Aloha, and welcome to the June issue of Kapiolani's Physician Enews Brief for medical · 2015-07-01 · June 2015 Aloha, and welcome to the June issue of Kapiolani's Physician Enews

June 2015

Aloha, and welcome tothe June issue ofKapiolani's PhysicianEnews Brief for medicalstaff.This issue will inform medical staff ofcurrent news, updates and event listings atour hospital.

Please contact Kathy McGarvey at 983-8565 or [email protected] questions.

IN THIS ISSUE

Save the Date – Kapiolani Soirée 2015

Unclear Medication Orders

Proposed Amendments to the MedicalStaff Rules and Regulations

MERS-CoV Medical Advisory

Construction Update

Choosing Wisely Transfusion Alert Goes toHard Stop

Hawaii Pacific Health Among TopOrganizations in Employee Engagement

Kapiolani Welcomes the Arrival of Its FirstApp

CATCH Conference

Dr. Calvin Sia to Receive National PrimaryCare Leadership Award

What are Focused Professional PracticeEvaluation (FPPE) and OngoingProfessional Practice Evaluation (OPPE)?

Healthy Pursuits: A Monthly PatientEnewsletter

Be Prepared

Reminder About Changes in DesignatedAlternates

Reminder: For Medical Staff IssuesInvolving Patient Care Call ThePerformance Improvement Hotline – 983-8211.

KMCWC Medical Staff Services

Centralized Credentialing VerificationOffice

Department Meetings

Welcome New Members and Allied HealthProfessionals

Welcome JABSOM Residents

Save the Date – Kapiolani Soirée 2015

A benefit for Kapiolani Medical Center for Women & Children, this event will be heldSaturday, Sept. 5, from 6-10 p.m. at 445 Cooke St. in Honolulu.

Table packages are limited. Call 535-7157 to reserve.

Unclear Medication OrdersDuring our Joint Commission survey in April, the surveyors found several instances ofunclear PRN medication orders, including:

Ibuprofen and acetaminophen ordered to be given "PRN fever”Morphine and lorazepam "PRN withdrawal score >8”Ibuprofen "PRN pain 2-4” and oxycodone/acetaminophen "PRN pain 1-4”

Why is this important?Unclear medication orders, particularly for PRN orders, is a patient safety concernbecause it places patients at risk for over- or under-dosing of medications. For example, ifthe PRN indication does not specify the condition under which a pain medication shouldbe administered, the patient's pain may not be adequately managed or the patient mayexperience significant sedation and/or respiratory depression related to double-dosing ofmedications.

Therapeutic duplication, which is prescribing two or more medications for the sameindication without clear directions for use, is an example of unclear medication orders.Therapeutic duplication without clear directions for use is problematic because it increases

the risk of adverse drug effects and allows the nurse to select the medication to beadministered, which is outside of the nursing scope of practice.

What do we need to do?The Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS)requires that multiple medications for the same PRN indication must include specificdirections for use. It is everyone's responsibility to ensure medication orders are clear.

In general:

Physicians and prescribers MUST write clear orders.Pharmacists MUST clarify unclear orders before they dispense medications.Nurses MUST clarify unclear orders before they administer medications.

PhysiciansUpon ordering PRN medications:

1. Review the patient's medication profile for other PRN medication orders and if thereis other PRN medication orders for the same indication:

a. Discontinue any PRN medication orders that are no longer needed, orb. Provide directions for sequencing the medications (i.e., use ibuprofen if pain

unrelieved by acetaminophen), orc. Specify the unique symptom for the new medication.

2. When multiple PRN medication orders are written for the same indication (i.e.,pain), specify when each medication is to be administered, such as priority,sequence and/or patient condition for use. For example:

Ibuprofen 600mg PO Q6H PRN mild pain 1-3Oxycodone/acetaminophen 1 tab PO Q4H PRN moderate pain 4-6Oxycodone/acetaminophen 2 tabs PO Q4H PRN severe pain 7-10

3. Please return pages to pharmacists and nurses in a timely manner to avoid delaysin therapy.

Proposed Amendments to the Medical Staff Rules and RegulationsThe Medical Executive Committee approved the following proposed amendments to theMedical Staff Rules and Regulations as recommended by the departments.

The amendments are being forwarded to the medical staff for review and comment beforethe MEC can forward the amendments to the board of directors for approval.

Please forward any comments by Aug. 10 to the Medical Staff Services Office. Questionsmay be directed to the Medical Staff Services Office at 983-8565.

Item 1Medical Staff Rules and Regulations, General Rules Regarding Surgical CareAs recommended by the Departments of Anesthesiology, OB-GYN and PerioperativeServices, revisions were made to clarify that anesthetic site for unilateral procedurerequiring unilateral anesthesia will be initialed by the anesthesiologist.

Item 2

Medical Staff Rules and Regulations, Perinatal ServicesAs recommended by the Department of OB-GYN, the entire Perinatal Services sectionshould be deleted from the Medical Staff Rules and Regulations. The section was writtenbefore 1985, when the perinatal services were established, and the section has neverbeen updated. Policies and procedures that are reviewed on a continuous basis are inplace to cover the service.

MERS-CoV Medical AdvisoryThe Hawaii Department of Health (DOH) has been monitoring emerging infectiouspathogens such as the Middle East Respiratory Syndrome Coronavirus (MERS-CoV),which was first identified in Saudi Arabia in 2012.

Infections continue to occur, primarily in the Arabian Peninsula, but have been exported tomultiple other countries, including to the United States in 2014.

While the current outbreak in the Republic of Korea is the largest outside of the MiddleEast, all transmission have been health care-associated, with no community spread.

The risk of MERS-CoV infection for Hawaii residents is low; however, given the speed andfrequency of global travel, we must continue to monitor for any potential cases and beprepared to manage them.

Please obtain a detailed travel history when evaluating acute febrile patients withunexplained illness. MERS-CoV should be considered in anyone presenting with thefollowing:

1. Fever and pneumonia or acute respiratory distress syndrome (ARDS) AND:

History of travel in or near the Arabian Peninsula within 14 days beforesymptom onset; ORClose contact with a symptomatic traveler who developed fever and acuterespiratory illness within 14 days after traveling in or near the ArabianPeninsula; ORAre part of a cluster of patients with severe acute respiratory illness ofunknown etiology in which MERS-CoV is being evaluated.

2. Fever and symptoms of respiratory illness AND being in a health care facility (in anycapacity) within 14 days before symptom onset in or near the Arabian Peninsula orthe Republic of Korea in which recent health care-associated cases of MERS-CoVinfection have been identified.

3. Fever or respiratory illness symptoms AND close contact with a confirmed MERS-CoV infection while the case was ill.

Persons with Middle East Respiratory Syndrome (MERS) may present with mild or norespiratory symptoms to severe acute respiratory illness, respiratory failure and death.Common symptoms include fever, non-productive cough, dyspnea, rigors, headache andmyalgia; pneumonia is a frequent finding, and gastrointestinal symptoms have beenreported.

Individuals with comorbidities (e.g., diabetes, chronic lung disease or renal failure, and

immunocompromise) may be more likely to have severe disease.

The median incubation period is estimated to be five days (range two to 14 days).Treatment is supportive; no specific treatment for MERS-CoV infection is currentlyavailable.

You should immediately report to DOH any patient you suspect as having MERS. OnO‘ahu, call:

Disease Investigation Branch: 808-586-4586After-hours: 808-566-5049

Testing for MERS-CoV infection by real-time, reverse transcription polymerase chainreaction for MERS-CoV can be performed by the State Laboratories Division pendingDOH review and approval. Multiple specimens should be collected from multiple sites,including especially a lower respiratory tract specimen as well as anasopharyngeal/oropharyngeal swab and serum.

To date, there has been no evidence for sustained human-to-human transmission in thecommunity. Limited human-to-human spread has been seen in health care settings and/orassociated with close contact with an individual infected with MERS-CoV. Stringentadherence to basic infection-control principles is critical to preventing diseasetransmission; standard, droplet and airborne precautions are currently recommended forevaluation and care of patients suspected or confirmed to have MERS-CoV infection.

For more information about MERS-CoV, visit:

who.int/emergencies/mers-cov/en/cdc.gov/coronavirus/mers/interim-guidance.htmlhealth.hawaii.gov/docd/updates-and-resources-for-clinicians

Construction UpdateThe following construction activities will occur over the next few weeks:

Miscellaneous steel work in the main site will cause a fair amount of noise andwelding. For your eye safety, please do not stare at the welding flash.Concrete pouring, fireproofing, and mechanical and electrical work will alsocontinue.Work on exterior windows and metal panel installation will additionally be carriedout.There may be some congestion in the private fire lane and driveway as theconstruction of the generator building continues and construction trucks come inand out.Drivers using Bingham Street should expect some delays, as construction andcommercial trucks will be in the area to haul away debris and delivering suppliesand construction materials.There may be some congestion at the patient drop-off area due to these activities.Staff will be on hand to assist patients and families.

Choosing Wisely Transfusion Alert Goes to Hard StopHPH Embarked on Choosing Wisely alerts in Epic as a way to guide clinicians to consideralternates to investigations and treatments that are felt to have marginal value asrecommended by various specialty societies under the American Board of MedicalSpecialties.

The first of these alerts targeted blood transfusions in adults older than 18 years of ageand was turned on in December 2014. Since then, the number of alerts that are firing hasbeen decreasing, suggesting an impact of this alert on the use of transfusions when theindications are not very clear cut.

In an effort to better understand the situations in which there are specific patientpopulations getting transfused at higher thresholds, effective this month, this alert willrequire a reason to be entered before you can proceed to complete the order.

HPH has deployed 42 of these alerts in the HER, and the Choosing Wisely steeringcommittee would welcome feedback on these alerts and your suggestions on improvingour provision of care to our patient population.

The physician lead for this project is Dr. Mark Baker; he may be contacted [email protected].

Hawaii Pacific Health Among Top Organizations in EmployeeEngagementHawaii Pacific Health has been recognized with the prestigious Gallup Great WorkplaceAward for the fourth year in a row.

The award recognizes HPH as one of 40 organizations leading the world in employeeengagement with winners based in a wide range of countries including Canada, China,India, Indonesia, Netherlands, Singapore, Thailand, the United Arab Emirates, the UnitedKingdom and the United States.

A team from HPH accepted the award on behalf of our organization earlier this month atthe Gallup Workplace Summit in Omaha, Nebraska.

HPH is currently ranked in the 86th percentile when benchmarked to a Gallup database ofmore than 1.3 million health care employees, and averages nine engaged employees forevery one actively disengaged employee, which is five times the rate in the U.S. and morethan 16 times the rate for workforces globally.

All of the companies honored with the award are recognized for the business impactachieved by integrating engagement into four areas that Gallup has identified as vital tocultivating a workplace culture of engagement: strategy and leadership, accountability andperformance, communication and knowledge management, and development andongoing learning.

Kapiolani Welcomes the Arrival of Its First AppJust like its patients, Kapiolani Medical Center has been expecting a little bundle of joy,and after months of anticipation, it's finally here!

Hapai (the Hawaiian word for "pregnant”) is a free, comprehensive maternity app fromKapiolani to help mother and baby stay healthy during and after pregnancy.

"We created the Hapai app with the needs and wants of our patients in mind,” saidKapiolani CEO Martha Smith. "Now, mothers-to-be have access to Kapiolani's wealth ofmaternity resources right at their fingertips.”

Each week, the Hapai app provides users with updates about their babies' development,changes to their bodies and things to do in preparation for their big day. Users simplyenter their due date, and Hapai will calculate how many weeks along expectant mothersare and how many days left until baby's arrival, all while providing helpful tools andresources to guide users through their pregnancy.

The Hapai app features:

Week-by-Week Calendar. Users can keep track of their pregnancy while learningabout their body, their baby and what to do weekly.Reminders. Users stay up-to-date on doctor appointments, shopping needs,exercise times and more.Notes. A virtual log to write down feelings, questions to ask the doctor and storeother pregnancy information.Checklist. Helps users get organized as they prepare for the big day with lists ofessential items and what they'll need to take to the hospital.Contraction Counter. A timer for contractions when a user thinks she's going intolabor.Feeding. Mommy can record all her baby's feeding details, from how long shenursed on each breast to the ounces of milk or formula baby drinks.Weekly Baby Names. Popular baby names for girls and boys each week.Resources. Helpful information from Kapiolani about pregnancy, breastfeeding,infant care, classes and more.Messages. Weekly notifications about important pregnancy updates and details.

Hapai is available to download for both iOS and Android mobile phones. To learn more,click here.

Promo cards are available for anyone who would like a supply for their office to provide topatients. Contact Katie Gallo at 535-7222 or [email protected].

CATCH ConferenceCongenital heart disease (CHD) is the most common defect in the United States,occurring in one out of every 110 births.

Currently, there are more than 1 million adults in the U.S. living with congenital heartdisease, and this number continues to rise.

To address this growing need, Hawaii Pacific Health will host CATCH: Caring for Adultsand Teens with Congenital Heart Disease Aug. 22 at the Hilton Hawaiian Village, CoralBallroom 1 and 2.

Adolescents and adults with CHD face unique challenges that require a specialized teamof clinicians that includes primary care physicians, cardiologists, internists, nurses andother health professionals.

At CATCH, an expert faculty from Hawaii and California will provide a comprehensiveoverview of research-based, cutting-edge care by medical professionals with specialexpertise in the complexities of CHD.

By the end of the conference, participants will be able to:

Identify potential comorbid conditions and complications in adults and teens withCHD.Review diagnostic and treatment options for adults and teens with CHD.

HPH is accredited by the Hawaii Medical Association to provide continuing medicaleducation for physicians.

HPH designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credit(s).Physicians should claim only the credit commensurate with the extent of their participationin the activity.

The HPH Continuing Education Department is accredited as a provider of continuingnursing education by the American Nurses Credentialing Center’s Commission onAccreditation. HPH designates this live activity for a maximum of 6.0 ANNC contact hours.

Early registration by June 30 costs $95 for physicians and $75 other health professionals.Regular registration costs $125 for physicians and $105 other health professionals.

To register, please complete the form found in the brochure here and return to HawaiiPacific Health Conference Services, or call 522-3469 for more information.

Dr. Calvin Sia to Receive National Primary Care Leadership Award

The Patient-Centered Primary Care Collaborative (PCPCC)recently announced that Dr. Calvin Sia will receive thegroup's prestigious 2015 Barbara Starfield Primary CareLeadership Award. Dr. Sia will be presented with the awardduring PCPCC's Annual Awards Dinner at its FallConference on Nov. 12, 2015, in Washington, D.C.

In making the announcement, PCPCC noted that Dr. Siawas recognized for spending much of his career advancingthe medical home concept in Hawaii as well as nationallyand internationally. Calvin C.J. Sia, MD, FAAP

"We are proud to honor Dr. Sia for his long-standing commitment to providing patient-centered care to children,” said PCPCC President Paul Grundy, MD, MPH, FACOEM. "Dr.

Sia was an early patient-centered medical home (PCMH) pioneer who advocated for themodel of care long before the concept was widely known, and his work set the foundationfor the principles of the PCMH. His dedication to the medical home was evidentthroughout his career as he advocated for accessible, family-centered, coordinated, andcomprehensive care for all children, especially at-risk children and those with specialhealth care needs.”

The Barbara Starfield Award was established in 2012 to honor the work of Dr. BarbaraStarfield, whose distinguished career at Johns Hopkins School of Public Health spannedover five decades, and included seminal research that highlighted the critical role ofprimary care in driving health system transformation. In recognition of exceptional worktoward advancing the medical home and person-focused care, the award was presentedto Dr. Starfield posthumously in April 2012, to Dr. Richard Baron in 2013, and to DebraNess in 2014.

"I am so honored to receive this award that celebrates the incredible work of Dr. Starfield,”said Dr. Sia. "I have dedicated my life to improving child health through partnershipsbetween families, primary care, and communities. It is a privilege to be recognized bysuch an incredible group of individuals who also value and advocate for advanced primarycare and the medical home.”

To read more about Dr. Sia, visit https://www.pcpcc.org/profile/calvin-sia.

What are Focused Professional Practice Evaluation (FPPE) andOngoing Professional Practice Evaluation (OPPE)?At the June 12 Medical Executive Committee meeting, Credentials Committee Chair Dr.Wallace Matthews reported that The Joint Commission surveyor indicated that we mustmove toward compliance with the elements of the standards relating to FPPE and OPPE.

Over the next several months, information and action-plan timelines will be disseminatedto departments. So what are they?

FPPE is a process whereby the organization evaluates the privilege-specific competenceof the practitioner who does not have documented evidence of competently performing therequested privilege at the organization. This process may also be used when a questionarises regarding a currently privileged practitioner’s ability to provide safe, high-qualitypatient care.

Focused professional practice evaluation is a time-limited period during which theorganization evaluates and determines the practitioner’s professional performance. Withregard to establishing the monitoring plan specific to the requested privilege, and thepossibility of using a 12-month provisional period, there is no longer a required provisionalperiod. The provisional period, when it was required, related to appointment to the medicalstaff and not to privilege. This means that departments must convert their provisional andobservation requirement criteria and processes to FPPE.

OPPE allows the organization to identify professional practice trends that impact onquality of care and patient safety. While departments have already identified data onperformance on an ongoing basis, rather than at the two-year reappointment process, the

data have been primarily related to medical record requirements. Overall improvementshave been realized in most of the current measurements that have been in existenceseveral years now. Departments will be responsible for evaluating their current OPPE dataand transitioning to more clinical data that would be meaningful, reliable and usefulmeasures.

The Medical Executive Committee is committed to making sure that all elements are metthat are designed for quality care and patient safety.

Healthy Pursuits: A Monthly Patient EnewsletterKapiolani launched a monthly patient enewsletter earlier this year, and we want allemployees and physicians to have the opportunity to receive it too.

By subscribing to our patient enewsletter, you will have access to useful health andwellness information to share with your patients. You also can stay informed of the topicspatients are interested in learning more about.

You can opt-in via the website link here to subscribe to receive the enewsletter via yourpersonal email address at home.

We have similar e-newsletters for each HPH hospital that you may also want to receive.

For questions or feedback, please send an email to [email protected].

Be PreparedHurricane season began June 1 and will last through Nov. 30.

Please see the 2015 Hurricane Season memos for employees and managers forpreparation instructions.

Contact your Safety Officer for questions or more information.

Reminder About Changes in Designated AlternatesPlease notify the Medical Staff Services Office at 983-8564 as soon as possible forchanges to your designated alternates. The Medical Staff Rules and Regulations requiresthat all providers with admitting privileges shall designate in writing two (2) or morealternates with comparable admitting privileges at this medical center. This information isprovided to all patient care units in the event that you are not available to attend to yourpatients. Please also note that providers are responsible to inform their designatedalternates when they are not available to provide services (when provider is on vacation,sick leave, etc.). There have been instances when designated alternates did not assumetheir designated alternate responsibility of providing coverage during the provider's periodof absence.

Reminder: For Medical Staff Issues Involving Patient Care CallThe Performance Improvement Hotline – 983-8211.The Performance Improvement Hotline provides physicians, patients and hospital staff aroute to refer questions involving the clinical care of patients in a confidential and timelymanner, and to eliminate documentation on Occurrence Reports that are not protectedunder the peer review process. Messages are recorded and are referred to respectiveDepartment Chairman or designated alternate to determine appropriate follow-up withphysicians.

The number for the Performance Improvement Hotline is 983-8211 and is confidential. Forconcerns about medical management requiring immediate intervention, please utilize theChain of Command.

Note: The Performance Improvement Hotline is totally separate from the CorporateCompliance Hotline. The Corporate Compliance Hotline (1-888-274-3832) is foremployees, physicians on Medical Staff, vendors, agents and partners of Hawaii PacificHealth to report any identified issues or questions associated with potential violations oflaws, rules, regulations, policies and procedures.

KMCWC Medical Staff ServicesKathy McGarveySupervisor983-8565

Diane BeaucheminMedical Staff Specialist983-8561

Kingston DiasMedical Staff Specialist983-8560

Nichole ShintakuMedical Staff Specialist983-8564

Fax: 983-8562

Centralized Credentialing Verification OfficeDonna HackbarthSupervisor973-7320

Lisa CohenCredentialing Specialist973-8126

May FloresCredentialing Clerk973-7301

Colleen HigaCredentialing Specialist973-7322

Jana LongProvider Credentials973-7330

Fax: 973-7325

Department Meetings

Anesthesiology: July 15 and Aug. 19, 7 a.m., Conference Room APerioperative Services: July 22, 7 a.m., Conference Room A; Aug. 26, 7 a.m.,Bingham Conference RoomPediatrics: No meeting in AugustOB-GYN: Aug. 25, 1 p.m., Auditorium

Welcome New Members and Allied Health Professionals

Lovedhi Aggarwal, MDFamily Medicine

Kelly A. Bear, DONeonatology

Jonathan A. Bernstein, MDMedical Genetics

Erin C. Gertz, MDOB-GYN

Donna Y. Y. Deng, MDPediatrics

Kimie K. Hirabayashi, MDOB-GYN

Andrea L. Parker, NPNurse Practitioner

Shandhini Raidoo, MDOB-GYN

Sheldon Riklon, MDFamily Medicine

Ryan J. Schlueter, DOOB-GYN

Chien-Wen Tseng, MDFamily Medicine Joseph C. Varcadipane, MD

Orthopedic Surgery

John R. Walker, DONeonatology

Jenny H. Welham, MDPediatrics

Seiji Yamada, MDFamily Medicine

Welcome JABSOM ResidentsKapiolani Medical Center welcomes resident physicians from the University of Hawaii atManoa's John A. Burns School of Medicine Obstetrics and Gynecology ResidencyProgram, Pediatric Residency Program and Neonatal-Perinatal Fellowship Program.

Questions? Contact Kathy McGarvey at 983-8565 [email protected].

KapiolaniMedical Center1319 Punahou St.

About the Kapiolani Physician Enews BriefThe Kapiolani Physician Enews Brief is published by the MarketingDepartment and the Medical Staff Services Office. We welcome yourstories or suggestions to help us improve the enewsletter. Please contact

Honolulu, HI 96826 Kathy McGarvey at 983-8565.

Kapiolani Medical Center is part of the not-for-profit Hawaii Pacific Healthnetwork.