The Bulletin: April 2008

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

Quarterly Consult: Pediatric Liver Disease and Transplant

Dr. Simon Horslen, medical director of the Liver and Intestine Transplant Service at Children’s, provides information for primary care providers on pediatric liver disease and transplant.

General Surgery Clinic Appointments Available Five Days a Week

The General Surgery division has overhauled how they schedule and see patients in their clinic to provide more timely access to their services. Improvements include increased capacity and appointment access. General surgeons are now available five days a week - Tuesday through Friday on the main campus, and Monday, Tuesday and Friday in Bellevue. Several appointments are reserved each day at both locations for patients who need to be seen immediately.

General surgeons at Children’s see infants to young adults for a variety of issues, from common procedures like hernias to more complex surgeries and transplants. Providers in the General Surgery Department work with specialists in all disciplines, including Pain Medicine, to meet each patient’s and family’s individual needs.

Call the Clinical Intake Nurses at (206) 987-2080 to request a consult or referral. For an urgent phone consultation with a Children’s physician, call the Physician Operator, at (206) 987-7777 or toll free at (877) 985-4637. Visit the General Surgery Web site.

Pediatric Multiple Sclerosis Clinic Now Accepting Referrals

Children’s neurologist Dr. Raymond Ferri, and Dr. Sylvia Lucas, of the University of Washington, are leading a new clinic for the treatment and care coordination of patients with childhood onset multiple sclerosis and related disorders.

Ferri and Lucas will see patients up to age 21 with the diagnoses of multiple sclerosis, acute demyelinating encephalomyelitis, transverse myelitis, optic neuritis, and neuromyelitis optica. The participation of Dr. Lucas at the university ensures a smooth transition from pediatric to adult care for this lifelong condition. Patient care will be coordinated with other specialties as needed, such as rehabilitation
medicine and ophthalmology.

The Multiple Sclerosis Clinic will be held on the first Monday afternoon of each month. To refer a patient or to request a consultation, please call the Clinical Intake Nurses at (206) 987-2080. For questions regarding referrals to this specialty clinic, Dr. Ferri can be contacted at ferrir@u.washington.edu.

Dermatology Services Temporarily Unavailable

Children’s is temporarily unable to provide general outpatient dermatology services. Dr. Robin Hornung had gradually reduced her time at Children’s during the past year and has now left to practice general dermatology at The Everett Clinic. Urgent inpatient dermatology consults are still available; however, there is no coverage for nonurgent calls to the physician phone line.

Children’s is actively recruiting dermatology faculty and looks forward to reopening the Dermatology Clinic in the near future. Community practitioners are available for pediatric dermatology until we are able to reopen; please contact the University of Washington Roosevelt Clinic or call Dr. Virginia Sybert at Group Health, Dr. Julie Francis at Eastside Dermatology or Dr. Robin Hornung at The Everett Clinic. You can direct questions about follow-up care for previous Children’s clinic patients to Kathleen O’Connell, RN, at (206) 987-8921.

Identifying Patients of the Future: Planning for Children with Chronic Illnesses

Many hospitals know very little about the patient population they serve because they analyze individual stays, admissions or discharges rather than populations-based data. Analyzing the hospital experience of a particular patient population provides clinicians and planners with an opportunity to prepare for groups of patients who can be expected to stay longer and be readmitted frequently.

More than 67% of patients discharged from Seattle Children’s in 2005 had at least one chronic condition, and this group accounted for almost 92% of all hospital charges for that year, according to data published recently by Dr. John Neff, director of Children’s Center for Children with Special Needs, and Pat Hagan, Children’s president and chief operating officer. Patients with chronic conditions are children with episodic chronic conditions, and lifelong chronic conditions, including those with progressive chronic illnesses, those dependent on technology and those with nonbenign malignancies.

The five-year trends showed chronically ill patients getting older and their conditions becoming more chronic and complex. These patients require multiple admissions, longer stays and the kind of specialized care Children’s offers. Children’s Hospital’s planned growth is based on the hospital experience and projected needs of our particular patient population.

Read the complete article in the Winter 2008 issue of Children’s Hospitals Today. Also, read a letter from Dr. Thomas Hansen, Children’s chief executive officer, to community members regarding the hospital’s growth on the Medical Staff Web site.

New Infection Control Practices in Effect in Intensive Care Units

The Intensive Care Units (ICUs), along with the rest of the hospital, have never been busier, experiencing exponential growth in census and acuity. Patients have become much more complex and are at extremely high risk for hospital acquired infections. The ICUs have instituted a number of new infection control practices to minimize the risk of these infections. Signage is posted on the door of every patient room to remind you of these new practices. All staff that see patients in the ICUs are required to follow these standard practices.

Practice 100% hand hygiene compliance. Wash your hands (or gel in) before you enter the room, even if you do not plan on touching anything. And wash your hands (or gel out) before you leave the room, even if you have not touched anything.
Long sleeves are not permitted in patient rooms, or cuffs must be rolled up, so hand hygiene can extend over the wrist area.
Watches and bracelets should be removed before entering the room, so hand hygiene can extend over the wrist area. If it is not possible to remove wrist jewelry, a cover gown can be used to cover this area.
Lab coats should be removed before entering patient rooms.
If rings are worn, providers must wear gloves before touching patients.
Phones and pagers must be answered outside the rooms.
Papers, notebooks, equipment, and other items should be left outside the patient’s room.

If you have any questions about these new practices, please feel free to contact any of the ICU leaders, Drs. Jerry Zimmerman, Harris Baden, Craig Jackson, or Cathie Rea or Debra Ridling. Dr. Danielle Zerr is also available for consultation.

Berg Named Director of Dentistry

Joel Berg has been appointed director of the Department of Pediatric Dentistry at Children’s. He joined the medical staff in 2003 and has served as the interim director of dentistry since 2006.

Dr. Joel Berg

Berg is a professor of pediatric dentistry and serves as the chair of the Department of Pediatric Dentistry at the University of Washington School of Medicine (UWSOM), where he holds the Lloyd and Kay Chapman Chair for Oral Health.

“We are fortunate to have Dr. Berg in this position. He has been instrumental in the growth of the dental program at Children’s,” says Dr. David Fisher, senior vice president and chief medical officer at Children’s. “Even with the department short two dentists this year, the volume of patients seen in the clinic continues to grow.”

Children’s Hospital’s dental program is the only program in the country to be continuously funded with two separate Title VII leadership grants from the Maternal and Child Health Bureau of the federal government.

Two new dentists and one oral surgeon will be joining the program by July 1, further expanding capacity.

Children's Welcomes Key Personnel

In March, Children’s welcomed Drexel DeFord as senior vice president and chief information officer, Wes Wright as vice president and chief technology officer and Steven Hurwitz as vice president of Human Resources.

Both DeFord and Wright come from Scripps Health in San Diego. Prior to working at Scripps Health, DeFord and Wright served in information technology leadership roles in the U.S. Air Force health system.

“Drex and Wes have an excellent track record and background in IT strategy and operations in health care,” says COO Pat Hagan. “They will lead efforts to make sure our people have the technical tools and equipment to do their best work.”

Hurwitz comes from Starbucks Coffee Company where he served as vice president of human resources for U.S. business for nine years. He will direct the Children’s Human Resources Department and report to Lisa Brandenburg, senior vice president and chief administrative officer.

“As we plan for growth, Steven will play a key role in recruiting and retaining the very best people,” says Brandenburg. “He brings great enthusiasm for our efforts to make Children’s one of the best places to work in the Northwest.”

Goldin Recognized as ARTist of the Month

Adam Goldin, MD, MPH, of General Surgery was chosen as Children’s ARTist of the month in March. The “ARTist of the month” award recognizes employees who exemplify community standards of Accountability, Respect and Teamwork.

Dr. Adam Goldin

Goldin’s nomination came from a parent who said, “We were blessed to have him repair our daughter’s birth defect — he saved her life. His manner and knowledge got us through the toughest time in our lives. Dr. Goldin did an amazing job of representing the hospital and all it stands for.”

Goldin has been a member of the medical staff since 2005.

Medication Reconciliation: What You Need to Know

Children’s is expecting an unannounced visit from Joint Commission surveyors this spring, and medication reconciliation is one of the topics they will discuss with physicians.

Electronic medication reconciliation was rolled out this winter in the Emergency Department and the Medical Unit and will be implemented in the Surgical Unit, Day Surgery, and the Operating Room in April. We continue to follow our electronic process in the clinics, and our paper-based process using the incoming medication list (IML) and the outgoing medication list (OML) in all other inpatient areas.

These are the questions you can expect:

Q: What is your responsibility in the medication reconciliation process?

A: Physicians are responsible for reconciling a patient’s medications in the Clinical Information System or on paper at admission, transfer and discharge.

Q: How does the next provider of care get information about a patient’s medications?

A: The next provider accesses medication information in the medication profile tab of the CIS or on the OML.

Q: Where can you find a description of the process?

A: On the Patient Safety site on CHILD.

Medication reconciliation is an important patient safety strategy that prevents medication errors. If you have any questions about how the medication reconciliation process works, please contact Dr. Mark Del Beccaro, pediatrician-in-chief and chief medical information officer, at (206) 987-1444.

Tamper-Resistant Paper Now Required for All Prescriptions

As of Monday, March 31, all prescriptions given directly to a patient must be on tamper-resistant paper. Children’s is making this change to comply with a new federal regulation to prevent unauthorized duplication or alteration of prescriptions.

All printers used to print prescriptions are now stocked with tamper-resistant paper; when you choose to print a prescription, it will automatically print on this paper.

If you plan to fax a prescription or transmit it electronically, you do not need to use tamper-resistant paper.

Several new policies and practices are being implemented to comply with the new regulation:

Whenever possible, print prescriptions electronically. Handwrite prescriptions only in areas that are not yet using EasyScript or when EasyScript is down. When handwriting prescriptions, use the standardized prescription forms made of tamper-resistant paper. These prescription forms have a revision date that is no older than September 2007. If you find any prescription pads dated prior to that date, shred them or place them in the secure recycle bins to prevent inappropriate use. Do not put them in the trash or in the open recycle bins.

Pharmacies are no longer allowed to accept prescriptions with anything that has been crossed out or erased on handwritten or EasyScript prescriptions. If changes to the prescription are required, providers must rewrite or regenerate the prescription.

Always use the appropriate tamper-resistant paper. All of this paper says at the bottom, “Void if altered or erased. See back for security features.”

Remember to avoid dangerous abbreviations. See CHILD for a list of those abbreviations.

Remember to print any prescription you handwrite. Prescriptions in cursive writing are no longer allowed in Washington state.

Children’s will continue to implement policies to ensure that pads for handwritten prescriptions comply with additional federal requirements that must be met by this October.

Any questions about this change can be directed to Dr. Mark Del Beccaro, pediatrician-in-chief and chief medical information officer, or Eric Harvey, pharmacy quality manager.

Rapid Response Team Implemented

Children’s new Rapid Response Team (RRT) will respond to staff concerns about a patient’s deteriorating condition. The RRT program will begin on the medical units on April 7. Surgical, dialysis, Seattle Cancer Care Alliance and Hematology-Oncology units will follow soon thereafter.

The team consists of an Intensive Care Unit (ICU) charge nurse and an ICU respiratory therapist who will respond to a call within five minutes, ensuring that the patient will be evaluated and treated in a timely manner.

The patient’s resident will be notified immediately when the RRT is called, and the patient’s attending physician will be called after the RRT responds.

The primary goal of RRT is to avoid cardiopulmonary arrests whenever possible, by improving staff recognition of the warning signs and the ability to intervene quickly when a patient’s condition is deteriorating.

The RRT is expected to reduce the frequency of Code Blue calls. Continue to call the Code Blue team for all life-threatening emergencies — when imminent respiratory, cardiac or neurologic failure is suspected and help is needed in less than five minutes.

CIS Upgrade Live on April 27

The Clinical Information System (CIS) will be upgraded on Sunday, April 27. The CIS Upgrade Guide provides an overview of the most important changes, which impact how orders and diagnoses are entered. The guide also lists new features that come with the upgrade. All CIS users should review the guide before April 27.

Prior to going live, drop-in training will be offered in W3745 from 9 a.m. to 5 p.m. the week of April 7-11 and April 21 - 25. Anyone who would like hands-on training is welcome to spend 15-30 minutes with staff who will be available to demonstrate and answer questions.

CIS staff will be at the hospital and in ambulatory team rooms during the week of April 27 to assist users. If you have any questions regarding the CIS upgrade, please contact Michele Englehart, CIS project manager, at (206) 987-4259.

Policy Change for Viral Respiratory Precautions

Children’s changed the policy for personal protective equipment (PPE) based on new guidelines from the Centers for Disease Control and our organization’s experience with best practices. New signs have been placed on the doors to inpatient rooms and in other areas that use PPE. Though the sign color remains the same, the new signs will have a removable sticker in place for the first few weeks to call attention to the new requirements.

Existing Policy	New Policy
Staff members may enter the patient’s room wearing only gloves.	Staff members will be required to put on gowns, gloves and masks at the door to patient rooms as they enter.
If working within 3 feet of the patient, gowns, masks and eye protection are required.	Eye protection is required if working closely (i.e. within 3 feet) with a coughing patient. Standard precautions would also require adding eye protection when splashes or sprays are anticipated, e.g., suctioning an open trach.

Fellows' Research Day

The annual Fellows’ Research Day is scheduled for Friday, April 25, at the Seattle Children’s Hospital Research Institute, Building 1, at Ninth and Stewart. The goal of the day is to showcase the exciting research being conducted by fellows in all departments throughout Children’s Hospital, through oral and poster presentations.

Annual Medical Staff Social, April 12

This year’s event will be held at Bellevue Arts Museum from 7 to 10 p.m. The first annual Richard Molteni Award for Professionalism and Quality will be presented. Please RSVP to Georganna Biggins.

New Medical Staff and Allied Health Professionals

Children’s welcomes these new medical staff members and allied health professionals.

Mary King, MD, Critical Care, Children’s
Jennifer Turner, MD, Rheumatology, Children’s
John Harvey, MD, Madigan Pediatrics
Amy Andersen, ARNP, Anesthesia, Children’s
Alphonzo Flying Cloud, Jr., PA-C, Orthopedics, Children’s
Vanessa Garen, ARNP, Anesthesia, Children’s
Tina Kolman, ARNP, Hematology-Oncology, Children’s
Jennifer Shutts, ARNP, Seattle Cancer Care Alliance

PALS Renewal and PALS Provider Classes

A PALS Renewal Class will be held Friday, April 25, from 8 a.m. to 3:30 p.m. at Children’s Hospital’s 70th and Sand Point building. Current Basic Life Support (BLS) for Health Care Provider certification is highly recommended for all participants, and is required for all Children’s nurses prior to taking PALS.

A PALS Provider Class will be held on Saturday, April 26, and Sunday, April 27, at Children’s Hospital’s 70th and Sand Point building. This class will run from 8 a.m. to 4:45 p.m. on Saturday and from 8 a.m. to 1:30 p.m. on Sunday. The two-day provider course is for those taking the American Heart Association/American Academy of Pediatrics PALS course for the first time, or for those whose provider status has expired. Register online on the Medical Staff Web site.

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.