February 2, 2014                                                                                                     Issue 21
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Roxana Cannon Arsht Surgicenter 

& Practice Without Pressure Partner

To Bring Dental Surgery to People With Disabilities


Part 1: Reprinted with permission from The Perioperative Press, A Sharper View:
           A Newsletter for Perioperative Services, Christiana Care Health System,
   Summer 2013, Vol. 12.
 
                 

This year, the Roxana Cannon Arsht Surgicenter and Practice Without Pressure have partnered to bring surgical dental care to people with disabilities who need this level of care. With five dental surgeries there since January and several more on the way, this collaboration represents a significant step forward in access to care for people with disabilities. 

 

"I think we're off to a great start," said Dr. Melinda Randall, anesthesoloigst and Medical Director of the Surgicenter. "We're learning how to work together to blend what each organization does best for the benefit of these clients. It's a new direction for us at the Surgicenter and so far, has been a really good experience." 

 

For Deborah Gigliotti, the Surgicenter Nurse Manager, the opportunity to work with Practice Without Pressure holds personal significance. "I have people close to me with very special needs, so the idea that PWP exists, what it stands for and what it does, is very appealing to me." 

 

Practice Without Pressure is a non-profit organization that makes dental, medical and personal care routine for people with disabilities. At its Center in Newark, people practice procedures they have feared or avoided, and when ready, can join other clients who come to PWP for routine care.

 

After incorporating in 2002, PWP opened its first Center more than three years ago.  Since it began, hundreds have been helped by PWP. But some people who have come to PWP for treatment, have such significant dental issues, surgery has been necessary, but not readily available due to limited options for treatment and long waiting lists.  

 

Enter Christiana Care. Deborah A. Jastrebski, founder and chief executive officer of Practice Without Pressure, first connected with Dr. Edwin L. Granite. Dr. Granite, who passed away last December, was chairman emeritus of the Christiana Care Health System's Department of Oral and Maxillofacial Surgery and Hospital Dentistry, chief of Oral and Maxillofacial Surgery, and program director of the Oral and Maxillofacial Surgery Residency Program. 

 

"Eddie was our angel," Jastrebski said. He understood the need for greater access to care for our guys and gals. He opened doors for us that led to surgical care for our clients at Christiana Care. We will always be grateful to him." 

 

While Granite created opportunities, it was Wilmington Hospital staff, Jastrebski said, who deserve credit for keeping those door open. "We learned a lot working with them and have brought the benefits of that experience across the street to the Surgicenter." 

 

Practice Without Pressure has also found a kindred spirit in Deborah Gigliotti. "When Judy Townsley brought this opportunity to me," Gigliotti said, "it became apparent when she told me how pressed they were for OR time at Wilmington, I had the time available here and a physical lay-out that is easier for patients to negotiate. You just walk in. Our front desk is right there, and we're all on one level. Being smaller than the hospital makes it a lot easier for patients to maneuver here," she said. 

 

Dr. Andrew Swiatowicz, who works with PWP and is in private practice in Pike Creek, has experience in both hospital settings. He is board credentialed with Christiana Care and provides operatory dental care to PWP and other patients. "Wilmington Hospital has been supportive in the past, and their staff is great to work with too, but this environment makes a difference for our clients," he said. "An outpatient surgicenter is a little more calming for them than the hustle and bustle of the hospital. " 

 

Karen Bashkow, Senior Director of Programming for PWP and an RN, who has supported people with disabilities at both settings, concurs. "Changing rooms prior to surgery can be stressful. Hospitals are busy places and our guys and gals pick up on that nervous energy. It can lead to sensory overload and make them more anxious." 

 

PWP Practice Specialist Danielle Saienni, sees the difference first-hand. "At the Surgicenter, we are in one room where everything prior to surgery happens. The rooms are large with a reclining chair that converts to a stretcher. It's homey, comfortable and calm." 

 

Practice Without Pressure helps keep it that way. PWP staff serves as the link between what clients have practiced to prepare for surgery and what they experience before and after OR treatment. PWP practice specialists accompany clients on a walkthrough of the facility in the days before surgery and into the pre-op room where they prep and wait for surgery. 

 

"Having a familiar and understanding face makes a real difference for our clients and for Surgicenter staff who support them," Saienni said. That care extends to post-op where the presence of a family member or caregiver can be a comfort. 

 

It's not just who is there, but how people are treated that resonates. "Staff at the Surgicenter have been so helpful," said Bashkow. "The walk through is an extra mile they don't do for anyone else and it really makes a difference." They also understand how a small accommodation can save the day. "If someone can't get undressed right away, they'll let that slide until the last minute. If we need to walk around, we get to walk around," Saienni said.  

 

That appreciation cuts both ways. Randall and two of her colleagues have worked with Saienni. "She was great, really wonderful. Danielle knows the patients. She knows how to best deal with them, what their concerns are, if they're cooperative or combative, if they'll allow certain things or not. She'll know if they'll take a liquid to relax them. She was very helpful, very soothing for the patient. She brings a better understanding of what the patient is all about. 

 

"She also understands what will help the process for us and the patient. She told us about the patient, told us what to expect, what things we might encounter and then helped us a lot to determine the path we should take to treat the patient. 

 

"One patient had a nervous habit where she slapped her head, and Danielle suggested that the IV might come out if we put it in her arm during pre-op, so we did the IV back in the operating room after she had received inhalation anesthesia," Randall said. 

 

When another client needed an IV, Saienni worked with the team to make sure the patient stayed still and was supported during the procedure. "She understands that we can get the job done if we all work together to get it done safely," Randall said. "She was very helpful, very soothing for the patient. It worked out well." 

 

Said Gigliotti, "Our partnership has been a pleasure and brought joy to everyone we've had the opportunity to work with. My staff loves the patients, loves PWP. Everybody we've met in this whole experience has been a delight because everyone, the dentists, the oral surgeons, all of us have the same goal, which is a safe, great experience for every patient." 

 

For some, that care is long overdue. Noted Swiatowicz, "It helps these patients get the care they haven't been able to receive, some of them for decades because they're not suited for a regular dental office or they've never been able to find a dentist before PWP who was willing to work with their special needs to get them their healthcare." 

 

Now, the Surgicenter and PWP are making that care possible. "Every patient brings us trust, but PWP brings us the opportunity to do the right thing, to be of service and help the community and people that need us. I feel when you're able to help people, to relieve their pain or suffering, it's a gift. And when patients, through no one's fault, have communication issues, things can get missed. Getting PWP patients on the schedule to get them care as quickly as possible, is a gift from us to them," Gigliotti said.

 

 

We will feature three case histories of people supported by PWP at Christiana Care in our next issues.
  
Perioperative Perspective:
Latest Trends & Practices
Saturday, February 8 from 7 a.m. - 4 p.m.
John H. Ammon Medical Center at the Christiana Hospital Campus

   

Deb Jastrebski, founder and CEO of Practice Without Pressure, will conduct a workshop  on "Working with People with Disabilities in a Medical, Dental or Personal Care Setting," at this Annual Perioperative Services Conference.  

Practice Without Pressure, Inc.
2470 Sunset Lake Road
Newark, DE 19702
(302) 832-2800
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