BIDMC News and Notes
5/14/2012 (3:35:41pm)Tags: telemetry quality safetyComments: (0)
As nurses took a seat in the BIDMC auditorium, a beeping noise in the background could be heard every few seconds. Natalie Fealy, RN, took her place behind the podium and asked the crowd if they remembered hearing anything as they settled in for Nursing Grand Rounds.
Most of the crowd acknowledged the noise, but several had not heard it. The sound had been an actual recording from a floor of the "leads-off alarm," the alarm meant to alert clinicians when a patient's lead wires measuring their vital signs fall off. Alarm fatigue occurs when a clinician becomes desensitized to the sound and fails to respond. This national problem is being addressed on a local level at BIDMC, said Tricia Bourie, RN.
"We are being thoughtful about the changes we are making," said Bourie, who sits on BIDMC's Telemetry Task Force.
Telemetry involves attaching lead wires to a patient to monitor their heart rate, blood pressure and other vital responses. An alarm sounds if the patient's measurements are too high or too low or if the wires detach from the patient.
Some practice changes to emerge from the task force include additional monitors being installed in the back hallways so that all patients' vitals could be accessed at different points along the unit.
Nursing leadership is also reminding staff about the importance of a two-person telemetry initiation when a patient arrives on the floor. This involves a nurse and a patient care technician calling the nurse's station to give the room number of the patient, the telemetry box number and two patient identifiers to ensure the correct patient is being monitored.
"One change we asked from nurses was that they do not turn an alarm off from the desk," said Linda Denekamp, RN. "When you respond to a leads-off alarm, once you reattach the leads, the alarm turns itself off. If you turn the alarm off from the desk and then get distracted on your way to the patient's room, you run the risk of forgetting to respond to that original alarm."
Further changes are also in the works, according to Bourie. She said alarm sounds will be changed to prevent desensitization. Instead of having an alarm sound when a battery is low, a visual cue will be used instead. Varying sounds will be used for alarms that signify a patient getting up from their bed or chair versus a drop in their blood-oxygen level.
Electrodes connecting the lead wires to a patient will now be changed daily to prevent loss of stickiness and leads-off alarms. All patient care technicians underwent a telemetry competency test to ensure they were aware of the daily electrode replacement and the proper place to affix lead wires. The medical center also switched to snap lead sets, which stay on a patient better, decreasing the number of leads-off alarms.
Changes to Provider Order Entry orders for telemetry, a review of alarm defaults and purchasing the latest in telemetry technology are all on the horizon as well. The latest advances in telemetry technology allow nurses to query alarms for a unit, display information in waveform and show if lead wires are connected.
"We do not want to overwhelm our nurses with information, but we do want to ensure we are providing the best and safest patient care," Bourie said.
5/11/2012 (12:46:42pm)Tags: noneComments: (0)
The Carl J. Shapiro Institute for Education and Research at BIDMC has announced the 2012-2013 Rabkin Fellows in Medical Education, a training program that offers participants to develop their teaching skills.
The class includes Caryn Dutton, MD, MS, Obstetrics/Gynecology, Brigham and Women's Hospital; Elizabeth Farrell, MD, Hospital Medicine, BIDMC; David Fessler MD, MPH, General Medicine and Primary Care, Infectious Disease, BIDMC; Stewart Lecker, MD, PhD, Nephrology, BIDMC; Michele Walters, MD, Radiology, Children's Hospital Boston; and Mark Wyers, MD, Vascular Surgery, BIDMC.
"The Rabkin Fellowship not only provides the fellows with the knowledge and skills necessary to be effective teachers and leaders in medical education, it also fosters a growing and vibrant community of educators - one that serves as a rich source of support, advice and research collaboration," says Christopher Smith, MD, a co-director of the program.
The Rabkin Fellowship was established in 1998 to provide Harvard Medical School faculty with dedicated time to develop further the expertise and skills needed to launch or advance academic careers in medical education and/or academic administration. The Fellowship in Medicine Education is named for Mitchell T. Rabkin, MD, the CEO emeritus of Beth Israel Hospital.
Rabkin Fellows are required to undertake an analytic study, research or an educational project focusing on an important issue in medical education. Fellows select a mentor to help guide their work in developing this project. The fellows provide additional support and peer review for each others' projects over the course of the year. Rabkin Fellows present the results of their projects in a written report as well as orally at a concluding symposium.
The Fellows have welcomed the opportunity to grapple with medical education topics not typically considered in their usual roles within the academic medical center. The Fellowship provides an experiential learning laboratory in which the Fellows can implement the knowledge, skills and attitudes needed for organizational change and leadership with peer and faculty feedback and support. Many graduates of the program have subsequently led significant curricular and programmatic changes at their respective affiliated institutions. Moreover, a number of graduates have assumed educational leadership positions at the local, regional and national levels.
"Our evaluation of the Fellowship shows that the program fosters the graduates' sense of identity as medical educators as well as the skills necessary to enhance their personal and professional development," says co-director Lori Newman.
5/10/2012 (10:19:51am)Tags: nurses nursing qualityComments: (0)
The cheers coming from Fenway Park were not for the Red Sox, the Rolling Stones or the Liverpool Football club. Instead, nurses were the star attraction on Monday night at what was arguably the hottest ticket in town - the annual BIDMC Nursing Awards ceremony at the State Street Pavilion club high atop Fenway Park.
It's a special night to honor many of the wonderful contributions to excellent patient care provided around the clock by BIDMC nurses. This year, 64 nurses and three nursing assistive personnel were honored through 20 awards. An additional 29 employees were honored with nursing scholarships amounting to $100,000 (two are pursuing their initial nursing degree, 10 are working for their bachelors of science degree in nursing, and 17 are enrolled in master's degree programs).
President and CEO Kevin Tabb, MD, congratulated the nurses winning awards and thanked all the nurses present for their hard work. "It is true that I'm a physician, but I also worked for four years as a nurse in a CCU," Tabb said. "I spent two-to-three nights a week in a CCU while in medical school in Israel where almost all medical students work first as a nurse. That experience certainly gave me an incredible understanding and appreciation for what each one of you does every day. Could you imagine if we did that here, if all physicians first worked as a nurse?"
Sam Kennedy, Executive Vice President and Chief Operating Officer for the Red Sox, whose son and daughter were both born at BIDMC, welcomed and praised the nurses, saying, "I know for a fact this is the most important group within the walls of BIDMC."
Cindy Phelan, RN, Interim Vice President, Patient Care Services, and Chief Nursing Officer, and Laurie Bloom, RN, Director of Professional Development, hosted the Lois E. Silverman Department of Nursing Awards Ceremony.
"We are in a sea of change, as it seems we always are," said Phelan. "But despite the unknowns we're able to focus on what's really important - and that is our patients and our nursing practice. I know that's the case because all things point to our success. Infections are down. Patient satisfaction scores are up. The number of falls resulting in injury are down. The number of our nurses involved in research and academic pursuits are up. None of that would be possible without your hard work and dedication."
Bloom kicked off the awards by introducing a special tribute video presentation about the 11 nurses selected by their peers for the Gitta and Saul Kurlat Award for Nursing Excellence and the Edward and Marilyn Schwartz Awards for Excellence in Nursing Practice, many of whom were nominated for outstanding patient advocacy, patient education, peer education and/or spirit.
The applause from colleagues was rock star worthy over the course of the two-hour-plus ceremony as awardees pinned with corsages were called forward to accept their awards presented by department chiefs, physicians and nursing leaders.
"Some people think I'm the boss; some people think Bruce Springsteen is the Boss. Belinda is the boss," Mark Josephson, MD, Chief, Cardiovascular Medicine, joked in presenting the CVI Excellence in Cardiovascular Nursing Award to Belinda Morse, RN, Clinical Advisor, Electrophysiology Service.
"Belinda does her job with fire, intensity, compassion and patience. Help and care are of paramount importance," said Josephson. "God help anyone who crosses that code she has about her patients."
Before presenting the Internal Medicine Residency Nursing Excellence Award to Alexandra Smith, RN, Julius Yang, MD, PhD, Hospitalist, gave his heartfelt thanks to the BIDMC nursing staff for the exceptional care he witnessed as a family member when his mom was being treated for cancer.
"She was very brave, but she was very scared and watching her struggle with her cancer diagnosis I observed the way you took care of her," said Yang. "The doctors (helped) yes, but it was the nurses who truly gave her the strength, the dignity and the comfort she needed in her last years of life. My family is forever grateful for that."
In presenting the award to Alexandra "Cassie" Smith, RN, he spoke of how the award, now in its 10th year, was created at the suggestion of residents who felt that their best mentors and teachers - the nurses - were slighted when it came recognition at the annual teaching awards.
"We learn so much in how to care for patients, how to care for patients families, how to care for each other, how to manage, and how to lead from the role models we have on our units every day," said Yang. "Cassie has been a great role model on CC7 for four years now. It's been great to watch her develop into an outstanding manager and leader for all of us as she's taken over the role of resource; teaching not just her colleagues, but also the residents and interns. And for that we are all very grateful."
Between praising the passion and professionalism BIDMC nurses exhibit on behalf of their patients, the night was also a celebration of friendship and love shared between colleagues and friends.
"I've been a BID nurse for so long," Yole Morocco, RN, a 35-year veteran of the Emergency Department, said afterwards when asked what it meant to win the Excellence in Emergency Nursing Award, "I grew up here. I met my husband here. All my friends are here. It's like family. And it's just nice to be recognized."
5/10/2012 (9:57:11am)Tags: diversity neonatologyComments: (0)
DeWayne Pursley, MD, right, is congratulated by Reed Tuckson, MD, FACP, this year's Howard, Dorsey, Still Visiting Lecturer at HMS.
When nominating him for the Harold Amos Faculty Diversity Award, DeWayne Pursley, MD, MPH, Chief of Neonatology, was hailed by his colleagues for building a culturally diverse department, for emceeing BIDMC's annual Martin Luther King, Jr., celebration and for his contributions health disparities research.
"This was certainly not expected, but it is a nice acknowledgement," Pursley says.
His nominators made accurate assessments of their chief and colleague. Since the creation of the Department of Neonatology in the early 1990s, Pursley has attracted an impressive roster of physicians from a variety of cultural backgrounds. The department boasts young and older physicians with African American, Asian American and Latino roots.
"We even have a Yankees fan," Pursley jokes. "We recruit the most talented physicians. We have an amazing group of faculty who provide outstanding care and have made important academic contributions in newborn medicine. They also wonderfully reflect the populations of patients they serve. I think we have set the benchmark for diversity in the Harvard Medical School system."
The Harold Amos Faculty Diversity Award recognizes Harvard Medical School faculty who have made significant achievements in moving the School toward being a diverse and inclusive community.
In addition to having a diverse department, Pursley's philosophy on education and research exemplifies the award's ideals. He hosts eighth grade students from Boston Public Schools as part of the Red Sox Scholars Job Shadow Day each year, giving them, and other middle and high school students, a personal tour of the NICU. He encourages his staff to take advantage of BIDMC's many Pipeline programs to advance themselves into challenging careers in health services. Each summer, Pursley's department partners with neonatology colleagues at Brigham and Women's Hospital and Children's Hospital Boston to engage college and medical students of all backgrounds from around the country in research projects.
"For the middle and high school students, I try to demonstrate the importance of teamwork and how each role in the NICU from physician to respiratory therapist to nutritionist to nurse is important to the care and health of the baby," Pursley says. "I want to show students the rich options for careers in health care."
Pursley's research is focused on racial and social disparities in infant mortality. He says his time in medical school and earning his master's degree in public health laid the foundation for this investigative work.
"My first introduction to the newborn exam was by Dr. Will Cochran, my predecessor at BIDMC. I enjoyed my pediatrics rotation and when the attending physician took me into the NICU, I thought, ‘This is it,'" Pursley says. "I liked the idea of being an age-based generalist and the breadth of clinical experience there. There was also a public health perspective present because you are exploring approaches to improve care access and quality for underserved women and their babies. That is what motivated my master's in health policy and management and laid the seeds for my research into disparities."
Pursley's commitment to underserved populations is shared by his family. His wife recently returned from an orphanage in Tanzania and spent a month with their two daughters working in Malawi when they were high school students. His son graduated with a degree in economics at Vanderbilt, but chose as a first job to be a counselor at an all boys high school in Chicago's South Side.
"I'm very proud of my faculty and my family," Pursley says.
5/9/2012 (1:27:41pm)Tags: nursing stress responseComments: (0)
Marybeth Meservey, NP, left, and Donna Feeney, RN engage in the listening exercise.
Nurses move at a nonstop pace and that can take a toll both physically and emotionally. In a nursing week, lunchtime grand rounds session Tuesday, palliative care physician Heidi Blake, MD and integrative medicine fellow, Michelle Dossett, MD, PhD, introduced the concept of mindfulness as a way to ease the impact of daily stresses, especially those related to the suffering nurses so often encounter.
Dossett described mindfulness as a way of purposely paying attention in the present moment, non-judgmentally. "As nurses, as clinicians, we're all juggling a lot, and mindfulness can be used to bring focus and help us with this juggling act," she said.
Studies have shown that employing tools like yoga and meditation can have shared benefits across the patient-provider relationship. Former BIDMC cardiologist, Herbert Benson, MD, showed that the "stress response gets turned down during mediation," Dossett said. Other studies have shown that these tools can help health care workers lower anxiety and work-related burnout and increase empathetic responses.
"Over time, practicing mindfulness can help care givers develop qualities that are relevant to better patient care," said Dossett. "And one study of clinicians who practice mindfulness and meditation reported improved treatment outcomes for their patients."
According to Blake, generally, at least 10 minutes of daily meditation is recommended for lasting change, but "taking any amount of time to center yourself is valuable." She led the nurses through a five minute guided mediation where they were asked to let go of everything else and focus only on their breathing.
"I was really fighting it. My mind kept wandering to what I have to do this afternoon," said Katherine Brideau, RN. "When my mind wandered, I liked that I could come back to concentrating on my breathing."
After the focusing exercise, Blake and Dossett asked participants to pair up and take turns sharing a story about a time when each was truly present with a patient or family who was suffering. The listeners were asked not to speak or give advice, but simply to be mindful and present.
"It was amazing to experience the stress in her voice," said one participant. "I could really put myself where she was. It's exactly what I have felt before," said another.
"We should do more of this kind of thing. It's something they don't teach you in nursing school," said Marybeth Meservey, NP. "You just have to go through it and learn once you're on the floor."
Blake and Dossett left participants with a simple, informal refocusing tool that anyone can use at home, with colleagues or before entering a patient room. The tool is called STOP where S asks a person to Stop; T means Take an intentional breath; O is a reminder to Observe the thoughts and feelings that are happening in the moment; and P stands for Proceeding with non-judgmental awareness.
Over time these simple mindfulness exercises, say Blake and Dossett, can have benefits at home and at work, reducing stress, anxiety and depression and helping individuals become more compassionate care givers.
5/4/2012 (1:57:08pm)Tags: noneComments: (0)
BIDMC President and CEO Kevin Tabb joins in the tribute to Al Agress, marking his 45th anniversary as a volunteer. (Photo by Bruce Wahl)
The packed crowd erupted into applause for Alfred "Al" Agress, offering a standing ovation to mark his 45 years as a volunteer at BIDMC.
"His main focus for the last 29 years has been the maker of baby hats for the hospital nurseries," said Volunteer Services Program Coordinator Terry Morgan. "Al has literally gone through miles of stockinette, cutting it to exact lengths for the NICU, Labor and Delivery and the Feldberg nurseries, then carefully folding the brims and taping the tops. In these last few years that has been about 18,000 baby hats per year."
Agress began his volunteer career supporting the Volunteer Workshop at BIDMC. The workshop was originally located off-site and Agress would pick up need items needed or drop off creation. When the workshop moved on campus, Agress continued to assist by gathering and storing supplies.
He then switched to baby hat construction. Morgan said Agress came to her a couple of years ago questioning how cost effective it was for him to create the hats.
"We calculated the cost of the stockinette and masking tape with the cheapest manufactured hat we could find from vendors and found that making the hats saved the hospital about $156,000," Morgan said. "We are grateful for Al's 45 years of service and support of our littlest patients and their caretakers."
5/2/2012 (12:55:54pm)Tags: HIV AIDSComments: (0)
Michael Wong, MD, (standing, center) an infectious disease doctor at BIDMC and a member of the AIDS Action Committee Board of Directors, joined with other leaders as Massachusetts Gov. Deval Patrick signed legislation designed to easy the ability to administer HIV screen tests.
The legislation replaces the need to get a written consent.
According to the Centers for Disease Control, an estimated 25,000 and 27,000 people are living with HIV or AIDS in Massachusetts and 21 percent of them are unaware they are HIV positive.
"We cannot end the AIDS epidemic in Massachusetts if those who are HIV positive are unaware of their status," AIDS Action President and CEO Rebecca Haag said in a statement. "Increasing HIV testing will help get those infected into care and treatment earlier and will result in better health outcomes and lower health care costs for those who are living with HIV."
(Photo by State House News Service)
4/27/2012 (2:57:17pm)Tags: noneComments: (0)
Emily Carmen walked into the BIDMC's Kirstein Living Room and clapped her hands over mouth in surprise. Before her stood her colleagues and managers in Linen Services as well as senior leaders from Patient Transport, Support Services and Neonatology to celebrate naming the clean laundry room in the east campus basement in her honor.
"You have given us 43 years of service and that is an incredible achievement," said Bob Cherry, Senior Vice President, Support Services. "Every time we fold a towel or deliver linens, we will think of you."
For more than four decades, Carmen has delivered clean linen to departments, making sure they have the supplies they need to keep patients warm and comfortable. In recognition of her dedicated service, the laundry room in the east campus basement has been named the Emily Carmen Clean Linen Room.
Ralph Fiore, Manager of Linen Services, presented Carmen with an identical plaque to the one that will sit outside the room and said that Carmen was a steady presence in the department, having never called out sick.
"When I came here three years ago, I asked about my staff on the east campus," Fiore said. "They told me, ‘Wait until you meet the woman who runs things over there. She knows everything and has it all under control.' Emily, you are irreplaceable."
Nebiye Woldehaimanot, Manager of Patient Transport and a former Linens Manager, recalled Carmen being an excellent teacher to new staff and setting high expectations for her colleagues.
"I managed her, but really she managed me," Woldehaimanot said with a laugh.
DeWayne Pursley, MD, MPH, Chief of Neonatology, said knowing Carmen was always at the ready with fresh linen for the hospital's tiniest patients made his job a little less stressful.
"Emily personalized a way to show her dedication to patient care without actually needing to put a hand on a patient," Pursley said.
Carmen said she tried to maintain a positive attitude each day because "you meet all kinds of people and never know what they are going through." She called her colleagues "her family" and said she had two wishes for them.
"I hope you continue to love me and I hope that whoever takes my place will make sure you continue to get your towels and linens," she said.
CAPTION: Emily Carmen receives a citation from Bob Cherry, Senior Vice President of Support Services marking the naming of the Clean Linen Room in her honor.
4/20/2012 (3:36:06pm)Tags: malpractice patient safetyComments: (0)
BIDMC's lead role in a pilot aimed at trying to reform the medical malpractice system gathered considerable attention this week.
Ken Sands, BIDMC's senior vice president for health care quality, led a team that worked with the Massachusetts Medical Society to design a "Road Map to Reform." BIDMC, BID-Needham and BID-Milton will be among the seven hospitals participating in the trial.
The Boston Globe highlighted the effort in a front page story. That was followed by interviews with Sands on WBUR-FM, NECN and WAMC-FM in Pittsfield, among other outlets.
The program relies on the idea of doctors and hospitals disclosing medical errors, apologizing for them and offering a settlement that would not involve the court -- although patients would retain their legal rights.
A report published earlier this year by the US Department of Health and Human Services found that 80 percent of medical errors are unreported. This program is modeled after a successful process launched at the University of Michigan Hospital that has drastically reduced the number of lawsuits and amount of money spent on medical malpractice premiums.
4/19/2012 (11:03:08am)Tags: noneComments: (0)
A marathon runner had just passed mile 25 on the Boston Marathon route when he staggered and collapsed. His 34-year-old son and running companion – along with a police officer and another runner – carried the barely-responsive marathoner to the roadside.
A physician spectator jumped the barrier and performed cardiopulmonary resuscitation minutes before a Boston EMT used an automated external defibrillator (AED) on the then-63-year-old marathoner. He was taken to Beth Israel Deaconess Medical Center, where he became responsive en route to the hospital and was released three days later.
This survival story in 2010 is one of three cardiac arrest collapses on the Boston Marathon route since its debut 115 years ago. The other two men, in 1973 and 1996, were not so fortunate and passed away.
The differences between this man’s survival and the two previous fatalities are timing and technology. The likelihood of survival decreases by 10 percent for each minute of delay from collapse to CPR to defibrillation, according to a February 2012 article in Pacing and Clinical Electrophysiology (PACE), co-written by retired BIDMC cardiologist Stafford I. Cohen, MD, and Ethan R. Ellis, MD, Cardiology Fellow.
“A person’s best chance for survival, if he or she collapses on the marathon route, is to be given immediate CPR and prompt AED,” said Cohen. “CPR can extend the time until AED is used. Timing is crucial because your brain needs oxygen.”
Instances of cardiac arrest on the course are rare, and most cases are caused by underlying cardiac problems, such as the 1996 victim who had a suggestive history of coronary artery disease and took 5 ½ hours to reach the finish line, where he collapsed.
“The likely profile of a runner at risk for cardiac arrest during a marathon is a history of coronary artery disease, older age and being on the course for more than four hours,” Cohen and Ellis wrote. The age of 35 separates older from younger runners. Men are more prone to cardiac arrest during physical exertion, but the reasons are not perfectly clear, according to Cohen.
“Marathons are grueling and involve hard cardiac work,” said Cohen. “It is a stressor for preexisting heart conditions.”
This does not mean that running a marathon should be avoided, but rather runners should thoroughly and properly train for it. “The Boston Marathon is a qualifying race for the Olympics,” said Cohen. “It’s understood that training for a marathon is healthy. If you’re not healthy and haven’t had your physician’s approval to run a marathon, you shouldn’t enter.”
Despite the risk factors, the odds of suffering cardiac arrest on the course are low, with a range as high as one in 200,000. The survival in 2010 was Boston’s first, “a statistic to be added to the growing number of fortunate runners whose lives have been restored with chest compression and an AED while on the pavement of a marathon,” Cohen and Ellis wrote.
This year, the American Red Cross is offering CPR training to runners, their friends and family members so lifesaving efforts can begin sooner. Community police vehicles and ambulances are also equipped with AEDs, and runners’ medical needs are assessed upon their completion of the marathon. Those with problems are triaged to medical tents with advanced lifesaving capabilities, set up just beyond the finish line. On race day, approximately 60 AEDs are also placed along the route.
“Organizers have to be prepared,” said Cohen. “They never know what will happen.”
