RCS Newsletter Mar 2010

8/14/2019 RCS Newsletter Mar 2010

1/9

Volume 1, Issue 2 The First Breath of News March,

Happy Saint Patrick's Day, March 17! Page 1

RESPIRATORY CAREAll the News You Can Inhale

1 Brief Notes & Employee in Focus

2 Creative Cooking Corner with the Krazy Kook

3 Night Shift News

4 Managing with Rhonda & Employee Anniversaries

5/6 Essential Education / Respiratory Technology Update

7/8 Prairie Dawn / Respiratory High Fives

9 Credits and Other Stuff

Brief Notes from the EditorTerry Nuttall

Spring ostensibly begins on March20, 2010, at 12:32 P.M. EDT when

the Sun passes directly over the

Earth's equator. This moment is

also known as the vernal equinox in

the Northern Hemisphere, when

day and night are about equal in

length. For those of us living in Wisconsin, this usually only

means that the sky is mostly grey with cool drizzle falling on our

heads. However, at least there is an emerging hope that the

light and warmth of summer is within reach once more. The

onset of Spring also usually means the beginning of a decline

of RSV and Bronchiolitis cases in the hospital for which we

have to wear those much loved isolation gowns that endlessly

overfill the tiny trash bins. Perhaps we will also see an

attendant decline in the use of PEP therapy which we all 'know'

is so very effective for those with Bronchiolitis but for which

there is a marked paucity of reliable evidence. Well, perhaps

we won't. In any event, this is also the month of Saint Patrick's

Day. So enjoy and may trouble avoid you!

Employee in FocusTerry Nuttall

In our monthly newsletter's ongoing quest to recognizeeach invaluable employee who doesn't mind the attention,

Wendy Sinjakovic has kindly consented to being the

second victim, (I mean employee) in our series, Employee

in Focus .

Wendy's motivation for working at Children's Hospital ofWisconsin was borne from more than mere financial or

situational consideration. Her lovely daughter, Megan,

began having respiratory problems more than eight years

ago at ten months of age when she was hospitalized at

CHW for a couple days, for the first of multiple

admissions. Two weeks later Megan was again admitted,

this time to the Pediatric Intensive Care Unit where her

respiratory distress was so severe that she required

intubation and emergency bronchoscopy. For the next

three years Megan was visiting CHW every couple of

months for continuousalbuterol aerosols and even

Heliox once to avoid another

intubation. Megan's last

hospitalization occurred just

prior to her fourth birthday.

Wendy has managed to control

her asthma at home for the last

four years successfully. Wendy

began attending college about eight months after

Megan's first hospitalization and then decided to become

a respiratory therapist after her fourth admission to CHW.

Her daughter's respiratory issues played a large role in

her decision to learn respiratory care and has helped her

manage Megan's asthma symptoms. In coming to our

Respiratory Care Services department at Children's

Hospital of Wisconsin two years ago, Wendy is fulfilling

Wendy Sinjakovic

Continued on page 2


2/9



her goal of caring for children with respiratory difficulties in the

same way that her own child, Megan, had been cared for at

CHW during her acute exacerbations of asthma. It is Wendy's

way of giving back to the hospital that has helped her daughter

through some very challenging times.

For Wendy's courage in consenting to be the focus of this

column and for her two years of service to the Respiratory

Services Department at CHW we are happy to present her

with a personalized shot glass, filled with her favorite green

beverage (if you print this out

in color, that is.)

Congratulations Wendy

in keeping your daughter's

asthma under control and

fulfilling your goal. We are

glad you are a part of our

team!

Employee in Focus cont' Continued from page 1

Creative Cooking Corner

Luscious Lasagna

1 lb ground Italian sausage

1 lb ground turkey

1/2 cup onion2 cloves garlic

1(28oz) can crushed tomatoes

2(6oz) cans tomato paste

2(6oz) cans tomato sauce

1/2 cup water

2 tablespoons sugar

1 1/2 teaspoon basil

1/2 teaspoon fennel seeds

1 teaspoon Italian seasoning

1 tablespoon salt

1/2 teaspoon pepper

1 tablespoon minced parsley or 3 tablespoons fresh

chopped parsley

12 lasagna noodles

16 oz ricotta cheese

1 egg

1/2 teaspoon salt

3/4 cups sliced mozzarella cheese

3/4 cup parmesan cheese

Preheat oven to 375 degrees

Cook sausage, turkey, onion and garlic until brown. Stir in

tomatoes, tomato sauce, tomato paste and water. Season

with sugar, basil, fennel, Italian seasoning, pepper and 1/2

the parsley. Simmer for 1 1/2 hours. Meanwhile soak lasagna

noodles in hot water and in small bowl, mix the ricotta cheese

with the egg, salt and remaining parsley, set aside.

Spread meat sauce over bottom of greased dish. Arrange six

noodles over meat sauce. Spread with 1/2 ricotta mixture. Top

with 1/2 mozzarella cheese. Spoon meat sauce overmozzarella and repeat layers until done. Top with remaining

mozzarella and parmesan cheeses. Spray aluminum foil,

cover and bake for 25 minutes, uncover and bake

an additional 25 minutes or untilcheese is melted and top isbrowned.

This recipe is easily doubled so you may bake one and freeze

another for up to 2 months. Just unthaw in fridge and bake

according to directions. Great for those busy working days

when you want a nice home cooked meal without the hassle!

Watch for next month's delicious

recipe by the Krazy Kook.

Till next time, bon apptit!

ByKaren Jones

our Krazy

Kook

Creative Cooking continued at right

Creative Cooking cont'


3/9



Night Shift NewzzzBy Anthony Martinez

My Weekend is Better thanYour Weekend!

I can remember, back in grade school, having this squishy lunch

box that looked like a fire station. Pretty cool I thought. Until I

realized that the Force was not with me and everyone, who was

someone, had a Star Wars lunch box to hold their Jedi enhancing

lunch morsels. It didnt take long, after the heckling I endured, to

see my fire station squishy lunch box being hurdled around theroom like R2D2 at Dagobah!

The first annual RCS Night Shift We Survived Viral Season and

Now We Need to Do Something Fun Wii Bowling Tournament is

upon us! Alright, maybe well shorten that a bit. Now that our staff

is in place, its time to pick up your controller, grab some snacks

and have at it!

You dont have to have a Wii System to play.

Teams now forming! If youre interested in playing or being a team

captain, if you have a Wii System and if youre willing to host ameeting, send an Email to:[email protected]

Awesome Job!I just want to thank all you guys who helped out and who

were working the weekend of February 26th! Those who

could help did and I appreciate all the efforts that you gave.

We truly cant be successful without all of us working

together and I commend you guys for the job you did.

Awesome job!

Oh I Got This!In the 2010 Vancouver Winter Olympics, Steven Holcomb lead

his team with USA Sled 1 to a gold medal in the 4 man bobsled.

What nickname did they have for their sled?

The first correct answer wins a large box of Cinnamon Toast

Crunch! Unopened of course! Send your answer to:

[email protected]

(Dont tell my son!)
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


4/9



by Rhonda Duerst

Icant believe anothermonth has gone by. The good thought iswinter is almost over. I have really enjoyed watching the Winter

Olympics over the past 2 weeks. It is amazing what some

people can do when they put their mind to it. It fascinates me

when I hear the stories of how the athletes get to where they are.

Most have faced many challenges during their journey but never

gave up. Some worked for years and others not as long. They

did not do it alone but had both family and team members to

encourage them along the way. The will and determination is

what carried them through their journey. They never lost sight of

where they were trying to go and now they are at the Olympics.

As they look forward I am sure they have many more visions of

what they want to do. We are not much different than these

athletes except our personal visions are on a different path. We

each have our good times and our bad times but we seem to

never give up. Each person is driven by their own goals. Only

the person can make the choice of how they will grow and what

they will strive for.

Without a vision it is hard to imagine what the future will hold.Over the past month I have had the opportunity to participate in

strategic planning at the organization level as well as at the

department level. This has been a fun experience and I am

excited for our future. I believe we have a great team within our

department as well as within our organization and we will

continue to strive to be the best! No structure can be held up

with only one post or pillar, it takes many foundation supports to

make the structure sound. Our organization and department are

no different. We will be describing our vision in vivid detail over

the next few months. We have a mission and vision which will

guide us to excellence. We begin with a foundation of five pillarsof excellence: People, Service, Quality, Finance, and Growth.

Each month I will update on where we are, what we have

accomplished and where we are going.

I have submitted an application to the AARC's Quality

Respiratory Care Recognition Program to be recognized as a

quality department. This is something we would not be eligible

for without each and every member of our team. I thank each

Managing With

Rhonda

and every one of you! I am so excited to have all of you as

members of my team.

"To dream anything that you want to dream. That's the

beauty of the human mind. To do anything that you want to

do. That is the strength of the human will. To trust yourself

to test your limits. That is the courage to succeed."

--- Bernard Edmonds

Employee AnniversariesCongratulations to these invaluable individuals!

Employee Name Years of ServiceHeather D Knez 3

Laurie Smrz 4

Russell R Haeuser 2

Terry K Nuttall 18

Wendy R Sinjakovic 2

This occasion would not be complete without awardinthese exemplary employees

a complimentary

personalized stein to be

filled with the beverage

of their choice. However

due to budgetary

constraints which we are

still working under, we

can only offer you one.

We hope you don't mind

sharing in the spirit of the

teamwork which you are

so noted for.

Managing with Rhonda, cont'

Employee Name BirthdayKaren March 11

Wendy S. March 12Jamie March 31Angela March 28

Eye hear it's yourbirthday.Have fun!


5/9



Fun with the NBRC

I have had many lengthy discussions with the NBRC lately

regarding the now, 8 year old continuing competency

program. There are many things at stake here and the

process is not the easiest but I can and will help you in any

way that you need. Any of you who graduated after July 1,

2001 fall into the CCP requirements set forth by the NBRC.

Now, whereas the state of WI does not require that you take

any CEUs in order to maintain your license the NBRC is

requiring that you take 30 CEUs in a 5 year time frame in

order to maintain your credential. Please dont confuse the

two. Also, along with the CEUs that you have to take, you

also have to pay them $125/5 years to be a part of this

program even though its mandatory. I know, I know, its

all very confusing! You have an exempt period for 1 year

after you graduate, but starting the 2nd year, you have to

start paying the NBRC $25/month, or if you want, you can

pay the entire $125 at the back end of the 5 year window, as

long as you dont go beyond that 5 years. When I say

beyond that 5 years, I mean that you only have until the

end of the month in which you graduated. So, if you

graduated May 4, 2007, then you have until May 31 2010 to

pay the money. Also, along with paying the fee every

month, or every 5 years, you must submit the CEUs that

you obtained directly onto the NBRC website. You still

have to do this even if you are a member of the AARC. If,

at the end of your 5 years, your CEUs are not submitted

onto their site, then your credential will expire. Your 5 year

time frame is re-set every time you take another credential.

So, for those of you getting ready to take the RRT after

you do this, you will then have 5 years from the end of that

month to pay the fee, obtain all of the necessary CEUs and

then record them.

The advantage of being an AARC member is that you just

have to copy the CEUs from your transcript over to the

NBRC website and you really dont have anything to keep

track of. All of our CEUs are approved by the AARC and as

long as you are a member ($90/year) they will create a

transcript where all of your CEUs are kept. No need to

keep a thing unless you are just the type that keeps

everything.

Essential Education

by Heather Knez

This is a bronchial cast retrieved from a patient recently.Thank you Rick

Nelson, who gave

this to me after it

was given by the

patient's father to

him. If anyone

would like to see

this cast, it is now

in histology,

preserved for teaching purposes. Just let me know.

A bronchial cast is basically sputum that has become very

thick and sticky, falling along the walls of the bronchi and

taking that shape. These are very dangerous as they can

completely occlude the airway causing respiratory andeventually, cardiac arrest. Sometimes, they can be coughed

up by patients during an asthma attack. They can also form in

patients that have bronchitis and of course, plastic bronchitis.

Often, they have to be removed by bronchoscopy as in the

case of this one. In severe cases many bronchial casts form

almost as soon as they are removed. This particular bronchial

cast came from a patient who had recurring problems with

bronchial casts occluding his bronchi, in particular, his right

mainstem.

I am completely fascinated by these things as well as what

the body can do in general and the things that make us whole,

or sometimes not so whole. I wanted to share this with all of

you as I know you have the same (or close to the same)

passion for this kind of thing as me otherwise, you wouldnt

be here.

Continued next column Continued Page 6, Left


6/9



I know this is very cumbersome and there are things that we

have learned along the way. It has really started to impact the

therapists here and you all need to have a good understanding

of this as its not going anywhere. Questionssee me.

Thought of the Month by Heather

Despite all of the chaos that we all have on a daily basis with

work, home and just plain living, let's all be positive that the

outcomes of our efforts will always be favorable.

This is in the area where

I grew up. It is in a place

in the Shawnee NationalState Forest called Pine

Hills. Inspiration point is

the top of a great big

cliff that we hiked up to

as teenagers, sit and just look for miles. I ran across it as I

was looking for positivity images and just had to share it

as it brought back some really good memories very

tranquil.

Respiratory Technology

Updates

Information Services by Deb Bakalarski

Those of you who have been working in the center tower(C7 and C8) may have noticed the new addition of

computers in the rooms. The installation has been a bit slow

as they must wait until the room is empty before they can

drill in the walls and pull the wires through the ceiling. The

computers wont be fully functional until the entire floor is

finished. When both floors are all done the only place still

using handhelds will be the NICU.

I am also on a committee that will be bringing you a

downtime order entry system. We are scheduled to go live

during the second quarter of this year. Demos will be starting

in March. This will enable us to place orders, see results and

documents if/when sunrise is down. It will also enable us to

place orders if the entire computer network is down. No more

paper orders! There is no worklist here so billing is still on

paper for us. We hope to never use it but they may end up

doing trial runs a few times a year just to help people not

forget how to use it. It looks and acts very much like sunrise

does now.

Difficult Airway Cart by Khris O'brien

Critical care will soon have a difficult airway cart. The cartincludes a very cool device called a Glidescope which takes

the place of a laryngoscope blade. The fiberoptic blade is

attached to a video screen which gives a beautiful view of

the airway. It has 2 sizes of wands with 2 sizes of

disposable blades for each wand (4 blade sizes total). Each

wand costs about $6000 each (ouch!). The cart will be

housed in the bronch room on W4; you may be asked to get

it for difficult intubations. Before you take it back to the room,be sure to wipe it down with the cleaner in the cart. LMAs,

NP and oral airways as well as tube exchangers will be in

this cart. ET Tubes and tape etc will stay in the intubation

kits. It will be out for a week for show and tell soon. I will let

you know when & where so you can get familiar with it. Even

I could intubate with this thing!

Essential Education, cont'

Just tell

me where

the coffee is

please!


7/9



Appropriateness of Care

As we all know, hypertonic 3% saline is being used on anincreasing number of patients who do not have bronchiolitis .

3% hypertonic saline has only been studied on bronchiolitis

patients. It has not been studied in any other patient

population (or at least no published articles yet).

There is a Cochrane paper from 2008 that reviewed 4

studies of 3% hypertonic saline on bronchiolitis patients. I

was unable to find any newer articles. 3 of the studies the

hypertonic was given Q8, one study was given with a mix of

frequencies ranging from Q2-Q6. There was no difference in

Length of Stay (LOS) between the two frequencies studied.

Q8 resulted in the same LOS as the more frequent dosing.

3% hypertonic saline did show an almost full day reduction in

LOS for bronchiolitis patients. The patients were given the

hypertonic saline until discharge.

My recommendation would be to respectfully remind the

physicians that there is currently no evidence proving

effectiveness of hypertonic saline in any patient population

other than bronchiolitis. If they would still like to consider

using it, you may want to ask the physician what their

measures of success will be. Are they expecting less or

thinner secretions, decreased respiratory rate or improved

chest x- ray? Then consider suggesting a trial period of use,

at which time the measures of success will be evaluated to

decide if the therapy is successful. If there is no

improvement in their measures, suggest discontinuing thetreatment. It is important for us to evaluate their measures in

a non-biased way. So, be sure to pass off in report who you

spoke with and what the measures of success are. This

way, those coming after you can follow-up at the appropriate

time interval and speak to the specific points the physician

mentioned. Speak in terms of outcomes when discussing

changing the frequency or discontinuation of hypertonic

saline with physicians.

For pts who do have bronchiolitis, either on chest x-ray,

positive culture or clinical picture (documented by the MD asa viral respiratory pattern), hypertonic saline is a proven

treatment plan. Inform the physician that the research has

shown no difference in LOS between Q8 and more frequent

treatments. A Q8 frequency, for this population, would be a

cost effective way to administer the proven treatment plan.

I have the original articles at my desk and I put a copy of

each of the articles that I currently have in a folder in the

conference room. If you wish to give an article to a

particular physician, feel free to make a copy of the copy so

that it is still available for others to use as they need to.

Cues for Effective Communication

Pay attention to your body. If you notice responses

like increased HR, sweating, fast or slow breathing or

general anxiety you are in a conversation where the

stakes are high. Noticing what is happening is the first

step to changing it.

Continued next column

Prairie DawnBy Khris O'Brien

Bizarre image but Wise Words


8/9



Honoree

Name

Submitted

byComments

Mike

PaquetteKhris O'brien

Mike did a fantastic job completing all necessary paperwork for the unplanned

extubation event study this past weekend - outstanding!! Thank you!! Khris & Melissa

Wayne BartaRebecca

RiedererThank you for assisting me with the INO in surgery. Your help was greatly appreciated!

Angela

Delle-Grazie

Anthony

Martinez

Thanks so much Angela for picking up hours this weekend to help our staff! You efforts are

greatly appreciated!

Mary

Multhauf

Anthony

Martinez

Thanks so much Mary for picking up hours this weekend to help our staff! You efforts are greatly

appreciated!

Robert ToddAnthony

Martinez

Thanks so much Bob for picking up hours this weekend to help our staff! You efforts are greatly

appreciated!

Michael

Wolter

Katherine

Halvorson

Thanks for making it so easy to work with you, Mike! I look forward to being with you every third

weekend...you are always there to help me. I especially need to thank you for being my right

hand for the twin delivery...I know that I can always count on you!

Jason OuseyAnthony

MartinezGreat job Jason being in charge on Monday and managing the team with 3 sick calls!

Danielle

SeguinKathryn Gill

Thank you for always being a helping hand!! It is reassuring to know I can always count on youto be there to lend a steady hand & do it with a smile!

Lynn KlichAnthony

Martinez

Thank you Lynn for taking a leadership role and calling people to see if they could help cover

sick calls last night.

Danielle

Seguin

Anthony

Martinez

Thank you Danielle for taking a leadership role and calling people to see if they could help cover

sick calls last night.

Wendy

Robinson

Anthony

Martinez

Thanks so much for coming in tonight and helping when we had 2 sick calls! Your help is greatly

appreciated.

Richard

NelsonSteph Nierode

Thank you Rick for coming and assessing a pt that was not in protocol. The patient's mom and I

appreciate the time you took to help suction and explain the assessment data you found! Way to

go! Glad you are a part of the CHW team!

Hilary

LedbetterKhris O'brien

Thank you very much for helping Mike get the UPE forms collected for our first UPE patient. He

just told me you were instrumental in getting all the forms collected. Thank you very much - the

forms were completed perfectly!

Jennifer

Posvic

Hilary

LedbetterThank you for staying after your scheduled shift to help when we had a sick call on nights.

Jackie

Schreier

Anthony

Martinez

Thanks Jackie for staying over into night shift to help NICU with first rounds. That really helped a

lot and I appreciate it!

Respiratory Care Services

High FivesCongratulations to All!


9/9



C R E D I T S

Thank you to everyone who has contributed material,support and ideas to this newsletter. It is your

contributions that make this possible.

Anthony Martinez

Rhonda Duerst

Khris O'Brien

Heather Knez

Karen Jones

Wendy Sinjakovic

Deb Bakalarski

CALENDAR EVENTS

American Red Cross Month

Irish-American Heritage Month

National Nutrition Month

National Kidney Month

National Sleep Awareness Week: Mar 8-14

Middle Name Pride Day: Mar 10

National Pi Day: Mar 14 (it's 3.14, OK?)

Ides of March: Mar 15

Incredible Kid Day: Mar 15

Everything You do is Right Day: Mar 16

Charlene Williams Retirement Party: Mar 18

International Earth Day: Mar 20

Smoke & Mirrors Day: Mar 29

Holy Week: Mar 29-Apr 3

Passover: Sundown Mar 29-Apr 6

Take a Walk in the Park Day: Mar 30

The month of March is National MS Education & Awareness Month.This national campaign, spearheaded by the Multiple Sclerosis

Foundation (MSF), in cooperation with the MS Coalition and other

organizations, will promote an understanding of the disease and will

provide education, empowerment, and assistance to those living with it.

Upon request, educational literature is available for MS patients, family

members, healthcare providers, the media, and all others who wish to

broaden their understanding of this chronic, progressive neurological

disease.

MS is usually diagnosed between the ages of 20 and 50, with a risk in

the general population of approximately 1/750. Two hundred people are

diagnosed with MS every week and more than 2.5 million people areliving with this disease worldwide. Like other autoimmune diseases, MS

is more common in women than men. The most common symptoms

associated with MS include visual disturbances, balance and walking

difficulties, debilitating fatigue, weakness, numbness, and bladder

dysfunction. While there is currently no cure for MS, there is a great deal

a person can do to manage the disease and maintain their quality of life.

The best place to start is with reliable information about MS.

Further information about MS and National MS Education & Awareness

Month can be found by clicking Multiple Sclerosis Foundation or by

calling 1-888-MSFOCUS (673-6287).

The Multiple Sclerosis Foundation is a national, non-profit organization

dedicated to improving quality of life for individuals with MS through

educational programs and support services.

Article Reference: Medical News Today
http://www.msfocus.org/http://www.medicalnewstoday.com/articles/97726.phphttp://www.medicalnewstoday.com/articles/97726.phphttp://www.medicalnewstoday.com/articles/97726.phphttp://www.msfocus.org/

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RCS Newsletter Mar 2010