“In true Delaware fashion, we formeda partnership that has the creativity offour very different but complementaryorganizations to focus on caring forour neighbors. To do that effectively,we need to be well-educated and well-informed. We also need creative ideas,and those are embedded in the fabricof the DHSA.”

Gov. Markell helped kick off the con-ference by pointing out the regionaleconomic impact of DHSA.

“When it comes to innovation, work-force development and science andtechnology, this alliance just has itnailed,” he says. “Efforts like thisdon't start with the government; theystart with people who have not onlytremendous vision, but also the abilityto execute.”

Transformation

Nurse navigators guideheart-failure patients 2

OB emergency response team 3

Nursing specialty certification 4

Nursing Excellence Awards 5

News

Delaware Marathon:A day to remember 11

Gift of Life program wins honors 13

State Trauma Symposium 14

Proper disposal of pharmaceuticals 19

F O C U SDelaware Health Science Alliancepowers bench to bedside medical research

The 2nd annual DelawareHealth Science Alliance

(DHSA) research conferencehosted by Christiana Careshowcased new opportuni-ties to enhance collabora-tions and reinvent healthcare.

The May 4 event at the JohnH. Ammon MedicalEducation Center featuredChristiana Care Presidentand CEO Bob Laskowski,M.D., Gov. Jack Markell,and other regional andnational leaders in healthcare and research.

The DHSA partner institu-tions—Christiana Care,Alfred I. duPont Hospitalfor Children, ThomasJefferson Medical Collegeand the University of Delaware—focus on developing world-classhealth care education, interdiscipli-nary research and quality health caredelivery through the expertise andresources of its member organizations.

Driving medical researchChristiana Care aims to help Delawareand the surrounding region drivemedical research from discovery todelivery and ensure innovation.

Dr. Laskowski says he is repeatedlyasked when he is going to build amedical school in Delaware.

"I always reply, 'We already have one,at Thomas Jefferson [University,Philadelphia],'" he says. “In the pasttwo years, that relationship has turnedinto so much more.

DHSA leaders, from left, UD President PatrickHarker, Robert J. Laskowski, M.D., Delaware Gov.Jack Markell, DHSA Executive Director KathleenMatt, Thomas Jefferson University President RobertBarchi, and Nemours CEO Tom Ferry.

Visit the Flickr Gallery on Christiana Care’s website for more conference photos.

After discharge, a clinicalnurse navigator followsup with each patient byphone within 72 hours.“This contact is impor-tant,” says JoanneMatukaitus, RN, MSN,director ofCardiovascular /CriticalCare Patient CareServices.

“We want to make surepatients have the rightmedications in compli-ance with doctor’s ordersand that they schedule afollow-up appointmentwithin one week of dis-charge at the HeartFailure Clinic or withtheir private physician,”

she says.

Encourages outpatient follow-upThis follow-up encourages patients toseek outpatient treatment early and asneeded to maintain their independ-ence and quality of life and to avoidreadmission to the hospital.

“We recognized that the ability ofpatients to see their doctors quicklyafter a hospital discharge can signifi-cantly reduce the chances that thepatient is readmitted to the hospital,”Dr. Saltzberg explains. “The HeartFailure Program is committed toensuring that adequate services areavailable for heart failure patients tohave the best hospital experience, awell-coordinated discharge and timelyfollow-up in the community.”

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Heart failure patients have anew ally. Clinical nurse

navigators are joining theChristiana Care Heart FailureProgram this spring.

Specially trained registerednurses now guide heart failurepatients through the care andresources they need while in thehospital and follow up withthem after discharge to avoidreadmission.

No. 1 diagnosis in Medicare“Heart failure is the numberone diagnosis among Medicare-eligible patients admitted to thehospital for cardiovascularcare,” says Heart FailureProgram Medical DirectorMitchell T. Saltzberg, M.D. Toooften, patients who return home facereadmission within 30 days.

“Heart failure is a complex illness thatoften requires specialized care, testing,procedures and multiple consults by avariety of health professionals,” Dr.Saltzberg says.

“Coordination of care and services bya clinical nurse navigator facilitates ashorter length of stay and a smoothertransition to outpatient care. Thenurse navigator is an advocate toensure that patients’ needs are met ina timely and coordinated fashion.”

Upon admission, Heart FailureClinical Leader Carolyn Moffa, FPN,MSN, pairs heart failure patients witha clinical nurse navigator to showthem the ropes. “During the inpatientstay, we identify and assess the risks

for readmission and work with eachheart failure patient to address anybarriers to a successful transition fromhospital to home.”

Nurse navigators as liaisonsIn the hospital, clinical nurse naviga-tors are liaisons between patients andtheir family members with physicians,therapists, case managers, social work-ers and other members of the healthcare team. They provide educationand answer questions about medica-tions, nutrition, activity, and weightand fluid monitoring, extending theopportunity for patients to learn toself-manage their chronic illnessbefore discharge.

T R A N S F O R M A T I O N

Heart failure nurse navigators guide patients through care

Patti Christopher, RN, reviews heart failureeducation with a patient on 5E.

In obstetrics, a crisis can loom at any time.

At Christiana Care, expectant mothers in perilreceive care within minutes, thanks to theObstetrical Emergency Response Team(OBERT).Instead of going through traditional escalationsteps, OBERT brings immediate help to obste-tricians and nurses responding to such condi-tions as shoulder dystocia, hemorrhage andfetal distress. “Things can deteriorate quickly in obstetrics,and many problems can’t be predicted,” saysMatt Hoffman, M.D., MPH, director of theDivision of Education and Research. “WithOBERT, we often are able to intervene beforesomething becomes a full-blown emergency.”Responds wherever needed

The team has responded not only to cases in Laborand Delivery and maternity units, but also to theEmergency Department—and, on one occasion, thehospital parking lot.“OBERT brings our expert personnel to thepatient’s bedside for an obstetrical emergencywithin minutes,” says Dot Fowler, MSN, RNC,director, Patient Care Services, Women's andChildren's. “It’s available 24 hours a day, sevendays a week for any obstetrical patient atChristiana Hospital.”Launched here in September 2009, the concept isbased on a model developed at the University ofPittsburgh.Developed presentation

In March, the Christiana Care team was invited topresent the OBERT story at the QualityImprovement Initiatives in Obstetrical Care Forumat the Obstetrical Society of Philadelphia, one ofthe oldest OB/GYN educational groups in thenation.Christiana Care is one of the highest-volume healthsystems for births in the Mid-Atlantic region.Currently, more than 7,000 babies a year come intothe world at Christiana Hospital, born to a widelydiverse population of parents.“As a high-risk obstetrical referral in Delaware, wetake care of very complex patients, and this isanother part of our safety net,” Dr. Hoffman says.

Emergency response team acts quickly in obstetrical crises

T R A N S F O R M A T I O N

OBERT team members Cynthia Fowser, RN, Gregory W. Demeo, D.O.,Jill Mahone, RN, Adeyinka Reid, RN, Valerie Pappa Gray, RN, and LoriSmith, RN stand ready to intervene in obstetrical crises.

Delaware Marathon volunteerappreciates urgent care receivedKerry Wilson, a pregnant volunteer at the Delaware Marathon May 16,started having contractions during the race and went to ChristianaHospital. She sent this note to Christiana Care Vice President,Emergency, Trauma & Aeromedical Services Linda Laskowski Jones.

Linda (and team),Hi. I was the pregnant volunteer at the race on Sunday. I justwanted to send a thank you to you and your team for all of theirhelp on Sunday. I really am glad you made me stay put and go tothe hospital. Your training, knowledge, and attentiveness reallycame through and I very much appreciated it! Turns out that Iwas indeed having contractions (low intensity but high frequency)2-3 min apart. So they set me up with some IV fluids, a shot tostop the contractions, and a steroid for the baby’s lungs in caseshe did come early. I was not dilated luckily. Went to the regularob yesterday morning and they sent me to our hospital in PA aswell for monitoring. Was 1-2 min. apart contractions! YIKES! Sonow I’m on bed rest, no more volunteering or anything until thislittle one comes. So very happy to have caring and attentive peo-ple working the medical tents at races.Thank you again so much for your care and support!

It’s Magnetic!“Forces of Magnetism”4: Personnel Policies and Programs5: Professional Models of Care6: Quality of Care

14: Professional Development

Whether to pursue a specialitycertification or not is a decision

faced by many nurses in their path ofprofessional development. Nursesachieve and maintain nationally recog-nized certification through hours ofclinical practice and passing a rigorousexam. Certification validates a nurse’sknowledge in a speciality area.

Christiana Care is committed to help-ing nurses begin this journey.

We now offer more review courses oncampus and prepayment options forcourses and initial exams throughPatient Care Services Education withinthe Department of Nursing, as well ascertification renewal (as outlined inPatient Care Services Policy #300).

Eliminate barriers“We want to eliminate any barriers toobtaining nurse certification,” saysTamekia Thomas, MSN, RN, PCCN,critical care education coordinator.“Achieving certification is an impor-tant step in a nurse’s commitment tohigher standards and better patientoutcomes.”

Earlier this year, Christiana Careachieved Magnet® recognition forexcellence in nursing by the American

Nurses Credentialing Center (ANCC).Only 6 percent of U.S. hospitals haveearned this honor, the highest level ofnational recognition for sustainedexcellence in nursing care.

Goal is 25-percent increaseAs of March 2010, 934 nurses--fewerthan one-third of the nurses atChristiana Care--were certified. Ourgoal is to increase the number of certi-fied nurses by at least 25 percent dur-ing the next three years.

During May, nursing certificationreview courses in gerontology, med-ical-surgical and CCRN/PCCN/ CENwill be offered on campus, and morecourses are planned.

Obtaining and maintaining a profes-sional certification takes commitmentand dedication.

“The preparation necessary to achiev-ing certification is hard work, and weare trying to make the process seam-less for our nurses by eliminating anyperceived barriers,” Thomas says.

For more information about certifica-tion, visit the Nursing Certificationwebsite on the Nursing Portal underEducation.

Policy breaks down barriers to nursingspecialty certification and renewal

Christiana Care invites alldepartments, units and teams

to participate in the 2010 AnnualFocus on Excellence Awards (FOE)program.

It’s time to share projects thatdemonstrate improvement in process or outcomes.

To get started, complete an onlineletter of intent on the portal

by June 4.

Key dates: n June 15: DRAFT abstract due.

n Aug. 20: FINAL abstract andpresentations due.

n Oct. 17-22: FOE Exhibition in Room 1100, Christiana Hospital andoutside the Wilmington Hospitalcafeteria.

n Nov. 18: Awards celebration.

The FOE Awards:n Provide an opportunity for for-mal team recognition.

n Foster departmental and sub-sidiary performance improvementefforts, teamwork and integration.

n Encourage interdisciplinary, inter-departmental and inter-subsidiaryparticipation on projects to enhancerelationship-building, organization-al learning and integration.

n Reinforce use of PDCA (Plan-Do-Check-Act) as a performanceimprovement model.

n Educate staff about ongoingefforts to improve clinical and serv-ice quality and safety.

n Position Christiana Care forexternal recognition as a qualityleader.

Cheryl Wade, RN - MICULoretta Walls, RN - VNA, CamdenKim Watson, RN - CVICUDeborah Willeford, RN - CHR EDDarla Winstead, RN - WH Post AnesthesiaJeanna Wood, RN - SCCC

Advanced PracticeMarilynn Bartley, RN, MSN - TraumaProgramMary Ciechanowski, RN, MSN - Stroke

EducatorGwen Ebbert, BSN, RN-BC - SDS, 4DKim Berl, RN - SDS, 5 E/W

Non-Direct CareBeth Donovan, RN, MSN - Wound OstomyContinenceHelen Jackson, RN, BSN - ParentEducation

LeadershipEileen Evangelista, RN, BSN - PCC, MICUConnie Jordan, RN-BC- Nurse Manager,6E

Partners of NursingPatient Escort

2010 AnnualNursing ExcellenceAwards Direct Care

Frances Baker, RN - Wilm EDDanyell Bishop, RN - 4DCatherine Bloss, RN - 5APatty Bracken, RN - 7EMaria Brown, RN - TSUSarah Burcham, RN - 6BColleen Callahan, RN - 5ALynda Cavanagh, RN - 3DBabin Chandran, RN - 5E/WGabriella Collins, RN - Operating RoomHeather Corrado, RN - 3WTerry Craig, RN - Wilm ACE UnitJanice Crispin, RN - Virtual ICUBarbara Dean, RN - NICUTom Desper, RN - 2CBrenda DiSabatino, RN - 6A ACEAlana Downs, RN - 4CSharon Ennis, LPN - 3BTracie Farmer, RN - CDUSuzanne Fischer, RN - IVBarbara Foote, RN - 3BAngela Forese, RN - 3WJosh France, RN - 5EMary Gallagher, RN - VNAAdeyoyin Gbadamosi, RN - 4EShirley Gharbin, RN - 4EAshley Gleber, RN - Wilm ORJackie Grau, RN - MICUBarbara Griffin, RNBeth Gunther, RN - PACUMary Harrington, RN - 5CAmanda Hill, RN - 4E/WDianne Holleran, RN - Labor & DeliveryEmily Joyner, RN - 4CAnn Kaiser, RN - CH EAU Jennifer Keith, RN - WH ORKathleen King, RN - 6N/SKim Manley, RN - HVISKristina McCarthy, RN - 6BDeborah McCracken, RN - HVISElizabeth Mitchell, RN - SurgicenterDaphne Mullett, RN - 3A

Jaime Murray, RN - HemodialysisJolene O’Neill, RN - Per DiemLinda Papa, RN - SPUGeraldine Pelensky, RN - Wilm EDSusan Penta, RN - WH Surgical ServiceBrittany Powers, RN - 5DDionne Price, RN - 4E/WKim Proctor, RN - CVICULea Purcell, RN - WH ICUAlison Purner, RN - 5BJaclyn Rehm, RN - 5BSusan Reynolds, RN - 4AAndrea Riley-Desgouttes, RN - 4SOlivia Ringer, RN - SCCCLinda Roderick, RN - CICUDavid Salati, RN - CHR EDLindsay Sanderson, RN - 4DEva Smith, RN - 6ELori Smith, RN - Labor & DeliveryDreama Szutenbach, LPN - VNA, CamdenDawn Todd, RN - 3 SurgicalTracy Townsend, RN - GI LabJudith Tozzoli, RN - CH SurgicenterJennifer Vansant, RN - VNA, New Castle

N A T I O N A L N U R S E S W E E K

Marilyn BartleyTrauma Program

Helen JacksonParent Education

EducatorGwen EbbertSDS, 4D

Mary CiechanowskiStroke

Partners of Nursing - Patient Escort

APNs Non Direct CareBeth DonovanWound Ostomy Continence

PCC - MICU Nurse Manager, 6E

Thomas Jefferson and PhiladelphiaCollege of Osteopathic Medicinehead the list with eight and 10 newresidents, respectively.

Drexel, Temple, Maryland andVirginia Commonwealth have sentus at least three new residents.More than 40 other Universitiesfrom Florida to Vermont, and as farwest as Iowa and Michigan are rep-resented.

Brian W. Little,M.D., Ph.D., has

been namedChristiana Care’schief academic offi-cer.Since joiningChristiana Care in2000 as vice presi-dent of AcademicAffairs, Dr. Littlehas established aculture of excel-lence, helpingChristiana Careachieve regional and

national prominence in education andresearch. Our thriving graduate medical education pro-grams, now totalling more than 250 residents,bring doctors in training from throughout thenation to Delaware. With the help of hisleadership, Christiana Care has:n Promoted interdisciplinary education.n new programs in cardiology, sports med-icine and nephrology.n Launched Achieving Competency Today,an education program nationally recognizedfor innovation in hospital-based education.n Guided the transformation of the clinicaland translational research activities ofChristiana Care from a focused effort in clini-cal trials to a broad-based enterprise withnumerous federal and private grants andcontracts and international research—culmi-nating in the establishment of the DelawareHealth Sciences Alliance. n Helped numerous faculty membersdevelop collaborative research projects withthe University of Delaware/DelawareBiotechnology Institute, Thomas JeffersonUniversity, A.I. DuPont Hospital for Childrenand other institutions.

Brian Little, M.D.,Ph.D., namedchief academic officer

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Roger B. Thomas Memorial LectureFaith T. Fitzgerald, M.D., MACP, (above left, with Virginia U. Collier, M.D.,Hugh R. Sharp, Jr. Chair of Medicine), delivered the 5th Annual Roger B.Thomas Memorial Lecture, sponsored by the Department of Medicine atChristiana Care. Dr. Fitzgerald, a professor of Medicine and associate dean ofHumanities and Bioethics at University of California, Davis School ofMedicine, presented a lecture, titled “The Virtual Patient.”

Christiana Care had a very suc-cessful residency match pro-

gram this year.

“We have accepted 90 graduatingstudents and residents into our allo-pathic residencies and fellowships,osteopathic residencies, pharmacy,podiatry, dentistry and oral max-illofacial surgery residencies,” saysBrian Little, M.D., Ph.D., ChiefAcademic Officer.

Brian W. Little, M.D., Ph.D.

Match program fills all residency programs openings

Focus on Excellence – Best Practice Review – May 2010

Consistent with our strategies for engaging staff in continuous improvement and best practices, we regularly reviewimportant topics in Focus to help reinforce safe-practice behaviors. These tips reinforce information and enable staff tobetter articulate our safety practices during an unannounced survey.

SPECIMEN LABELING

Q. What is the Best Practice for verifying the correct patient and collecting specimens for clinical testing?

A. . The best practice is to identify the individual as the correct patient and to MATCH the service or treatment tothat patient. This includes collection for blood, urine, stool, sputum, and specimens from procedures.

BEFORE COLLECTION:

Compare patient ID label with lab requisition/order using two unique identifiers.

Take specimen label and specimen container to bedside

Compare patient ID band with the specimen label using two unique identifiers, and then collect the specimen

AFTER COLLECTION and BEFORE LEAVING THE ROOM:

Place your initials, date, and time of collection on the label

In the presence of the patient, place the specimen label on the container

If the patient collects the specimen himself (urine collection), it is to be handed to staff and labeled immediately infront of the patient

BEFORE SENDING:

Compare the labeled specimen with the lab requisition using two unique identifiers, and then bag the specimen andrequisition.

To ask questions, contact the content expert: Kathleen Gorczyca - 733-3627. To reach the Safety Hotline, call SAFE(7233) from within Christiana or Wilmington hospitals. From outside the hospitals, call 302-623-SAFE. Further informa-

tion is available on the portals in the Archives of Best Practices. From your portal, choose Focus on Excellence, JointCommission Readiness, Ongoing Strategies, Educational Strategies, Monthly Q&A.

Christiana Care’s Center for WoundCare and Hyperbaric Medicine

received a Center of Distinction Awardfrom the nation’s leading wound caremanagement company, Diversified ClinicalServices.

The award recognizes high patient satis-faction rates, exceptional healing results,and outstanding clinical outcomes over thepast twelve months.

For more details on the award, visitwww.diversifiedcs.com.

Nada Raiser (left), areavice presidentDiversified ClinicalServices, Jacksonville,Fla., presentsDiversified ClinicalServices’ Center ofDistinction Award toNicholas O. Biasotto,D.O., medical directorof Christiana CareWound Care Center,and Wound Care CenterDirector AdrienneAbner.

Wound Care team earns Center of Distinction Award

C L I N I C A L E X C E L L E N C E

Strong home-health-care link to health system benefits all

At the Visiting Nurse Associationsof America annual meeting in

April, Lynn C. Jones, FACHE, presi-dent of Christiana Care Visiting NurseAssociation (VNA), said VNA nursesbenefit greatly from being associatedwith a local health system.

His presentation centered on theadvantages of working together, bothfor the organizations and for the com-munities they serve. Jones addressedhistorical drivers toward affiliation,differing mind sets of hospital andhome health agencies, and how thetwo worlds are converging withintoday’s health care reform.

Key benefits of collaboration include:

National expert on autism lecturesJohn B. Moeschler, M.D., director, Clinical Genetics, Division of Genetics andChild Development at Dartmouth-Hitchcock Medical Center, lectured on recentresearch into the genetics of autism at the John H. Ammon Medical EducationCenter in April.

Lynn C. Jones, FACHE

n Shared planning for health carereform challenges.

n Reduced avoidable hospital read-missions.

n Enhanced clinical programming.

n Improved communication andtransitions across the care continuum.

n Higher patient satisfaction.

n Increased opportunities for pallia-tive care.

CEOs from VNAs in Rhode Island,Connecticut and Maine joined Jones insharing their successful experiences.Most VNAs operate independently,without benefit of health system affilia-tion.

GET HELP WITHTOBACCO CESSATION

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nurses increased 28 percent with 76newly hired nurses from July 2007 toJuly 2009.

“Partnering with a Managed CareOrganization to Improve HeartFailure Patients” presented by GaleM. Bucher, RN, MSN, COS-C, RhondaCombs, RN, MSN, Lynn C. Jones,MHA, FACHE, and Mary Nordenson,RN, BSN, MHM, illustrates how hometelemonitoring improves outcomes inheart failure patients and reducesrehospitalization and emergency roomencounters. Pre and postfinancialinformation showed significant costsavings to insurance companies (up to85 percent) by aligning with homecare agencies to deliver telehealth.

Christiana Care Visiting NurseAssociation colleagues visited the

annual meeting of the Visting NursesAssociation of America in April, bring-ing some of their proudest accom-plishments of the year to share.

One of the projects was an orientationand continuing education programdeveloped to prepare private dutynurses to provide quality care formedically complex patients. Education and preceptor support“Private Duty Nursing: The Journeyfrom Novice to Expert,” a presentationby Suzanne Butler, RN, BSN,Cleveland Cartwright, RN, andJoEllen Workman, RN, MSN/HAS,detailed VNA’s ongoing educationand preceptor support program toprepare private duty nurses for treat-ing medically complex patients athome.

Typically, the patients are under age 21and ventilator dependent, who requireeight to 16 hours of skilled serviceevery day.

VNA’s Private Duty Nurses have pro-vided care to our community

VNA shares transformational ideas at national gathering

(statewide) since 1988. However, ashortage of qualified nurses has led tosignificant discharge delays fromacute care settings for these patients.

VNA’s new program offers:

n Classroom training and an assignedpreceptor for each student

n Annual competency labs

n Ongoing support from a supervisor,clinical coordinator, case managementand office staff.

Results of their endeavor includeincreased nurse satisfaction and reten-tion, and staff expansion to accommo-date additional patients.

The number of qualified private duty

At the annual Visiting Nurse Association of America meeting, from left, Andy Carter,president and CEO of the VNAA, Gale Bucher, RN, MSN, COS-C, VNA COO RhondaCombs, Mary Nordenson (Delaware Physicians Care Insurance), Suzanne Butler, RN,BSN (VNA Private Duty), Cleveland Cartwright, RN, (VNA Private Duty), and Lynn C.Jones, president of Christiana Care Visiting Nurse Association.

It’s Magnetic!

“Forces of Magnetism”

Force 10:Community and the Health Care Organization

T R A N S F O R M A T I O N

COMPLIMENTARY MEAL SCHEDULE

Christiana Hospital – June 2

Lunch - 10:30 a.m.-1:30 p.m.

Dinner - 4-7 p.m.

Midnight shift meal - midnight-3 a.m.

Wilmington campus – June 3

Lunch - 11 a.m.-1:30 p.m.

Dinner - 5-6:30 p.m.

Boxed meals for midnight shift atWilmington campus may be picked upfrom the kitchen after 4:30 pm June 3.

Boxed take out requests for Christianaand Wilmington are available for staffwho are unable to leave their postduring the scheduled serving times.Christiana) (cafeteria kitchen forWilmington) the morning of the event.Please e-mail Ann Marie Phillips forWilmington or Mike Frawley forChristiana Hospital by May 25 withthe number of boxed meals needed.Selection will be Barbecue Chicken orVegetarian.

The cafeterias at Wilmington andChristiana Hospital are closed for break-fast on the morning of the Magnet celebra-tion (June 2 for Christiana and June 3 forWilmington) so staff can prepare for theevent.

The coffee shops open at 6:30 a.m. onJune 2 (Triangle Room Christiana) andJune 3 (Whirling Top Wilmington) toserve early breakfast.

Celebrating our Magnet status

In her comments announcingMagnet status for Christiana Care,

Gail A. Wolf, DSN, RN, FAAN, chair,Commission on Magnet Recognition,summed up the magnitude of theaccomplishment.

“People think Magnet is aboutnursing, but it is really totally aboutpatient care,” Wolf said. “From [theboardroom] down through the CEO toeveryone that lays hands on patients,to the security staff and volunteerswho greet people at the door, everysingle person is a player.

“I want to make sure that all of thepeople that contributed to this arerecognized for the enormous gift thatthey brought to the table for patients.”

As part of our Magnet celebration,Christiana Care is offering a compli-mentary meal for all employees. Themeal is way to thank the entireChristiana Care team for dedicationand hard work for achieving Magnetrecognition this year.

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Any medical team volunteers who expected a ho-hum kind of day at the May 16 Delaware

Marathon sponsored by Christiana Care were sur-prised by the 34 patients seeking aid in their medicaltent.

Equipped with event radios for emergency commu-nication, the team rotated coverage of the medicaltent, finish line and the relay race transition area.

“We had a truly amazing day,” says LindaLaskowski Jones, RN, ACNS-BC, CCRN, CEN,MS, Christiana Care vice president, Emergency,Trauma & Aeromedical Services.

The team, which included nine nurses fromChristiana and Wilmington emergency depart-ments, seven physicians and an EMT fromChristiana Care’s Medical Reserve Corps, were supported byEMT's from the City of Wilmington nad New Castle Countyparamedics with their mobile command unit and bicyclepatrol.

The most emergent care rendered was to a 50-year-oldmarathoner who went into cardiac arrest at the finish line.Revived with CPR and a single shock from an AutomaticExternal Defibrillator, the patient was accompanied by medicsand Emergency Medicine Resident Julie Silverman, M.D., toChristiana Hospital, where he survived “fully intact,” Jonessays.

Look in a near-future issue of Focus for a feature story onthe patient who survived cardiac arrest at the finish line.

Jones says the team also managed:n A male marathon runner with chest pain who hadischemia and was sent to Christiana EmergencyDepartment.

n A pregnant event volunteer who was having severeabdominal pain (later confirmed to be contractions).

n A runner who broke a leg at the finish line.

n Cases of severe respiratory distress, exhaustion/hypo-glycemia, leg cramping and agitation, knee abrasions, and onecase of a missing relay race athlete whose disappearancedistressed his three teammates.

“I received wonderful feedback from the marathon organizersregarding our overall set-up and operations,” Jones says. “Itwas exhilarating to be a part of the great teamwork that weshared. I especially want to thank Tony Reed, M.D., who hasworked with me for the past few years in coordinating thismedical team event.”

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Christiana Care President andCEO Bob Laskowski, M.D., withWilmington Mayor Jim Baker,speaks to neighbors at the race.

Overheated runnersget help cooling off.

Delaware Marathon: A day to remember

LindaLaskowskiJones treats arunner’sskinned knees.

2-way radioskept everyoneinformed.

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Sometimes quick intervention andtreatment make all the difference.

At least Professor Peter Caws thinksso.

Caws, a professor at GeorgeWashington University, experienced asudden onset of Guillain-Barré syn-drome (GBS) last October while inWashington, D.C. It began withstrange sensations in his feet oneevening, and by morning he couldhardly stand or use his hands. Doublevision would follow. “I was complete-ly helpless,” he says.

Guillain-Barré syndrome is a neuro-logical disorder characterized byascending paralysis. Loss of motorfunction begins in the peripheral nerv-ous system and is marked by weak-ness in the legs, arms and upper body.Without treatment, symptoms increasein intensity until muscles, includingrespiratory muscles, become para-lyzed. Typical recovery from GBS cantake up to a year.

Wanted to be close to homeWhile colleagues recommended heseek medical attention in nearbyBaltimore, Caws returned to Newarkinstead. “I did not want to be hospital-ized far from my family, and hurriedback to be admitted to ChristianaHospital,” he says. Decisive action byhis neurologist rapidly brought Caws’symptoms under control.

Aggressive therapy achieves big gains Following a seven-day stay atChristiana Hospital, Caws was trans-ferred to the Center for Rehabilitationat Wilmington Hospital for physical

and occupational therapy. On arrivalhe was unable to walk. Repositioningand transferring required two-personassistance because he was so weak.Even simple activities such as eatingand dressing were difficult.

Caws received aggressive therapythree hours per day. Physical therapytreatment targeted his individual needfor balance, gait and transfer training;as well as exercises to strengthen hiscore and upper and lower body. Italso incorporated customized activi-ties necessary for his commute toWashington and his return to teaching.Occupational therapy focused onrestoring fine motor coordination andindependence with activities of dailyliving.

“Mr. Caws is very in tune with his

Peter Caws, Ph.D.

Professor turns homeward for Guillain-Barré syndrome care

body,” says Laura Michelsen, DPT.

“He was an active participant in thera-py and he questioned the value ofevery exercise we suggested. This own-ership of his therapy regimen, com-bined with seeking medical treatmentearly, facilitated his quick recovery,”she says.

“One doesn’t realize that just standingup employs visual, muscular, and neu-rological cues,” says Professor Caws.“It was humbling to have to think‘where are my feet’ before beginning towalk. I have great respect and admira-tion for the careful but challengingexercises my [therapy] team devel-oped,”

After one week of therapy, he waswalking independently with a walkerand able to go up and down a fullflight of steps without assistance. Hissitting and standing balance improveddramatically, and he regained self-suffi-ciency with daily activities. Caws wasdischarged and returned to teachingtwo weeks later.

No better place for treatmentToday, Caws has resumed his activelifestyle. He teaches full-time, exerciseswith a personal trainer and maintainsan active social life with his wife. “Iwas just amazed by the quality of care[at Christiana Care]. I count myselfextraordinarily lucky to have been theobject of such high level professionalattention, prompt treatment and skillfultherapy. I could not have received bet-ter care anywhere in the country,” hesays.

Electrophysiology labs, HVIS, non-invasive services, E-tower practiceoffices and nuclear medicine.

Vigneau assumed executive responsi-bility for the Kidney TransplantProgram in 2008 and is one of thethree Christiana Care executivesleading our strategy in our southernservice area.

Penny Vigneau, MSW, MBA, hasbeen appointed appointed senior

vice president of the Center for Heart& Vascular Health.

Vigneau earned her masters degree insocial work from West VirginiaUniversity and her MBA from theUniversity of Chicago.

She joined Christiana Care as vicepresident in 2005. Since then, she hasled the numerous transformative ini-tiatives, such as:

n Transitioning the cardiac surgeryprogram from private practice to ahospital-employed physician group

n Initiating the cardiac surgery pro-gram at Beebe Medical Center.

n Facilitating the Christiana CareVascular Specialists sub-corporation.

n Implementing the neurovascular

Accepting a plaque from Gift of Life from Philadelphia Chapter Gift of LifeDirector of Hospital Services Gwen O'Shaugnnessey (right) are, (from left)Christiana Care Chief Operating Officer Gary Ferguson, Veronica McCall of Giftof Life-Philadelphia, Joanne Matukaitis, RN, MSN, CNA, BC, director, Cardio-vascular /Critical Care Patient Care, Critical Care Medicine, and Gerard Fulda, M.D.,FACS, FCCM, FCCP, director of Christiana Care Surgical Critical Care.

The Philadelphia Chapter of the Gift of Life organ donor programpresented a plaque to Christiana Care to recognize Christiana

Care's leading role in the program.

More than 42 families have donated 100 organs for transplant throughChristiana Care, which is the leading health care facility for transplantdonations to Gift of Life's Philadelphia chapter.

Christiana Care honored for leading role in Gift of Life program

Vigneau named seniorvice president, Heart& Vascular Health

Penny Vigneau, MSW, MBA

interventional program for acutestroke rescue.

n Launching the cardiovascular spe-cialty programs for screening and pre-vention, pulmonary hypertension andadult congenital.

n Overseeing several constructionprojects, including new

by Christiana Care EmergencyMedicine physician Brian Levine,M.D., and lectures on beach surfinjuries, pediatric sports-relatedinjuries and forensic medicine casestudies.

“The symposium is always a big suc-cess because the hospitals within ourstatewide trauma system work verywell together,” says Christiana CareTrauma Program and TSU ManagerJoan Pirrung, APRN, BC. The sympo-sium draws people from Delawareand the surrounding states.”

Annual symposiumfeatures state’s toptrauma experts

Steven Johnson,M.D. (left) andMarilynn Bartley,RN, MSN, FNP-BC, (right) gave ajoint presentationabout their med-ical mission toHaiti.

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The 2010 Delaware TraumaSymposium April 30 at the Chase

Center on the Wilmington Riverfrontattracted some 480 people to the nine-hour annual event.

The popular symposium this year fea-tured:

n Keynote speaker University ofArizona Medical Center TraumaMedical Director Peter Rhee, M.D.,who gave a presentation onSuspended Animation in Trauma.

n From Haiti to Home: A JourneyUnparalleled,” presented by MarilynnBartley, RN, MSN, FNP-BC and StevenJohnson, M.D.

n Extremity Compartment Syndromeand Fasciotomy, presented byChristiana Care Trauma SurgicalCritical Care Attending Surgeon andGeneral Surgery Residency ProgramDirector Frederick Giberson, M.D.,FACS.

n Marc Zubrow, M.D., Director ofCritical Care Medicine, ChristianaCare Health System, presenting onTelemedicine in Trauma.

n Health Care: Right or Privilege? byEhyal Shwieki, M.D., trauma surgicalcritical care attending surgeon.

n Presentations on numerous othertopics by Delaware’s top experts, suchas a trauma-related drug abuse update

Frederick Giberson, M.D.

Medical tent volunteers had a busy day May 16 at the annual DelawareMarathon sponsored by Christiana Care Health System. See story, next page.

M.D., Pamela Douglas-Fontello, RN,and David A. Paul, M.D.

n “Correlation of proton magnetic res-onance spectroscopy (MRS) and volu-metric MRI of the preterm white mat-ter,” by Erlita Gadin, M.D., David A.Paul, M.D., Amy Mackley, RNC, KertAnzilotti, M.D., Karl Steiner, M.D.,and Cole Galloway, M.D.

n Use of antenatal steroids in verylow birth weight infants between 1994and 2006,” by Celina Sindall, M.D.,David A. Paul, M.D., Robert Locke,D.O., Amy Mackley, RNC, andDeborah Ehrenthal, M.D.

Mitchell T. Saltzberg, M.D., present-ed "Implanted Cardiac RhythmManagement Devices in Heart Failure:Who, What, Where?” at the ThirteenthCongress of Chest Pain Centers in LasVegas, Nevada.

At the Med-Peds Program Director’sAssociation Annual Meeting in April:

n Allen Friedland, M.D., et al., pre-sented ”Med-Peds Program DirectorsProfessional Activities.

n Allen Friedland, M.D., JenniferPackard, M.D., and Daniel Elliott,M.D., presented “Impact of a RegionalMed-Peds Meeting on Student Interestin Med-Peds.”

n Ellen Justice, MLIS, AHIP, RoyKao, M.D., Tony Bianchetta, M.D.,and Allen Friedland, M.D., presented“Librarian and Med-Peds TeachingResident Collaboration: LibraryInformatics and Evidence-BasedPediatrics Showcased.”

n Allen Friedland, M.D., et al, pre-sented “Do Med-Peds GraduatesMaintain Dual Board Certification?”

Publishing, PresentingAppointments, Awards

PublishingHeather Bittner Fagan, M.D., FAAFP,Denise Taylor, MS, RD, MeganLaurent, et al., published an articletitled “An obesity prevention programin a Delaware elementary school,”Delaware Medical Journal.2010;82:133-136.

Nathan Merriman, M.D., et al., pub-lished an article titled “Hip FractureRisk in Patients With a Diagnosis ofPernicious Anemia,” inGastroenterology (Vol.138, Issue 4).

PresentationsDenise Lyons, MSN, GCNS, BC andPatricia M. Curtin, M.D., FACP,CMD, presented a poster titled “TheWISH Program: An InterdisciplinaryApproach to Geriatric Education,” atThe American Geriatrics Society 2010Annual Meeting and at the ModelGeriatric Programs: Materials andMethods Swap, in Orlando in May.

The following papers were presentedby the Division of Neonatology,Department of Pediatrics at thePediatric Academic Societies Meetingin Vancouver, BC:

n “Immunoreactive trypsinogen (IRT)is elevated in very low birth weightinfants who die,” by Sarvin Gavham,M.D., Amy Mackley, RNC, LouBartoshesky, M.D., Aaron Chidekel,M.D., and David A. Paul, M.D.

n “Does prolonged premature ruptureof membranes increase the odds ofnecrotizing enterocolitis?” by RaquelGomez, M.D., Robert G. Locke, D.O.,Amy Mackley, RNC, and David A.Paul , M.D.

n “A pilot study of antibiotic usageacross four NICUs for early and lateonset sepsis,” by Haritha Vellanki,

Christiana Care’s Trauma Programhas been redesignated as a Level I

Trauma Center after verification by theAmerican College of Surgeons.

Redesignation means that ChristianaCare continues to offer the highestlevel of trauma services.

Mark D. Cipolle, M.D., PhD., chief ofTrauma Surgery, has been appointedchair of the Delaware Committee onTrauma (COT).

Look for a full story on ChristianaCare’s leadership role in Delaware traumacare and a profile of Dr. Cipolle in a near-future issue of Focus.

Trauma Centerredesignated Level IMark Cipolle, M.D., namedDelaware Committee onTrauma chair

Mark D. Cipolle, M.D., Ph.D.

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An article cowritten byLinda Laskowski Jones,

RN, ACNS-BC, CCRN, CEN,MS, and her husbandLawrence J. Jones, III, NREMT-B, BA, for the magazineNursing2009 won a silveraward" in the “How To”category from the AmericanSociety of HealthcarePublication Editors (ASHPE).

Laskowski-Jones, Christiana Care vice president,Emergency, Trauma & Aeromedical Services, andher husband are members of the Blue Mountain SkiPatrol in Palmerton, Pa.

To read the full article, check News & Events onyour portal.

VP Linda Laskowski Jones’ article wins silver award

Christiana Care advertisingwins national acclaim

Two Christiana Care advertising campaigns wonnational healthcare advertising awards this

spring. Our community benefit campaign won asilver Aster Award for a newspaper advertisingseries. Our heart arrhythmia ad won a silver in theHealthcare Advertising Awards.

The Aster Awards, which received more than 3,000entries this year, are hosted by MarketingHealthcare Today Magazine and Creative Images,Inc. The Healthcare Advertising Awards, sponsoredby Healthcare Marketing Report, is the nation’soldest, largest health care advertising awards com-petition. Approximately 4,000 entries were consid-ered this year.

Linda Laskowski Jones

An ad for Christiana Care’s Healthy BeginningsProgram for young moms-to-be promotes prenataleducation, medical care and peer support to helpgive babies their best chance starting out in life.

Parents can give the whole family aleg up on success with a few simplesteps that will boost the healthy quo-tient on their daily diet without sacri-ficing good taste.

First, switch from whole milk to low-fat milk and nonfat milk, also knownas skim milk. (If you are currentlydrinking whole milk, it might be easi-er to take it in stages, as you and yourkids will have to adjust to a slight dif-ference in taste.)

Get more mileage out of meatsCut back on high-fat cuts of meat,such as beef and pork. You can makethese meats go further by thinking ofthem as ingredients you add to rice,beans or pasta, rather than the maincourse.

Also, banish soda and other sugarysoft drinks from your home. If youdon’t buy it, your kids are much lesslikely to drink it.

Kids need to eat right to grow upstrong and healthy.

As babies and toddlers, Mom and Dadare in charge of what their little oneseat.

But in a world of fast food and snacksfilled with salt, sugar and fat, how doyou keep your children on the pathtoward nutrition as they become moreindependent?

Teach your children how to eat wellYou can start by giving your child aneducation in eating well. For example,read the labels together when you aregrocery shopping, comparing not onlyprice but how much sodium and fat isin that frozen pizza. What is the calo-rie count for a serving of applesauce?Are there many vitamins in it? Or issugar the primary ingredient?

Compare two similar products from anutritional standpoint. Then ask yourchild to decide which will go into theshopping cart.

You can extend that learning curve toeating out. When you and the kidsgrab a quick bite, steer them awayfrom the fries and toward the salad.Instead of a double dip of ice cream,indulge in a refreshing scoop of waterice.

Say no to fried foodsMake certain your children know thatpreparation makes a huge differencein the calorie count of foods. Say “no”to chicken that is breaded and fried;say “yes” to chicken that is grilled andskinless.

More important, keep in mind thatparents are ultimately the greatestinfluence on what their kids eat. Itdoesn’t make much of an impact on adaughter whose parents caution her toavoid sweets as mom is going back fora second helping of lemon meringuepie.

Be a good role model. Lead by exam-ple.

Teach children about nutrition for a healthy start in life

Christiana Care’s Community Health Outreach& Education Program, partnering with the

Delaware Chapter of the American Academy ofDermatology screened 278 people at the Helen F.Graham Cancer Center.

Many abnormal skin conditions were detected andreferred for follow up.

Dermatologists and physician assistants, nurses,clerks and others volunteer to staff the free earlydetection program each year in May.

For information on skin cancer screening and earlydetection, call 623-4661.

Physician Assistant Megan Bovero, PA-C, examines patient Ternoskifor signs of skin cancer at a screening at the Helen F. GrahamCancer Center.

Free skin screeningdetects cancers early

In 2007 the Joint Commission (JC)introduced the Anticoagulation

National Patient Safety Goal (NPSG)to “reduce the likelihood of patientharm associated with the use of anti-coagulant therapy.”

The requirements of the NPSG intro-duced broad sweeping changes for allJC accredited health care organizationsand the patients “under their umbrel-la,” both inpatient and outpatient.

Several elements of performance are:

n Implementing an anticoagulantmanagement program.

n Approved protocols are used: l For the initiation and mainte-

nance of therapyl Are appropriate to the medication

used, and condition treated.

n Warfarin specific elements:l Warfarin is dispensed for each

patient in accordance with establishedmonitoring.

l INRl A baseline INR is established

for all patients started on warfarintherapy.

l A current INR is available andis used to monitor and adjust therapy.

Christiana Care gathered representa-tives from physician groups, Nursing,Pharmacy, Nutrition, the ClinicalLaboratory, Administration, DataAcquisition, and PerformanceImprovement and formed a team ded-icated to meeting the requirements ofthe NPSG.

The team has accomplishedmany things, such asreviewing patient educationand associated materials,implementing an anticoagu-lation monitoring service,revising heparin preprintedorder sheets and MAR anddeveloping a new warfarinpreprinted order sheet.

With the advent of CPOEthere is less need forpreprinted sheets, howeverstructure is still necessary tomaintain established proto-col ordering. Fortunately,CPOE has a solution.Ordering heparin infusionsand warfarin via a PowerPlan (PP) or Care Set (CS)provides the necessarystructure by groupingrequired orders and CCHSdosing and monitoringguidelines together.

The chart below showsavailable CPOE orderingmethods for heparin infu-sion and warfarin, how toaccess the Christiana CareDVT/VTE prophylaxis pro-tocol, as well as stand aloneenoxaparin and dalteparin.

THERAPEUTIC NOTES

Need a gift but don’t have time togo shopping?

The Glass Box gift shop at ChristianaHospital and the Window Box giftshop at Wilmington Hospital mayhave just what you are looking for,whether it’s flowers, balloons,refreshments, reading materials, or aspecial gift for a loved one, co-work-er or baby.

The gifts shops are run by the JuniorBoard of Christiana Care and featurea great selection of reasonably-pricedmerchandise. The gift shops alsohave convenient hours for ChristianaCare employees on the go. Profitsfrom both gifts shops benefitChristiana Care programs.

Glass BoxChristiana Hospital302-733-1100Monday – Friday 9 a.m. to 7 p.m.Saturday and Sunday 11 a.m. to 4p.m.

Window BoxWilmington Hospital302-428-2246Monday – Friday 9 a.m. to 4 p.m.Saturday and Sunday 11 a.m. to 2 p.m.

Gift stores offer convenient shopping

Coupon Coupon

Christiana Care’s PharmaceuticalWaste Reduction Effort (PARE) is

a cooperative endeavor involvingOccupational Safety, Pharmacy,Nursing, Environmental Services andother departments to improve regula-tory compliance, staff safety and envi-ronmental stewardship.

Guidelines for PARE factor in wherev-er we create pharmaceutical waste,such as nursing units, pharmacies, lab-oratories and other clinical areas, aswell as in the soiled utility room anddesignated areas.

By providing methods to properly dis-pose of unused pharmaceuticals, wecomply with regulations and helpensure that untreated waste does notenter our water supplies or landfills.

FAQsWhen do PARE guidelines apply?

PARE applies whenever we dispose ofan unused quantity/portion of anyEnvironmental Protection Agency-reg-ulated substances or pharmaceuticalswe have determined should be treatedsimilarly, or expired pharmaceuticalsthat cannot be returned for credit.

Why are we doing this?

Once disposed, many pharmaceuticalsmeet the definition of hazardouswaste, the handling and disposal ofwhich are subject to requirements of

the EPA and the Joint Commission.Compliance with the regulations andstandards helps prevent pharmaceuti-cal waste from damaging the environ-ment while ensuring we do not incurfines, penalties or administrativeactions.

In addition to proper segregation anddisposal, PARE includes analysis andtracking to learn how to reduce wastefrom unused pharmaceuticals, sam-ples, expired pharmaceuticals anditems that are used infrequently byfinding less hazardous alternatives.

What is our education strategy?

PARE training will include informa-tion regarding which pharmaceuticalsrequire special disposal methods.Some current disposal practices willnot change, including the pouring ofIV nutrition and unmodified salinesolutions down the drain and placingempty sharps in sharps containers.However, some changes are alreadybeing implemented. For example,white/yellow chemotherapy recepta-cles are being removed from nursingunits, replaced with black waste con-tainers. Empty chemotherapy contain-ers should be placed in the black con-tainers. Staff can check pharmaceuti-cals to verify disposal methods on theprofile list located near the black con-tainers.

PARE program cuts pharmaceutical waste

Anew project to increase access to materials atthe Junior Board Cancer Resource Library

will begin making its rounds throughout theHelen F. Graham Cancer Center in June 2010.Volunteers from the Junior Board will providecancer patients expanded access to educationalmaterials. Booklets and pamphlets will beavailable on a mobile cart which will visit waitingareas and infusion suites in the Cancer Center.Materials are free and are aimed to meet thegeneral needs of patients across the continuum ofcancer care, as well as materials for caregivers andfamily members. Junior Board Member, Zita Aquino shows a brochure to

patient Brenda Selby at the Helen F. Graham Cancer Center.

C-A-R-T: Cancerawareness resources to go