Hospital of the University of Pennsylvania

INSIDE

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Volume 23 Number 8 April 20, 2012

Writing from the Heart Reconnects Young Patient ......3

A Hawaiian Oasis at 1500 Market ..............................3

Did You Choose? ......................4

Free Skin Care Screening ........4

Save a Life with a Platelet Donation ......................4

A deer in the headlights.

That’s how Stuart Carter, a MS3 student at the Perelman School of Medicine, described feeling when he began his first clinical rotation at HUP in early 2011. “It was scary, trying to navigate the system... especially Founders 14, which is a fast moving, well-oiled machine,” he recalled.

Enter Diana Santangelo, BSN, RN, a clinical nurse who participates in the new program focusing on interdisciplinary education that pairs nurses with medical students who are new to clinical rotations. Remembering the fear that she too felt on her first clinical rotation as a student nurse, Santangelo took the time to show Carter not only the ins and outs of the unit but also the key roles nurses play in patient care. Looking back, he said, “It was nice to have someone help ease my burden. Now I feel much more comfortable interacting with the nursing staff.”

In a sense, this new program is an extension of Penn Medicine’s unit-based clinical leadership. These interdisciplinary groups have demonstrated the immense benefits of health-care professionals working as a team instead of in side-by-side silos. The mentoring program brings them together as well but at an earlier stage…and it’s a win-win situation for everyone.

Structuring the ProgramBetty Ann Boczar, BSN, nurse manager of Founders 12 and 14, and Kate FitzPatrick, MSN, RN, clinical director, Nursing Operations and Women’s Health, were brought into this program early in the planning process but both credit Victoria Rich, PhD, chief nurse executive, UPMC, as “the visionary” who kick-started the initiative with Stanley Goldfarb, MD, associate dean for Curriculum, and other medical school faculty and administration. .

“Medical students had no idea of the various roles of nurses, and nurses didn’t know how much the students knew — what their background would allow them to do,” Goldfarb said. “It’s two different worlds coming together.”

Input from groups of nurses and med students helped shape the structure of the mentoring program, said Anna Delaney, chief administrative office of Academic Programs. “We asked them, ‘What is it you don’t understand about each other? What has worked well and what hasn’t?’”

From that feedback, “we developed a checklist of nursing actions that we felt were important for a medical student to see,” said Jennifer Kogan, MD, of Internal Medicine. This included patient admission and discharge, wound care, medication administration, and the nurse-to-nurse shift report.

HELPING SOM STUDENTS LEARN THE ROPES New Nurse Mentor Program

Underscores Importance of Team Work

` Diana Santangelo shows medical student Stuart Carter proper medication labeling and administration.

(Continued on page 2)

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What Does a Nurse Do?Medical students receive classroom training in clinical areas, but their knowledge about the flow of the hospital and how a patient unit works is minimal. “Diana was the point person I could direct questions to,” Carter said. “She showed me the structure of the floor, the different roles of nurses, support staff.… I had a much better perception of who to go to for answers and as a result I was a more helpful med student.”

The biggest surprise, Santangelo said, was how little medical students seem to know about the role of the nurse in patient care. “Sometimes I feel like they think things magically happen!” she said, laughing. “I tell them, ‘These are the steps we have to do to prepare for a discharge…so be nice to me when you’re an intern and I call you 15 times!’”

“The process from the doctor typing an order into the computer to its execution is like an algebra equation; many factors play into it,” explained Ian Villarreal, BSN, nurse mentor on Founders 14. For example, for medication administration, “we have to know ‘Can the patient swallow? If there are two meds, are they compatible?’... There are a lot of subtleties to be learned.”

A Treasure Trove of InformationWound care on a patient with diabetic foot ulcers. Pulling together information for a patient discharge. “These are things you never see that when you’re with a resident or attending,” said Ivor Asztalos, second-year medical student at Penn. But, what’s even better, he said, is knowing where all that information is charted online. “It’s a treasure trove of information. And it’s not only great information but there’s also electronic charting for information that’s frequently difficult to acquire, like a patient’s daily intakes and outtakes or weights.”

The nurse’s information can also help confirm findings, Asztalos said. “Pre-rounds with residents are directed at information pertinent to the organ systems involved. For example, if it’s a heart patient, we look for edema, check the heart and lungs. But nurses do a head-to-toe assessment every day,” he said. “This information can help confirm a finding but the average med student may not know this information even exists…or how to find it.”

Asztalos also learned about the Navicare tracking system. “If patients aren’t in the room, where are they? With Navicare I know if a patient is in transit, on the way back.… I don’t have to waste time trying to find out.”

Villarreal mentors his assigned med student but will take other students under his wing when he’s tackling one of the checklist items. “I just call out, ‘Hey, want to watch an interesting wound change?’ and two or three eager students will follow me.”

The biggest challenge, he said, is finding a time when nurses are performing their patient-care activities and med students have the

time to watch. “We’re hoping to get a day where a med student will only shadow you – no other responsibilities. Right now we try to grab them when we’re doing something on the checklist but they’re not always available.”

Others in the program have found the timing to be a challenge as well. “We’re going to recommend that time be set aside on all mentoring units so students can spend several hours with their mentor,” said Keith Hamilton, MD, associate director of the Internal Medicine Clerkship.

Success Leads to Expansion The mentorship program recently won the Dean’s Award for Excellence in Medical Student Teaching by an Allied Health Professional but this is not stopping its leadership from making it even better. “It’s is an ongoing process,” Kogan said. “We have to remain flexible and willing to make changes.” Boczar and FitzPatrick will receive the award at the Perelman School of Medicine commencement next month.

Based on the positive feedback, Hamilton said that every student who does a rotation in internal medicine will now participate in this interdisciplinary process. Since the program was piloted last year on Founders 12 and 14, it has expanded to include Founders 8 (the CCU) and Labor & Delivery, as well as the Acute Care for Elders unit at Penn Presbyterian and one of its general internal medicine floors. “Each unit we choose brings something unique to the table,” Hamilton said. “For example, CCU nurses have expertise in reading telemetry, and the ACE unit demonstrates the nuances in caring for the elderly.”

“Eventually we want to roll this program out throughout the Health System,” Boczar said. “We’re already getting requests from the surgical units.”

“Now that health care is a team sport, it’s crucial for medical students to understand the roles of other members of the team,” Hamilton said. “When they graduate, they will be helping to lead these teams. It’s important to ‘grow up’ in this environment.”

` The mentor board on Founders 14 provides information to help medical students on their first clinical rotation, including names and photos of all the nurse mentors.

HELPING SOM STUDENTS LEARN THE ROPES(Continued from cover)

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WRITING FROM THE HEART RECONNECTS YOUNG PATIENT Twenty-year-old Stephanie Tini had been battling Hodgkin’s lymphoma since December. A tracheotomy kept her airways open but her dependency on a ventilator prevented her from speaking. She could mouth words to those who visited, but communicating to her outside world of friends was extremely limited.

In February, at the request of Stephanie’s sister – and after getting the ok from her nurse manager — Wendy Palma, RN, of the MICU, wrote a letter to a charitable organization called Little Philly Smiles (www.littlesmiles.org), asking for a laptop for the young patient.

Writing “from the heart,” Palma said, “…While [Stephanie’s] journey down this rocky road began several months ago, her smile has continued to shine…. We, as an interdisciplinary team, would love to see her obtain a laptop to be able to communicate with her friends, watch movies and enjoy a life of a ‘normal teenager’ and not one that has been living in a hospital for the past two and a half months. She has truly touched our unit and become a part of our family.”

Within a day of emailing the request, the organization’s director called to learn more. “Three hours later, we had board approval,” Palma said. “They were that touched by the request.” So touched that Kate Patterson, Little Philly Smiles director, drove from Kennett Square to present the laptop personally.

Exhibitors of the Philadelphia Flower Show were not the only ones vying for an award. The tenants of 1500 Market Street were asked to put their creative talents to work as well. Using the assembled kits (which contained a pineapple, coconut, sea shells, bamboo rods and Hawaiian leis) provided by the building management — as well as five items of each team’s own choosing — they were challenged to create a display to match the Flower Show’s theme: Hawaii: Islands of Aloha.

Members of Patient Registration and Scheduling went all out. Alice Tracy baked the foundation for their entry: a chocolate cake, which served as land, and two vanilla cakes, which became the basis for a tiki hut (vanilla wafers formed the walls). White chocolate shells and real ones were scattered on top of the brown sugar beach. Real plant leaves were mixed in with silk flowers for the foliage.

Using the provided box, team members created the backdrop (with colored paper for the sky, water, sign and sun), beach chairs, and surf boards. “We made clams by putting two shells together, with palm trees made out of bamboo and silk leaves,” Tracy said.

Not only did the team have a great time putting the island scene together, their ‘delicious’ entry – Hawaiian Island Oasis — won first prize and tickets to the Flower Show.

“The team was filled with creative minds that were willing to try things and the end result shows it!”

` Stephanie Tini with her mom, Roxanne (l.) and Wendy Palma, the MICU nurse who wrote the heartfelt letter that re-opened a line of communication for her young patient.

` Winning team members (l. to r) Nicholas Roper, Alice Tracy, Berna Johnson, Shauna Williams, and Tiffany Thomas. Not shown: Annette January.

“It touched me that it was so generous,” Palma said. “It’s hard working in the MICU — so much sadness. It’s the happy moments like this one that keep us going.”

At last report, Stephanie was looking forward to being discharged. According to Palma, she is eating, talking and continuing to enjoy her laptop!

A HAWAIIAN OASIS AT 1500 MARKET

COMING SOON: PENN RELAYS Thursday, April 26 to Saturday, April 28. For more information, go to www.thepennrelays.com.

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HUPdate

Helping People ALL THE TIMECongratulations to the December winners of the Helping People All the Time raffle.

EDITORIAL STAFF Sally Sapega Editor and Photographer

Trissy Harding Designer

ADMINISTRATION Susan E. Phillips Senior Vice President, Public Affairs

CONTACT HUPDATE AT: 3535 Market Street, Mezzanine Philadelphia, PA 19104

phone: 215.662.4488 fax: 215.349.8312 email: sally.sapega@uphs.upenn.edu

HUPdate is published biweekly for HUP employees. Access HUPdate online at http://news.pennmedicine.org/inside/hupdate.

FREE SKIN CANCER SCREENINGPenn Dermatology and the Abramson Cancer Center are sponsoring a skin cancer screening on Saturday, May 19, from 8 am to noon in the Perelman Center for Advanced Medicine. This free event is offered to help spread the important message that early detection and prevention of skin cancer saves lives. Appointments are necessary and space is limited. To make a reservation, call 215.662.2737.

SAVE A LIFE WITH A PLATELET DONATION The Penn Medicine Blood Donation Center recently expanded its collections to include platelet cells. Platelets are small cells in the blood that play an important role in helping blood clot. They are often used in life-threatening situations or for patients at risk for bleeding, such as burn and trauma patients, cardiopulmonary bypass patients, stem cell transplant patients and cancer patients.

Platelets are extremely fragile and must be used within five days of being collected, which makes it very challenging to meet the daily demands for this product.

Please consider donating platelets by calling the Center at 215.614.0406. The donation center is located on the Penn Tower Bridge and is open for platelet collections Mondays through Wednesdays, from 8:00 am-1:00 pm. Platelet donations must be scheduled a minimum of 48 hours in advance. Your platelet donation is used exclusively for a patient being treated at HUP.

For more information contact Barry Overton at 215.662.0439.

DID YOU CHOOSE? ENROLL TO EARN A PREMIUM DISCOUNT ON BENEFITSIf you haven’t done so already, be sure to choose your benefits for FY13 during Open Enrollment, which runs through Sunday, April 29. Employees can earn a premium discount on their medical contribution if they do not use tobacco products or are enrolled in a tobacco cessation program or will be enrolled by June 30, 2012.

Remember that this year is an active enrollment, meaning employees must select benefit choices during enrollment to receive the premium discounts.

All employees should have received an Open Enrollment newsletter in the mail providing an overview of benefits and discounts for your healthy habits. You can also easily access the 2012-2013 Online Enrollment Guide online at www.uphshrandyou.com. If you have any questions, contact your HR benefits specialist at 215.615.2675.

Jessica Bang . . . . . . . . . . PeriOp Nursing

Courtney Callinan . . . . . . . . .Founders 14

Stephanie Caniglia . . . . . . . Silverstein 9

Cashin Chandler. . . . . . . . . . .Founders 10

Annie Chapman . . . . . . . . . . . . . .Ravdin 9

Mark Dillon . . . . . . . . . . . . . . .Founders 10

Dawn Dixon . . . . . . . . . . . . . . . .Radiology

Susan Dougherty . . . . . . . . Silverstein 10

Jasmine Drake . . . . . . . . . . . .Founders 11

Antoinette Edwards. . . . . . . . . .Radiology

Bridget Ferrarie . . . . . . . . . . . . .Radiology

Enrique Flores . . . . . . . . . . . . . . Rhoads 6

Reginald Gary . . . . . . . . . . . . . . .Radiology

Regina Halligan . . . . . . . . . Silverstein 12

Abigail McDonald . . . . . . . . .Founders 11

Alison McCaulley . . . . . . . Silverstein 12

Leslie Miles . . . . . . . . . .Patient Transport

Nicholas Palma . . . . . . . . . . . . . .Ravdin 6

Sheila Parker . . . . . . . . . . . . .Founders 11

Tarella Peterson . . . . . . . Respiratory Care

Bruce Price . . . . . . . . . . . . . . . .Founders 9

Erika Reeder . . . . . . . . . . . . . . . .Radiology

Darline Rosier . . . . . . . . . . Silverstein 12

Clarence Spencer . . . . . . . . .Founders 10

Tara Thomas . . . . . . . . . . . . . . . .Radiology

LATEST GRANT WINNERSThe Penn Medicine CAREs Foundation Grants Program recently announced grant award winners for the third quarter. Congratulations to the following employees, listed below with their outreach activities:

• Johanne Louis of Geriatric Medicine at HUP, The Vermase Foundation

• Marion Leary of Emergency Medicine at HUP, Sink or Swim Philadelphia

• Nicholas Kenji Taylor, student at the Perelman School of Medicine, The Cut Hypertension Program

• Phillis Dupree of Penn Care at Home, Heart of the Caregivers in the Community

• Pandora Chua, student at the Perelman School of Medicine, University City Hospitality Coalition Clinic

If you’re involved in community outreach activities, you can apply for a grant to help fund these projects. The deadline for the next round of applications is Friday, June. 1. Go to www.pennmedicine.org/community to apply and for more information.

MAKE IT COUNTS