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March 30, 2015
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Volume 4, Issue 13
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SERVICE EXCELLENCE
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Service Standard of the Week:
Workplace Cleanliness
We maintain a professional, clean, organized work bag and work area, whether in the patient's home or in the workplace.
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Workplace Cleanliness is Everyone's Responsibility
By Stephanie Jackman-Havey, CFO/COO
We spend a great deal of time at the office, so it's important that we all take pride in our work environment. We have an amazing Facilities department as well as building cleaning crews that work hard to keep our spaces clean, but employees need to do their part as well.
With that said, it's SPRING CLEANING TIME!! Please take a moment this week to clean out your desk drawers, filing cabinets, and anywhere else you stash items away. Make sure anything with patient health information is discarded in the appropriate shredding receptacles located around the office. Storage archiving boxes will also be available for patient or financial files that can be sent to our offsite storage facility.
Did you know that an average work desk has 400 times more bacteria than an average toilet seat? Take a few minutes and clean your electronics with special wipes for your screens, a keyboard cleaner that picks up junk in between the letters, and even a spray can of air should do the trick. While you're at it, don't forget to wipe down your phone and desk too!
A cluttered environment restricts ability to focus and limits the brain's ability to process information. Remember the circular file. If you have to ask if you need it, you probably don't.
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Recognizing Some of our Nurses in the Field
By Mary Ambrefe, Pharm.D., CGP, Clinical Pharmacist and Manager of the Pharmacist Consultation Program
Since last October, I have had the privilege of sharing some home visits with a number of our clinicians. Those have been some of my most favorite and treasured days. While my initiative with Atrius and the VNA calls for me to work in a remote capacity, supporting the nurses who provide care to the same patients I do, I have been afforded an opportunity to join them in the home with the purpose of putting my face to the many notes I have authored.
What was striking on so many visits was the rapport that the nurses had forged with so many of our patients. It makes perfect sense that establishing that meaningful relationship early on, facilitates honest dialog and comfort between patient and clinician. One of the barriers to this has been staffing shortages and the unfortunate but necessary practice of shifting and adding assignments to accommodate all the patients that need to be seen and sending a clinician who is best suited to address and treat their needs.
That said I am heartened by the amount of resources being devoted to Workforce Development across the enterprise. I know this will eventually translate into fewer staffing challenges, more permanent assignments and the greater job satisfaction that will follow. As a member of the Education Department, I have the unique perspective of seeing some of the herculean efforts being made and the investment in our new hires. I genuinely hope together we can each make the VNA a warm and welcoming environment in which new hires choose to stay. Properly developed, which studies show can take up to 18 months, we are all investing in a colleague within whom we can collaborate over the long haul.
On a final note, I want to reiterate how fortunate this agency is to have Jill Enwright, Shannon Granata, Erin Woods, Michelle Guerra, Colleen Conneely, Stacy Campbell, Maureen McDermott, Maureen Mallett, Kit Jennings, Kim McCarthy, Hulay Kamara, Esther Njorge, Meaghan Weymouth, Christina Hanley, Bonni Mills, Susanne Cawley, and Kathy Maurice on staff. Every one of these women walked into their visits prepared, pleasant, and professional. They have impressed me with their ability to work autonomously while also remaining open and appreciative of what I could offer to support their practice. These women have stepped up at a most challenging time often to the exclusion of personal or family time to not only get the job done but to do it in a way that provides compassionate and exceptional care , reflecting beautifully on this agency. When I go home at night after these visits I always say to my family, "I had the best day with..., if I ever need a nurse, I want it to be her" my family laughs at me now as soon as I begin the sentence!
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Patient Expresses Gratitude
Please see the note below sent in by a patient seen out of the Worcester office. What a great example of how Service Excellence really does make a difference for our patients!
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The VNA Care - Worcester, MA
Attention: Wendy Drake, Rehab Supervisor and Peg Quinlivan, Supervisor
Re: Lindsey Merchant, Physical Therapist
I would like to extend a big thank you to the VNA organization for Lindsey's help, guidance, exercise programs, doing rolling logs and much, much more. All taught with a pleasant smile and encouragement. I commend her for her knowledge and professionalism, an excellent representative for the VNA.
In my estimation the VNA has an A+ reputation because you have people like Lindsey on your staff.
Again, thanks very much.
Sincerely,
M.P.Boosahda
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AGENCY ANNOUNCEMENTS AND UPDATES
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Worcester Business Journal Interviews Julie Boon
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Our very own Julie Boon, clinical services manager in the Worcester office, was just highlighted in Worcester Business Journal's very first Health Care Magazine.
Thank you to Julie for doing such a fantastic job of representing all that is so great about our organization! Click the link below to see the full magazine and turn to page 34 for Julie's article.
https://nebusinessmedia.uberflip.com/i/482401-health-march-23-2015
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Moving Forward Update
Issue 12 - March 27, 2015
Dear Atrius Health Colleagues:
Many of you have already heard that, after much thought and consideration, Roberta Zysman has decided not to accept the role of Senior Vice President of the West Region for Atrius Health. Roberta has been a wonderful leader and contributor to both Dedham Medical Associates and Atrius Health over the past three years and we will miss having her as part of the leadership team.
I am delighted to announce that Kathy Gardner, Chief Administrative Officer for Atrius Health, has agreed to assume the position of Interim Senior Vice President, West Region. Kathy will bring to this position a wealth of knowledge about Atrius Health and the industry, a demonstrated commitment to the success of our merged organization, and thirty years of experience in managing clinical, operations, and business development. Most recently Kathy has overseen the Pioneer ACO work led by Emily Brower and her team, managed the Atrius Health Hoshin planning process, and led the creation of our new Project Management Office. In 2004, Kathy was appointed Executive Director of Atrius Health to help design and facilitate new collaborative clinical programs across the Atrius Health medical groups. Kathy began her career at Harvard Vanguard (then part of Harvard Community Health Plan), as a surgical staff nurse and went on to work in various clinical, management and program development roles across the organization. Kathy received her undergraduate degree in nursing from Salem State College and her Master in Business Administration from Suffolk University.
To additionally support the West Region as we are Moving Forward with our integration work, Dr. Michael Querner, Chief Medical Officer for Dedham Medical Associates, will become Interim Regional Medical Director for the West Region while continuing to serve in his role as Chief Medical Officer for the Dedham and Norwood sites. Mike has been an active, thoughtful and well-respected participant in the Atrius Health Chief Medical Officer council for many years and has earned the trust of the Dedham Medical clinicians and is a key member of the management team. He has successfully led quality improvements for Dedham Medical Associates for many years. Mike, an internist, has served Dedham Medical Associates and its patients since 1992. He received his medical degree from the University of Connecticut School of Medicine and did his internship and residency at Boston City Hospital. Mike will be working closely with Dr. Anne Dixon, Site Medical Director, Harvard Vanguard Wellesley and Dr. Elizabeth Dupuis, Site Medical Director, Harvard Vanguard Chestnut Hill/West Roxbury to provide clinical oversight and direction for the West Region.
Dr. James Cooley will transition out of his role as Interim Regional Medical Director for the Harvard Vanguard West Region. Jim will continue as Harvard Vanguard Medical Director for Professional Affairs, and as Interim Regional Medical Director for Harvard Vanguard in the South Region until a permanent regional medical director is selected. I want to thank Jim for his excellent medical leadership in the West Region over the past two years.
I am confident that the West Region management team, under the shared leadership of Kathy Gardner and Dr. Michael Querner, will continue the excellent work that has already begun to create a high-functioning region that will meet our objectives of increasing quality outcomes, improving patient experience, reducing total medical expenses and building high clinician and staff satisfaction.
The timing for the transition from Roberta to Kathy will be at the end of April. We are completing the plan for transferring Kathy's current responsibilities to members of the senior leadership team.
Thank you for your support of the entire West Region management team.
Dan Burnes, MD
Transition Chief Executive Officer
Send your questions about integration activities to Integration@AtriusHealth.orgNote if you want your name kept anonymous.
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Scenes from the Street
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And they said it wouldn't last!!
By Geri Spina, Clinical Services Manager
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Cheers to everyone in the Needham office who have continued to keep the "honeymoon" alive in the kitchen.It is said that after 3 consecutive weeks a habit is formed and whatever it is that you have chosen to take on becomes natural - no more effort than brushing your teeth. Our 3 week mark will be on April 1st!!
The Connecter last week highlighted the fact that now that we have gone through all the Service Excellence Standards -- the biggest challenge will be keeping those standards ALIVE in our minds and actions.
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Many great ideas start with great enthusiasm, but fade without the staying power of practice. Just like in our profession - we got better at our clinical expertise and knowledge of our industry by practice!!
I never would have thought "Workplace Cleanliness" would have elicited the responses it did - but at some point it became infectious!! (No pun intended)
Let's keep the momentum going and keep the pride in our work as an agency and team.
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CLINICAL SERVICES
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Clinical Services Announcements and Updates
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Remote Patient Monitoring Program Start Date
By Kathy Duckett, Director of Population Health
The start date for the Remote Patient Monitoring program has been changed. The new start date will be April 13, 2015.
Please contact Kathy Duckett with any questions or if you need further information at kduckett@vnab.org.
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McKesson System Upgrade for VNAB Home Care and Hospice
By Kathy Schuft, Clinical Application Specialist
Reminder: The agency will be applying an update including the Spring Regulatory Update to the McKesson System Wednesday, April 1st for VNAB Home Care and Hospice.
Changes to Medications: As all clinicians know there has been a problem with obsolete medications when trying to change or discontinue a medication. This update will contain a fix for this problem. Please see separate article in this Connecter that explains how obsolete mediations will be handled now. This will apply to both Home Care and Hospice.
If there are any additional Hospice changes they will be communicated separately.
Here is what you need to know about the night of the update:
- The system will be shutdown at 9pm sharp on Wednesday, April 1st
- During the shutdown the following systems will be unavailable:
- Horizon Homecare for VNAB & Hospice
- TeleHealth Interface
- WebChart
- Web Referrals
- Laptop Users:
- Full detail and instructions regarding the ESD transfer will be communicated in an email and/or next Connecter article.
- It is most likely that the ESD transfer will need to be performed in the office. Please stay tuned for details.
- iPadUsers and Office Staff:
- You must be signed out of the system by 8:45pm to avoid losing any documentation
- Please do not log on again before 6am the next morning
If you have any questions please contact Kathy Schuft at 617-886-6968 or kschuft@vnab.org.
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Get Ready to Order Patient Supplies from Byram Medical! The VNAB Supply Line closes on April 1, at 12 noon.  VNAB nurses will be able to order supplies for all patients, regardless of insurance plan, using the Byram Medical Supply Phone Order System at 800-248-4546.
Clinicians should call 800-248-4546 to order clinical bag replacement supplies,and VNAB Weekend Nurses with Supply Boxes should call the same number to order replacement supplies. Our emergency supply closet/cabinet sign-out process has not changed. Nurses will be assisted by a designated support person in each office to complete the Emergency Supply Form, and sign out items that their patient needs. The completed form is then used to bill appropriate patients (BCBS products & Medicare episode). Facilities will inventory the supply cabinets on a regular basis, and order replacement supplies as needed. Byram Medical will be calling clinical managers for authorization of any orders that are above par level or not on our Formulary. You can give your manager a "head's up" with the rationale, which will support a quicker authorization. A big Thank You in advance, for your support in helping make the new order process a success!! Questions? Contact Judy Sojack at 617.886.6801 or jsojack@vnab.org. |
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Change in Policy and Procedure for VNAB Clinicians
By Annemarie Martin, Director of Patient Services
Please note the following policy change for Reporting Known/Suspected Abuse/Neglect of Children, Elders, and Disabled Adults. Policy Numbers Home Care Record 3:04, 3:05, 3:06
As mandated reporters, clinicians file reports of known and suspected abuse and neglect of children, elders, and disabled persons. VNAB has determined that the agency needs to track these reports because of possible patient endangerment issues. We are requiring that clinicians submit an incident report at the time of the filing. Include the patient name and ID number and that suspected abuse or neglect was found along with a brief summary of the situation.
- Use of the Patient Handbook
The VNAB Patient Handbook contains a wealth of information for patients and families to use as they transition home after a hospitalization. The handbook not only introduces patients to the world of home care, but also has many health and safety tips.
Just to name a few
- Early Response Plan
- How to avoid preventable hospitalizations
- Home safety tips
- Preventing Falls at home
- Explanation of their home health service
- Health Care Proxy information
- Nutrition
- Emergency Preparedness
- Medication Chart
- Care plan and schedule calendar
- Oxygen Safety and Storage
- Managing Pain
Once your patient has signed their admission consent, take a few minutes at subsequent visits to review the teaching material in the VNAB Handbook.
Please see your manager with any questions.
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Obsolete Medications will be Fixed After Next McKesson Update
By Kathy Schuft, Clinical Application Specialist
Over the past several years clinicians have experience difficulties when trying to change or discontinue a medication that has been marked obsolete. An obsolete medication is one that has been retired by McKesson because they have added a corrected version. The McKesson update scheduled for the evening of April 1st will contain a fix for this problem. Here is how obsolete medications will now be handled:
Changing an Obsolete Medication:
- If you attempt to change a medication and you receive the pop-up that the medication is obsolete click OK and then Cancel your attempt to change the medication.
- Highlight the medication again and discontinue using Tools è Discontinue Med Order
- You do not need to send the discontinued medication as an interim order if it is an admission or you are sending an updated medication order to the physician for the same medication.
- Add the medication in again with the change
- Send the added medication as an interim order unless it is a admission
Discontinuing an Obsolete Medication:
- Discontinue the medication by using Tools èDiscontinue Med Orders
- If you get the pop-up that the medication is obsolete click OK
- Continue discontinuing the medication by adding the end date
- Send as an interim order unless it is for an admission
- Click OK and the medication should be discontinued
If you have any questions you may contact the Clinical Application Department Help Line at 617-886-6730 or Kathy Schuft at kschuft@vnab.org or 617-886-6968 (x6968).
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New Teaching Tool for Patients Taking Coumadin
Mary Ambrefe, Pharm.D., CGP, Clinical Pharmacist
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The Bleeding Precautions Teaching Tool which was previewed at the Coagucheck Meter Training, is now branded and available for distribution to patients. This document which meets our agency health literacy standard, is intended to support teaching around warfarin use.
Being a high-risk medication, warfarin and its associated risks must be taught and documented with each visit. Please see your office education manager for a supply or look for the tool where patient teaching tools are kept in your office.
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Tuberculosis: Find it and treat it
In recognition of World TB Day, celebrated on March 24, below are some frequently asked questions from the Association for Professionals in Infection Control and Epidemiology about TB to remind us that TB can be cured.
Tuberculosis (TB) is an ancient disease, yet remains a worldwide problem. In 2013, more than 9 million people had active TB worldwide, leading to 1 million deaths. The United States reported nearly 10,000 people with TB, meaning about 3 in every 100,000 persons was affected.
How is TB spread?
TB is caused by a bacterium called Mycobacterium tuberculosis that is spread from person to person through the air when a person with active disease speaks, coughs, or sneezes.
What could happen if I come in contact with someone who has TB?
Two conditions can happen if someone inhales enough TB germs to become infected - latent TB and active TB.
In most cases, a person's immune system is able to contain the TB germ and not cause any illness. This is called latent TB infection (LTBI). These people are not contagious and do not have any symptoms. But since the germ can stay inactive in the body, TB can become active and cause illness later in life.
Approximately 10 percent of people who become infected with TB develop active TB disease, which means they have symptoms of TB.
Who is most at risk for developing active TB disease?
Certain people are more likely to develop active TB. For example, people with weakened immune systems because of disease or medications, the very young and the very old, people who are diabetic, or substance abusers are more at risk.
How does TB affect the body?
TB can infect many organs of the body, including the lymph nodes, spine, and kidneys; but TB of the lungs (pulmonary TB) is the most common form.
What are the symptoms of TB?
- A cough that doesn't go away
- Coughing up sputum which may be bloody
- Weakness
- Weight loss
- Fever
- Sweating at night
People with symptoms of TB or those who are exposed to TB should be checked. This can be done through a blood test or a tuberculin skin test (TST). The TST involves a small injection of fluid on the person's forearm. These tests will only tell if the person has been infected, not if they have active disease. Persons who test positive from either of these tests receive further evaluations including chest x-rays and possibly sputum collection.
How is TB treated?
Persons with active TB need medicines to cure the disease. These drugs will also make the person non-contagious in a relatively short time; however, to fully cure the person, the drugs must be taken for 6 - 9 months.
Some cases of TB are resistant to antibiotics and stronger medications must be taken for longer time periods. Regular contact with the healthcare provider and the Department of Health are very important to ensure that the treatment is completed.
Persons with LTBI should also take medication to reduce the chance of letting the germs grow in the body and leading to active disease. This treatment is much simpler, usually only one drug for 4 - 9 months.
Is there a vaccine to prevent TB?
Currently, there is no universally effective vaccine against TB. BCG [bacilli Calmette-Guerin] vaccine is given in some foreign countries that have a high caseload of TB. It has been shown to reduce TB meningitis in children. It is not a routine vaccine in the United States.
TB screening is still recommended for people who had the BCG vaccine. According to the CDC, "the presence of a TST reaction in persons who have been vaccinated with BCG does not predict whether BCG will provide any protection against TB disease."
If you think you have been exposed to TB in your community, through your job or while travelling, get a TB screening test. This service is often free of charge at your health department.
Each year, World TB Day is recognized to help remind us that TB can be cured.
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FACILITIES
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New ID/Key Access Cards for Worcester Office
By Lorraine Potter, Director of Facilities
On Monday, April 6, a new ID/security system will be installed in the Worcester office. This will require all staff who currently have access to the Worcester office to be issued new ID badges. Please see Donna, Worcester office receptionist, to sign for and receive your new badge.
If you encounter issues accessing the parking lot gate, the front door, and/or the supply room, please see Donna or contact Lorraine Potter at lpotter@vnab.org or 508-751-6826.
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FUND DEVELOPMENT
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Bequest Funds Staff Education in Therapies for Parkinson's Patients
Thanks to a bequest from William A. Yoffie and Judith S. Yoffie, four clinicians from VNA Care Network completed the training and certification process for the Lee Silverman Voice Treatment (LSVT) BIG® and LSVT LOUD®.
Physical and occupational therapists use LSVT BIG and speech therapists use LSVT LOUD to teach patients how to self-correct their movements and voice, respectively. LSVT BIG teaches exercises that use "large" limb and body movements needed in everyday living, which leads to improved balance, speed and quality of life. LSVT LOUD focuses on exercises that stimulate the voice box muscles and speech mechanism to help patients be understood without straining their voice.
Congratulations to Wendy Drake, PT, rehabilitation services manager, Tom Durkin, OT, and Rick Etre, PT, completed LSVT BIG certification and Emily Gibbs, SLP, received the LSVT LOUD certification. A pilot program of BIG and LOUD is currently underway in Worcester.
"There aren't a lot of options out there for Parkinson's patients. LSVT BIG and LSVT LOUD are both promising approaches for treating major problems for Parkinson's patients in a different way," said Wendy.
A bequest, or a charitable gift left to a nonprofit in a will, is one of the many ways people support the work of VNA Care Network Foundation and Subsidiaries. The bequest from William A. Yoffie and Judith S. Yoffie funds educational opportunities for the organization's clinical staff.
Jane Woodbury, vice president of fund development said, "Bequests like the Yoffies' and other donations play a critical role in enabling us to bring new therapies into patients' homes, care for those in need, invest in new technology, and more to fulfill our mission."
If a patient or family member has questions about making a donation, please put them in touch with Jane at 888-663-3688, ext. 1360 or jwoodbury@vnacarenetwork.org. Donations may also be made on our websites: www.bostonvna.org, www.vnahospicecare.org, and www.vnacarenetwork.org.
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HUMAN RESOURCES
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Clinical Application Specialist Positions
We have two exciting opportunities for clinicians, with one position located in Danvers or Needham, and the other position located in Worcester.
In this role the clinician will oversee and provide support and efficacy of all clinical information applications, clinical informatics and IT utilization. The successful candidate will also provide instruction and support to all staff in order to reach and maintain a high level of competence in using clinical applications. They will act as a liaison between clinical and all other departments as it pertains to clinical software application issues.
RN, PT, OT, or SLP with a Bachelor's Degree in their professional field required. Experience with desktop applications (Access, Excel, PowerPoint, Word) and process flow design required. Experience with complex health care clinical applications and home health care applications preferred.
Please contact Cheryl Milas, Bev Riley or Ann Bohac if interested.
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Job Postings - VNA Care Network and VNA Hospice Care
To learn more about career opportunities, contact a human resources representative:
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Job Postings - VNA of Boston and VNA Hospice Care
To learn more about career opportunities listed in the links above, contact Debbie Brown, Human Resources Manager at dbrown@vnab.org. |
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QUALITY AND RISK MANAGEMENT
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Quality Role and the Joint Visit
By Maura Vitello, Patient Care Manager
What is gained from a joint visit with quality staff? Tips to make your visits go more smoothly; time management efficiency; collaborative care; and your time to shine and show case your ability to care for our patients. You are doing a great job. Let's go!
The joint visit can be done for various reasons: OASIS Accuracy, Yearly Reviews, and Preceptor/newly hired clinician, Case conference to problem solve a challenging case, etc. As managers, it is how we stay in touch with how things are going out in the field. The joint visit is an opportunity to get advice from a colleague who is charged with improving practice for the good of the Agency. We work together to identify areas of great strength as well as assist with challenges in regards to patient care and OA documentation. The communication is a two way street.
What can you do to make the most of this time, to make it your visit too? Here are some tips to remember:
- Keep an open mind and be confident in your practice.
- Have your questions ready.
- Documentation is the only place where all can see the results of assessments and the care provided, allowing us not only to bill but to ensure that the care we are providing is safe.
Remember that quality staff are here to support your understanding of the Oasis Guidelines and Best Practice for Patient Centered Care. Some examples of information that may come through at joint visits:
- Having your Referral/Back Pages readily available
- Remember your OASIS walk
- Accurate skin assessment to include edema
- Use of dyspnea scale
- Use of F2 look up, tip text, OASIS guidance
- Med rec, high risk medications
- Orthostatic VS
- Use of MACH 10
As Patient Care Managers, we have great appreciation of your hard work, flexibility, collaboration, and commitment to our patients and the agency. Your level of service excellence and all that you do to keep our patients home and out of the hospital is duly noted! Families comment on how special they feel when the agency sends two people to care for them. The joint visit is a learning experience that builds on best practice for our quality patient care. It enhances OA accuracy and the OASIS walk detailing our patient needs.
Thank you for your collaboration during this time!
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OASIS & Coding Education Sessions - To Be Completed by March 31st All Clinical Staff: We have appreciated the excellent participation! Thank you. - We are continuing the first of four quarterly and required OASIS & Coding Education Sessions to be held this year (March, June, September, and November).
- You may attend any session in any office since the same presentation is being given across the VNAB/VNACN enterprise.
- This quarter's focus is OASIS C-1 Updates, Risk Identification, Risk Adjustment, and the Heart Failure Patient.
- Please plan to attend if you are a Clinical Manager, RN, PT, OT, LPN, PTA, or COTA, as the OASIS is an assessment influencing the plan of care and the outcomes of our work.
Please contact the Patient Care Manager in your office with any questions. The 2 remaining sessions are: - Needham > Tuesday, March 31: 8a-10a
- Worcester > Tuesday, March 31: 8:30a-10:30a
Patient Care Managers |
Office
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Name
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Office
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Cell/Direct
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Position
| | Rehab | Kyra Mihalick | 617-886-6500 X3085 |
617-913-6823
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Patient Care Manager
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Quincy/
Weymouth
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Carol Morris
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617-886-6435
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617-913-3006
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Patient Care Manager
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Charlestown
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Elaine Gardner
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617-886-6464
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617-680-1105
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Patient Care Manager
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Danvers
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Marilyn Bowden
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888-663-3688 X1271
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774-502-7478
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Patient Care Manager
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Gloucester
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Marilyn Bowden
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888-663-3688 X1271
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774-502-7478
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Patient Care Manager
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Leominster
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Terry Dancewicz
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888-663-3688 X1341
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774-502-7481
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Patient Care Manager
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Needham
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Maura Vitello
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888-663-3688 X4536
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774-502-7475
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Patient Care Manager
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Southborough
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Maria Dunn
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888-663-3688 X1317
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508-688-2449
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Patient Care Program Manager
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Worcester
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Christine Gill
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as of 3/30/15
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TBD
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Patient Care Manager
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