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June 22, 2015
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Volume 4, Issue 25
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I am writing today to express my sincere appreciation to all of you who took the time to participate in our recent employee survey. Believe it or not, nearly 90% of our employees took the time to express their thoughts and opinions through this process. That is just an amazing number. We have had the opportunity to take a look at the feedback that you have provided and we are getting a clear understanding what is important to all of you and what the main themes are.
The senior team has met and from the data that you have provided we have created a first draft of a vision for our new integrated culture that we will build together. This vision for our new culture will be presented tomorrow at our agency-wide Leadership Meeting. Over the course of the summer our Directors will be facilitating groups of our management team to obtain feedback related to the eight vision statements that we have developed based on your feedback.
More information to come on this exciting initiative but wanted to take a moment to say thank you for your participation in the survey.
Mary Ann
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SERVICE EXCELLENCE
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Service Standard of the Week
Customer Contact:
We greet our patients, customers, and colleagues with a warm smile, maintain eye contact (when culturally appropriate) and acknowledge their needs or concerns.
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Customer Contact and First Impressions
By Cathy Romeo, Multicultural Services Manager and Service Excellence Champion
"You only get one chance to make a great first impression." Most of us have learned through experience how difficult it can be to recover from poor first impressions! Greetings---our first contact with our patients and other customers---can set the tone for a relationship, and appropriate greetings may be even more significant to those from formal cultural perspectives. Members of our Cultural Diversity Council agree, and they offer the following suggestions for respectful greetings:
- On arrival at a patient's home, pause at the door, saying, "Good Morning/Afternoon! I am (name/title/VNA) here to see Mrs. Sanchez. May I come in?" Asking for admittance is respectful but even more critical if the clinician was somehow not expected, or if the patient will accept only a female or only a male clinician and that need was not communicated to us.
- Use a warm tone of voice, smile and make eye contact. However, if the person you are greeting does NOT return eye contact and responds with downcast eyes, then direct eye contact may be considered disrespectful by that person. For example, our Vietnamese Diversity Council Member tells us that among traditional Vietnamese, downcast eyes may be a sign of polite respect or deference to someone who is unfamiliar, older or an authority figure.
Often family members can tell us what a patient may hesitate to ask.Asking about a patient's preferences is in itself a demonstration of respect and empathy and may help create the positive first impression that helps to build a successful relationship!
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Susan Higgins, Clinical Coordinator, submitted the following note of praise from a patient's family about Colleen Conway, RN in the Woburn office. Thank you very much for making my father comfortable after struggling with pain prior. The family was all around singing to him in his final moments, after Colleen cared for him. He passed peacefully.
The family asked that donations be made to hospice in lieu of flowers. Great job Colleen!
Kathy Souleotis, Patient Services Manager, passed along this message from a happy MD about Val Green, RN out of the Charlestown office who cared for his patient.
I received a call from Dr. Stephen Spector. He wanted to let me know that Val Green provided excellent care to one of his patients. He stated that Val pointed this patient in the right direction and patient is now more compliant with his medication regime. He felt her interventions were instrumental in this patient's progress.
Geri Spina, Clinical Services Manager, shared this note from a grateful patient out of the Needham office
I would like to send this note to express my heartfelt thanks to my VNA nurse, Joanne Folan, and my PT, Debbie Strzetelski, for all their help and support as I recovered from knee replacement this spring. Both Joanne and Debbie, working in coordination with each other, helped to make my recovery easier. With a complication or two resulting from the surgery, I felt I was in the best of hands having these two very experienced and professional women by my side. To have access to the expertise and knowledge of the VNA Network certainly allows for a greater sense of comfort as patients recovery from surgery or illness. Please thank them again for me. I do miss their visits and comforting manner.
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AGENCY ANNOUNCEMENTS AND UPDATES
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Message from Atrius' New President and CEO
Check out this quick video from Dr. Steven Strongwater, the newly appointed President and CEO of Atrius Health. His vision for the future of Atrius Health, and the role home health care and hospice will play will lead to great things for the VNA, Atrius, and all the patients we care for.
Video Link: https://youtu.be/TytVWbWHJOY
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MOVING FORWARD UPDATE
Issue 28 - June 22, 2015
There are lots of activity and updates in the Innovation Center to share with you!
Focus For Our Research And Development
The first task for the Innovation Center is to select the areas in which we will focus. Since our last update a month ago, the Atrius Health Innovation Center team has been busy getting out to practices and collecting pain points (difficulties and obstacles in our current healthcare system) through conversations with both clinical and non-clinical staff. We were delighted that so many staff participated in these Town Halls, and many concerns and suggested solutions were collected. After 14 practice-based Town Hall meetings, and an Idea Generation event at Riverside, nearly 1,000 pain points have been catalogued and reviewed by the team! Additionally, nearly 5,000 patient "hot comments" from our Press Ganey reports have been reviewed with associated pain points captured. Some of the concerns that kept reappearing included limited appointment access, poor transitions of care, desire for different ways to provide care and meet patient needs, difficulty engaging patients in their healthcare, untimely follow-up with patients, and poor alignment with the current payment structure and provision of care.
Since those meetings, the Innovation Center team has been hard at work grouping the pain points into categories, and prioritizing the categories in order to narrow the field to a few frequent and high impact pain points. We plan to use this information to identify our first area of focus for research and development by July 1st.
We Need Your Ideas
Keep those pain points and ideas coming! Even though the Innovation Team is moving through additional phases of project development, we are interested in continuing to hear from the practices on obstacles to high quality care. Every submission is thoughtfully considered, and helps to continually inform our work.
The Innovation Team will be hosting an Open House in the Innovation Center Obeya (mission control room) over the summer, so that interested employees can stop by, see how the work is organized and planned, and meet the team. The day and time of the Open House will be announced at a later date.
New - Micro-grants For Your Innovation Ideas
We are pleased to announce that the Innovation Center will offer Micro-grants to those clinicians and staff who are interested in trying out an idea to improve patient care. The micro-grants are typically small - $5,000 - $10,000 - and are intended for a relatively short-term innovation project.
New Positions Available In The Innovation Center
The Innovation Center is recruiting for the following position:
Clinical Innovation Engineer: The role of the Clinical Innovation Engineer is to provide additional clinical knowledge, technique, and expertise to the project team, while acting as a liaison with peers to ensure solutions are clinically and operationally feasible. Clinical Innovation Engineers can either be an MD or APC, and are expected to have a half-time clinical practice.
Within the next couple of months, recruitment will begin for an Innovation Implementation Manager to work closely with the practices to ensure effective implementation of any newly created product or workflows.
Karen DaSilva, MD
Vice President, Innovation
Send your questions about integration activities to Integration@AtriusHealth.org. Please note that, if you would like your question to be anonymous, you may indicate that and your name will not be shared beyond the one person who manages the mailbox.
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Reminder: Southborough Office Closed Saturday, June 27
Due to utility work being performed in and around 333 Turnpike Street, the Southborough office will be closed on Saturday, June 27. Staff who would normally be working out of the Southborough office during this time should plan to report to the Worcester office for the day.
Please note that Southborough office phone extensions will be unavailable during this time. There will be no disruption to Delta access or any network services, including phone extensions originating from other offices. The office will re-open Sunday, with phone capabilities restored, and staff should plan to report as usual.
Affected staff should contact their manager with any questions.
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CLINICAL SERVICES
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Clinical Services Announcements and Updates
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Hospice Bridge Line Forwarded to Referral Center
The VNAB Hospice Bridge line is currently being forwarded to a voicemail box in the Referral Center. Please leave a message and someone will return your call as soon as possible.
Please see your manager with any questions.
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Reminder: McKesson System Upgrade in June
By Kathy Schuft, Clinical Application Specialist
Please remember that there will be a McKesson update for both home care and hospice the end of June. Changes for home care staff are communicated in a separate article in this Connecter. Most importantly - You will be required to change your password after the update. Changes for Hospice will be communicated separately. These are the details:
The night of the update:
- The system will be shutdown at 9pm sharp on Wednesday, June 24th
- During the shutdown the following systems will be unavailable:
- Horizon Homecare for VNAB and Hospice
- TeleHealth Interface
- WebChart
- Web Referrals
- Laptop Users:
- Full detail and instructions regarding the ESD transfer will be communicated in an email.
- To help you plan we do know that the ESD transfer will need to be performed in the office and will take about 30-45 minutes. Further detail to follow.
- iPad Users 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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Changes to McKesson for Home Care after Update
By Kathy Schuft, Clinical Application Specialist
The McKesson system will be updated the night of June 24th. Listed below are updates that will affect clinical staff in home care. Any Hospice changes will be communicated to staff separately.
Homebound status - McKesson has made changes to the homebound status screen in the SOC/ROC and Recert Oasis. These changes caused them to move the DME screen to the screen prior to homebound. VNAB clinical staff should continue to document homebound status in the care plans in Orders rather than using McKesson's homebound screen.
Additional Flags - McKesson has added flags to M1400, M1230, M1306, M1322, and M1330. Remember that when you answer a question in an Oasis after start of care the system will add a color to the answer to indicate whether the patient has improved (green) or the patient has gotten worse (red). No color means no change in condition. Yellow means the answer is inconsistent with a previous Oasis. Here are the titles to each question.
M1400 - Respiratory question
M1230 - Speech and oral expression question
M1306 - Pressure ulcer question
M1322 - Pressure ulcer stage 1 question
M1330 - Status ulcer question
Infection Disease Screening in Profile - McKesson has added a hyperlink in Profile that will give clinicians a place to document whether the patient has traveled to a foreign country recently and may have been exposed to an infectious disease. The Quality Department is in the process of evaluating this new screen and will let you know of any change in policy.
A1c Documentation - McKesson has added a place to document a diabetic patient's hemoglobin A1c to meet the new regulation. If you are unsure or unaware of the new regulation please read Joan Fall's article in the June 9th Connecter. The new documentation area can be found in the SOC/ROC and Recert Oasis under Endocrine.
Password Changes - ALL staff will be required to change their McKesson password when they first sign into the software (laptop users after the ESD). The new password will be case sensitive. When changing the password please follow the same guideline set by our agency as listed below.
Change Horizon Home Care Password:
- It is best to change the Horizon's Home Care password at the same time that you change your network password so that you only have one password to remember:
- Open Horizon's Home Care with your User Name and current password
- You will be prompted to change your password
- Follow the prompts: Enter old password, then new password twice using the agency guidelines:
- Must be at least 8 characters
- Must be alphanumeric with at least one letter capitalized
- Must have at least one of these symbols: ! @ # $
- Do not use any other symbols
- Click OK
- Using the red X, close the password change window
- Close out of Horizon's Home Care
- Re-sign into Horizon's Home Care using the new password
- If you are on a laptop you must transfer after you change your password
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New Negative Wound System
By Carol Jones, Senior CWOCN
WE HAVE ANOTHER NEW NEGATIVE WOUND SYSTEM YOU NEED TO BE AWARE OF
The AVANCE Flex is the unit that is now being used by Apria. In many cases it will replace the Medula Pump. It is made by Molnlycke which is a very reputable company. The application is exactly the same as with the Medela Pump (the foam and film are the same). All of the WOCN's are being trained in it's use, but if you see one and need help navigating the machine, just call the number on the pump and they will help you.
The support number is 800-780-1228. Our Apria representative is Molly and her number is 508-951-6554 if you need additional help. In addition , I have sent all of the WOC nurses and email with video instructions for use which they can share with you.
Questions? Contact Carol Jones at cjones@vnacarenetwork.org.
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Reminder: Fallon Supply Update
Fallon Health has recently changed their policy regarding supply and DME ordering for their patients. Moving forward, clinicians ordering supplies/DME for Fallon patients are required to use the following vendors:
- pleurx catheters > Enos
- all other supplies and DME > Lakeview Medical.
As a reminder, Lakeview Medical is Reliant Health's preferred vendor for ALL supply/DME orders.
If you have any questions, or experience issues ordering through these vendors, please contact Linda Britt, Manager of Administrative Services, at 617-886-6302.
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Labs - Info for Nurses and Office Staff
By Beth Mena, IV Clinical Services Manager
Nurses do a tremendous amount of lab work on our patients and in general; we are experts in acquiring, transporting, and facilitating the results to the ordering physicians and IV vendors. It is a lot of work and takes time, coordination, skill and commitment to do it right. Labs are a very serious and potential litigious issue that affects not only patient care and safety but also our relationship with outside referral sources such as IV vendors, MD offices, clinics, hospital laboratory, and patients themselves. Sometimes there are problems related to spoiled labs, lab service errors, physicians that don't get results, and critical labs that don't get reported in a timely manner. Here are some tips for best practice:
- Any clinician drawing labs needs to understand the professional responsibility; know your policy.
- Be cool: Use a cool pack or ice cubes in your transport bag and get specimens to the lab within 2 hours whenever possible. If you are putting labs in a drop box for pickup - be sure to keep cool with a cool pack too. Many specimens require spinning within 3-4 hours.
- Complete the lab slip correctly and completely. Note the associated diagnosis, ordering MD full name, MD telephone #, and Fax # (not needed for the HV MD's if using HV form). IV Vendor Fax #'s should also be on the lab slip when applicable.
- Lab results need to be reviewed by a licensed clinician in a timely manner - this is our policy. Labs on the VNACN side are printed from the GFI Fax by an office CSA. The report is given to a licensed manager, coordinator or primary nurse to read and evaluate for urgent/critical results. If critical results, that clinician needs to contact the primary nurse for urgent action or contact the MD themselves and process further orders. All communication regarding critical values should be documented in the medical record either in the visit note or doc com. VNAB has a similar policy.
- Reports with lab values that are all normal (no "Flagged" values) will be given directly to the clinician or put into the clinician's mail box. The PN will follow up with the physician when deemed necessary and process further orders.
- If lab results are not received on same or next day, we need to follow up with the lab to question both what the results are and why they were not received by us.
- Occasionally a lab might notify us on off hours about a critical lab, the triage nurse taking the call may be looking for a note in the chart to see if the physician has already been notified. If there is no note, they may be calling the physician in the middle of the night. Let's do our best to follow-up and document on labs same day or next; especially when we may know ahead that the results are likely to be a problem.
Questions? Contact Beth Mena at 508 751-6846 or bmena@vnacarenetwork.org.
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HHA Corner
By Elaine Buckley, Manager of Patient Services
This week we would like to talk about discharging patient's when a HHA is involved.
The department is noticing a large volume of HHA visit write offs. This means, the patient was discharged from service and they continued to receive HHA services. This is a huge cost to the agency as we still are obligated to pay for the services and have no ability to bill the insurance company.
The HHA Department has a specific extension to help with this. When discharging your patient, please double check to see if HHA services are ordered. If they are, call 978-777-6100 X1234 and leave a message with the patient's name, ID and date of discharge. We will make sure we discontinue the HHA services. You may use this "communication" line for other changes as well to include:
- Holds (example: If the patient has been hospitalized)
- Resumes (example: When the patient is home from the hospital)
- Any unplanned cancellations (example: Related to MD appointments when the HHA is scheduled to visit)
We hope you find this communication helpful. Please feel to contact Elaine Buckley at 978-777-6100 X1265 or Amanda Burke at 978-777-6100 X1204 with any questions or concerns.
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FUND DEVELOPMENT
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Goldman Sachs Volunteers at Tippett Home
Employees from Goldman Sachs spent Friday sprucing up the grounds of the Stanley R. Tippett Home. The effort was part of their annual Community Teamworks Day, which sends employees to area nonprofits to lend their support. The group helped clean up debris in the yard, put mulch in the flowerbeds, paint the shed, and more. The company also made a donation to help cover the cost of the supplies. Goldman Sachs has included the Tippett Home in the Community Teamworks Day for over a decade.
| Left to right: Diane Bergeron, vice president of hospice and advanced illness management, John Kenney and Tred McIntire, both of Goldman Sachs, and Jane Woodbury, vice president of fund development
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HUMAN RESOURCES
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Employee Referral Bonus up to $5,000!
Employee referrals are often the most successful way for us to find the best candidates for open positions. Demand for physical therapists and nurses continues to be issue throughout the industry and the VNA is no exception.
In order to attract and retain new RNs and PTs, we are offering an employee referral bonus of up to $5,000!!! Certain conditions apply and the bonus will be paid in equal installments to eligible employees at the new recruits three and six month anniversaries.
Please contact Cheryl Milas at cmilas@vnacarenetwork.org or Debbie Brown at dbrown@vnab.org for more information.
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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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Job Postings - VNA Care Network and VNA Hospice Care
To learn more about career opportunities, contact a human resources representative:
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Employee Advisory Team Suggestions
To suggest an area of focus to the Employee Advisory Team (EAT), please email your suggestion to EATSuggestionbox@vnab.org. Suggestions can include ideas to improve current processes and procedures, remove redundancies, or even to provide feedback on something you think is/is not working. Please feel free to discuss any issues that you would like brought to EAT with the following members of the committee:
- Ellen Cavalier
- Kelly Frew
- Mary Helen Mahoney
- Becky Manning
- Susan Marlin Procter
- Annemarie Martin
- Mary McCarthy
- Ilona O'Connor
- Mae Powers
- Maria Rodrigues
- David Rose
- Chris Schultz
- Danny Yan
EAT is also on the lookout for new members. If you're interested in participating, or for more information on what EAT is all about, please reach out to any of the members listed above. Meetings are held monthly and alternate between the Charlestown and Braintree offices.
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QUALITY AND RISK MANAGEMENT
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OASIS Change Form: Clinician's Responsibilities
By Maura Vitello, Patient Care Manager and Maria Dunn, Patient Care Program Manager
OASIS Change Forms and OASIS Lock Notes (McKesson Follow-up Notes and Encore Doc Coms) provide the following critical information regarding clinician's responsibilities for the OASIS tool:
- Corrections made to the OASIS tool
- Per OASIS guidance and clinical documentation
- Recommendations for referrals based on your (the clinician) and other clinical documentation
- PT, OT, ST, MSW, HHA, etc.
- Documentation additions/corrections that you, the clinician, are responsible to perform
- Clarification of documentation inconsistencies including diagnosis/PMH
- Referral information received (i.e. discharge paperwork, "back pages")
- Process Measures (aka Best Practices) M2250 in OASIS and accompanying MD orders
- Medication/teaching/allergy/immunization information
- Other additions to orders/POTs/485s, etc.
- Additional supporting documentation (in Encore use addendums)
Please review the OASIS Change Forms; contact the sender OR your Patient Care Manager with questions. We are happy to assist you!
When disagreeing with corrections, document an "I Disagree" Follow-up Note in McKesson or Doc Com in Encore. Comments are not needed in this note/doc com. A conference will be scheduled where you may provide OASIS Guidance to support your recommendation.
We are committed to your ongoing understanding and implementation of OASIS Guidance; please contact your Patient Care Manager assistance with quality or OASIS specific questions or your QI Support Coordinator/QI Nurse (contact info below). Consider adding their contact information to your new VNA issued iPhone! Remember that your e-mails sent using your VNA issued iPhone are protected so you can contact QI using Outlook e-mail with your new VNA issued phone. QI staff will respond to you quickly when contacted via Outlook e-mail!
We look forward to working with you as we meet our quality goals with continued excellence in documentation, OASIS and outcome measures.
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2nd Quarter OASIS Education
Below is the Quarter 2 OASIS education schedule for all offices. Our topic this quarter is Wounds. Mandatory attendance is expected for all clinical professionals. You may attend any site but be sure to sign in on the attendance so you will get credit for attendance. If you do not attend any of the sessions, you will need to complete the makeup test and have a meeting with the PCM in your district to be sure you are understand the Q2 content.
The Quality Department is committed to ensuring the CMS guidelines are used in our clinical practice to our patients. Thank you to all our staff for their continued clinical commitment to understanding OASIS and reaching for the best outcomes for our patients.
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QI SUPPORT
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Covering Office
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Email
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Office Phone
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Position
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All MN & SW
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Hughes, Kim
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kcao@vnab.org
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617-886-6501 x5419
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QI Support Coordinator
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All VNACN
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Schultz, Chris
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cschultz@vnab.org
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617-886-6501 x6527
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QI Support Coordinator
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All VNACN
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Rao, Shamala
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srao@vnacarenetwork.org
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508-756-7176 x6876
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QI Nurse
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VNA HOSPICE CARE
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What Diseases can be Treated with Palliative Care?
Originally, palliative care was developed for people with terminal illness. But, within the past decade, it has become a medical specialty that focuses on a much broader range of serious or life-threatening diseases.
As the World Health Organization states, "All people have a right to receive high-quality care during serious illness and to a dignified death, free of overwhelming pain and in line with their spiritual and religious beliefs."
Today, patients with cancer, heart disease, chronic lung disease, AIDS, Alzheimer's, multiple sclerosis, amyotrophic lateral sclerosis (ALS), and many other serious illnesses are eligible for palliative care. One of the primary goals is symptom management. The disease itself may cause symptoms, but so can treatments. For example, chemotherapy drugs may cause nausea and vomiting. Also, narcotic drugs to control pain frequently lead to constipation.
By providing relief for various symptoms, palliative care can help you not only carry on with your daily life, but also improve your ability to undergo or complete your medical treatments. (Source: WebMD)
Here are some symptoms that palliative care may address:
- Pain
- Constipation
- Nausea and vomiting
- Diarrhea
- Bowel or bladder problems
- Loss of appetite, weight loss, or wasting
- Shortness of breath or labored breathing
- Coughing
- Depression
- Delirium or mental confusion
- Weakness
- Difficulty sleeping
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