the MBA

program at Hofstra Zarb School of Business.

The cardiology department has always been

a unique group full of committed, capable

and talented staff members. And now, with

the many new staff members and Assistant

Nurse Managers, teamwork in the cardiology

department has become more dynamic and

effective. I look forward to its continued

application and growth… and both seeing

and being part of, the differences it will

make.

Critical Care Educators Nadine Minto, RN

I have worked for the last four years as a

Critical Care Educator at Lenox Hill Hospital.

Previously, I worked as a staff nurse on the

cardiothoracic unit and as an Adjunct

professor at Adelphi University. Learning is a

“lifelong process”, that requires active

participation and collaboration between

student and professor. I am very pleased to

see how much the education department has

grown at Lenox Hill Hospital, because the

institution believes in its continued

importance to enhance and develop better

collaborators. Bigger and brighter things

such as; doctors and nurses learning,

training, and working together awaits us in

the near future.

Michele Miltner RN, BSN, CCRN

I have a bachelor’s of science in nursing from

Mount Saint Mary College and a member of

Sigma Theta Tau. Early in my career, I worked at

Huntington Hospital for two years on a medical

surgical unit. I came to LHH in 2011, and

completed the first cardiothoracic ICU fellowship.

In my career at LHH, I frequently took charge,

precepted, and became member of CCC. I am

also a member of AACN and completed my

CCRN certification in 2012. In July 2013 I joined

the NSLIJ Lenox Hill Health System’s education

department. I will be graduating in the fall of 2014

with a master in nursing education from Molloy

College. In my current job description I am

ACLS/BLS instructor, an I-learn administrator, a

critical care educator for cardiothoracic ICU and

help coordinate and master programs for the

nursing fellows for the fellowship. The education

department is proactive and dynamic, because we

work collaboratively with many disciplines such

as; Quality Management, Pharmacy, and Dietary

among others, to ensure all our nurses and allied

health team members are competent and

comfortable performing their functions.

Success Stories at Lenox Hill Hospital!

Sean Conway, NA 5 Uris Wins the first Patient and Family Centered Caring Heart Award

Sean receiving his Caring Heart Award.

5 Uris nursing staff with Sean.

Sean with the 5 Uris Leadership




NSLIJ (Lesbian, Gay, Bisexual, and

Transgender) LGBT Pride Parade

“We had a blast participating on our NSLIJ

systems very first LGBT Pride Parade. The

community is excited to hear that Lenox Hill

HealthPlex will be opening soon this

summer. Hopefully you can join us next

year.” Ian Saludares, RN - nurse leader from

CCU participated in the first ever Pride

Parade for NSLIJ health system.

Night Nurse at Cabaret Cinema- July 11th

Edna Igoe, RN 9E/L has been named guest speaker at the Rubin Museum for the film “Night Nurse at Cabaret Cinema” July 11th

NSLIJ 2014 NYC Heart Walk

Telemetry Technicians By: Diana Worrell, Coordinator and Fredda S

Pearlson, RN 5 Uris

Lenox Hill telemetry technicians have been

an essential part of keeping all of our

patients requiring cardiac monitoring safe.

The monitor techs are integral to trouble

shooting any problems as they may arise for

monitored patients. They work closely with

registered nurses, physician assistants,

nurse practitioners, and any others who have

primary, direct contact with the patients.

Before I began supervising our team of

telemetry techs on June 2013, the group of

20 was managed by five different managers

or supervisors, each with their own

management style. This situation resulted in

various communication challenges and

issues between and among the techs and

their managers. With the unwavering focus

on teamwork, I began working closely with

the techs and discovered opportunities for

learning, mentoring, and growth. As a result,

out techs today are providing consistent,

quality work. Through their daily efforts, and

as active members of the collaborative care

council, the techs are contributing to the

overall improvements in safety and

satisfaction in patient care, and the patient’s

overall positive impression of LHH. Our

outstanding team of telemetry techs knows

and appreciates that their daily efforts help

them continue to be valued members of the

cardiology department, and that their

continued contributions to patient care reflect

the best of teamwork in action

Rokiatu Traore becomes certified by the cardiovascular credentialing international- CCI

Monitor techs celebrating their week!

Margaret (Peggy) Daly becomes certified as a registered Medical Assistant




Forum of knowledge!!! Becoming comfortable with the

new hypertension treatment

guidelines!

You enter your patient’s room to hand him

discharge orders and notice that he appears

anxious…You ask him if you could be of

assistance and he says; “Dr. Matter said that

he is switching the blood pressure

medications that my primary care doctor had

me on, because there are new guidelines… I

am not comfortable with that”. Ideally, a

conversation between primary care providers

should have taken place prior to this

meeting. However, as the RN caught in the

middle of this dilemma, you attempt to

assuage your patient’s concerns by seeking

further clarification. Current blood pressure

management guidelines have changed and

you can help reduce your patient’s anxiety by

providing him with the information necessary

to make educated decisions. According to

the American Academy of Family Physicians,

the current guidelines for hypertension are

included in the Eight Joint National

Committee, or also known as JNC8. In

summary, these guidelines will dissuade

physicians and other primary care

participants to provide care for a patient that

is innovative and evidence based. Some of

the current recommendations are: 1)

Initiating medication treatment for patients

with a blood pressure (BP) greater than

150/90 if they are 60 and older with no

comorbidities. 2) If the patient has diabetes

or chronic kidney disease, treatment should

be initiated if a systolic BP is greater than

140 or a diastolic measure greater than 90.

3) In the general population, the initial

treatment of hypertension should include a

thiazide-type diuretic, an ACE or ARB

inhibitor, or a calcium channel blocker.

These new guidelines seek to reduce

aggressive pharmacological treatment of the

elderly and to help simplify the regimen for

licensed practitioners. Thus, as a prudent

nurse you will be armed with the tools

necessary to educate and relieve your

patient’s concerns.

http://www.aafp.org/news/health-of-the-

public/20131218hypertensiongdln.html

New Faces!

Samantha Gavares, RN 5 Uris

As a recently graduated registered nurse, I

am fortunate to begin my career at Lenox Hill

Hospital, 5 Uris. This telemetry unit has

granted me the opportunity to become part of

an interdisciplinary team with the common

goal of providing quality patient care. The

integrative staff consisting of doctors,

physician assistants, registered nurses,

aides, social workers, and other personnel,

brings various backgrounds, credentials, and

skill sets to the floor. Cohesiveness is

essential in the health care profession and

their collaborative efforts to deliver

exceptional care were apparent from my first

day on the unit. This experience has been

both challenging and rewarding. I have

already learned so much and knowing that

there is still so much more to learn can be

overwhelming. Therefore, I would like to

thank my managers, preceptors, and peers

for easing the transition into my new career. I

am grateful for their support and guidance

and look forward to continue working with

them in the future.

Honorable mentions: Robert Carroll, RN 5

Uris, Jonnell Kenneth Robles, RN 5 Uris,

Paula Christensen ANM 9E/L, Catherine

Graviano, RN 9E/L, Olga Verbitskaia, RN

9E/L, Marie Cantillo, RN 5 Uris

MD Forum

Joanelle Lugo, MD Associate Program

Director- Vascular Surgery

I am Dr. Lugo, one of the vascular attending

surgeons. I started last July, so I am

probably one of the newer faces on 5 Uris. I

went to undergrad and medical school at the

University of Michigan in Ann Arbor. I

trained in general surgery at Beth Israel

Medical Center here in Manhattan, and I

trained in vascular surgery at University of

South Florida in Tampa. I am boarded in

general and vascular surgery, and I am

credentialed to read vascular lab as a

Registered Physician in Vascular

Interpretation (RPVI). Here at Lenox Hill, I

am also the associate program director of

the integrated vascular surgery training

program. One of the collaborative care

projects we are developing in 5 Uris will be

monthly educational meetings with the

nursing staff. It will be very informal and

contain instructions on the pre-op vascular

patient, what to look for in the orders and

what to expect. Therefore our nurses will be

better equipped to care for our patients.




5 East / CCU By: Ian Saludares, MPA, BSN, RN, CCRN

Nurse Manager & Maxine Douglas, MSN,

RN – Assistant Nurse Manager - CCU and

Cardiac Telemetry / 5 Lachman

5 East / CCU (Coronary Care Unit) a 12-bed

intensive care unit, is the center for Lenox

Hill’s acute cardiac care providing state-of-

the-art cardiovascular care for its patients.

Through coordinated care, patients are

received from the emergency room and other

cardiac services, including interventional

cardiology and electrophysiology laboratory.

The unit is staffed by a group of talented and

energetic cardiovascular physicians who

undergo a rigorous and competitive

fellowship program. Additionally, the unit has

an equally talented, engaged and energetic

nursing staff highly trained to deal with

cardiac emergency care. Fifty percent of

CCU nurses have acquired their Bachelor’s

Degree and 21% have their Master’s.

Additionally, 32% percent are certified as

Critical Care Nurses (CCRN). The

Collaborative Care Council (CCC) of 5 East

has identified catheter associated urinary

tract infections (CAUTI) affecting our patient

population as early as January of this year.

The CCC collaborated with the entire CCU

medical team and other departments to

address this issue. Currently 5 East has

been 112 days CAUTI FREE. For the past

two years, 5 East’s scores have been on the

green both in Press Ganey and HCAHPS

nurse sensitive metrics. The Beacon Award

for Excellence of the AACN – American

Association of Critical Care Nurses is one big

project that the Collaborative Care Council

plans to start this year. The Beacon Award

for Excellence recognizes individual hospital

units that distinguish themselves by

improving every facet of patient care, and

provides a road map and tools to assist

hospital units on their path to excellence.

Ian Saludares, MPA, BSN, RN, CCRN

5Lachman / Cardiac

Telemetry By: Carmela Marasigan, MPH, RN

Assistant Nurse Manager, CCU and Cardiac

Telemetry / 5 Lachman

5 Lachman is a step-down telemetry unit that

cares for cardiac patients with rhythm-related

diagnoses. Occasionally, however, the unit

receives patients from the MICU step-down

unit or vascular patients. As a result, the unit

and its staff have become versatile in

providing care for patients with diverse

conditions. The unit is staffed by Residents

on cardiac rotation, two full-time Nurse

Practitioners, a case manager and a social

worker who provide collaborative continuous

care for the patients. Patient satisfaction in 5

Lachman has been consistently high in the

last two years, due in part to the nursing

staff’s collaborative team effort and caring

attitude. Patients come first in the unit and,

as one of the many ways that the nursing

staff ensures patient satisfaction; they

created an “NPO (nothing by mouth)

Tracking Tool”. The tool was created to

comprehensively monitor patients’ scheduled

tests or procedures and identify necessity for

patients’ NPO status and prevent patients

from being kept fasting for a long period of

time if it is not deemed necessary. The

nursing staff collaborated with multiple

disciplines such as the Dietary Department

and procedural areas to ensure accuracy of

time of tests and both the necessity and

duration of NPO status. Consequently,

patients were prevented from being hungry

for a long period of time. This project was

one of the finalists for the 2014 Collaborative

Care Council Poster showcase. Initiatives

like this showed the extraordinary

collaboration that staff in the unit put forth.

This year 5 Lachman is piloting a CHF

initiative that is intended to decrease 30 days

readmission rates for CHF patients. This is in

coordination with a hospital-wide CHF

taskforce. The unit is also working with

another pilot project focusing on “behavioral

coaching” for patients by seeking to make

every patient interaction an opportunity to

teach (teaching moments) while striving to

gain patient self-reliance through two-way

nurse-patient coaching. We are hoping that

these two pilot programs will be rolled out at

a hospital-wide level in the future.

Carmela Marasigan, MPH, RN

Maxine Douglas, MSN, RN




As health care transforms, we need strong

leadership to prepare our organization for the

challenges ahead. Not only must we be

known for our quality care and exceptional

service, but also for advancing our mission,

vision and values under unified guiding

principles. Without strong leadership - and

followership - we simply cannot be

successful in the new health care era.

NSLIJ 2014 Leadership Gathering

At the Hilton Hotel - New York, NY

Person of Interest:

Lyndon Guo, RN

Interviewed by: Carmela Marasigan, RN, MPH

Lieutenant Lyndon Guo started working at

Lenox Hill Hospital (LHH) in June 2011 in the

CCU (Cardiac Care Unit). Previously, he

worked in CCU at the Veterans Affairs

Medical Center in Oklahoma City for 4 years.

Since 2011, Mr. Guo has been serving in the

United States Navy Reserves while working

for LHH. In the summer of 2013, he was

deployed to Kandahar, Afghanistan to serve

as a critical care nurse taking care of trauma

patients at the Multinational Medical Unit, a

combat hospital in Kandahar Airfield.

Lieutenant Guo learned firsthand about

collaboration and interdisciplinary care while

working side by side with physicians, nurses,

and medical specialists caring for very sick

patients. Despite the grueling 28-day training

in the US, Mr. Guo found the experience to

care for wounded people intimidating in the

beginning, because, these patients were

affected by the casualties of war. On duty,

he was exposed to TBI (traumatic brain

injuries), amputations from explosions, and

injured children, which caused a lot of angst;

“We had to take care of Afghan civilians,

detainees, police, army, and other coalition

forces such as the British, and the

Australians, contractors, and of course, our

very own soldiers. Some of the Afghan

people are hopeful while others gravitate in

hopeless despair. Their culture is very

different than ours, and in some ways, they

can be very primitive people, because they

can be uneducated, religious, and develop

extremist ideas as a result of being

brainwashed by radical groups such as the

Taliban. These behaviors are no different

than the ones learned throughout

civilizations and history. My job was to care

for any and all patients that I have

encountered. Some patients did well and

continued to live, while others got shot or

blown up, and left to perish on the streets.”

Eventually, Lt. Guo credited military

camaraderie and interdisciplinary

collaboration as the reasons he was able to

adapt to the patient population. He gained

new knowledge and skills, and more

importantly, established new friendships.

Like the healthcare model at home, Lt. Guo

observed that the entire medical team and

nursing staff at the combat hospital worked

together as one team with one goal “one

flight model”, which is, to work together and

achieve the best care and outcomes for the

patients. On his return to the United States,

Lt. Guo found it challenging to reconnect with

friends and family, and especially his two

toddlers, however, it didn’t take him long to

rekindle strong bonds. And with the support

of family and friends, Mr. Guo is back at work

and in school studying part-time to become a

nurse practitioner with advanced holistic

nursing at New York University. Lt. Guo is

also one of the first recipients of the Brave

Heart Award given during the 2014 Nursing

Week Celebration here in Lenox Hill Hospital

last May.

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