Hospital of the University of Pennsylvania

INSIDE

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Volume 25 Number 13 June 27, 2014

Protect Your Skin This Summer ............................2

An Anniversary to Remember ................................2

Speaking with HUP’s Leaders ......................................3

Seeing Clearly Now .................4

The 2014 winner of the Victoria Rich Patient Satisfaction Award was HUP’s Intensive Care Nursery. A new initiative, called Team Nursing, addressed several challenges on the unit, including the number of nurses caring for an infant, the amount of patient movement from one bay to another, and the staff nurses’ lack of primary patients.

As part of the model, the staff is divided into two teams, each having responsibility for two bays of patients. Nurses can choose their assignment within their team’s bays. Within six months of initiating, patient transfers within the four bays decreased from a high of 14 to 1.

This new consistency of care also resulted in care by a smaller team. Before Team Nursing, an average of more than 10 nurses cared for an infant during a hospital stay. Post change, that number had dropped by more than half.

Our Nursing

SUPERSTARSDuring this year’s annual Nurses Week Award Ceremony, several nurses received special recognition for going the extra mile to provide safe and quality care to our patients. “As I learn more about your accomplishments,” said Regina Cunningham, PhD, HUP’s chief nursing executive, “I can’t tell you how impressed I am, with both your creativity and innovation.”

A Dedication to Patients and Staff This year’s winner of the Joan

Bretschneider Shared Governance Leadership Award was Jennifer Perno, BSN, CMSRN, of Founders 14, a unit for non-surgical patients.

According to the nomination letter, Perno developed and implemented a falls action plan with the use of the 12-hour bed alarm program. After implementation, “the unit had just 3 falls during the first month and then had the longest record without any falls, 60 days!” She also worked with other staff to develop a script for patients, helping them and their families understand the reasoning behind the initiative.

(Continued on page 4)

SEEING CLEARLY NOW

` Members of HUP’s Intensive Care Nursery, this year’s winners of the Victoria Rich Patient Satisfaction Award.

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` Debbie and John McColgan, Jr, pose with chef Michael Filan before enjoying their anniversary dinner of filet mignon and rack of lamb.

T O R E M E M B E RDebbie and Jack McColgan celebrated their 38th wedding anniversary at HUP with a special meal prepared by Food Services in a room decorated by the Rhoads 7 nursing team. At HUP for more than 100 days, Jack battled large B cell non-Hodgkin’s lymphoma with radiation, chemotherapy, and other treatment along the way. Despite the long and painful journey, his wife and care team were there every step. “The care is beyond anything you can imagine,” said McColgan. “The nurses who treated me were angels. It’s like having 60 angels. I can honestly say that from the [patient] transporters, to the CNAs [certified nursing assistants], nurses, doctors, management, they’ve always treated me with respect. The quality of care has been outstanding.”

Jack McColgan recently passed away but his wife, recalling her “wonderful husband,” wrote, “Thank you for everything, it was such a wonderful night, an anniversary to remember.”

An Anniversary

Protect Your Skin This Summer! Summer is in full swing and everyone is ready to head outdoors to enjoy the sunshine. But it’s essential that you enjoy it safely.

Skin cancer is the most common type of cancer in this country. In fact, more non-melanoma cancers are diagnosed each year than the combined total of breast, lung, prostate, and colon. Americans have a one in five chance of being diagnosed with a non-melanoma cancer … and the vast majority of cases are caused by radiation from the sun.

Sunbathing is fine as long as you wear sunscreen.

FICTION: “Sunscreen is a false security blanket. Sunbathing is very bad even with sunscreen.”

Sunscreen sprays are better than lotion.

FACT: A sunscreen you actually use is the best! In other words, “Any sunscreen is better than no sunscreen. Make sure it has an SPF of at least 30 and broad spectrum coverage [both UVA and UVA].”

Apply sunscreen before you go out and you’ll be fine for the day.

FICTION: You need to apply prior to going outside but then every hour (and after going in the water). And be sure to use enough: “Each application should be one ounce worth, or the size of a golf ball or shot glass.”

One sunburn won’t raise your risk of skin cancer.

FICTION: Sunburns damage DNA, which can lead to the formation of cancer cells, but it’s a slow process. “Sunburns in childhood and young adulthood can lead to significant damage later on.”

Skin cancer is curable.

FACT: “Very curable … if caught early. Do a self-exam monthly and have a doctor check your skin every year.” To learn what changes to look for, go to the American Academy of Dermatology (aad.org) or the Skin Cancer Foundation (skincancer.org).

We asked Joseph Sobanko, MD, of Dermatology Surgery, to give us the lowdown on what’s fact and what’s fiction when it comes to protecting your skin from the sun’s rays.

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SPEAKING WITH HUP’S LEADERS

Penn Medicine recently approved a 3 percent base pay increase for all eligible UPHS employees, which will appear in the July 11 paycheck. “Our philosophy is to remain competitive in our market,” said HUP executive director Garry Scheib at a recent Meal with an Administrator.

The raise was approved following the Health System’s financially strong year. “We’re one of the few health systems in our market — and in the country — to be doing so well,” he said. “These are tough times in health care.”

Observation status is the biggest financial risk hospitals have faced in the last few years, Scheib said. “Medicare made the decision to stop paying inpatient rates for stays of 24 hours or less. They cut revenue by 80 percent on all of these patients.”

At UPHS, observation patients represent 12 percent of all its patients, but the average in the region is 25 percent. “In one health system in our region, 50 percent of its patients are observation status. They’ve lost 40 percent of their revenue in just a couple years.”

To compound Medicare’s drastic reduction in reimbursement, “Medicaid is now using observation status for its patients as well but they’re paying nothing,” he said.

The new provisions for insuring patients under the Affordable Care Act has not yet had an impact on the Health System. “Less than one percent of our patients have switched to being covered through the insurance exchanges and almost every one previously had health insurance,” he said.

Another impact on hospital revenue is the proposed Medicaid expansion of the ACA. Because Pennsylvania decided not to expand Medicaid coverage, many people in the state

remain uninsured. Governor Corbett would like to cover this population through the insurance exchanges, using the federal money funding the expansion to support insurance exchanges. But the federal government has not approved this request.

Hospitals have to find new ways to reduce expenses while maintaining high-quality patient care. One staff participant said, “I think every department can be streamlined to make things more efficient and cost effective.”

Scheib agreed. “We are challenging managers to work with staff to find ways to cut costs.”

In addition, he said “we are planning to bring in resources to support our organization in process improvement. There is an opportunity for standardization in health care. We have to find and eliminate unnecessary variations in clinical care and in administrative policies and procedures.”

Every $75,000 saved by eliminating waste and unnecessary variations is equal to one job. “I’m very proud that Penn has not had a major layoff in 15 years and we want to keep it that way. Our philosophy is to do everything we can to maintain jobs.”

Only a few days remain before the deadline for completing the new HIPAA training. “The government is setting the bar higher for protecting patient information, making it much harder for people to inappropriately access confidential medical information,” Scheib said. “All employees have to be compliant with the new training.”

Fair Warning, a new computer software program, will now look for trends in accessing patient records, for example, an employee looking at records of patients who live in his or her town. “If the program discovers such a trend, we will pursue an investigation,” Scheib said.

“We need to do all we can to make sure our records are secure. There is zero tolerance for employees who inappropriately access and use information from medical records.”

An AnniversaryPrescription drugs – especially controlled substances – are kept under lock and key at HUP. We need to be just as careful with prescription pads and paper. To decrease the use of fraudulent prescriptions, UPHS has put in place several safety measures, including:

• Using only UPHS tamper-resistant paper/pads.

• Keeping pads and paper in a locked area. • E-prescribing when possible. • Shredding prescription pads of prior

providers.• Locking printer trays.• Reporting prescription diversion.To learn more, view the entire Medication Safety Part II Huddle — and other Accreditation/Regulatory theme huddles — at http://pennpoint.uphs.upenn.edu/sites/CEQI/Regulatory_Affairs/default.aspx.

SURVEY>>>>>>> READINESS

“We are challenging managers to work with staff to find ways to cut costs.”

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HUPdateEDITORIAL STAFF Sally Sapega Editor and Photographer

Lisa Paxson Designer

ADMINISTRATION Susan E. Phillips Senior Vice President, Public Affairs

Holly Auer Director of Communications

CONTACT HUPDATE AT: 3535 Market Street, Mezzanine Philadelphia, PA 19104

phone: 215.662.4488 fax: 215.349.8312 email: sally.sapega@uphs.upenn.edu

HUPdate is published biweekly for HUP employees. Access HUPdate online at http://news.pennmedicine.org/inside/hupdate.

If a child has trouble seeing, his or her world shrinks considerably. Indeed, nearly 80 percent of what a child learns is obtained visually. Reading — and learning — become a struggle and the child falls farther and farther behind.

Now, thanks to a Penn Medicine CAREs grant, students at the Folk Arts-Cultural Treasures Charter School (FACTS) who couldn’t otherwise afford glasses will be able to see the world through “new” eyes.

The majority of students at FACTS are first-generation Asian Americans and Asian immigrants. Jennifer Lai, MSN, data nurse coordinator in Vascular Surgery, learned of the need for glasses when she

Perno also implemented the “comfort cart,” which provides patients with the comforts of home, such as personal hygiene items, magazines, books, and games, among other things.

For staff, Perno helped create a morale booster club known as “The Socialites.” Introduced in 2012, the club included nominations for employees of the month award, a “brag board” to thank staff or comment on a job well done, as well as organized events outside of work. As a mentor “Jennifer has made herself available to help others at all times…. [helping] new-to-practice nurses develop strong clinical skills.”

Our Nursing

SUPERSTARS(Continued from page 1)

SEEING CLEARLY NOW

If you do volunteer community outreach, your organization may be eligible to receive a Penn Medicine CAREs grant. To learn more and apply, go to http://uphsxnet.uphs.upenn.edu/community/.

In addition to the entity awards, the CPUP and HUP winners of this year’s UPHS Nursing Clinical Excellence Awards are:

Lillian Brunner Clnical Judgment and Decision Making: Dawn Drazek (CPUP) and Mae McHugh

Rosalyn J. Watts Nurse-Patient/Family Relationship: Danielle Gordon (CPUP) and Melissa Trolene

Dorothy Botdorf Award for Clinical Leadership: Carlin Ciasullo (CPUP) and Michelle Otto

Helen McClelland Award for Clinical Scholarship: Bonita Bennett (CPUP) and Theresa Gorman

` Jennifer Lai (l.) with students and nurse Loretta Veney from FACTS.

` Left: Chief nursing executive Regina Cunningham (c.) with CPUP’s nursing excellence winners (l. to r.): Bonita Bennett, Carlin Ciasullo, Dawn Drazek, and Danielle Gordon.

` Right: Regina Cunningham (c.) with HUP’s nursing excellence winners (l. to r.): Michele Otto, Mae McHugh, Theresa Gorman, and Melissa Trolene.

began volunteering at the school, where her daughter goes to kindergarten. “This population often has little or no access to quality health care,” she said. “I asked the school nurse if there were any health-care needs and she told me glasses are a big one.” The nurse tests the vision of all the students and each year at least two or three need glasses “but their families cannot afford them.”

The grant will help fund glasses for all the students who currently need them. “We take basic things, like vision, for granted … but I can’t imagine how a child would deal with this kind of deficit.”