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August 17, 2015
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Volume 4, Issue 33
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SERVICE EXCELLENCE
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Service Standard of the Week
Professional Image:
We are service professionals who uphold the reputation of our company by demonstrating a professional appearance.
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What NOT to Wear When You Work
By Geri Spina, Clinical Services Manager and Service Excellence Champion
| I remember going to work at my second job out of nursing school. I got a position in an extension of the Emergency Room which was called the "Overnight Ward." It was set up as a short stay for the patients that hadn't really required a long term hospitalization, GSW with chest tubes for a week, cellulitis patients that needed antibiotics for a few days. It was an area of the hospital that was attached to the Trauma Center and was somewhat removed from the standards of regular floor nursing.
While we were required to wear whites -we didn't have to wear a cap or a nursing uniform. - We could wear khakis and a shirt or nice top.
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One day I did come to work with my white pants and nice top. I was approached by the Nursing Director who clearly felt my "boucle top" did not meet the standards of the dress code. And while it was not revealing - nor was it explicitly said in the dress code policy - Do Not Wear Boucle - to her it did not represent what she felt was our profession and her nursing staff. Of course, being pointed out, and having my direct supervisor speak with me left me embarrassed and honestly a little peeved. Why were they picking on me, did she see what everyone else wore? You get the picture?? The truth is - there may always be a point of view each of us has regarding what we think is professional and what is not. What I didn't appreciate than, but DO appreciate now is -- it is not about me!! It is about OTHERS - the patients, the referral sources, and the people in which we encounter in our agency. With the attention off of us - the attention is put where it belongs: on the care of the patient, on the reputation of who we are in our community, and on the pride that comes with that.
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Update to Footwear Policy
Based on staff feedback, the Service Excellence Champion group has been reviewing the Grooming and Professional Appearance Service Standard and recommended a modification to the senior team which has been approved. Moving forward, it is now acceptable for office-based staff to wear open-toe footwear, with the caveat that there must be a back/strap on the heel (i.e. no flip flops or open-back sandals). Per regulation, field-based staff are required to wear closed-toe/heel footwear, and as such, this change can only be extended to those not in direct patient-care roles.
For safety reasons, all staff must wear shoes that are appropriate for their job function and are asked to choose their footwear carefully to avoid injury. Please contact a member of the Service Excellence Champion group with any questions.
Champions
Debbie Brown
Katie Callahan
Simone Charpentier
Lori DeRosa
Wendy Drake
Jill Enwright
Kelly Frew
Nancy Ledoux
Annemarie Martin
Cheryl Milas
Adele Pike
Lorraine Potter
Cathy Romeo
David Rose
Kathy Souleotis
Geri Spina
Charlvic Williams
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Note from grateful patient regarding Susan Spencer, PT in the Danvers office Dear Ms. O'Connor: I want to commend the staff members of the VNA Care Network who provided me with wonderful inhome care following my recent hip replacement surgery. I felt very fortunate to be in the capable hands of Susan Spencer, who provided me with outstanding physical therapy. I feel her knowledge, professionalism, caring attitude and effective therapy contributed greatly to my rapid recovery. As a result of her therapy, I have been able to resume all of my pre-operation activities, ranging from being a scheduled Greeter at the Logan International Airport's USO Lounge to getting down AND UP from playing with my four grandchildren on the floor. In addition to Ms. Spencer, the members of your Nursing Staff provided me with wonderful care, answered all of my questions and provided additional information about what they were doing, along with what I could do to speed up my recovery. In conversations I have about my recovery, I continue to speak highly of your staff and the care provided by the VNA Care Network. Sincerely, T.C. Note from grateful patient regarding Katherine Shlien, PT in the Charlestown office Dear Ms. Manning, For numerous weeks I have been visited (treated) by Katherine (Riley) Shlien in her capacity as a Visiting Nurse Physical Therapist and I would like to express my appreciation for her expertise and her hard work with me to help me regain some of the strength I have lost after debilitating illness and confinement. She seemed to know just how hard to work with me, keeping me encouraged and taking care not to exceed my physical abilities to perform or exacerbate my constant pain, which even the medications do not seem to be able to control. Physical therapy at home was prescribed by my Primary Care Physician, Dr. John McCarthy of Lahey Burlington, as a preparation for inpatient therapy at Spaulding Rehabilitation Center. I have seen improvement, which gives me hope that I will be able to continue to build my strength at Spaulding so that I do not suffer any decline in what we have worked hard to accomplish. My goal is to be mobile again and be able to get out of bed and my wheel chair by myself permanently. Besides her professionalism and her high standards of work ethic, she has a wonderful personality, and I looked forward to her visits, even though I was totally wiped out afterward. She is a positive asset to your organization. Truly yours, P.F.S
Note from grateful patient regarding Mary Buccieri, RN in the Charlestown office Dear Ms. Souleotis, For numerous weeks I have been visited by Mary Buccieri in her capacity as a Visiting Nurse and I would like to say that her professionalism and her caring have been of great help in ministering to me during a very difficult time. I suffer from multiple conditions, and to top it all off, I was hit with a severe case of shingles. She has been in communication with my Primary Care physician, Dr. John McCarthy to keep him informed, even though the new computer system at Lahey has made contact all but impossible; but she persevered. Due to my present condition, I am unable to get to Lahey Clinic in Burlington. She has seen me through some very painful days, and has worked very hard to find the best ways to ameliorate my condition at every turn. Besides her excellent work, and work ethic, she has a wonderful personality, and I have looked forward to her visits, and her insights to alleviating my maladies. She is an asset to your organization as well as to her profession. Sincerely, P.F.M. Note from grateful patient regarding Amanda Noyes, RN in the Southborough office Dear Ms. O'Connor, Our sincere thanks to the team that cared for Dr. D. His primary care nurse Amanda Noyes was kind and supportive to him during his recovery period. His physical therapists Angela and Tom were very knowledgeable and helpful. Many many thanks to this wonderful team. Our sincere gratitude. Dr. D & wife A grateful patient acknowledged Mary Anesse, PTA in the Worcester office with the following note: I wanted to take the time to let the VNA know that Mary is an excellent therapist. Mary has done a great job with my exercise program for my hip replacement. She has helped me in using my second floor stairs and also taught me to use my crutch to get around With her help and professionalism I have made steady improvement .
Please share all your notes of praise and recognition with connecter@vnacarenetwork.org
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AGENCY ANNOUNCEMENTS AND UPDATES
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HIPAA and Breach of PHI Reminder
Due to a recent HIPAA breach, we are reminding ALL staff that each and every employee has a responsibility to maintain the confidentiality of all patient health information (PHI). This is the case whether you work in the field or in the office. If a breach is determined to be intentional and/or egregious, the employee is subject to disciplinary action, up to and including termination of employment.
We all expect that our PHI (and that of our families) to be kept confidential and we must make every effort to protect the privacy and security of our patients' health information. If you suspect a HIPAA breach, please contact your manager immediately.
Quick HIPAA Overview
HIPAA stands for the Health Insurance Portability and Accountability Act. The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information. The HIPAA Security Rule sets national standards for the security of electronic protected health information. The Privacy Rule, a Federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information. It applies to all forms of individuals' protected health information, whether electronic, written, or oral. The Security Rule, a Federal law that protects health information in electronic form, requires entities covered by HIPAA to ensure that electronic protected health information is secure.
PHI Identifiers We See and Use Each Day:
- Patient's name
- Postal address
- Telephone numbers
- Fax numbers
- Social security numbers
- Medical record number
- Health plan beneficiary numbers
Security of PHI/Confidentiality Reminders:
- Under no circumstances should an employee access a patient's record unless they are directly involved with the case.
- All paperwork containing PHI must be thrown out in an appropriate shredding dispenser. There are several dispensers located in each office location. DO NOT put PHI in recycling and trash bins as they are NOT secure.
- It is a good habit to minimize your computer screen when leaving your desk, so that PHI is not left open for all to read.
- Turn over any paperwork or reports you are working on containing PHI when leaving your desk even for a few minutes.
- Do not allow a lot of time to go by after sending PHI to a printer/copier.
- Do not mention a patient by name in cabs or in public areas.
- Demographic information entered into our systems (McKesson & Encore) needs to be accurate so that plans of care, verbal orders, and discharge summaries are mailed/faxed to the correct providers.
- Never leave your laptop/iPad/iPhone unattended in your vehicle or bag. Do not leave these devices in the back seat of cabs or in any other visible area of your car, even if it is locked.
- Create strong password and do not share your username or password with anyone.
- Never transmit PHI over the Internet (e.g. email outside the organization).
We have policies and procedures to safeguard confidential patient information. These include patient's rights to health care privacy, release of medical records, documenting patient's sensitive health history in the medical record, authorization to access electronic patient health information (ePHI), and medical record retention and destruction. Click here for the full list. Please contact your manager or Privacy Officer with any questions.
Privacy Officers:
- Jean Clive, VNAB: 617-886-6499
- Jeannett Dorey, VNA Care Network: 508-751-6862
- Mary Sheils, Hospice: 508-756-7176 X5540
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Jennifer Wisel: New Clinical Services Manager in Leominster
By Paula Schultz, Director of Clinical Services
Please join me in welcoming Jennifer Wisel as the new Clinical Services Manager in the Leominster office. Jennifer will be moving into her new role as of 8/31 and will be orienting herself one day a week during the month of August. Jenifer has been a Clinical Case Manager in our Leominster office since 2012 and has over 28 years experience in many health care settings including acute care, outpatient, as well as home health care.
Jennifer recently completed a master's in nursing program and has been working closely with Adele Pile, Director of Education, on an education module for clinical staff in their role in supervision of unlicensed staff in the home care setting.
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Openings in Preschool Program
Children's Garden Child Care Center, located in our Worcester office, has openings in their Preschool Program for children between the ages of 3-5 years.
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The VNA Walking Warriors want to invite you to please join our team today!
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The 2015 Boston Heart Walk
Saturday September 12, 2015 @ 9:00am
DCR's Hatch Shell on the Charles River Esplanade
Each registered participant is eligible for an Atrius Heart Walk T-shirt. Please contact me by Wednesday, August 19th with your order and size information.
(Youth Small, Youth Medium, Youth Large, Adult Small, Adult Medium, Adult Large, Adult X-Large, Adult XX-Large, Adult XXX-Large)
VNA Care Network Foundation is making a difference by participating once again in the American Heart Association's Annual Heart Walk. I need your help to make our team a success. Are you ready to build healthier lives by joining our team?
It only takes 2 easy steps!
1) Click on the link below to visit the team web page.
2) Click the "Red "Join Team" button and follow the prompts to register.
Once you've joined the team, we'll need your help to reach our team fundraising goal. Don't worry - fundraising is easier than you think. The American Heart Association provides all the tools you need, including your own personal fundraising page. Plus, I'll be here to support and encourage you along the way. Please don't hesitate to contact me with any Heart Walk questions.
Why Heart Walk? Did you know 1 in 3 Americans have some form of cardiovascular disease and that heart disease kills more women than all forms of cancer combined? We can change these statistics by joining together to walk and fundraise for Heart Walk.
Help grow our team, please feel free to forward this email to anyone you think will want to walk, raise funds and make a difference in our community. All are welcome; it's the more the merrier, when it comes to our Heart Walk team!
Follow This Link to visit our team web page and help with the efforts to support American Heart Association - Boston, MA
We would like to thank you in advance for your participation!
Cyndi Anderson
HR Administrative Assistant
(508) 751-6806
Fax: (508) 373-7598
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CLINICAL SERVICES
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Clinical Services Announcements and Updates
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iPhone Photo Program
By Carol Jones, Senior CWOCN
As all nurses know, we have been anxiously awaiting the roll out of the iPhones for photo consults. Well the time has come!
The roll out will take place with one office each week.
- Southborough roll out was 8/3/15
- Danvers roll out was the week of 8/10
- Gloucester roll out is the week of 8/17
- Needham roll out is the week of 8/24
- Worcester roll out is TBA
- Leominster roll out is TBA
The EDCUCATOR AND WOC in each office will schedule times for teaching nursing staff how to do this per the VNA protocol and give you all the needed handouts.
Please do not use your VNA iPhone for pictures prior to having been taught how to do this in your office. I know it has been a long wait, but please continue to use your VNA camera for all photo consults until the day you are educated on the iPhones by an office-based Educator or WOC nurse.
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Behavioral Health Referral Process
By Molly Lukason, Behavioral Health Program Manager
As we all know, new programs coming on board can cause confusion when it comes to the referral process. With the Behavioral Health Program, we want to make sure all clinicians are comfortable with the referral process so that documentation and follow up are a collaborative effort. The following process will answer many questions as to the different scenarios when making that referral. As always, if you have any questions, please feel free to contact Molly Lukason or Carol Morris. We are more than happy to help.
Prior to making a referral to Behavioral Health, the SN/Rehab - primary/referring clinician will verify that the patient has a documented diagnosis of depression, anxiety, or early onset dementia.
Please note the following referral process to Behavioral Health: WHEN
- Adding Behavioral Health as a new discipline:
- VNAB Process:
- SN/Rehab will contact MD for Behavioral Health (BH) referral and send a 110 to MD.
- Following initial evaluation by the BH clinician and approval for the program
- BH will complete a 110 which would include the BH plan of care and a brief summary
- Homebound status can be removed from the macro
- VNACN Process:
- BH will contact MD for referral
- Following initial evaluation by the BH clinician and approval for the program
- BH will complete MD orders which will include the behavioral health plan of care and a brief summary
- Transitioning to Behavioral Health with SN/Rehab discharge prior to the recertification window:
- VNAB Process:
- SN/Rehab will complete the discharge summary
- BH will complete the 110 as above
- VNACN Process:
- SN/Rehab will complete the discharge summary
- BH will secure MD orders for BH visits
- Transitioning to Behavioral Health during the recertification window with SN discharge:
- SN/Rehab will refer patient to BH at least 2 weeks prior to the end of the certification.
- BH will evaluate for appropriateness of the patient for the program. If the patient is not considered appropriate, then SN will move forward with their discharge. If the patient is appropriate for the program then:
- SN/Rehab will complete the follow up OASIS tool
- SN/Rehab will complete a discipline discharge summary
- BH will write the recertification order
- Recertification when both SN/Rehab & Behavioral Health will continue into the next certification.
- SN/Rehab will complete the follow Up OASIS
- SN/Rehab will complete their recertification order
- SN/Rehab will complete the Service/Frequency order and BH will notify scheduling (VNAB) or Coordinator (VNACN) as to which visits they are scheduled for
- BH will complete their recertification order by the end of the recertification window
- All discipline orders will flow to the 485
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Goggles to be Provided to all Clinicians
By Susan Stiller, Quality Improvement Review Specialist and Infection Control Officer
| In the coming weeks goggles will be made available for all clinicians to keep in their clinical bags.
It is the organization's expectation that by the end of October, every clinician will have a pair of goggles in his or her clinical bag at all times.
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Infectious diseases can be transmitted through various mechanisms, among which are infections that can be introduced through the mucous membranes of the eye. Therefore, their use will help to provide protection from splashes, sprays, and respiratory droplets that occur during clinical care procedures if splashes are anticipated.
They should fit comfortably over prescription glasses. Eye protection should be removed by handling only the earpieces that secure the goggles to your head, as this is considered relatively "clean." The front should not be touched, as these are the surfaces most likely to become contaminated by sprays, splashes, or droplets during patient care. Goggles should be wiped down with a towel, soap, and water if visibly soiled and disinfected with 70% alcohol and allowed to air dry. Gloves are to be worn when cleaning and disinfecting.
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OASIS Definitions vs. Rehab Definitions
Kyra Mihalick, Rehab Patient Care Manager
What you learned in [physical, occupational, speech] therapy school:
- Minimal assistance. Definition: The patient performs 75% or more of the task and requires assistance for 25% or less of the task.
- Toilet Transfer. Definition: Getting on and off of the toilet.
For a rehab clinician, that may seem simple, straight forward, and second nature. However, OASIS and rehab interpretations do not always line up. Below is a summary of OASIS Interpretations vs. Common Rehab Interpretations to guide you as you perform an OASIS assessment.
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OASIS
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OASIS-C Interpretation
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Common Rehab Interpretation
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"Assistance"
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Any type of human assistance: verbal cueing, supervision, spotting, contact guard, any type of physical assist
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Supervision, contact guard, min A, mod A, max A
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"Independently"
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Performs SAFELY, requires no human assistance (see above definition), and requires no further instruction or training. Not included ANYWHERE in plan of care/interventions
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Performs task by self with or without equipment
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"Minimal human assistance"
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Any type of verbal cueing, S, CG, spotting, environmental set up, physical assistance
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Patient performs 75% or more of the task and requires assistance for 25% or less of the task
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"Toilet transfer"
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Getting on and off the toilet AND getting to and from the toilet
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Getting on and off the toilet
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"Bed to chair transfer"
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Ability to safely move from the bed to the nearest sitting surface, which may require ambulation to another room
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Stand/pivot or stand/step transfer to/from bed and chair. Chair is generally next to the bed
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Assistance of person at all times
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Patient is UNSAFE and requires assistance (see above definition). May or may not have caregiver available
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Patient lives with someone who is able to assist
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Reference: Talbot JS, Kornetti D. Achieving OASIS-C Accuracy: Functional Scoring. Home Health Section of the APTA. October 2012.
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New Rehab Clinical Resources!
By Jenn Bilodeau, Manager of Rehab Orientation & Education
I am happy to announce that we have added several clinical resources geared specifically toward rehab clinical practice in home care and are now available for you to use as a resource. These clinical resources include:
- Home Health Objective Test Toolbox
- Speedy Reference Guide (includes predictive and reference values for functional tests, lung sound reference guide, modified BORG scale)
- Kornetti & Krafft Webinar Series (each webinar is 90-minutes and includes a resource tool to help put what you learn into clinical practice). Webinar topics include:
- Goal Writing Workshop for the Home Health Clinician
- Skilled, Reasonable & Necessary - Defensible Documentation for Strength/Aerobic Capacity Impairments
- Homebound Status and Completing the Home Assessment
- OT Utilization in Home Health
- ST Utilization in Home Health
- Using the International Classification of Function (ICF) Model to Stand Up to Audit Scrutiny
- Proposed CoPs - Are We Ready for Interdisciplinary Care?
- ICD10 - A Primer for Home Health Therapists
- Skilled, Reasonable & Necessary - Defensible Documentation for Balance Impairments (Coming Soon!)
- Skilled, Reasonable & Necessary - Defensible Documentation for Gait Impairments (Coming Soon!)
- PPS2016 - Overview of the Final Rule (Coming Soon!)
- Developing Clinical Competency for Therapists: A Primer and Tool to Get You Started (Coming Soon!)
For VNAB staff:
- The Home Health Objective Test Toolbox and the Speedy Reference Guide can be accessed through Outlook email ŕ Public Folders ŕ Clinician Help Files ŕ Search 'Rehab'
- The Kornetti & Krafft Webinar Series can be accessed through Home Care Central ŕ VNAB ŕ CORE CONTENT ŕ E-courses ŕ Kornetti and Krafft Webinar Series
For VNACN staff:
- All of the above resources can be accessed through the Ed Portal ŕ Training Library ŕ Clinical Resources
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Cleaning and Disinfecting Policy
By Susan Stiller, Quality Improvement Review Specialist and Infection Control Officer
Cleaning and disinfecting are important parts of a comprehensive infection prevention strategy. In the last decade there has been more research into knowledge of how long pathogenic organisms survive on objects and how they are transmitted to patients. There has also been more research into disinfection products, their effectiveness and any health risk to the person using the product. Knowledge continues to grow in this area. For this reason, we are reviewing disinfection products and will be updating practices based upon the review. This information will be provided to all staff during the upcoming OSHA education in September, please stay tuned.
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FUND DEVELOPMENT
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Register Now to Get Your Step Out for Hospice Sweatshirt
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Show your support for VNA Hospice Care by registering today for the 18th annual Step Out for Hospice walk/run on Sunday, Sept. 27, in Woburn.
Connie McGilvray, co-chair of the Woburn Friends of VNA Hospice Care and one of the event organizers, describes Step Out for Hospice as "more than a walk. It's a giant street party. There's live music and dancing, chowder, hotdogs, raffles, and more."
Step Out for Hospice starts at the Irish American Club of Woburn, 147 Main St., and goes around Horn Pond.
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Children ages 13 and under can join the 1-mile Fun Run beginning at 11:30 am. The Fun Run is free.
The 3-Mile Walk starts at noon, and 5-mile Road Race at 12:30 pm. Preregister now for the Walk or Road Race for a discounted fee of $30. Step Out for Hospice sweatshirts are guaranteed for entries received by Sept. 23.
To register, visit http://vnahospicecare.kintera.org/stepout2015 or contact Meaghan Gangi, development associate, at 781-569-2820 or mgangi@vnab.org. Register at the event beginning at 10 am for $40.
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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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Safety Event Reporting System (SERS)
As of September 1, we will be using the Atrius Health electronic Safety Event Reporting System (SERS).ALL STAFF (clinical and non-clinical)MUST ATTEND ONE TRAINING SESSION.
Please see the additional training dates that have been added below.
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DATE
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OFFICE
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ROOM
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TIME
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August 25
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Weymouth
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Conf Room
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8a - 9a
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August 27
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Weymouth
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Conf Room
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8a - 9a
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Please contact Donna Peters at 617-886-6808 or dpeters@vnab.org with any questions.
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