Inside:Job Shadow Day ..................... 11111

Jeanette Ives Erickson ............ 22222¸ Strategies for Changing

Organizational Culture

Fielding the Issues .................. 33333¸ Staff Perceptions of the

Professional Practice

Environment Survey

Clinical Narrative .................... 66666¸ Mary Elizabeth McAuley, RN

YMCA Black Achiever Award . 77777

Carbon-Monoxide Safety ........ 88888

Hand Hygiene ......................... 99999

Quality & Safety ................... 1010101010¸ Unacceptable Abbreviations

Educational Offerings ........... 1111111111

Senior HealthWISE Lecture .. 1212121212

CaringCaringFebruary 17, 2005

H E A D L I N E S

Working tMGH

Staff, groundhog, all seeshadows on Job Shadow Day

Bigelow 13 operations coordinator, Carolyn Washington (front),explains order-transcription to East Boston High School student,

Nicole Paulson, as Phil, the groundhog (back) looks on.(See story on page 4)

ogether to shape the futurePatient Care Services

Page 2

February 17, 2005February 17, 2005Jeanette Ives EricksonJeanette Ives Erickson

Jeanette Ives Erickson, RN, MSsenior vice president for Patient

Care and chief nurse

Strategies for changingorganizational culturemeeting the challenges of the current

healthcare realityn February 3,2005, as part of

a series of work-shops on executive

development and influ-encing organizationalculture, the Patient CareServices Executive Com-mittee attended a day-long session facilitatedby Edward O�Neil, PhD,director of the Center forHealth Professions at theUniversity of Californiain San Francisco.

I think we all recog-nize that as a society, asa sector in the businessworld, and as an organi-zation, we are facingunprecedented change.An aging population, ashrinking workforce, andincreased diversificationin local and nationaldemographics presentvery real challenges toour current way of doingbusiness. In order to

O respond to these changeseffectively, healthcareorganizations need tocreate and sustain infra-structures that are flex-ible, functional, and re-sponsive. I think every-one who works in healthcare would agree that intoday�s reality, that�s atall order.

Dr. O�Neil and hisassociates have an im-pressive record in assist-ing healthcare organ-izations to prepare forand engage in strategiesto successfully meetthese challenges. As partof our work together, wereviewed existing prac-tice models, re-examinedour use of systems andtechnology, looked atcurrent leadership-devel-opment strategies, and ina very meaningful way,explored a framework

for managing change.We began our session

on February 3rd by de-scribing the existingculture at MGH to get abasis for comparison aswe work toward a cul-ture change. Some wordsused to describe our ex-isting culture included:¸ interconnected¸ a strong sense of per-

sonal accountability¸ fast-paced¸ relationship-driven¸ having a strong pre-

sence outside the wallsof MGH¸ constant sense of ur-

gency/excitement¸ an expectation of ex-

cellence¸ entrepreneurial spirit¸ days are getting longer

(starting earlier andending later)¸ complex¸ dynamic¸ a feeling that when

you work at MGH youare part of a family

As Dr. O�Neil remind-ed us, culture is invis-ible�it�s not somethingyou can see or touch�so we rarely think of it interms of the power it hasto advance or curtailchange. But organiza-tional culture is the back-drop for all processes,so we need to make it�visible.�

As you can see fromthe list of descriptionswe generated, many as-

pects of our current cul-ture are positive anddesirable, and we wantto make sure we preservethose good qualities aswe move forward. Howdo we decide what topreserve and what tochange? Dr. O�Neil sug-gests that any strategy toimpact a change in organ-izational culture needs tobe linked to values. Andwhile that may soundsimple, a role-playingexercise we engaged inclearly demonstrated thechallenges that arisewhen emerging needscome up against existingculture.

This was a fascinat-ing exercise. Our groupwas asked to divide intotwo �cultures.� One wasa remote island popula-tion whose healthcarepractices revolved aroundfaith-healing, prayer,community and familysupport, and herbal rem-edies. This populationheld a deep cultural fearof the color red. Theother group represented

an American healthcaredelegation who had cometo the island to admini-ster medication to helpcurb a rising infant-mor-tality rate. But the medi-cation they brought wasred. It was a classic caseof emerging need clash-ing with existing culture.Interactions between thetwo groups spotlightedthe delicacy and com-plexity of what is re-quired to effect culturalchange.

Dr. O�Neil stressedthat significant changetakes time, commitment,and frequently, the de-velopment of a �newlanguage� that is moremeaningful in the emerg-ing culture. For instance,�culturally competentcare,� now a commonphrase in our vernacular,was unheard of just tenyears ago. As we�ve shift-ed to a culture that em-braces diversity, our lang-uage has evolved to en-compass that change.

One thing that�s truecontinued on next page

Your Opinion Counts!Staff Perceptions of the

Professional Practice EnvironmentSurvey – 2005

Surveys will be mailed to all direct-careproviders during the last week of February.

If you don’t receive a survey by March4th, please call The Center for Clinical &Professional Development at 726-3111.

All individual responses are keptconfidential.

Please complete and return yoursurvey by March 25, 2005.

For more information, call 726-3111

of every culture, is theimportance of story-telling. Stories are theway we share values,share practice, and makeour work visible. Dr.O�Neil points to story-telling as the single mosteffective tool in influenc-ing cultural change. Hestresses that the storieswe tell must be linked toour values and help de-lineate the change we�rehoping to bring about.

We all know the pow-er of story-telling fromour own practice of shar-ing clinical narratives.As we move forward we

will look for individualswilling to share theirstories. We will look forways to link our storiesto our values. And wewill be vigilant in moni-toring our environmentto ensure that the organ-ization can sustain thechanges we implement.

As I said, this work-shop was one in a seriesof sessions focusing onexecutive developmentand influencing organi-zational culture. I�m veryexcited about this work,and I will keep you in-formed as we proceed onthis journey.

Jeanette Ives Ericksoncontinued from previous page Point, click, and buy

with E-BuyAs you may have heard, E-Procurement (or E-Buy) is coming to MGHbeginning March 1, 2005. A front-end system for PeopleSoft Purchasing,E-Buy will allow staff to generate requisitions on-line for every vendor(except Standard Register), eliminating the need for cumbersome paper andfax ordering. With its Amazon.com-like interface, E-Buy really is as easyas point, click, and buy. While eliminating paper from the ordering processis an obvious plus, many others benefits make E-Buy an indispensableimprovement, including:

¸ the ability to track your order in real time from creation of the requisitionto payment of the invoice¸ the ability to access the complete database of items to quickly locate the

correct product¸ an electronic approval system for improved spending management¸ better utilization information at your fingertips for trend-analysis, budget-

review, etc.¸ E-Buy will save time!!!

For more information about the new E-Buy purchasing system, contact theoperations coordinator on your unit.

February 17, 2005February 17, 2005Fielding the IssuesFielding the IssuesStaff Perceptions of the

Professional Practice EnvironmentSurveyQuestion: What is the

purpose of the Staff Per-ceptions of the Profes-sional Practice Survey?

Jeanette: The survey wasdeveloped to obtain feed-back from staff about theenvironment of practiceat MGH. We know thatto enhance the quality ofcare, it�s important forstaff to feel supported intheir professional prac-tice. This is a �reportcard� on our ability to dothat, one I take very seri-ously. The Patient CareServices leadership teamuses the informationobtained in the survey toidentify ways to improvethe practice environment.

Question:Who receivesthe survey?

Jeanette: The survey ismailed to all direct-careproviders throughoutPatient Care Services.The survey will be mail-ed on February 22, 2005.Please be sure to returnyour survey by March25th (the day we beginto tabulate the data).Your input is very im-portant. We�ve alwayshad a high rate of returnon these surveys, and Ihope this year will be noexception.

Question: Does my opin-ion really matter?

Jeanette: Absolutely!This survey is one wayfor me to hear directlyfrom you about how youthink we�re doing in cre-ating an environmentwhere clinicians feelsupported in their prac-tice. Feedback from thissurvey has spurred manychanges over the years.The Culturally Compe-tent Care lecture series,the Materials Manage-ment Nursing Task Force,pagers for social work-ers, and the �Fielding theIssues� column in CaringHeadlines all originatedbecause of feedback Ireceived from The StaffPerceptions of the Pro-fessional Practice Survey.

Question: In the past,I�ve noticed a number onthe back of my survey. Ithought the survey wasanonymous. Is there away to trace my answersback to me?

Jeanette: The number onthe back of the survey isthe cost center for eachclinician�s department.That number allows usto group data into mean-ingful sub-sets. There isno way to link any re-sponse to an individualstaff member. All indivi-dual results are complete-ly anonymous and confi-dential.

Question: Who sees theresults?

Jeanette: Aggregateddata from the survey areshared at three levels: myexecutive leadership

team (the Patient CareServices Executive Com-mittee); discipline-spe-cific staff meetings (Nurs-ing, Social Work, Physi-cal Therapy, Occupa-tional Therapy, and theChaplaincy); and in staffmeetings on individualpatient care units. Ateach level there shouldbe discussion about whatthe survey tells us andhow we can use the in-formation to improvethe practice environ-ment. This process helpsus to support staff andensure that MGH re-mains the employer ofchoice for all disciplineswithin Patient Care Ser-vices.

Please take the timeto complete and returnthe survey by March25th. Your input is im-portant. Thank-you.

Page 3

Page 4

February 17, 2005February 17, 2005

hile PunxsutawneyPhil was looking for

his shadow on Groundhog Day, Wednesday,

February 2, 2005, several stu-dents from East Boston HighSchool (EBHS), our high-school education partner,�shadowed� health-care professionals atMGH. GroundhogJob Shadow Day,provides studentswith an opportunityto see first-handwhat a professionalwork day looks like,and understand in areal way how theworkplace can be anextension of theclassroom. High-school sophomoreswho participated inthe program will beable to apply to theMGH Summer Jobs for Youthand ProTech programs, forinternships offered during theschool year.

Groundhog Job ShadowDay is also an opportunity forstudents to begin to think ser-iously about pursuing a careerin health care. This year, anumber of MGH departmentsparticipated in Job ShadowDay, including: Nursing, theChaplaincy, the Gillette Centerfor Women�s Cancers, HumanResources, Pharmacy, Radia-tion Oncology, the MGH Can-cer Center and many others.Students were paired withMGH staff members and spenttime observing, learning, ask-ing questions, and when ap-propriate, assisting their job-shadow hosts in performing

Student OutreachStudent Outreach

W certain tasks. Not only did theexperience provide an up-close look at the dynamicworld of health care, it gavestudents an understanding ofthe skills and education re-quired to pursue careers invarious disciplines. Job-sha-

dow hosts were able to ad-vise and coach students as tohow best to achieve theirprofessional goals.

Almost 750 Boston pub-lic high-school students sha-dowed 139 volunteers atBoston-based businesses thispast Groundhog Day. JobShadow Day began in Bos-ton in 1996 and is now ob-served by thousands of stu-dents across the state andhundreds of thousands na-tionwide. Locally, Job Sha-dow Day is the result of apartnership among BostonPublic Schools, the BostonPrivate Industry Council, theMassachusetts Departmentof Education and JuniorAchievement.

Punxsutawney Phil saw

Groundhog visits MGHon Job Shadow Day

�by Galia Kagan Wise, manager,MGH and East Boston High School Partnership

his shadow and so didmany MGH employees.

Groundhog Job Sha-dow Day is supported bythe MGH/EBHS partner-ship and is a program ofthe School PartnershipInitiatives in the MGHCommunity Benefit Pro-gram. For more infor-mation about the MGH-East Boston High SchoolPartnership, please call4-8326.

Page 5

February 17, 2005February 17, 2005

Opposite Page:Opposite Page:Opposite Page:Opposite Page:Opposite Page: East

Boston High School students,

Fritzkeysha Chery (taller), and

Fallon Holloway-Lewis, learn

about life in the Same Day

Surgical Unit from clinicians,

Matthew Powers, RN, and

Marie Collins, RN (right).

This Page:This Page:This Page:This Page:This Page: Above, Patricia

Lynch, RN, familiarizes Chery

and Holloway-Lewis with some

of the pediatric procedures

performed in the SDSU.

Center: Student, Nicole Paulson

(left), learns about some of the

specialized supplies used on

the Burn Unit from nurses,

Laurie Eiermann, RN (center),

and Brook Holmes, RN.

At left: Burn nurse, Dawn

Heffernan, RN, shows Paulson

how pain medications are

administered in the Burn

ICU; Phil, the groundhog,

looks on.

Page 6

February 17, 2005February 17, 2005

Mary Elizabeth McAuley, RN,staff nurse, Endoscopy Unit

M

continued on page 7

Endoscopy staff nursehelps raise awareness about

health literacy

ClinicalNarrativeClinicalNarrative

y name is MaryElizabeth Mc-Auley, and I

have workedon the Endoscopy Unitfor three years. Prior toEndoscopy, I worked inthe Medical IntensiveCare Unit (MICU) as thepermanent night resourcenurse. As a senior staffmember, I was involvedwith a number of unit-based committees, buttransitioning to the En-doscopy Unit (and theday shift) has allowedme to become involvedwith collaborative gov-ernance.

For the past 18 monthsI�ve been a member ofthe Patient EducationCommittee. I attendedtwo workshops on �Howto Write in Plain Lang-uage� that emphasizedthe need to create patient-education materials inlanguage that�s under-standable to the averageperson. I�ve become in-creasingly aware of thenumber of individualsaffected by healthcareliteracy and the need forhealthcare providers tobe able to recognize whenan individual is at risk.This awareness has en-hanced my practice.

Gastroenterologyholds a serious and im-portant place in healthcare. Colorectal cancerkills more than 56,000people a year. Researchshows that removal of

rectal polyps dramatic-ally reduces the incidenceof subsequent rectal can-cers. As a preventativetool, endoscopic screen-ings are key to early de-tection of deadly gastro-intestinal cancers. TheAmerican Medical Asso-ciation recommends en-doscopic screenings atage 50 (younger if thereis a family history). Work-ing on the EndoscopyUnit allows me to teachpreventative health mea-sures to patients on adaily basis.

Mr. J came to Endo-scopy because he wasscheduled for a screen-ing colonoscopy. Ourunit secretary asked meto speak to Mr. J becauseshe was concerned hemight not have a ridehome. Since patientsundergoing a colonosco-py receive intravenousconscious sedation andare still drowsy after theprocedure, they�re re-quired to make arrange-ments for a ride homeprior to having the pro-cedure.

Mr. J was a well-kept, pleasant, disting-uished-looking 74-year-old man who assured mehe had carried out all thepre-procedure instruc-tions correctly. He justneeded to call his daugh-ter for a ride home beforewe began his procedure.Mr. J picked up the tele-phone, and I realized

something was wrong ashe struggled to dial. Hewould hit a couple ofnumbers then put thephone down. I immedi-ately offered him assist-ance with the call. Hecorrectly told me thenumbers, but he couldn�trecognize them on thephone.

After confirming hisride home, Mr. J wasasked to fill out somepaperwork, which con-sisted of a past medicalhistory and a list of cur-rent medications. Mr. Jtold me he�d forgottenhis glasses and couldn�tfill out the forms. (For-getting glasses is a com-mon reason given bypeople who are unable toread.) It was becomingincreasingly obvious thatMr. J was going to needhelp in dealing with themany healthcare formshe would have to com-plete. I assured him thatI�d be happy to assisthim with the paperwork.As we reviewed the forms,Mr. J was vague aboutwhat illnesses he�d hadand couldn�t rememberwhat medications he wason. Knowing this infor-mation is critical in orderto prevent side-effectsdue to allergies and/ordrug-to-drug interac-tions. Fortunately, Mr.J�s past medical and med-ication histories are onfile in our hospital infor-mation system. I assuredhim I could access this

information and/or callhis daughter if necessary.

Once the assessmentwas complete, the IVwas started, and I ex-plained what was goingto happen in simple terms.Even though Mr. J washere for a screening ex-am, there�s always a pos-sibility that somethingwill be found that wouldrequire him to come backfor further testing. I need-ed to instruct him in acalm, relaxed mannerthat was understandableand complete. I reviewedthe procedure and en-couraged him to ask ques-tions. I told him thatduring the procedure, hewould be sedated. Thenurse would monitor hisvital signs and alert thephysician of any changesimmediately. After theprocedure, he would betaken to the recoveryroom and his vital signswould continue to bemonitored and assessedas the sedative wore off.He assured me he wascomfortable with theplan of care but wanted

to know that I�d checkup on him during theprocedure.

Since a variety ofclinicians interact withpatients during their timeon the unit, it was veryimportant to communi-cate Mr. J�s needs to allhis caregivers. My nextstep was to make surethe nurses and physicianinvolved in his care wereaware of Mr. J�s need tohave things explained interms that he could un-derstand.

On that particularday, I was working in thepre-procedure area, but Imade a point of keepingabreast of Mr. J�s pro-gress. As he moved fromarea to area, I touchedbase with him to let himknow I was available ifhe needed anything, andI communicated his spe-cial needs to his nurse.

Mr. J tolerated theexam well, but unfor-tunately a large polypwas removed, whichmeant he would have tocome back to the hospi-

Page 7

tal in three months. Priorto discharge-teaching, Imade sure Mr. J�s daugh-ter was present to hearthe instructions. Therecovery-room nursereviewed the dischargeplan with both of them,and Mr. J was given writ-ten documentation of hismedications and medicalhistory. Prior to leaving,Mr. J came over andthanked me for my helpand patience. Throughteamwork and commu-nication, Mr. J�s experi-ence was a positive one.My greatest thanks camewhen Mr. J returned threemonths later for his fol-low-up appointment andasked specifically if Iwould help him with the

paperwork. His nextexam was normal.

Healthcare literacyaffects 90 million peoplein the United States. Itresults in appointmentsbeing missed, preps be-ing done incorrectly.Patients with chronicillnesses have difficultymaintaining good health.Healthcare workers needto be observant and aware.When patients struggleto perform certain tasks,it could be the result ofliteracy issues.

I am fortunate to bepart of the Patient Educa-tion Committee and tohave attended workshopson plain language. As amember of this commit-tee, I had the opportunityto speak at Nursing GrandRounds about Health-care Literacy. Communi-cating this topic to my

colleagues is a responsi-bility I embrace. Throughmy involvement andheightened awareness ofthis issue, I was able toidentify a patient in needearly on, initiate a plan ofcare, and successfullyintervene. To me, this isthe essence of nursing.

Comments by JeanetteIves Erickson, RN, MS,senior vice presidentfor Patient Care andchief nurse

This narrative is a won-derful example of thepower of collaborativegovernance and its abilityto educate and informclinicians and improvethe care we give to pa-tients and families. Ex-perience and awarenessmade Mary look moreclosely at Mr. J. She knewit was more than lost glass-es. In the most compas-

Narrativecontinued from page 6

sionate and non-judg-mental way, she helpedMr. J complete all thenecessary tasks, and madeher colleagues aware ofhis special needs. Mr. J

sought Mary out on hisnext visit to MGH be-cause he felt so safe inher care. What bettertestament to her skill?

Thank-you, Mary.

The Employee AssistanceProgram

presents

Get the Skinnyon Popular Diets

presented by Suzanne Landry, RD,Ambulatory Nutritional Services

Come hear a nutritionist review thepros and cons of popular low-carbohydratediets. Learn how to live a nutritious, healthy

life style. Resources will be provided,and there will be time for a question-

and-answer session.

March 17, 200512:00–1:00pm

Wellman Conference Room

For more information, contact theEAP Office at 726-6976.

February 17, 2005February 17, 2005RecognitionRecognition

Ivonny Niles, RN,staff nurse, White 6

Niles recognized as 2005YMCA black achiever

t a special awardsceremony at theMarriott Hotel in

Copley Square onJanuary 27, 2005, Ivon-

ny Niles, RN, was recog-nized as one of greaterBoston YMCA�s 2005black achievers. Niles, astaff nurse on White 6,was nominated by hernurse manager, KathleenMyers, RN, who wroteof her, �I have workedwith Ivonny for the pasttwo years and seen hergrow into a caring, com-petent professional. Sheis a strong patient advo-

cate, supportive of indi-vidual differences, andan emerging leader inthis organization. Ivonnyprovides superb physicalcare but also nurtures themind and the spirit. On adaily basis, she promotesinquisitive thought andsupports a team approachto patient care.�

Niles is co-chair ofthe MGH Foreign-BornNurses Group, an activemember of the PCS Di-versity Steering Commit-tee, she is a member ofthe National Black NursesAssociation, the Nation-

A al Hispanic Nurses Asso-ciation, and is currentlyworking toward her ba-chelor of Science degreein Nursing.

The YMCA BlackAchievers Program rec-ognizes the professionaland community-basedachievements of blackmen and women whohave demonstrated ahistory of achievementand the potential for fu-ture development. Awardrecipients agree to do-nate 40 hours of commu-nity service to benefitminority youth.

Larry Washington ofMGH Police & Securitywas also honored thisyear.

For more informationabout the annual YMCA

Black Achievers Pro-gram, contact CarlyenePrince-Erickson, directorof Employee Education& Leadership Develop-ment at 6-6386.

Page 8

February 17, 2005February 17, 2005

Carbon-monoxidepoisoning: know the signs

�by Trisha Flanagan, RN, clinical nurse specialist

SafetySafety

arbon monoxide(CO) is a poten-tially lethal gas

that�s responsible forhundreds of deaths

each year (the actualdeath rate from CO poi-soning is 5,000 per yearin the United States, butthe majority of thosecases are suicide). Car-bon monoxide is a color-less, odorless gas that isproduced by the incom-plete combustion of cer-tain fuels. Homes (orcars) that are fueled bygas, oil, or wood, if notmaintained properly, canaccumulate dangerouslevels of carbon monox-ide.

During the homeheating season in NewEngland, scores of peo-ple are treated for car-bon-monoxide poison-ing. Exposure is mostprevalent in areas withinadequate ventilation,most commonly in auto-mobiles with snow-ob-structed exhaust pipes(which traps the fumesin the car) or homes withfaulty heating systems orblocked vents. Exposurecan also occur whenkerosene heaters are usedindoors, or when a stoveor oven is used to heat ahome.

Carbon-monoxidepoisoning is not just awinter hazard. Manycases of CO poisoningoccur as a result of ex-posure to boat exhaustfumes. Particularly sus-

ceptible are people whosit on the rear platformsof motor boats. The num-ber of drowning deathsrelated to CO poisoningis unknown. Anothermeans of exposure isriding in the back of pick-up trucks (out in the openor enclosed).

Carbon-monoxidepoisoning affects peopleat the cellular level. Car-bon monoxide competeswith oxygen to bind withhemoglobin, the redblood-cell protein thattransports oxygen fromthe lungs to the tissue.Carbon monoxide has agreater affinity for hemo-globin (200 times great-er) than oxygen. Theresult is that tissues be-come starved for oxygen.The tissues that show themost profound effects ofoxygen-starvation are thebrain and the heart.

Acute exposure tohigh concentrations ofcarbon monoxide pro-duce immediate sympt-oms of headache, nausea,and loss of conscious-ness. But it�s importantto note that carbon-mon-oxide poisoning can beslow and not easily de-tected in cases of chro-nic, low-level exposure.The symptoms of low-level exposure can beconfused with a numberof mild illnesses from aflu-like syndrome tofood poisoning.

Symptoms of carbon-monoxide poisoninginclude:

¸ headache (in 90% ofcases)¸ nausea, with or with-

out vomiting¸ dizziness¸ weakness¸memory deficit

As CO levels rise inthe blood, the signs andsymptoms become moreominous:¸ visual impairment¸ disorientation¸ loss of consciousness

A common myth isthat people with COpoisoning present with�cherry-red� skin. In real-ity, red skin occurs inonly about 2% of cases;patients are more likelyto present with pale orcyanotic skin tone.

Carbon monoxide isparticularly lethal inchildren. Their metabolicrates put them at higherrisk even at lower levelsof exposure. They typi-cally suffer more severesymptoms even withlow-concentration, short-term exposure. Childrenmay complain of nauseaonly and appear to havea gastrointestinal illness.In infants, CO poisoningcan mimic colic.

The first step in car-ing for someone with COpoisoning is to removehim or her from the siteof exposure. The rescueras well as the victimshould leave the conta-minated area. 100% oxy-gen should be administer-ed, and in more severecases, oxygen admini-

stration in a hyperbaricchamber is recommend-ed. Critically ill patientsmay require mechanicalventilation and admis-sion to an intensive careunit.

Carbon-monoxidepoisoning is always apossibility in situationssuch as house fires orwhen someone is foundunconscious in an idlingcar. When consideringwhether carbon-monox-ide poisoning has oc-curred, you should askthese key questions:

�Do your symptomsoccur only at home oronly at work and re-solve when you go to adifferent location?�

�Is anyone else atyour location exper-iencing similar symp-toms?�

�Do you have a car-bon-monoxide detect-or?�

Pulse oximetry is afrequently used, non-invasive device that de-termines oxygenationlevels by estimating theamount of oxygen-satur-ated hemoglobin. Pulseoximetry is not reliablein determining CO poi-soning because it cannotdifferentiate betweencarbon monoxide andoxygen bound to hemo-globin.

Being aware of symp-toms and high-risk situ-ations can help preventcarbon-monoxide pois-oning. Community-bas-ed education should ad-dress home-heating safe-ty, reducing the risk ofexposure, and knowing

when to seek medicalattention. Precautions tominimize the possibilityof CO poisoning include:

¸ annual inspection ofhome-heating systemsby qualified techni-cians¸ regularly checking

ventilation systems tomake sure ducts arefree of obstructions(such as snow, leaves,or animal nests)¸ proper use of kerosene

heaters and charcoalgrills¸ never allowing a car

to idle without ade-quate ventilation (anopen garage door maynot be enough to keepcarbon monoxidefrom accumulating)¸ checking motor vehi-

cle exhaust pipes tomake sure they�reunobstructed and notclogged with, or bur-ied in, snow¸ never riding in the

back of a pick-uptruck or on the rearplatform of a powerboat¸ installing carbon-

monoxide detectors inyour home, but notrelying solely on thealarm to confirm thepresence of carbonmonoxide�somedetectors are set forlow levels, others forvery high levels¸ immediately seeking

medical attention ifyou suspect carbon-monoxide poisoning

For more informationabout carbon-monoxidesafety, contact TrishaFlanagan, RN, clinicalnurse specialist in theED, at 4-4932.

C

.

February 17, 2005

Page 9

February 17, 2005

Next Publication Date:March 3, 2005

Published by:Caring Headlines is published twice eachmonth by the department of Patient Care

Services at Massachusetts General Hospital

PublisherJeanette Ives Erickson RN, MS,

senior vice president for Patient Careand chief nurse

Managing EditorSusan Sabia

Editorial Advisory BoardChaplaincy

Reverend Priscilla Denham

Development & Public Affairs LiaisonVictoria Brady

Editorial SupportMarianne Ditomassi, RN, MSN, MBAMary Ellin Smith, RN, MS

Materials ManagementEdward Raeke

Nutrition & Food ServicesMartha Lynch, MS, RD, CNSD

Office of Patient AdvocacySally Millar, RN, MBA

Orthotics & ProstheticsMark Tlumacki

Patient Care Services, DiversityDeborah Washington, RN, MSN

Physical TherapyOccupational Therapy

Michael G. Sullivan, PT, MBA

Police & SecurityJoe Crowley

Reading Language DisordersCarolyn Horn, MEd

Respiratory CareEd Burns, RRT

Social ServicesEllen Forman, LICSW

Speech-Language PathologyCarmen Vega-Barachowitz, MS, SLP

Volunteer, Medical Interpreter, Ambassadorand LVC Retail Services

Pat Rowell

DistributionPlease contact Ursula Hoehl at 726-9057 for

all issues related to distribution

Submission of ArticlesWritten contributions should be

submitted directly to Susan Sabiaas far in advance as possible.

Caring Headlines cannot guarantee theinclusion of any article.

Articles/ideas should be submittedin writing by fax: 617-726-8594or e-mail: ssabia@partners.org

For more information, call: 617-724-1746.

he STOP (Stop theTransmission of Path-ogens) Task Force has

announced new expec-tations for hand-hygiene

compliance and is making somechanges in the Hand HygieneRewards Program for 2005.

In the healthcare setting,hand hygiene is required beforeand after contact with patientsor their environment. Disinfec-tion with an alcohol-based handrub (such as Cal Stat) is thepreferred method of ensuringhand hygiene because it�s fast,convenient, and highly effectiveat killing pathogens. Hand-wash-ing with soap and water for atleast 15 seconds is also accept-able, and is required if hands arevisibly soiled before eating orafter using the bathroom. AtMGH, routine observations aremade on units to monitor com-pliance with hand-hygiene re-quirements. Results are reportedto staff and managers, allowingeach unit to see its own com-pliance rate and compare itsresults to those of similar units.

Perfect hand-hygiene prac-tices would result in a rating of100/100, meaning 100% com-pliance by 100% of employeesboth before and after contact.Compliance rates at hospitalsacross the country tend to belower than 100/100. At MGH,the STOP Task Force and unit-based hand-hygiene championshave been working to improvecompliance rates through edu-cation, monitoring, feedback,friendly inter-unit competition,and rewards.

Hand Hygiene Program:an MGH success story

�by Judy Tarselli, RN, Infection Control Unit

Many units have achievedlasting improvement in hand-hygiene compliance rates, andwe have started to see signifi-cant results. The Infection Con-trol Unit reported an overalldecline in the rate of some hos-pital-acquired infections in 2004,including a steady decline inMRSA (methicillin-resistantStaphylococcus aureus).

2005 is expected to bringgreater improvement in compli-ance rates and more opportuni-ties for rewards. Surveyed unitswill no longer compete againstone another. Instead, they willstrive to meet a numeric goal�a pre-specified rate for hand-hygiene compliance before andafter patient contact. All unitsthat achieve their goal will re-ceive a pizza party or similarreward.

Quarterly targets for hand-hygiene compliance in 2005are:¸ First quarter (January�March)

50% compliance before and80% after contact (50/80)¸ Second quarter (April�June)

60% compliance before and80% after contact (60/80)¸ Third quarter (July-September)

70% compliance before and80% after contact (70/80)¸ Fourth quarter (October�De-

cember)80% compliance before and80% after contact (80/80)

As always, the ultimate goalfor hand-hygiene compliance is100/100. Following are sometips to help us succeed in achiev-ing our goal:

¸ Every unit to reach the quar-terly goal will be rewarded,but both parts of the goal mustbe met¸ Pathogens can live on objects

and surfaces you touch, sohand hygiene is required be-fore and after contact withpatients� environment even ifyou don�t touch the patient¸ The greatest area for improve-

ment in hand hygiene is be-fore contact. Hand-washingbefore contact protects pa-tients from pathogens thatmay have been picked upfrom contact with the generalhospital environment¸ Gloves do not provide a per-

fect barrier and should not beused as a substitute for handhygiene. Cal Stat or hand-washing with soap and wateris required before and afterglove use¸ Give each other friendly re-

minders so hand hygiene be-comes automatic on your unit.Be sure to include all supportstaff and physicians in thesereminders because their ac-tions count, too

The rewards program wascreated to keep attention focus-ed on the importance of improv-ing hand hygiene. By promotingbetter hand hygiene, we canstop the transmission of path-ogens, and our patients are thereal winners.

For more information abouthand hygiene or the Hand Hy-giene Rewards Program, contactJudy Tarselli, RN, in the Infec-tion Control Unit at 6-6330.

HandHygieneHandHygiene

T

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February 17, 2005February 17, 2005

Abbrvs. can coz cnfsn.(Abbreviations can cause confusion)

�by Georgia Peirce, director of PCS Promotional Communications and Publicityand National Patient Safety Leadership fellow

Even under the best of circumstances, abbreviations can be misinterpret-ed or misunderstood. Abbreviations may have different meanings in dif-ferent settings. This can result in confusion and/or harm to the patient.Every abbreviation used in medical records and documentation should berecognizable, understandable, and mean the same thing to the diversecross-section of clinicians and employees involved in the care of the pa-tient. All abbreviations need to make sense in the context of the medi-cal-record entry. If you suspect that a particular abbreviation could lead toconfusion, you should spell the word out. The following table guides prac-tice at MGH:

Abbreviations and acronymsthat should not be used

Unacceptable Acceptable

Q.D. and Q.O.D. Use �daily� and �every other day�

D/C for discharge or discontinued Write �discharge� or �discontin-ued�

MS, MSO4 and MgSO4 Write �morphine sulfate� or �mag-nesium sulfate�

H.S. for half-strength or bedtime Write out �half-strength� or �atbedtime�

Zero after a decimal point (1.0) Do not use terminal zeros (1)

No zero before a decimal dose Always use a zero before a deci-(.5mg) mal when the dose is less that a

whole unit (0.5mg)

ss for sliding scale Use �sliding scale�

µg for microgram Use microgram or �mcg�

U for unit Use �unit�

IU for international unit Use �unit�

Apothecary symbols Use metric system (�ml� �mg� �mcg�)

Per os for orally Use �PO� �by mouth� or �orally�

qn as nightly or at bedtime Use �nightly�

BT for bedtime Use �bedtime�

Prohibited abbreviations apply to all hand-written and free-textelectronic clinical documentation

Meanings of commonly acceptable abbreviations can be found at:http://www.pharma-lexicon.com

Quality & SafetyQuality & Safety

The Employee AssistanceProgram

presents

Single Again FinancialSeminar

presented by Brendon Vigorito,regional coordinator of Education Credit

Counseling Services

Program focuses on credit-related decisions,financial obligations, building a credit history

and other fiscal concerns for divorced orsoon-to-be-divorced individuals.

February 22, 200512:00–1:00pm

Anesthesia Conference Room

For more information, contact theEAP Office at 726-6976.

The Employee AssistanceProgram

presents

Elder Care MonthlyDiscussion Groups

facilitated by Barbara Moscowitz, LICSW,geriatric social worker

Caring for an aging loved one can bechallenging. Join us for monthly meetings

to discuss legal, medical, copingand other issues.

Next meeting: March 15, 200512:00–1:00pm

Bulfinch 225A Conference Room

For more information, contact theEAP Office at 726-6976.

CaringCaringH E A D L I N E S

Back issues of Caring Headlinesare available on-line at the Patient

Care Services website:http://pcs.mgh.harvard.edu/

For assistance in searching back issues,contact Jess Beaham, web developer,

at 6-3193

Page 11

Educational OfferingsEducational Offerings February 17, 2005February 17, 2005

2005

2005

For detailed information about educational offerings, visit our web calendar at http://pcs.mgh.harvard.edu. To register, call (617)726-3111.For information about Risk Management Foundation programs, check the Internet at http://www.hrm.harvard.edu.

Contact HoursDescriptionWhen/WherePreceptor Development ProgramTraining Department, Charles River Plaza

7February 258:00am�4:30pm

Basic Respiratory Nursing CareEllison 19 Conference Room (1919)

- - -February 2512:00�4:000pm

- - -Advanced Cardiac Life Support�Instructor Training CourseO�Keeffe Auditorium. Current ACLS certification required. Fee: $160for Partners employees; $200 for all others. For more information, callBarbara Wagner at 726-3905.

February 288:00am�4:00pm

CPR�American Heart Association BLS Re-CertificationVBK 401

- - -March 37:30�11:00am/12:00�3:30pm

Congenital Heart DiseaseHaber Conference Room

4.5March 38:00am�12pm

16.8for completing both days

Advanced Cardiac Life Support (ACLS)�Provider CourseDay 1: O�Keeffe Auditorium. Day 2: Wellman Conference Room

March 4 and March 218:00am�5:00pm

Advance Directives: Hard Facts, Humor and How To�sO�Keeffe Auditorium

3.3March 78:00�11:00am

CPR�Age-Specific Mannequin Demonstration of BLS SkillsVBK 401 (No BLS card given)

- - -March 88:00am and 12:00pm (Adult)10:00am and 2:00pm (Pediatric)

New Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0(for mentors only)

March 98:00am�2:30pm

Nursing Grand Rounds�Methadone: an Important Analgesic.� Sweet Conference Room GRB 432

1.2March 911:00am�12:00pm

End-of-Life Nursing Education ProgramTBA

TBAMarch 9 and 108:00�5:00pm

OA/PCA/USA Connections�Professional Interactions in a Diverse Hospital Setting.� Bigelow 4Amphitheater

- - -March 101:30�2:30pm

Intermediate Respiratory CareWellman Conference Room

TBAMarch 148:00am�4:30pm

BLS Certification for Healthcare ProvidersVBK601

- - -March 158:00am�2:00pm

Natural Medicines: Helpful or Harmful?Founders 626

1.8March 164:00�5:30pm

CPR�American Heart Association BLS Re-CertificationVBK 401

- - -March 177:30�11:00am/12:00�3:30pm

Building Relationships in the Diverse Hospital Community:Understanding Our Patients, Ourselves, and Each OtherTraining Department, Charles River Plaza

7.2March 238:00am�4:30pm

More than Just a Journal ClubWelman Conference Room

- - -March 234:00�5:00pm

The Surgical Patient: Challenges in the First 24 HoursO�Keeffe Auditorium

- - -March 218:00am�4:30pm

Nursing Grand Rounds�Anti-Coagulation Update.� O�Keeffe Auditorium

1.2March 241:30�2:30pm

Congenital Heart DiseaseHaber Conference Room

4.5March 247:00�11:30am and 12:00�4:30pm

February 17, 2005February 17, 2005

CaringCaringH E A D L I N E S

Send returns only to Bigelow 10Nursing Office, MGH

55 Fruit StreetBoston, MA 02114-2696

First ClassUS Postage Paid

Permit #57416Boston MA

ElderCareElderCareSenior HealthWISE lecturefocuses on cardiovascular

health

Dorothy Noyes, RN,nurse practitioner for the

MGH Heart Failure DiseaseManagement Program

n Tuesday, February 8,2005, in the WalcottConference Room, Doro-

thy Noyes, RN, nurse prac-titioner for the MGH Heart Fail-ure Disease Management Pro-gram, spoke as part of the MGHSenior HealthWISE lecture series.Her topic was, �CardiovascularHealth.�

Noyes spoke about the riskfactors associated with cardio-vascular disease: high blood pres-sure (or a history of high bloodpressure), high cholesterol, obe-sity, a family history of heart dis-ease, or any combination of thesefactors (more than one risk factorincreases your overall risk forheart disease). She stressed thatheart disease, while typically as-sociated with men, affects wo-men, too, though women tend toexperience heart attacks differ-

O ently (reporting symptoms of nau-sea, fatigue, and heavy limbs).

In terms of preventing heartdisease, Noyes recommended:¸ a diet of fresh fruits, vegetables,

and fiber¸ limiting your intake of saturated

fats¸ limiting your intake of prepared

food (which can be high in so-dium)¸ exercise more (walking is still

the best exercise for good hearthealth)¸ control high blood pressure by

limiting your intake of alcohol,nicotine, and sodium; and keepstress to a minimumNoyes closed by reminding

elders that keeping fit is one ofthe best things you can do foryourself. For more informationabout the Senior HealthWISEprogram, call 4-6756.

Page 12