November 8, 2013

2 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME

Celebrating those who work to provide freedom, dignity, and quality care to those in need!Heroes of Home Care

November is National Home Care & Hospice Month

and is celebrated as way of paying tribute to the thousands of quiet heroes that provide quality home health, home care

and hospice services across the nation.

A Letter from a Thankful Patient

To all those involved in this patient’s stay, thank you for providing them with great patient care and showing humankindness!

Welcome to the Mercy Team!

Stephanie Alvarez, Access Care Rep ED Registration

Alma Reyes, EVS Tech EVS

Maria Garcia Villagomez, RN 7th Floor

Carol Miranda, RN 4th Floor

Erica Diaz, RN 5th Floor

Eileen Chetty, RN 5th Floor

Alberto Leon, EVS Tech EVS

Patricia Rehn, Director of Nursing

Shabana Abdulqadir, RN 7th Floor

Ruby Camello, RN 6th Floor

Troy Thornton, Security Officer Security

October new employees

November 8, 2013

THOUGHT:Surfing is popular in California. Sitting on a surfboard in the water, you must wait. You must be attentive, watchful, ready. When a swell comes along, you must apply your energy, paddling quickly with the wave. If you don’t put in any effort, the wave passes you by and you go nowhere. But if you do point yourself in the right direction and paddle, and if it is the right moment, then the power of the wave — much stronger than your own weak paddling — matches your effort, picks you up, and carries you forward.

“This is how our willingness can be utilized by the Spirit to affect real change. We cannot make ourselves holy, any more than surfers on a calm ocean can paddle themselves frenetically forward into a glorious ride. But we must be willing and attentive, or nothing will ever happen. With awareness, we wear down our resistance, our obstacles, our compromises. We attend to our desire for change, waiting watchfully, hopefully.

PRACTICE:Watch for moments when you can “Catch the Spirit” – Look for the fruits: charity, patience, joy, peace. Remember that God has you hear for a purpose. Today think of one person who is in your life. What does God want you to learn from that relationship?

For you love all things that are and loathe nothing that you have made; for what you hated, you would not have fashioned.

And how could a thing remain, unless you willed it; (Wisdom 11)

Living SpiritualityOpen Enrollment Will Be Over Before You Know ItOpen enrollment is your annual opportunity to enroll in or make changes to your Dignity Health benefits. Take action by Nov. 15 to be sure your coverage meets your needs.

Here’s how:

• Read your Open Enrollment materials carefully to learn what’s new and what’s changing in 2014. Click here to access an interactive version of the Open Enrollment Guide.

• On the Total Rewards Portal, http://DignityHealthMember.org/TotalRewards, you can access everything you need to know about your Dignity Health Benefits – including your current benefit elections and beneficiaries for life and AD&D coverage. And you can make new elections for 2014.

• You must be able to log in to the Dignity Health network to access the Total Rewards Portal. If it’s been more than six months since you last accessed the Dignity Health network, you’ll need to reset your password by visiting Dignity Health Password Self Service. You may also call the Dignity Health Help Desk at 1-888-307-0222 or email helpdesk@dignityhealth.org.

Questions?Call the Dignity Health Benefits Service Center at 1-855-475-4747, Monday through Friday from 6 a.m. to 5 p.m. Pacific Time.

See the flier on the last page of this issue for more information about Open Enrollment.

Sister Lucille Carreau, DHSSpiritual Services Supervisor

October Nurse Quarterly Raffle Winners

3rd prize: Merced Mall Gift Card Karen Mayfield

ICU

2nd prize: Dinner for 8 at Florencio’sLynn Borba

Cardiac Rehab

1st Prize: Spa Day at The Pedi Bar Judy Townsend

Family Birth Center

A Toyland HolidaySaturday, December 7, 2013Yosemite Hall (Commerce Bldg) Merced Fairgrounds

6:30pm - 11:30pm

• Bring a toy to donate to Kops for Kids

• Catered by España’s • Photobooth • Employees are

free and can purchase one guest ticket for $5.00

SAVE THE DATE

Tickets will be available starting next Tuesday in:Administration (333 Mercy Ave)

Human Resources (2740 M St)

Family Care Clinic (D St)

Medical Staff *for doctors only(333 Mercy Ave)

EMPLOYEE OF THE MONTHOctober

November 8, 2013

Brigid Ferrari, MSWSocial Worker

Brigid has been a social worker at Mercy for the past 2 years. She exemplifies humankindness each and every day she works. Brigid is a warm and compassionate person who is always willing to go the extra mile for our patients.

One such example of her excellence in care was when Brigid coordinated the transport of a very high risk patient from our hospital to a hospital in Seattle, Washington. The patient had to be flown by commercial airline and she needed portable suction and high flow O2.

Brigid worked with great compassion to assist this terminal patient in granting her final wishes to die at home with her family. While it took the efforts of our entire team, it was under Brigid’s leadership on this case that the patient was able to be flown to Seattle to be near her family, who would care for her until she passed away.

by Kelly Bitonio and Susie Brooks

I would like to invite you to put a smile on the face of a less fortunate child. “Operation Christmas Child” is a project of Samaritan’s Purse and is a ministry outreach to children all over the world that live in some of the most poverty stricken

environments. Shoeboxes are filled with items for a boy or girl in a specific age range.

Many of our departments have chosen this as their “Christmas Sharing” project, or you can participate on your own.

Shoeboxes along with instruction sheets are now available for pick up and due back by November 22. If you are interested give me a call at 564-5007 or email me at: Janice.wilkerson@dignityhealth.org

For more information about this project, go to Samaritanspurse.org and you will find some of the most heartwarming stories from children around the world that have received a shoebox. It’s hard to believe a shoebox can change a person’s life, yet it has.

Operation Christmas Childby Janice Wilkerson, Director of Missoin Integration

Over 20 companies and 597 individuals participated in Rideshare Week challenges and helped improve air quality across the region – all in all, 13 counties benefited from Rideshare Week participation! By using transit, carpooling or vanpooling, you have helped reduce the nearly 25,000 vehicle miles traveled each day by participants. These small changes make a huge positive difference for air quality and road conditions – so thank you for being a Rideshare Hero!

We would love to know how your Rideshare Week experience was. If you have 5 minutes, please take this brief survey to help us improve. And you’ll get another chance to win a prize: completed responses will be entered in a drawing for a $25 gas card! Click here to take the survey.

The winners from Merced County were Dave Cole of Hilmar Cheese and Michelle Hoyt from the City of Merced.

As always, we are committed to helping you share the ride, so for continuing support please don’t hesitate to contact the Commute Connection team.

Rideshare Week Successby Kari McNickle, Regional Planner for Commute Connection

National Radiologic Technology WeekNovember 3-9, 2013

November 8, 2013

JUST FOR NURSES

November 8, 2013

TIP OF THE WEEK: SURGICAL CARE IMPROVEMENT PROJECT (SCIP)

by Edith Reyna, RN-Quality Facilitator

Performance Measure: Prophylactic Antibiotic Selection for Surgical Patients

Why is this important? The selection of appropriate antibiotics for certain surgical procedures have been shown to reduce surgical site infections.

Approximately 1 million patients suffer from wound infections each year in the United Sates. Wound infections are responsible for an extension of hospital stay by an average of 1 week , which increases hospital cost by 20%. (1)

In addition, the second most common cause of nosocomial infections is surgical site infections. Surgical site infections occur in 2%-5% of clean extra-abdominal surgeries and up to 20% of intra-abdominal surgeries. Patients who develop surgical site infections are 60% more likely to spend days in an intensive care unit (ICU), five times more likely to be readmitted to the hospital and have twice the incident of mortality.

The development of wound infections require a local inoculum which is sufficient to overcome the local host defense. Wound infection development also depends on microbial virulence factors, the local environment, systemic factors, e.g. comorbility and surgical technique. Antibiotic prophylaxis plays an important part in prevention of wound infections. The efficacy of antibiotic prophylaxis has been demonstrated to be significant. However, antibiotic prophylaxis cannot be a substitute for any other prevention measure. This is why surgical environment

and infection rates are also tracked and monitored. It is important to recognize that antibiotic prophylaxis is an adjunct to all other preventative measures and should be regarded as one component of an effective policy for control of healthcare associated infections. The scientific basis for the perioperative use of antibiotics was established by Burke. (2) Polk and Stone have confirmed the hypothesis in clinical studies and paved the way for antibiotic prophylaxis in surgery. (3)

Selection of antibioticsAntibiotics used for prophylaxis should be active against the most likely infecting organism with relevant tissue penetration. Antibiotics should show a low toxicity, a low incidence of allergy, and should be involved in the selection of virulent organism.

The antibiotic should be administered ideally 30 minutes before incision in order to achieve relevant tissue concentration, but no longer than one hour prior to incision. For operations lasting longer than three hours a second dosage is recommended. There is NO evidence to support a prolongation of antibiotic administration to 24 or 48 hours in most instances. Single dose is cheaper and does not increase the risk of the development of bacterial resistance. (4-6)

The goal of prophylaxis with antibiotics is to use an agent that is safe, cost-effective and has a spectrum of action that covers most of the

probable intraoperative contaminates for the operation. First or second-generation cephalosporin satisfy these criteria for most operations, although anaerobic coverage is needed for colon surgery. Vancomycin is not recommended for routine use because of the potential for development of antibiotic resistance, but is acceptable if a patient is allergic to betalactams, as are fluroquinolones and clindamycin in selected situations.

Approved antibiotic selections can be found in the SCIPPER Binder, Pre-op, OR and PACU.

See article references on the next page.

ANSWER TO LAST WEEK’S QUESTION:

Paulina Bruns, RN4th Floor Telemetry-Nights

LAST WEEK’S WINNERS

What does CLIP stand for?

ANSWER: Central Line Insertion Practices

Below is a question from last issue’s “Tip of the Week”. The first day and night shift RN to respond to lindsey.gallagher@dignityhealth.org with the correct answer will receive a Mercy Medal from Greg Rouleau, CNO.

QUESTION

A. Held confidential by the Joint Commission (TJC)

B. Held confidential by the Centers for Medicare and Medicaid Services (CMS)

C. Made available to the public at the Hospital Compare Website

Your organization’s ratings on Core Measures are:

November 8, 2013

ARTICLE REFERENCES

1. Haley R W, Schaberg D R, Crossley K B, Von Allmen S D, McGowan J E. Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med. 1981;70:51–58.

2. Burke J F. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery. 1961;50:161– 168.

3. Polk H C, Lopez-Mayor J F. Postoperative wound infection: a prospective study of determinant factors and prevention. Surgery. 1969;66:97–103

4. Classen D C, Evans R S, Pestotnik S L, Horn S D, Menlove R L, Burke J P. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992;326:281–286.

5. Nichols R L. Surgical antibiotic prophylaxis. Med Clin North Am. 1995;79:509–522.

6. Dellinger E P. Antibiotic prophylaxis in trauma: penetrating abdominal injuries and open fractures. Rev Infect Dis. 1991;13 (Suppl 10):S847–857.

JUST FOR NURSES Don’t Miss Your Chance to Be Heard in the SAQ“To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.”

Sir Liam Donaldson, former chief medical officer for England, speaking at the launch of the World Alliance for Patient Safety in Washington, D.C. on Oct. 27, 2004

The Safety Attitude Questionnaire (SAQ) – ending on Dec. 6 – is an opportunity for every clinical employee to help Dignity Health assess the beliefs and attitudes about safety among our 30,000 clinical employees. Those beliefs and attitudes are a proven indicator of the likelihood for errors and injuries.

All clinical employees are asked to provide their candid assessments of the safety culture in their work areas and to be active participants in the follow up for their work groups.

This survey should take about 10 minutes to complete.

Pascal Metrics, the company administering the survey, has assured us that it will protect the confidentiality of all responses. The survey will be hosted on a Pascal Metrics server, completely separate from Dignity Health. All responses will be maintained in a password protected data base. Responses will be reported in the aggregate only (no individual responses). Group results will only be reported for groups of more than five.

WHERE AM I?This picture to the right was taken from somewhere around one of our facilities and the first person to email lindsey.gallagher@dignityhealth.org with where the picture was taken will get a prize.

Halloween Fun at Mercy

In October, Dorothy and the PFS team followed the yellow brick road right to the bank and posted a record breaking $20.6M in payments. This is also in part due to our Patient Access team for accurate data capture at the time of registration and also the HIM department for keeping coding backlogs to a minimum.

When the Wizard of Dignity Health heard about the cash collections in Merced, he refused to send Dorothy back to Kansas in hopes of a repeat performance in November, but you know what they say, there’s no place like home!

November 8, 2013

by Lori Graver, PFS Director

PFS HAS A RECORD MONTH!

It’s back! Text OE2014 to 313131 to opt in to the Open Enrollment text message reminder service and a chance to win a prize!**Phone numbers will be stored confidentially,

and only for the duration of the Open Enrollment period. After November 15, 2013, all phone numbers will be deleted from the system.

Dignity Health 2014 Benefits Open EnrollmentOctober 28 – November 15, 2013It’s time for you – the people who bring humankindness to life at Dignity Health – to make important decisions about your benefits.

• Learn about any changes to your current plans or new plans available to you

• Review premium contributions that will be deducted from your pay in 2014

• Enroll in or change your coverage for 2014

• Remove or add eligible dependents

• Participate in a Health Care or Dependent Care Spending Account for 2014 (you must enroll to participate in 2014).

¡ Remember, Health Care Reform requires most Americans to have medical insurance in 2014.

Open Enrollment ends November 15, 2013 at 11:59 p.m. Pacific Time.

Get started at My Health http://DignityHealthMember.org/TotalRewards

Want the details? Scan this QR code to instantly access the electronic Open Enrollment Guide