Aug. 10 Common Ground: sign those scripts
Aug. 10, 2014
IN THIS ISSUE
practicalPRACTICAL MATTERS
TOP READS
tramadolTramadol to become Schedule IV controlled substance

Tramadol will become a US Drug Enforcement Administration (DEA) Schedule IV Controlled Substance on Monday, Aug. 18. This means that hospital discharge prescriptions for Tramadol will not be transmitted electronically and will print out like all other controlled substances.  It will be subject to all of the other regulatory requirements of a C-IV medication.

 

For more information, contact Joe Schnabel, director of pharmaceutical care, 503-561-5165 or read the DEA backgrounder on its ruling. 

 

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infectionSalem Hospital does well in state's infection report
  • Goal is zero infections from any cause
  • Physician-led efforts play big role
  • Central line and surgical site infections analyzed

The state of Oregon recently issued its annual hospital-acquired infections report. Salem Hospital has relatively low infection rates, either at the same or lower levels than other hospitals nationally. The actual number of infections is very low so having even just one can make numbers look wildly different from one year to the next. (West Valley Hospital, along with many other small hospitals, was exempt from reporting data for this reason.)

 

Salem Hospital's goal is to achieve zero infections from any cause. In its work toward that goal, the hospital identifies areas where patients acquire infections and compares processes to evidence-based measures or guidelines such as those recommended by the U.S. Centers for Disease Control and Prevention.

 

Physician-led efforts are essential to effective change and Salem Hospital accomplishes much of that through its Quality Operations Committee. This is a physician-hospital team that looks at opportunities for improvement, determines how to achieve them and provides staff and financial resources to achieve the necessary improvement. The hospital provides staff to work on these projects, including helping providers understand the data, identify evidence-based approaches and evaluate and replicating success.

 

Specific infection information

 

Central line-associated bloodstream infections:

  • Salem's adult intensive care unit had half the infections as expected. Of the last five years, two years had zero infections.
  • Salem's neonatal intensive care unit only had one infection, which is within the normal range.
  • The QOC team worked on standard order sets in the electronic health record and verified the actual site of the infection to ensure corrective actions were the correct ones. Infection prevention staff also did daily rounding with ICU patients with central lines, looking to make sure dressings were clean, dry and intact, and worked collaboratively with unit nursing staff.

Surgical site infections:

  • Coronary artery bypass graft. Salem had fewer than half what was expected and is within normal ranges. It watches these types of infections very closely and collaborates with doctors to identify and address problems.
  • Colon surgery. Salem had less than half the number of expected infections and is better than the national baseline. The 2013 rate was about half the 2012 rate.
  • Hip prosthesis was within normal expectations. While the 2013 rate is almost identical to 2012, both are lower than 2011.
  • Knee prosthesis was within normal expectations and has decreased each year over the three years it has been reported.
  • Laminectomy was a bit lower than expected and at about half the 2012 rate. When we saw an increase in laminectomy infections in 2012, Salem Hospital formed a team including physicians, operating room staff, infection prevention staff and nursing staff. Processes in the operating room were observed and measures were implemented to enhance infection prevention practices related to use of equipment during surgery, attention to surgical attire and hand hygiene, as well as managing the operating room environment.
  • Clostridium difficile infection LabIB (C-diff). The hospital's infection rate was lower than expected. The QOC selected C-diff as one of its first projects when it formed at the end of 2012. They put together a team using Lean/Kaizen processes and went through all the recommended guidelines to find opportunities for improvement. Identified "high-touch areas" are now cleaned twice daily. Staff tested cleaned areas with fluorescent markers and used environmental swabbing to help identify areas that need increased training to keep clean. This team also reinforced hand hygiene and isolation practices. The hospital has seen a slight decrease in this rate so far this year.

Other infections:

  • Flu vaccination. Salem Hospital's 65 percent staff vaccination rate in 2012 was within national baseline. The 2013 results will blast that record, following the successful No Flu Here League campaign, which produced a 91 percent staff and 98 percent physician vaccination rate.
     
  • Surgical Care Improvement Project. The hospital's overall compliance is at 98 percent.

Oregon Association of Hospitals and Health Systems projects

The OAHHS referenced several of its quality improvement projects in its news release about the infection report. Salem Health is not participating in these efforts, as noted below:

  • Partnership for Patients. The hospital did not participate because it has its own goals for improvement. Participating in that project would have required a focus on the areas required for those projects. The hospital felt it wasn't in the best interest of patients to take focus off areas where it knows it has opportunities to improve.
  • Yellow, Green and Black Belt certification in Lean processes. Salem Health has a Lean/Kaizen program in effect and elected to not divert attention from its program.

Read the full report.

 

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RxAll printed scripts require MD signature
by Cort Garrison, MD
Chief Information Officer and Interim Chief Medical Officer

All printed scripts must be signed before a patient can be discharged. Patient discharges have been delayed when providers were not available to sign printed prescriptions. This affects patient satisfaction and the hospital's ability to admit patients who need care.

For more help and resources relating to e-Prescribe, please refer to the e-Prescribe toolbox/resources hyperlink under Physician Links on the MyEpic/Radar page or the ePrescribe toolbox on the Salem Health intranet.

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grandCover Oregon and ACA implementation update

Participants in the September Friday Grand Rounds session will have the opportunity to hear from representatives of the Oregon Health Authority.

The program will:
  • Clarify misunderstandings about the Affordable Care Act and Cover Oregon
  • Help participants confidently respond to patient questions about the Affordable Care Act
  • Describe ways the ACA and Cover Oregon expand health care coverage
The session is on Sept. 12, 7 to 8 a.m., in Wedel Auditorium. Read more.

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WELCOME TO SALEM HOSPITAL

Tyler J. Green, MD - greenDiagnostic Radiology

Salem Radiology Consultants

 

Medical Education:

University of Colorado, Health Science Center

Aurora, CO

August 2003 to June 2008

Internship:

Internal Medicine

University of Wisconsin School of Medicine

Madison, WI

July 2008 to June 2009

Residency:

Radiology, General

University of Colorado, Health Science Center

Aurora, CO

July 2009 to June 2013

Fellowship:

Interventional Radiology

University of Colorado, Health Science Center

Aurora, CO

July 2013 to June 2014

Christopher G. Mapa, MD - Internal Medicine

SH-Adult Medicine Hospitalistmapa 

 

Internship:

Internal Medicine

 

Weiss Memorial Hospital

Chicago, IL

July 2008 to June 2009

Residency:

Internal Medicine

Weiss Memorial Hospital

Chicago, IL

July 2009 to June 2011

 

Weiss Memorial Hospital (Chief resident)

Chicago, IL

July 2011 to June 2012

Fellowship:

Infectious Diseases

Loyola University of Chicago

Stritch School of Medicine

Chicago, IL

July 2012 to June 2014

Board Certification:

American Board of Internal Medicine

Bijaya K. Shrestha, MD - Pulmonary Medicine

Salem Pulmonary Associatesshrestha 

 

Medical Education:

Tribhuvan University Institute of Medicine

Kathwandu, NEPAL

Degree: Oct. 2002

Internship:

Internal Medicine

Mt. Sinai School of Medicine

Englewood, NJ

July 2008 to June 2009

Residency:

Internal Medicine

Mt. Sinai School of Medicine

Englewood, NY

July 2009 to June 2011

Fellowship:

Type: Pulmonary Medicine

Wake Forest University Baptist Medical Center

Winston Salem, NC

July 2011 to June 2014

Board Certification:

American Board of Internal Medicine

American Board of IM/Pulmonary Disease

Karen J. Spangle, MD - Emergency Medicine

Emergency Medicinespangle 


Medical Education:

Tulane University School of Medicine - New Orleans, LA

August 1996 to May 2000

Residency:

Emergency Medicine

University of Chicago Hospital

Chicago, IL

July 2000 to June 2003

Board Certification:

American Board of Emergency Medicine

Sarat K. Velivela, MD - Internal Medicine

Adult Medicine Hospitalistvelivela 

 

Residency:

Internal Medicine

Synergy Medical Education Alliance Saginaw, MI      

July 2004 to June 2007

Board Certification:

American Board of Internal Medicine 

PRACTICAL MATTERS
riskNew American College of Surgeons Surgical Risk Calculator  

by Jonathan Durning, MD

 

The National Surgical Quality Improvement Project of the American College of Surgeons has developed a tool to predict the risks of post-surgical complications for your patient. The tool considers the patient's underlying health status and the operation planned. Using data from more than 1.5 million surgeries, the calculator predicts the chance that a patient will have any of nine different outcomes within 30 days after surgery. 

 

Salem Hospital has provided access to this tool under Physician Links on the MyEpic/Radar page. The tool considers the patient's underlying health status and the operation planned.

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POPharmacy to focus on IV to oral conversions

 

In early August, pharmacy staff began working to convert patients who are on certain IV medications to their oral equivalents. This protocol was approved by Pharmacy and Therapeutics last June.The medications are almost all 100 percent bio available.  

 

The change in protocol reduces the number of times the hospital accesses IV lines, thereby reducing the risk of a hospital-acquired infection. The oral equivalents are generally more affordable than their IV alternatives, reducing the cost of care across the organization.

 

Read the protocol.  

 

For more information, contact Matthew Tanner, PharmD, pharmacy residency program director and clinical coordinator, 503-814-2048.

 

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urineFeedback requested on changes to urinalysis results

 

The laboratory is in the process of updating urinalysis instrumentation.  

 

As part of this process the hospital is looking at what tests are useful. The laboratory would like to know if removing results for urobilinogen and bilirubin from the current urinalysis results would affect physicians' ability to make treatment decisions.

  

Please contact Cal Smith, hematology specialist, at 503-561-6025, if you have feedback or questions about this proposed change.

 

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sunshine2013 Open Payments (aka Sunshine Act) data coming soon 

  

Open Payments is a national disclosure program that promotes transparency by publishing data on the financial relationships between the health care industry (applicable manufacturers and group purchasing organizations; together referred to as reporting entities) and health care providers (physicians and teaching hospitals) on a publicly accessible website. This publicly available website is designed to increase access to, and knowledge about, these relationships and provide the public with information to enable them to make informed decisions.

 

The public can search, download and evaluate the reported data. Centers for Medicare & Medicaid Services will release the 2013 data publicly by September 30, 2014. To learn more about Open Payments, review the User Guide.

 

Physicians can register in the Open Payments System. The Open Payments review and dispute process began July 14 and ends Aug. 27, 2014.  

   

At Salem Health, you can contact Ellen Hampton, director of Corporate Integrity, Safety and Risk Management, for more information. 

 

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COMING EVENTScoming
CHECFor your patients, from the CHEC

 

The Smart Choice© Health Insurance Workshop

The class includes a workbook for participants to take with them. Presented by Oregon State University Extension Services, this workshop will help participants:
  • Understand the basics of health insurance 
  • Learn strategies to help select a health insurance plan
  • Increase capabilities to make a Smart Choice© Health Insurance decision

Saturday, September 6, 9:30 to 11:30 a.m.

or

Monday, September 8, 6:30 to 8:30 p.m.

$5

Read More 

 

Welcome to Medicare

This session will be led by a Certified Senior Health Insurance Benefits Assistance (SHIBA) Counselor. The presentation will cover:

  • How Medicare works
  • Supplemental insurance options
  • Assistance for people with low income and resources
  • How the Affordable Care Act improves Medicare
  • How to prevent, detect and report Medicare fraud and abuse
Wednesday, Sept. 10, 2 to 3 p.m.

or

Wednesday, Oct. 8, 2 to 3 p.m.

Free

Read more 

 

Arthritis Management Resources

This is a peer-led support group that offers information about helpful resources in managing day-to-day activities while living with arthritis.

Thursday, Aug. 14, 6 to 7:30 p.m.

Saturday, Nov. 8, 11:30 a.m. to 12:30 p.m.

Free

Read more
 
Family Fun Night

Join us as we share fun activities and healthy foods the whole family will love. The evening includes 30 minutes of exercise appropriate for all ages and 30 minutes of hands-on nutrition education in healthy cooking. Each family will be introduced to the 5-2-1-0 healthy living program and invited to participate in the 30-day home challenge for a chance to win prizes!

 

Friday, Aug. 15, 5 to 6 p.m.

Free with any Salem Cancer Institute food pantry donation

Read more 

  

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IN THE NEWS...NEWS 
newsCity Hall approves Salem Health's Howard Hall plan
Overturning the landmark commission recommendation, the Salem City Council voted to approve the demolition of Howard Hall. Read the Statesman Journal article.

OHSU receives another $100 million for cancer research
Bringing it closer to meeting Phil Knight's $500 million challenge, OHSU just received another $100 million from an anonymous donor. Read the
story on Oregon Live.
Common Ground Newsletter Editorial Board 
For past issues of this newsletter, visit
Email us anytime with feedback, suggestions, or something for the next issue!  Dr. Ian Loewen-Thomas, Chair, Compact Implementation Committee
 
 

Salem Health

503-561-5200