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For internal use only. Please do not distribute.
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Weekly Newsletter for Employees of VNA Care Network Foundation
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To ensure you're seeing the Connecter in its entirety:
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CONNECTER
ARCHIVES
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Below is this week's issue of the Connecter newsletter, which is required reading for all employees. The next edition will be published on Monday, March 21, with articles due to connecter@vnacarenetwork.org by Friday, March 18.
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KEY DATES THIS WEEK
- Tuesday, March 15: Mantoux Clinic > Charlestown
- Tuesday, March 15: Mantoux Clinic > Worcester
- Tuesday, March 15: Mantoux Clinic > Danvers
- Tuesday, March 15: Mantoux Reads Clinic > Needham
- Tuesday, March 15: Mantoux Clinic > Southborough
- Tuesday, March 15: OASIS Education > Charlestown
- Tuesday, March 15: OASIS Education > Danvers/Gloucester
- Tuesday, March 15: OASIS Education > Southborough
- Tuesday, March 15: OASIS Education > Worcester
- Wednesday, March 16: Medispan Update
- Wednesday, March 16: Mantoux Clinic > Weymouth
- Wednesday, March 16: Mantoux Reads Clinic > Needham
- Wednesday, March 16: Safety Issues For Home Health Care Providers Inservice
- Wednesday, March 16: OASIS Education > Weymouth
- Thursday, March 17: Focus on Falls Prevention Inservice
- Thursday, March 17: Mantoux Reads Clinic > Worcester
- Thursday, March 17: Mantoux Reads Clinic > Charlestown
- Thursday, March 17: Mantoux Reads Clinic > Southborough
- Thursday, March 17: Mantoux Reads Clinic > Danvers
- Friday, March 18: Mantoux Reads Clinic > Weymouth
- Saturday, March 19: IT Maintenance
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IN THIS ISSUE:
SERVICE EXCELLENCE
ANNOUNCEMENTS AND UPDATES
CLINICAL APPLICATIONS
CLINICAL SERVICES
FACILITIES
FUND DEVELOPMENT
HUMAN RESOURCES
INFORMATION SYSTEMS
QUALITY AND RISK MANAGEMENT
VNA HOSPICE CARE
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March 14, 2016
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Volume 5, Issue 11
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Service Standard of the Week:
Service Standard #1: Customer Loyalty
We ensure that our customers are the priority focus at all times by anticipating their needs and delivering exceptional service.
Here are some behaviors that demonstrate standard #1:
- Create a professional environment by providing support and the tools needed to achieve our vision and mission.
- Deliver evidenced-based, comprehensive care to all patients and referral sources.
- Learn something unique about each patient/customer and personalize your service to create customer loyalty and delight.
Huddle Topic Suggestions/Conversation Starters:
- Describe a method you use to establish a connection with a new patient.
- Throughout the time you're caring for a patient, how do you reinforce that they need to ask for our agency by name in the event of a hospital admission or if they require home health and/or hospice care in the future?
- How do you build effective relationships when you only interact with customers over the phone or via email?
- How do you bring to life our mission in your daily work?
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Service Excellence Champion Group
The Service Excellence Champion group meets monthly to discuss ways to further our organization's commitment to exceptional service excellence.
Key Initiatives Being Worked On:
- Improving patient experience
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- Town Hall Meetings
- Streamlining communication methods and tools
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- Huddle strategies
- Ongoing Service Excellence training
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- Ann Bohac
- Debbie Brown
- Katie Callahan
- Jen Casper
- Simone Charpentier
- Lori DeRosa
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- Wendy Drake
- Jill Enwright
- Kelly Frew
- Dave Hanley
- Brielle MacDonald
- Cheryl Milas
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- Mary Ann O'Connor
- Adele Pike
- Lorraine Potter
- Dave Rose
- Geri Spina
- Charlvic Williams
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Submitted by Linda Osterman, RN in the Southborough office
I want to commend OT Jerilyn Spokis. Yesterday, when she was visiting patient Doris V, she called me from the home as patient had a heart rate of 160-170. She was asymptomatic, but Jerilyn recognized not to give her a shower, even though the patient was insisting she have her shower anyway. She called me and I was able to move my visit time up to meet her there so we could collaborate face to face in real time about the patient. I confirmed that the heart rate was correct and contacted the MD. The patient was dehydrated and we decided to continue watching her closely. Ultimately, she did have to go to the ER and was admitted to Memorial. I haven't heard the final outcome, but the patient is 90+ years old, so I commend Jerilyn on her great assessment skills, and also for the kindness and concern she shows toward every patient and family she treats. I really like working with her, she is a great asset to the VNA, and to the communities she serves.
Submitted by Nancy Ryan, Rehab Services Manager in the Southborough office, on behalf of a patient Dear Stacy (PTA Stacy Choquette), Just a little note to thank you for the gentle and wonderful care you've given me. The VNA has always come thru for me. You and all your colleagues are top notch caregivers. It's been great working with you and I wish you nothing but the best. Thanks, Rick L. Submitted by Caroline Walton, Clinical Services Manager in the Gloucester and Danvers offices, on behalf of a patient "It is not how much you do, but how much love you put in the doing." Mother Theresa To: Kim Connelly, RN, Christine Medeiros, LPN, John Budrow, PT, Diane Letellier, PTA, Bonnie Cruickshank, PTA, Cheryl Peabody-Nutting, and Janet Lucey To all my caregivers at VNA Care (editor's note: it hasn't even launched yet and patients know our new name...I think it's a good sign!) I can't thank you enough for all the care, compassion and support over these past few weeks. The progress I have made at this point is amazing! In part I know it is because of my own drive and determination that I am healing so quickly - but it is also because of all of you with your guidance every step of the way! Submitted by Theresa Quinn, Resident Service Director at New Horizons Lynn Van Hook is the VNA Care Network skilled nurse who sees many of the residents here (New Horizons, Marlborough, MA). She is consistently polite, pleasant and professional with her interactions with staff and residents. She goes out of her way to communicate with me and review any concerns she has about the residents. I have observed her to be very patient and compassionate with the residents, especially those with cognitive deficits. It is a pleasure to work with her. Submitted by Michele Flanagan, RN in the Worcester office I wanted to take a minute to let you know what an asset Gary Weller is to this agency. Today, I called him to ask about a problem I had communicating from home. He was able to talk me through the steps needed to troubleshoot, and ultimately fix the issue. We also fixed a password issue with my iPhone during this call. Every time I have ever needed to call Gary for help, he has been able to fix whatever issue it is that I have. I have seen him help several of my fellow employees and he's usually present during in-services to troubleshoot equipment issues. Just wanted to acknowledge a job well done! Submitted by Robin Wilson, Palliative Care Program Manager Christine McCarthy has been working for the past year on a very complicated palliative care case which was frustrating, demanding, and unsafe. Chris has never given up on the patient or her family. She also remained in touch with the family attorney after the patient had been discharged. The patient now will be moving into a new, safe, clean residence with her son which is what she has most desired thanks to the hard work and follow through by Christine. Outstanding perseverance and care has allowed this patient and family feel safe and advocated for. Great job Chris!
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Scenes from the Street
Share your pictures from the office or the field with us by sending them to connecter@vnacarenetwork.org!
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ANNOUNCEMENTS AND UPDATES
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Length of Service Award Recipients - Rose Monahan
Our employees are our greatest asset and best indicator of our success...and based on our HomeCare Elite status and 4-4.5 CMS Star ratings, we have an exceptional team! We are lucky to have so many dedicated employees who commit themselves to our organization and the patients we serve.
Over the next several weeks we will go office by office and recognize all those who have reached milestone anniversaries. Congratulations!
Rose Monahan Hospice Home
Mary Anne Sullivan
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25 Years
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Susan Swift
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15 Years
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Blanca Galvez
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5 Years
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Norovirus - What is it?
By Susan Stiller, QI Specialist and Infection Control Officer
Norovirus is a very contagious virus. The virus causes inflammation of your stomach or intestines leading to stomach pain, nausea, and diarrhea and vomiting. A person with norovirus infection can shed billions of norovirus particles, but, it only takes as few as 18 viral particles to infect another person.
How is it transmitted? You can get it from close contact with an infected person, contaminated food or water, or by touching contaminated surfaces.
What are the symptoms? Typically they are acute-onset of vomiting, watery, non-bloody diarrhea, abdominal cramps and nausea. Some people may also have low-grade fever, headaches, and myalgias (body aches).
How long does it last? Symptoms have a short duration usually lasting 24 to 72 hours with most people recovering fully. But for some, especially for young children, older adults, and people with compromised immune systems, norovirus can lead to severe dehydration, hospitalization, and death.
What is the treatment? There are no specific treatments. Replacing fluids to help correct dehydration is important.
How can you help it from spreading among patients and staff?
- Wash your hands often with soap and water for at least 20 seconds. Avoid touching your mouth. The alcohol in the hand sanitizer is not effective against norovirus so using soap and water is preferred.
- Clean and disinfect frequently touched surfaces with a bleach-based cleaner.
- Remove and wash soiled clothes and linens immediately when soiled, dry in dryer.
- Use gown and gloves when caring for patients to reduce exposure to vomit or fecal matter.
- If you are sick, stay home for at least 2 days after symptoms stop as the virus continues to shed even when feeling better.
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Encore Medispan Update Wednesday
By Christine Day, Clinical Application Specialist
Attention Encore Users: on Wednesday, March 16, a Medispan update will be placed on the server at 2pm.
Please remember that this file will be picked up by your laptop with its first laptop sync after that time. It takes about 30 minutes to process on your laptop. Please setup for your usual overnight communication Wednesday evening so that you will pick up the Medispan file overnight avoiding a potentially lengthy communication in the morning.
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Encore Patch Scheduled for next Tuesday 3/22
There will be an upgrade/Patch in Financial to version 06.00.0230 on Tuesday, 3/22. All users must be out of Encore by 8pm. An email will be sent alerting you when the placement is complete.
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Updates for Both McKesson and Encore in March
By Kathy Schuft, Clinical Application Specialist
Toward the end of March there will be an update to both McKesson and Encore to bring in quarterly regulatory updates. We are in the process of reviewing information from the software companies and planning dates. We will give you information as soon as it is available.
Please stay tuned to the Connecter for further information. If you have any questions you may contact me at kschuft@vnab.org or 617-886-6968.
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What is New in Behavioral Health?
By Molly Lukason, Behavioral Health Program Manager
With each passing week, more and more patients are participating in our Behavioral Health Program. Currently, we have 87 active patients. We have also reached out to patients who completed the program during 2015 to elicit their feedback. Some interesting results show that more than half of these patients have not had a behavioral health related hospitalization since completing the program. Nine months after completing the program, more than half report that the program continues to be useful and that they use at least one skill learned during the program to help them through difficult situations or transitions.
We will continue our outreach to patients for feedback and suggestions that may help other patients as we move forward. This is invaluable to growing the program and reaching a wider patient population. Thank you for your continued support of this program. Please continue those referrals!
UPDATED Behavioral Health Clinician Contact List
- Susan Alberto, RN: 774-432-1654
- Christine Mello-Byrne, RN: 617-913-5667
- Sarah Bernd, RN: 617-733-6892
- Kay Diane Dennis, RN: 617-947-1544
- Lynda Wallack, RN: 617-851-3902
For any questions, concerns or inquiries regarding behavioral health, please call Molly at 774-502-5545.
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Referrals to VNAB Social Work and CRS
By Adele Pike, Director of Education
The VNAB Social Services Team wishes to remind VNAB clinicians of the guidelines for referring to our Social Worker, Mary Beth Kelly, and to our CRSs: Jen DiMatteo, Susan Marlin Procter, and Simone Charpentier. We ask that only the Primary Clinician make referrals and note that Social Worker and CRS will only act on referrals after the Primary Clinician has confirmed the need.
Please refer to the grid for guidance on the services provided by the Social Services Team and the patients who are eligible for these services.
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New VNAB Consent and Handbook
VNAB: Calling All Clinicians who conduct SOC/Admission Visits and 1st Evaluation Visits - New Patient Consent and Patient Handbook, as of 3/7/16.
As of March 7, the VNAB will be using the new Patient Consent and Patient Handbook during SOC/Admission Visits, as we have been discussing during recent Team Meetings. In the near future this will be rolled out to VNA Care Network clinicians and staff as well.
Click the FULL ARTICLE button below for more information.
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Focus on Fall Risk Reduction
I'd like to invite ALL clinical staff to attend one of our three Continuing Education sessions entitled Care of the Patient at Risk for Falls The first session will be held in Worcester from 8:30-10:30am, Thursday March 17, 2016. Subsequent sessions will be held in Needham on Thursday, April 21 from 2-4pm and in Charlestown on Thursday, May 5 from 8:30-10:30am.
Click the FULL ARTICLE button below for more information.
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Inservice: Safety Issues For Home Health Care Providers
We are pleased to announce that Safety Education in-services, presented by our Security Consultant, Clare M. Schroeder, are now being offered organizational-wide and open to all staff. Title: Safety Issues For Home Health Care Providers. Danvers Office | Wednesday, March 16 | 8:30-9:30am
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Mantoux Testing in March
By Beverly Salate, Wellness Manager
BEGINNING IN 2016 ALL MANTOUX TESTING WILL BE IN FEBRUARY/ MARCH...MARK YOUR CALENDARS!! Please note that some dates have changed.
Wellness will be doing Mantoux testing for all licensed clinicians around the first quarter OASIS education sessions. This is a change for both VNAB and VNACN. We will be in each office 1-hour before the session starts and will stop 5 minutes before the program begins. We will also be available 1-hour after the program to administer Mantoux. We cannot plant a Mantoux on a Thursday, as staff would have to come in on the weekend to have it read, so I have added additional sessions in a few of the offices that are not around OASIS sessions. Wellness will also be available 2 days after the Mantoux is planted to read the results All licensed clinicians are required to have a yearly Mantoux (or complete a positive reactor's form). Mantoux can be safely given 7 days apart and it is recommended that pregnant women be tested as well. Questions? Contact Beverly Salate at 888-663-3688 ext. 5603 or bsalate@vnacarenetwork.org.
March 2016
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Sun
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Mon
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Tue
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Wed
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Thu
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Fri
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Needham 7:30-11
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Needham 7:30-11
Worcester reads 8-11
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15
Charlestown 7:30-11
Worcester 7:30-11
Danvers 7:30-11
Needham reads 8:30-3
Southborough 1:30-4:30
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16
Weymouth 7:30-11
Needham reads 12:30-2
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Worcester reads 8-11
Charlestown reads 8:30-10
Southborough reads 12:30-4
Danvers reads 1-4
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Weymouth reads 8:30-10
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20
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21
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Woburn 8-11:30a
Worcester 1:30-4:30
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Leominster 7:30-11
Woburn 1-4
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Woburn reads by manager |
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Woburn reads 7:30-11a
Leominster reads 8-11
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27
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28
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Woburn 7:30-11:30a
Danvers 1:30-4:30
de Rham 10-12p
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Needham
8-12:30
New Horizons 8-9a
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Woburn reads 12:30-4
de Rham reads 11-1p
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April 1
Needham reads by manager
New Horizons reads 8-9a
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New HVAC System in Worcester
The Worcester office is installing an upgraded heating and A/C system over the coming months.We will need to relocate staff and Facilities and IT are working to get everyone accommodated in temporary locations while their area is being worked on.
The schedule is as follows:
- 1 North (daycare/reception) - 3/14 to 3/18 after hours to accommodate daycare
- 2 South (referral center) 3/21 to 4/1 (Time TBD after meeting)
- 2 North (clinical area) 4/4 to 4/15 (Time TBD after meeting)
- Boilers and other prep work 4/15 to 4/29
- Start up 4/29 to 5/20 (Pending on Weather)
Please contact Lorraine Potter, Director of Facilities, with any questions at LPotter@vnab.org.
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Long Term Pharmacy Solutions Supports VNA Hospice Care
Long Term Pharmacy Solutions recently signed on as a $10,000 Platinum Sponsor of the 22nd annual Dine-Around, Auction and Casino Night on Saturday, April 30, at the Winchester Country Club to benefit VNA Hospice Care. This is the second year Long Term Pharmacy Solutions has been a lead sponsor of the Dine-Around. Pictured from left are Steven Geoffroy, RPh, president and CEO, and Paulette Geoffroy, business manager, both of Long Term Pharmacy with Meaghan Gangi, development associate. An anonymous donor also joined Long Term Pharmacy Solutions as a Platinum Sponsor of the benefit organized by the Winchester Friends. For more information about the Dine-Around or to purchase tickets, contact Meaghan at 781-569-2820. Tickets are also available online by clicking here.
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Boston Globe Subscribers: Donate Ad Space
You can donate ad space to VNA of Boston, VNA Care Network, and VNA Hospice Care through the Globe Readers And Nonprofits Together (GRANT) program. Watch your email or mail for your voucher. You can also complete a short form on the Boston Globe's website. For the organization name and city, please use one of the following: - VNA of Boston, Charlestown
- VNA Care Network and either Needham or Danvers
- VNA Hospice Care, Woburn
Thank you to everyone who helped us earn a free ad in last year's GRANT program. We hope you'll help us take advantage of this great opportunity again this year. Be sure to submit your voucher by April 30, 2016.
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2015 BCBS Fitness Reimbursement
In 2015 were you a member of your fitness facility or gym for four consecutive months while also being a BCBS HMO Health Plan Member?
Just a reminder that you still have time to submit for your 2015 BCBS Fitness Reimbursement of up to $150 per family. Please print the BCBS Fitness Reimbursement form and follow the directions to receive your membership reimbursement of up to $150.
THE DEADLINE TO SUBMIT FOR THIS
REIMBURSEMENT IS MARCH 31, 2016!
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 Employee New Hire Referral Bonus Program
The new hire referral bonus program includes employee referrals for RNs, LPNs, PTs, PTAs, OTs, COTAs, and SLPs. If you would like to refer a friend, family member, or colleague, please inform the appropriate Human Resources Representative at your location prior to the applicant coming in for an interview. Please note, when two or more employees refer the same applicant, the referral bonus will be split equally amongst the employees. Referral bonuses are paid out after the referred employee's three and six month anniversary, as long as they are in a paid status at those intervals. Please contact Cheryl Milas at cmilas@vnacarenetwork.org or Debbie Brown at dbrown@vnab.org for more information.
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 Job Postings - VNAB and VNAHC
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 - VNACN and VNAHC
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:
- Liz Bourne
- Ray Brackett
- Linda Britt
- Kim Dio
- Kelly Frew
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- Mary Helen Mahoney
- Susan Marlin Procter
- Mary McCarthy
- Ilona O'Connor
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- Mary Ann O'Connor
- Mae Powers
- David Rose
- Danny Yang
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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 in the Charlestown office.
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IT Maintenance Saturday
The IT Department is scheduled to perform routine maintenance on the Worcester office's network Saturday, March 19 beginning at 6pm with an expected completion time of 10pm. During this time, the following services and technologies will be unavailable: - Encore
- Office phone lines for Worcester- and Rose Monahan-based staff. The main agency phone number will continue to forward to the answering service.
- Email for VNACN-based users (e.g. XX@vnacarenetwork.org)
- Worcester network folders
Please plan accordingly and feel free to contact the IT Department with any questions or concerns.
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IT Department On-Call Staff for Week of 3/14/16
For Encore issues including communications, Encore laptops, WebVPN and general technology
- Through Friday, March 18, 11:59 PM - Sean Carroll (508) 868-0615
- Beginning Saturday, March 19, 12:00 AM - John Severin (781) 775-7982
For McKesson issues including iPads and laptops and general technology (support is provided weekdays 6:00 PM to 10:00 PM, weekends and holidays 7:00 AM to 3:00 PM)
- Through Tuesday, March 15, 10:00 PM - Carol McDonald (617) 913-3003
- Beginning Wednesday, March 16, 6:00 PM - Jose' Parra (617) 913-3003
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QUALITY AND RISK MANAGEMENT |
Process Measure Documentation
By Kyra Mihalick, PT, DPT, COS-C, Patient Care Manager
A reminder to all clinicians: per agency expectations, process measures should be documented at EVERY OASIS time point (SOC, ROC, Recert, AND Discharge) and at least once a week otherwise. High risk patients may be educated more frequently than once a week.
M2400, which is used to calculate process measures to capture the use of best practices, is completed at Transfer and Discharge. This question specifically asks about process measure inclusion in the plan of care and implementation at the time of or any time since the previous OASIS assessment.
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Joint Commission Due for a Visit to VNACN in 2016
By Donna Peters, Director, Quality Assurance & Risk Management
The Joint Commission (JC) is the accrediting body that assesses and evaluates agencies on programs, policies, and compliance standards. Home health and Hospice have been fortunate to receive this nationally recognized accreditation status. The JC symbol reflects the agency's commitment to quality and professional standards.
In an effort to help providers meet JC standards and elements they have designed a series of standards for agencies to follow that mirror CMS and regulatory compliance. The chapters encompass home health and hospice elements and are:
- Environment of Care
- Emergency Management
- Human Resources
- Infection control
- Information management
- Leadership
- Medication management
- National Patient Safety
- Life Safety
- Provision of Care
- Record of Treatment
- Rights and Responsibilities
- Performance Improvement
- Waived testing
Each of these areas has a designated internal chapter leader/facilitator who will be preparing each area for the JC survey coming in 2016 (anticipated in Quarter 4).
Please stay tuned for agency updates regarding best practice, examples of JC survey questions, and information that may be asked of you when the surveyors arrive.
Happy spring everyone!
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Q1 OASIS Education
See below for the remaining Q1 OASIS Education sessions.
Please Note that the final Needham session will be held on Friday, March 25, 2016 NOT Thursday March 24,2016 as was previously posted.
Be sure you get to one of the FINAL Mandatory Education sessions. These classes are mandatory for all RN, PT, OT, and ST clinicians. If unable to attend a session, you will be given a take home test to complete and then meet with the PCM in your office to review. Sessions are optional for LPN, PTA, and COTA and it is at the discretion of the manager for these staff to attend.
Office
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Day/Date
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Time
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Presenter
| Charlestown | Tuesday, March 15 | 8:30-10am | Elaine/Kyra | Charlestown | Thursday, March 31 | 2-3:30pm | Elaine/Kyra | Danvers/Gloucester | Tuesday, March 15 | 8:30-10am | Marilyn | Danvers/Gloucester | Thursday, March 24 | 8:30-10am | Marilyn | Danvers/Gloucester | Tuesday, March 29 | 2:30-4pm | Marilyn | Leominster | Wednesday, March 23 | 8:30-10am | Surabhi | Needham | Friday, March 25 | 8:30-10am | Maura | Quincy | Thursday, March 24 | 8-9:30am | Kyra/Carol | Southborough | Tuesday, March 15 | 2:30-4pm | Maria/Surabhi | Weymouth | Wednesday, March 16 | 8:30-10am | Kyra/Carol | Weymouth | Thursday, March 31 | 2-3:30pm | Kyra/Carol | Worcester | Tuesday, March 15 | 8:30-10am | Chris | Worcester | Tuesday, March 22 | 2:30-4pm | Chris |
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PATIENT CARE MANAGERS
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Name
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Email
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Cell
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Position
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Covering Office
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Bowden, Marilyn
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774-502-7478
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Patient Care Manager
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Danvers and
Gloucester
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Dunn, Maria
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508-688-2449
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Patient Care Program Manager
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SS02 Southborough
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Gardner, Elaine
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617-680-1105
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Patient Care Manager
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Charlestown
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Gill, Christine
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774-502-5725
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Patient Care Manager
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Worcester
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Mihalick, Kyra
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617-913-6823
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Patient Care Manager
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VNAB Therapy
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Morris, Carol
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617-913-3006
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Patient Care Program Manager
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Quincy
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Saxena, Surabhi
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774-463-7336
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Patient Care Manager
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Leominster & SS55 Southborough
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Vitello, Maura
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774-502-7475
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Patient Care Manager
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Needham
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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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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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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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508-756-7176 x6876
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QI Nurse
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Hospice Memorial Service Sunday, April 10
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March 14, 2016 |
The Connecter
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Volume 5, Issue 11
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FOLLOW US ON SOCIAL MEDIA!
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Confidentiality Notice: The Connecter newsletter is an internal communication intended only for employees of VNA Care Network Foundation and Atrius Health. Information contained within this newsletter includes confidential, proprietary, and privileged content. Unauthorized forwarding, printing, copying, distribution, and/or negligent handling is strictly prohibited and could result in disciplinary action.
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