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July 28, 2015
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Volume 4, Issue 30
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SERVICE EXCELLENCE
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Service Standard of the Week
Workplace Safety:
We assess and maintain a safe work environment.
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Workplace Safety is Everyone's Responsibility
By Cheryl Milas, Human Resources Manager
This week's Service Standard deals with Workplace Safety. Every employee is responsible for workplace safety therefore it is important to be aware of our organization's safety procedures. Any unsafe situation needs to be brought to your manager's attention immediately.
With the warm summer months we tend to think beaches, cookouts, and spending time with loved ones instead of workplace safety. In reality, the summer season can be especially dangerous when heat and humidity rise. In addition to sunburns, heat stroke can send people to the hospital quickly. Heat stroke can progress very rapidly from heat exhaustion or cramps. Everyone is susceptible to heat stroke if the correct precautions are not taken. Senior citizens, children and people with heart disease and high blood pressure are at the highest risk. They also make up a large portion of our patient population.
Warning signs include fainting, dizziness, light headedness, rapid pulse, painful muscle cramps and spasms, headache, nausea and vomiting, rapid breathing and disorientation. If you, colleagues, patients or family members are exhibiting these signs, emergency services should be called immediately. While you wait for medical assistance, put damp and cool cloths or towels on the person and have them lie down until emergency personnel arrive.
Being alert to the symptoms of heat stroke are important to ensuring your own health as well as others around you. It is especially important to check on our patients who may be living alone or in a non air conditioned environment. Some preventative steps to prevent heatstroke include: avoiding strenuous outdoor activities until cooler morning or evening hours, wear lightweight, loose-fitting clothing, stay well hydrated and avoid alcoholic and caffeinated beverages, eat smaller meals throughout the day to keep your energy up and always wear sunscreen when outdoors especially on hazy days. By following these helpful tips it will keep you as well as other safe throughout the summer months.
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Shared by Clinical Services Manager Peg Quinlivan:
Patient Maurice was very grateful of the services he received and passed along this:
- Mike Lusignan "is a gem"
- Maryann Lindgren "is an inspiration"
Submitted by Computer Operations Manager Dave Hanley on behalf of a happy customer of PC Tech Eric Bromberg
Eric is amazing. He wasn't able to exactly figure out my issue...but he exhausted every tool at his disposal in his attempt. He was friendly, accommodating, and just really great to work with. Just wanted you to know!
Submitted by Partners Case Manager
I can say without reservation that I wouldn't be able to do my job without DeAnne Mignault, and, our patients quality of life would be diminished.
DeAnne's willingness to make a visit to a patient having a panic attack today averted an emergency room visit. The patient called me after her visit to tell me DeAnne "saved his life". There was more going on with the patient then the panic attack and DeAnne's clinical assessment helped us determine he could remain at home.
Additionally, Christine Marre, Patti Darling and Mae Powers are equally as much of our "team" as DeAnne and without fail they all make things work for our shared patients.
It's a pleasure working with the VNAB.
Yelp.com Review | 7-26-15
We have dealt with the VNA of Boston starting 4 weeks ago. We have nothing but great things to say about them. From the minute we called them, they have been nothing but very nice and caring. They have gone far above their duties, including showing up on their days off, and calling us back with information when we thought they were finished with their job. The visiting nurse ( Nancy G ) has been great with my father. She has been tough, but it is just what he needed. Debbie his regular nurse has also been strict with him, but has a great impact on him. The physical therapist also has been fantastic. Simone has given me resources that I never knew existed. Shout out to all of you! Very glad we chose you to take care of my dad. Lisa King referred us to you! Would recommend you without hesitation!!!
Submitted by Susan Walker, PT | Worcester Office
I was with patient Carol today and she is head over heels for Wendy Minnich! She loved her to pieces! She said she was the sweetest thing and took her time to explain everything very thoroughly! She said sometimes in healthcare people rush you along but Wendy really listened and took her time. Just wanted to pass it along. It's nice when we get compliments!
Submitted by Clinical Services Manager Sharon Heard on behalf of a very grateful patient of
Carolyn Wirth, nurse on the Needham hospice team.
Dear Carolyn, a heartful of gratitude for the loving care you gave Frank during his illness. Your caring and competence was so evident in your manner of treatment. You gave me confidence to care for him. We feel so very blessed you were here at his passing. It was so comforting to me and the children here. God bless you and your work.
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Scenes from the Street
| Submitted by Michael Hoadley, PT | Worcester Office
Funny story.
I was working with the patient in the middle who is from Ghana and speaks very broken English, but gets the general idea. We were walking in the hallway of her building when the woman on the left pokes her head out the door to see what was going on.
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Sure enough she is a patient I had recently seen because of a knee replacement! This patient is Arabic and does not speak any English. She sees us walking in the hallway and immediately starts smiling and calling us over. Of course I recognize her, but apparently these two patients are also friends! We ended up in a three-way hug somehow and despite all three of us not really being able to understand each other's languages, it seemed everyone knew what was going on!! Chalk it up to two satisfied customers!
One of the patient's daughters was happy to take our picture!
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AGENCY ANNOUNCEMENTS AND UPDATES
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Home Health Care Star Ratings
CMS established the Home Health Compare (HHC) website on Medicare.gov as a tool for consumers to use when choosing a home health care provider. Designed to be an easy-to-access, convenient source of information on provider quality has proven to be cumbersome for some consumers faced with an urgent need to make a choice.
In order to make the information contained within HHC easier to use, a "star" rating system is being developed to summarize some of the findings in an easier to understand way.
Which measures are included? - The HHC Star Ratings methodology includes 9 of the 27 currently reported process and outcome quality measures. These measures were chosen based on the following criteria:
- The measure should apply to a substantial proportion of home health patients and have sufficient data to report for a majority of home health agencies.
- The measure should show a reasonable amount of variation among home health agencies and it should be possible for a home health agency to show improvement in performance.
- The measure should have high face validity and clinical relevance.
- The measure should be stable and not show substantial random variation over time.
The 9 measures selected based on these criteria are:
- Process Measures:
- Timely Initiation of Care
- Drug Education on all Medications Provided to Patient/Caregiver
- Influenza Immunization Received for Current Flu Season
Outcome measures:
- Improvement in Ambulation
- Improvement in Bed Transferring
- Improvement in Bathing
- Improvement in Pain Interfering With Activity
- Improvement in Shortness of Breath
- Acute Care Hospitalization
The provider preview report was published last week and both VNACN at 4 stars and VNAB at 4.5 stars did great! Way to go!
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New Rehabilitation Services Manager Hired for VNAB's Charlestown Office
By Judy Walsh, Director of Rehabilitative Services
Jessica Hammond, DPT, will join the Charlestown Office Team as Rehabilitation Services Manager on September 8, 2015.
Jessica comes to us with a Master of Science in Physical Therapy from Boston University (2001), and a DPT from MGH Institute of Health Professionals (2004). She is also an APTA Certified Clinical Instructor.
She has attended several advanced clinical trainings including: Physical Activity Guidelines & Cardiac Rehabilitation, Wounds, ICU training, TBI, Anodyne, Prosthetic Advancements, Modality Training for Wounds, Contractures, Pain and Incontinence Management, Geriatric Strength Training, Wheelchair Positioning, Complex Disease Management, Dementia.
Throughout her career, she has practiced in Acute Care, SNF, Long Term Care and Home Care. She comes to us with 10 years of management experience. She is a collaborative problem solver who uses a team approach to ensuring high quality, patient centered care. She serves as a resource for her team members and will be a wonderful addition to our leadership team. Please join me in welcoming Jessica when she begins in September!
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CLINICAL SERVICES
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Clinical Services Announcements and Updates
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Virtual Medical Visit Pilot Program Clarification
I want to clarify that we are working on the development of a potential new telehealth initiative, a Virtual Medical Visit Pilot program. Though we are just in the discussion stage, we are interested in finding nurses who would be excited to participate in a new way of providing home health visits in the home. We are looking for nurses, particularly those who currently work on the South Shore, who would be interested in a providing home health visits that combine our clinical assessments with technology such as an electronic stethoscope, electronic spirometer, or portable EKG to provide additional assessments, and then being part of a virtual Medical visit with a physician or nurse practitioner to "close the loop" in real time to meet the patient's needs in the home.
If you are interested in being a part of this innovative pilot program, please contact Donna Peters at dpeters@vnab.org.
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Change in Lancets
By Adele Pike, Director of Education
VNAB will soon stop stocking the push button (blue) lancets. We will continue to stock the white/beige lancets that clinicians have been using to perform finger sticks for INRs. This white/beige lancet produces a blood sample that is large enough for current glucometers and for the COAGUCHEK INR meters --- so less confusion and a cost savings!
Please see your manager with any questions or concerns.
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Behavioral Health Update
By Molly Lukason, Behavioral Health Program Manager
Success Story
"Mary" is a 60-year-old female living alone and feeling "negative about everything in my life." The referral was made from a VNA clinician feeling that behavioral health, with the focus and structure, could help Mary work through some of these depressed thoughts and help her to live a better quality of life. Although behavioral health visits usually last about 8 weeks, Mary started feeling better at week 4 and by week 6 was feeling "so much better", that she requested behavioral health discharge her as she wanted to drive again and pursue forgotten friendships and strengthen family relationships. Mary noted that she now has skills to look at her life differently.
Flexibility in thinking, looking at how emotions influence current thought process, and improving quality of life-no matter what age- is what the Behavioral Health Team is all about. Please remember to think about referring to behavioral health before you discharge so that behavioral health can conduct the evaluation. Once the patient begins the program, then the behavioral health clinician will do the recert (if/when due) and continue the patient under skilled nursing.
Welcome to Susan Alberto!
We would like to welcome Susan Alberto, RN to the Behavioral Health Team as of August 3, 2015. Susan has worked with VNACN for several years and has a strong nursing and mental health background. Susan is coming to behavioral health from the Danvers office. Sarah Bernd, RN, Kay Diane-Dennis, RN and Christine Mello-Byrne, RN continue to travel throughout the service area providing cognitive behavioral therapy and supportive counseling to our patients. The collaboration with clinicians is outstanding.
If you have any questions regarding the Behavioral Health Program, including possible cases that you would like to discuss further or a referral, please call Molly Lukason at 774-502-5545 or email her at mlukason@vnacarenetwork.org.
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Early Response Plan - Patient Teaching Tool
The Early Response Plan (ERP) teaching tool has been revised and updated! VNACN and VNAB worked together and merged our two tools into one that will now be used across the entire VNA.
Members from the Best Practice and Safe Side committees gave feedback. Other clinicians were interviewed and told us how they use the patient tool, gave recommendations about what they liked, and what they would change. Case managers from the Arius practices weighed in with suggestions. Some of the language was changed to reflect health literacy guidelines.
Clinicians agree the tool is helpful in teaching patients when to call us and to Call us First. While we give it to all patients on admission, clinicians know that teaching has to be reinforced over the course of several visits the first couple of weeks. And because there is a lot to learn for patients, giving them reminders throughout their length of stay is important.
The following are specific instructions for Encore and McKesson users:
For Encore Users:
The new ERP form will be included in all admission packets. As the admitting clinician, please complete the ERP during the admission visit. Review and give it to the patient. The goal of using this form is to assist patients to identify early symptoms and prevent ED/re-hospitalization.
The ERP's in current teaching booklets are not to be completed on admission but will be used by the primary clinician during the episode.
- Admitting clinician completes initial assessment and identifies patient specific problem.
- The top portion of the form is to be completed, including clinician and MD names with office phone numbers and clinician extension. The patient should be instructed to press "0" for after -hours calls to reach the answering service. Also, patient must be instructed not to leave a voice mail if issue is urgent.
- Areas of concern are completed with parameters for the patient.
- Once completed, the clinician will review the ERP with the patient/caregiver.
- The completed form should be placed on the patient's refrigerator.
- This form should be reviewed with the patient and updated on subsequent visits.
For McKesson Users:
The ERP tool is part of the admission handbook. In about two weeks, you will start to see the revised edition in the handbook. Copies of the new tool will be in the forms bin in the offices until the handbooks are revised. Please review the tool with your patient and their family members, ensuring that they know where to find the VNAB phone number and to Call us First. Review with them when to call 911. This is your usual practice.
Just a reminder for everyone:
If the patient has an Atrius PCP, the admitting clinician will include the appropriate listing of Atrius clinics in that area and review this with the patient/caregiver. Atrius has several urgent care centers that are open on the evenings and on the weekends. The lists are in the office's forms bin.
The tool is below:
As you begin to use it with patients, please give both the Best Practice and Safe Side committee members your feedback. We want to hear what you and patients are saying; what they like and what we can improve upon with the tool. Remind patients that we have nursing triage staff on call 24-hours a day including nights, weekends, and holidays. Click here for a PDF.
The patient teaching tool content and instructions will be reviewed at team meetings. Please see your managers with any questions.
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Hot Weather Tip for All VNA Nurses
By Lindsey Gallagher, Manager of Education, Needham
This is a reminder that the INR machines and the INR test strips are sensitive to temperature.
 DO NOT leave the machines in your car overnight or for extended periods of time. Operating the meter outside of the temperature range of 59 to 900 F will cause an error message to be displayed on the meter. The strips are also sensitive to temperature and if they are damaged and you have left them in the car, you may be required to pay for the strips.
SO...on these HOT days we've had recently- think of how hot it is in your car when you return after a long visit- do you think it may be greater than 90o? Best practice is to bring the meter in with you to long visits and always at the end of the day. Stay cool out there!
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FUND DEVELOPMENT
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Staff Serving on Host Committee for 10th Annual Heroes in Health Care Gala
Four employees are serving on the Host Committee for the 10th annual Heroes in Health Care Gala on Saturday, Nov. 14, at 6 p.m. at the Mandarin Oriental Hotel, Boston, to benefit VNA of Boston's Maternal Child Health Program and Charitable Care Fund.
Barbara Belony, RN, clinical manager; Marie Carten, RN; Marie Davis, PT; and Debra Nowak, PT, are all serving on the Host Committee.
"That they volunteer on weekends and evenings soliciting support is truly a testament to their incredible commitment and kindness. It speaks volumes about who we are and the importance of what we do. Barbara, Debra, Marie, and Marie have my immense gratitude and deepest respect," said Laura Wise, manager of fund development.
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| Left to right: Barbara Belony, RN, clinical manager; Jill Shah, 2014 Heroes in Health Care honoree and senior vice president of MINDBODY Exchange; and Renee Picard Walsh, co-chair of the Heroes in Health Care Host Committee
| Marie Carten, RN, with David Brown
| Dr. David Meeker, president and CEO of Genzyme, accepted the 2014 Heroes in Health Care award on behalf for Henri A. Termeer, former chairman, president and CEO of Genzyme Corporation, from Marie Davis, PT.
| Dean Matsuno and Debra Nowak, PT
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Each year, the VNA of Boston celebrates the work of special honorees during the Gala. Dr. Edward Benz Jr., President & CEO of Dana-Farber Cancer Institute; Larry Jasinski, CEO of ReWalk Robotics; and Mark Levin, Kevin Starr and Dr. Robert Tepper, the Co-Founders of Third Rock Ventures will be this year's Heroes in Health Care. Heroes in Health Care has raised $2 million in essential funding for VNA of Boston's direct patient care and support for vulnerable, underserved populations. To learn more or get involved, contact Laura Wise at 617-886-6460 or lwise@vnab.org. Event details are also available at www.bostonvna.org/gala. |
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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:
- Kelly Frew
- Mary Helen Mahoney
- 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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Recertifications and Resumptions of Care: Breaking News For All Clinicians!
New Mandatory Requirement in Risk/ADS Tab
When a recertification is clinically indicated, the recertification assessment visit MUST be made by a qualifying clinician (SN, PT, OT, ST) during the LAST FIVE DAYS of the certification period FOR ALL INSURANCES.
To assist with this, the Encore recertification alert will be changed effective Wednesday, 7/22/15. You will now be alerted of recertifications due 14 days prior to the first day of the (5 day) recertification window. Per clinical indication, either discharge the patient prior to the last day of the recertification period OR recertify the patient during this five day period. Encore scheduling assignment of the recert visit and how you coordinate this with other clinicians will remain the same.
TO RECAP:
A recertification requires that the following is done during the FIVE day recertification window for all patients and all insurances:
- Assessing the patient during the 5 day window
- Completing an OASIS during the 5 day window (as indicated by the patient's insurance)
- Obtain an order to continue treatment and document in the new box shown below during the 5 day window
- Developing the POT during the 5 day window
- Sending an e-mail to QI requesting coding updates to
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To assist with this process, a new box has been added to the Risk/ADS tab called "POC Communication to MD".
The purpose of this box is to assist you with documenting the TC to the physician at Recertification and Resumption of Care & to assist you with documenting the new order obtained to continue patient care. INSTRUCTIONS: For a non- Recertification or ROC visit: - The first question in this box (highlighted in pink) is mandatory for all visits. Answer N in the first box only (other boxes not required)
For a Recertification or ROC visit: - The first question in this box (highlighted in pink) is mandatory for all visits.
- Other boxes below must be filled out for Recertifications and Resumptions of Care (ROCs).
- Please fill in all boxes with either Y or N:
- Then complete ONE of the next three communication boxes to designate the individual spoken with (i.e. MD, Designee or CM)
- If not able to obtain order, please contact your Patient Care Manager for further instruction.
- The "Requested call back from MD" box should typically be answered Y.
QUESTIONS: Please contact your office's Patient Care Manager.
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High Risk Tools By Maria Dunn, Manager Patient Care Management Program To All Clinical Staff: a reminder to please complete the following high risk tools at OA time points as indicated. This is important for our reportable outcomes, most importantly our accurate patient assessment for implementation of the appropriate plan of care. Thank you much! High Risk tools must be completed at all: This includes: Please contact your office's Patient Care Manager with any questions.
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QI SUPPORT
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Covering Office
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Name
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Email
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Office Phone
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Position
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All VNAB
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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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