The Bulletin: July 2005

The Bulletin is a monthly newsletter for Children's and community providers.

Phone Standards Improvements

In response to requests for an “end of the day” option, the standards for physician-to-physician phone consultation will change from three options to two as of July 15.

When you call the physician operator at (206) 987-7777 to speak with the provider on-call for any specialty, you will be asked if you need to speak with the on-call provider within 15 minutes, or by 5 p.m. the same day. You will also be asked your preferred contact information for the return call.

If you call to speak with a specific physician, we are happy to page that person, or if you prefer, your call will be transferred to the department for you to leave a message.

Also, if you call any of the clinical departments and get a phone tree, you will be instructed to press “7” for the physician operator, rather than “0.”

Please contact Margot Kravette with questions at (206) 987-5765.

New Process Aims to Reduce TPN Errors

Children’s has changed the way we administer total parenteral nutrition (TPN) to better serve our patients and reduce errors. The physician, a dietitian, and a pharmacist with prescriptive authority will make decisions about TPN together during daily rounds.

The dietitian and pharmacist will then complete the details of the order. The bedside RN is responsible for administering and monitoring TPN using a standardized approach.

This process meets the new national guidelines for safe practice published in November 2004 by the American Society of Parenteral and Enteral Nutrition.

For more information on this change, contact Polly Lenssen at (206) 987-5110.

Do the ‘Write’ Thing: Don’t Use Abbreviations

Data shows that using abbreviations in any part of a patient’s chart - orders, prescriptions, progress notes, etc. — can lead to patient harm and put other providers at risk of making misinformed decisions.

The Joint Commission on Accreditation of Healthcare Organizations has identified several commonly used abbreviations that are particularly dangerous:

Write out “unit” or “units” or “international units.”
QD or QOD: Spell out once daily or every other day.
µg: Spell out micrograms or use mcg.
MS, MS04, MGSO4: Spell out morphine or magnesium sulfate.
Terminal zeros: Leave out zeros after decimals when writing whole numbers (e.g., 2 units, not 2.0 units).
“Naked” decimals: Add zero before leading decimals (e.g., 0.2).

Children’s policy strictly forbids the use of these abbreviations in the medical record.

In fact, the use of any abbreviation in a patient’s chart is strongly discouraged due to the potential for patient harm.

Do the “write” thing for patient safety: Clearly spell out your intent in all Children’s clinical documentation.

Vascular Anomalies Clinic

Children’s now offers a semi-monthly clinic to evaluate and treat all types of vascular anomalies including hemangiomas, lymphatic malformations, venous malformations and other types of vascular tumors.

Wait time for an appointment is typically less than two weeks. The multidisciplinary care team includes pediatric otolaryngologists, dermatologists, interventional radiologists, ophthalmologists, hematologists, and general, neuro, plastic and orthopedic surgeons.

To make a referral, call (206) 987-2080 or fax a New Patient Referral Form to (206) 985-3121.

For more information about the clinic, e-mail Clinic Coordinator, Ronna Smith, ARNP.

Psychiatry Resource Available via E-mail

Children’s offers an e-mail resource for your general questions related to diagnosis, prioritizing treatment needs, pharmacological treatment, and managing medication side effects of children and adolescents with psychiatric problems.

Send your question to child.psych@seattlechildrens.org. Dr. Kathleen Myers, director of the Psychiatry Consultation and Liaison Service, will generally respond within 24 hours and will definitely respond within three days.

This resource is for primary care physicians, and is not a referral service or a shortcut to services at Children’s.

For referrals, call the intake line at (206) 987-2760.

If you have a patient whose family is concerned about getting treatment at Children’s because of cost, or paying their Children’s health care bills, please refer them directly to a Children’s financial counselor at (206) 987-3333 or, for assistance in Spanish, (206) 987-5786.

The Children’s Financial Assistance Program is not a form of insurance, but it can help families pay part or all of the bills for medically necessary services that insurance doesn’t cover. Families may apply before or after their child receives care.

Eligibility for financial assistance is based on family income and hospital resources. Patients must be under age 21 and have their primary residence in Washington, Alaska, Montana or Idaho.

Financial Counselors Can Help

The Children’s Financial Assistance Program is not a form of insurance, but it can help families pay part or all of the bills for medically necessary services that insurance doesn’t cover.

Families may apply before or after their child receives care.

Eligibility for financial assistance is based on family income and hospital resources. Patients must be under age 21 and have their primary residence in Washington, Alaska, Montana or Idaho.

Governor and Legislature Expand Coverage for Children

Gov. Christine Gregoire and the Washington State Legislature reversed deep cuts to health care coverage for children in the recently passed 2005-2007 state budget, ensuring health care coverage for 40,000 more children in our state.

In addition, the legislature has set the goal of providing health care coverage for all children in Washington state by 2010.

Currently, there are nearly 100,000 uninsured children in Washington who do not have access to the health care they need to stay healthy.

The new state budget rolls back bureaucratic barriers to enrollment and extends a child’s Medicaid eligibility to 12 months of continuous coverage; shelves monthly premiums for children on Medicaid; tables co-pay requirements for prescription drugs and transportation; and provides better coverage for immigrant children.

Joyner Receives Teaching Award

Congratulations to Dr. Byron Joyner of the Pediatric Urology division who was awarded the 2005 Dr. Julian Ansell Resident Teaching Award by the Department of Urology at the University of Washington.

Dr. Joyner has also been named the training program director for the Urology residency at UW.

New Medical Staff

Julianne Bishop, MD, Hospitalist
Eric Demers, MD, Neonatology
Daniel Doherty, MD, Neurodevelopmental
Laurilyn Helmers, MD, Anesthesia
Paul Lin, MD, Reproductive Endocrinology, Seattle Reproductive Medicine
George Powers, CRNA, Anesthesia
Johanna Vidal, MD, SeaMar Community Health Center

Grand Rounds

View the schedule of upcoming Grand Rounds.

Grand Rounds Online

View online versions of recent Grand Rounds.

On-Call Schedule

The on-call schedule for inpatient services can be found in the secure area of the Medical Staff Web site. It is updated on a daily basis.