MARCH 2014 EDITION
A Publication for physicians of St. Mary’s Medical Center
and the Palm Beach Children’s Hospital
Physician Newsletter
www.stmarysmc.com • (561) 844-6300 • www.palmbeachchildrenshospital.com
Special Surgical Care Unit
Located on Waters 3
Now Available!
Telemetry Monitoring
We are pleased to offer
remote telemonitoring for your
Gynecological, Orthopedic, Spine, Surgical
and VIP patients.
Advantages:
Special Surgical Care Unit
Waters 3
• Vital statistics monitored from unit
• Reduced patient transfers
• Increased patient safety
• Increased patient satisfaction
Serving:
• Gynecological • Surgical
• Orthopedic • Spine
For questions or additional information, contact
Theresa Bubb-Jones, Administrative Director
561.841.9829 or [email protected]
PLEAsE RE-REGIsTER YOUR vEHICLE!
We are proud that our hospital and service to the community continues to grow and we appreciate your support and
collaboration in providing the vast array of services to our patients.
One of our primary focuses is to provide access and parking and security for our mutual patients and visitors.
All physicians parking on our campus are required to re-register their vehicles and display the assigned decal on the outside
left rear window of their vehicle. We will be reissuing new St. Mary’s parking decals to all individuals parking on our campus.
The Parking Permit Application can be picked up in Human Resources or the Medical Staff Office. Please ensure that you
have your car tag number with you at the time that you complete the form. For convenience, these forms can also be emailed.
We appreciate your cooperation as we continue to enhance our campus. If you have any questions about authorized parking
areas, please contact Simone Dixon in Human Resources at 561-842-7415. You may re-register your vehicle in the Medical
Staff Office (Barbara Barrett) or in the Human Resources Department.
www.stmarysmc.com • (561) 844-6300 • www.palmbeachchildrenshospital.com
St. Mary’s Medical Center and the Palm Beach Children’s Hospital
spotlight on
Nathan Unger,
Pharm D
St.
Mary’s
Medical
Center and Palm Beach
Children’s Hospital is
pleased to announce
an exciting collaboration with faculty from
Nova Southeastern University College of
Pharmacy (NSU-COP).
Nathan Unger,
Pharm.D., Assistant Professor with NSU-COP,
graduated Summa Cum Laude with a Doctor
of Pharmacy from the University of Florida
and subsequently completed two years of
post-graduate residency training specializing
in infectious diseases.
As a consequence
of this relationship between NSU-COP and
St. Mary’s, Dr. Unger is often seen on the
medical floors rounding as a member of an
interprofessional team of providers, including
St. Mary’s Trauma Team and Dr. Osiyemi,
Medical Director of Infectious Disease
Program at St. Mary’s. In addition, those
seeking continuing education credits at some
of the educational programs provided by St.
Mary’s may have seen programs delivered by
faculty from NSU-COP.
The Pharmacy Department at St. Mary’s has
served as a traditional site for NSU pharmacy
students for over 20 years; however, in his
role as a preceptor, Dr. Unger introduces
the students to the growing field of clinical
pharmacy whereby pharmacists serve as
integral members of an interprofessional team
in effort to provide the most appropriate,
evidence-based care of patients. As members
of the team, the students are tasked
with reviewing patient charts to identify
opportunities to improve medication therapy
and minimize adverse effects. This includes
ensuring medications are appropriately
adjusted based on kidney and liver function,
presence of drug-drug interactions and
monitoring for toxicities, amongst other
responsibilities.
This collaboration with NSU-COP has and
will continue to increase the amount of
research conducted at SMMC in order to
continue providing the highest level of care
to our patients. Currently, Dr. Unger and
other faculty from NSU-COP are working
with St. Mary’s on research in the areas of
trauma, infectious diseases and pediatrics.
One successful example highlighted by
several media outlets including CNN, is the
joint efforts to identify bacteria and the level
of antibiotic resistance in the mouth of local
sharks. Videos can be accessed at the YouTube
page for “StMarysMC”.
2
DOCTOR’s DAY CELEbRATION
In appreciation of your dedication and commitment to your patients and
the community, St. Mary’s Medical Center and Palm Beach Children’s Hospital
would like to invite you to a special
DOCTORS’ DAY CELEBRATION
Monday, March 31st, 2014
BREAKFAST 7:30 am to 9:30 am Administrative Boardroom
LUNCHEON 11:30 am to 2:00 pm Administrative Boardroom
For more information call 840-6089
Registration forms for the new parking decal will be available.
sAvE THE DATE
The Annual Meeting of the Medical Staff and Election of Officers is
scheduled for WEDNESDAY, JUNE 11, 2014, at 6 pm at The Breakers.
For additional details please contact Barbara Barrett, Director, Medical
Staff Services at 882-6447 or [email protected]
PEDIATRIC
CARDIOLOGY
SYMPOSIUM
A COMPREHENSIVE REVIEW FOR THE PEDIATRIC HEALTHCARE PROFESSIONAL
Symposium Seating and
Resort Accommodations
are limited.
Registration is required.
Register online now:
PBCHevents.com
REGISTRATION FEE:
Physicians in Practice, Residents
and Fellows .....….……..$119
Nurses and Allied Health Care
Professionals ............…$59
Students ………………..$59
For more information, call:
561.844.7439
Location:
PGA NATIONAL RESORT & SPA
400 AVENUE OF THE CHAMPIONS
PALM BEACH GARDENS, FL
SATURDAY, APRIL 26, 2014
Presentation Topics:
● Evaluation of Cardiac Murmurs in Children
● Endocarditis Evaluation and Management
● Biotech Revolution: Technology Inspired
by Nature
● Pediatric Hypertension
● Evaluation and Management of Syncope
● Non-Cardiac Surgery in the Cardiac
Patient
● Metabolic Syndrome in Children and
Adolescents
● Chest Pain in Children: What to Do?
Speakers:
Emmanouil Tsounias, MD
Course Director
Pediatric Cardiology
West Palm Beach, FL
Lawrence Adams, MD
Pediatric Gastroenterology
West Palm Beach, FL
Abdul Aldousany, MD
Pediatric Cardiology and
Neontology
Miami, FL
Vassili Bazalitski, MD
Pediatric Anesthesiology
West Palm Beach, FL
● The Gastroenterologist’s Role in the PostOperative and Long Term Care of the
Cardiac Patient
● Kawasaki Disease: Recommendations
and Management
● Sudden Cardiac Death in Childhood
● Diagnosis and Management of Arrhythmias
in Childhood
● Diagnosis and Management of GI
Disorders Associated with Congenital
Heart Disease
● Preoperative Assessment: The Anesthesia
Perspective
● Transition From Hospital to Home: The
Importance of Close Pediatric Follow Up
Michael Black, MD
Pediatric Cardiovascular
Surgery
West Palm Beach, FL
Omer Mansoor, MD
Pediatric Nephrology
West Palm Beach, FL
Robert Cywes, MD
Pediatric Surgery
West Palm Beach, FL
Pediatric Cardiology
Marco Danon, MD
Pediatric Endocrinology
Miami, FL
Renato Dubois, MD
Pediatric Cardiology
West Palm Beach, FL
Melvyn P. Karp, MD
Pediatric Surgery
West Palm Beach, FL
Levi Novero, MD
Naples, FL
Amit Patange, MD
Pediatric Cardiology
West Palm Beach, FL
Chad Sanborn, MD
Pediatric Infectious Disease
West Palm Beach, FL
Steven Schultz, MD
Pediatric Critical Care
West Palm Beach, FL
Carlo Zeidenweber, MD
Pediatric Cardiology
Boca Raton, FL
RESERVATIONS:
►Book your room at pgaresort.com or call 800.863.2819
►Symposium Registration - online at PBCHevents.com
www.stmarysmc.com • (561) 844-6300 • www.palmbeachchildrenshospital.com
Pharmacy Update
National Drug Shortage Updates
Please visit Ashp.org for Shortage Updates:
Atropine 0.4mg
Azithromycin 500mg/10mL Powder for Injection
Bupivacaine HCl+Epinephrine 0.25%-1:200,000
Solution for Injection
Carboplatin 450mg/45mL Solution for Injection
Cefazolin 1g/10mL Injection
Ceftriaxone 1g/15mL Injection
Chlordiazepoxide 25mg Capsule
Chloroquine Phosphate 500mg Tablet
Dexamthasone 4mg
Dextrose 5% Solution
Droperidol 2.5mg/mL injection
Ephedrine 50mg/mL Solution for Injection
Glycopyrrolate 0.2mg/mL Solution for Injection
Heparin 100unit
Labetalol 5mg/mL
L-Cystein 50mg Injection
Lorazepam 4mg/mL Solution for Injection
Meropenem 1g Powder for Injection
Methotrexate 1g Injection
Methylprednisolone 40mg Injection
Midazolam 5mg/mL Solution for Injection
Morphine 5mg/mL Solution for Injection
Neostigmine multiple concentration Solution for Injection
Nicardipine 2.5mg/mL Solution for Injection
Nitroglycerine 50mg+5% Dextrose
Octreotide multiple concentration for Injection
Oxacillin 2g Powder for Injection
Oxytocin 10 Unites/mL Solution for Injection
Poly-Iron 150mg Capsule
Rifampin 600mg Powder for Injection
Sodium Chloride multiple concentration Solution
Sodium Phosphate multiple concentration
Topiramate 25mg Tablet
Vancomycin multiple concentration
Vecuronium 20mg Powder for Injection
Water 50mL Injection
Please visit Ashp.org for Shortage Updates
Accessed 02/10/2014
INSTITUTE FOR SAFETY
MEDICATION PRACTICES: BEST
PRACTICES 2014-2015
BP 1: Dispense vinCRIStine (and other vinca
alkaloids) in a minibag of a compatible solution
and not in a syringe.
BP 2: a) Use a weekly dosage regimen default for
oral methotrexate. If overridden to daily, require a
hard stop verification of an appropriate oncologic
indication.
b) Provide patient education by a pharmacist
for all weekly oral methotrexate discharge orders
BP 3: Measure and express patient weights in metric
units only. Ensure that scales used for weighing
patients are set and measure only in metric units.
BP 4: Ensure that all oral liquids that are not
commercially available as unit dose product are
dispensed by the pharmacy in an oral syringe.
BP 5: Purchase oral liquid dosing devices (oral
syringes/cups/droppers) that only display the
metric scale.
BP 6: Eliminate glacial acetic acid from all areas.
St. Mary’s Medical Center is implementing these
best practices if they are already not in process.
www.ismp.org Access 02/12/2014
St. Mary’s Medical Center and the Palm Beach Children’s Hospital
Assessing Potential Glycemic Overtreatment
in Persons at Hypoglycemic Risk
Serious hypoglycemia is increasingly becoming recognized as a national public health issue
that potentially affects the quality of life for millions of persons with diabetes mellitus. Among
persons aged 65 years or older, hypoglycemic agents (sulfonylureas and insulin) are the second
most common medications associated with emergency department visits or hospitalizations and
adverse drug events reported to the US FDA, closely following warfarin.
Patients with high hypoglycemic risk factors include age ≥ 75 years old, serum creatinine ≥
2 mg/dL, cognitive impairment/dementia, advanced diabetes complications, diminished life
expectancy, major neurologic disorders, cardiovascular diseases, major depression, and alcohol/
substance abuse.
Patients with risk factors for serious hypoglycemia represent a large subset of individuals
receiving hypoglycemic agents; approximately one-half had evidence of intensive treatment.
A patient safety indicator derived from administrative data can identify high-risk patients for
whom reevaluation of glycemic management may be appropriate.
Tseng CL, Soroka O, et al. Assessing Potential Glycemic Overtreatment in Persons at Hypoglycemic Risk. J
AMA Intern Med. 2014 Feb 1;174(2):259-68
Patient Care and Safety Improved
in SMMC Operating Rooms
St. Mary’s Medical Center recently installed 23 Codonics Safe Label SystemTM within
the Omnicell Anesthesia WorkstationTM to conveniently and securely store medications
and supplies needed during cases. This addition helps with reducing medication errors
made during the selection, preparation and administration of injectable and intravenous
medications, helping to ensure medication accuracy prior to, during and after surgery.
The system is able to receive data imports from a nationally recognized electronic drug
formulary service, which facilitated configuration of the drug database.
Upon removing a drug from the anesthesia workstation, the nurse or anesthesiologist
scans the vial using the labeling system to positively identify the drug and verify that it
is correct. The user then selects and removes a dilution from the workstation. Once the
medication is prepared and ready, the labeling system produces a standardized bar coded
label, eliminating the need to manually add a second bar code label to the final product.
Color codes at St. Mary’s Medical Center:
Induction Agents
Process Yellow C
Tranquilizers
Orange 151
Benzodiazepine Antagonists
Orange 151. White Diagonal Stripes
Muscle Relaxants
Florescent Red 805
Relaxant Antagonists
Florescent Red 805. White Diagonal Stripes
Narcotics
Blue 297
Narcotics Antagonists
Blue 297. White Diagonal Stripes
Major Tranquilizers
Salmon 156
Vasopressors
Violet 256
Hypotensive Agents
Violet 256. White Diagonal Stripes
Local Anesthetics
Gray 401
Anticholinergic Agents
Green 367
P&T Updates Tuesday, February 11th, 2014
IV Shortage: Some IV medications are increaingly becoming in short supply.
Investigational Drug Study: Currently have 4 studies on hand to handle 4 products.
IVIG Availability: Carimune is our IVIG formulary product.
Nimodipine-Safety Concern: Send out safety education information on administration from
package insert.
Dual Physican Indication/Orders November 2013-JC requirement: Need to specify
indications for dual-indication medications (i.e. indicating which medication to try first).
MedWatch Safety Alerts
Safety concern with U-500 insulin
usage: HUMULIN R is the name used for
both U-100 insulin and U-500 insulin. Until
U-500 syringes/pens are available, use
tuberculin syringes to measure doses by
volume, using dosing conversion chart.
http://www.ismp.org/newsletter Accessed 02/10/2014
“With all the drug shortages, we now
treat with a special get-well card”
For More Information About Any of The Pharmacy Updates Please Contact Sheldon Lefkowitz at 882-2781
3
Chairman of the Board: Clint Glass
Chief of Staff: Sheela Shah, MD
Chief Executive Officer:
Davide M. Carbone
Chief Medical Officer:
W. Jeffrey Davis, DO
CONTINUING MEDICAL
EDUCATION
APPROvED CME COURsEs
Wednesday, March 5
• Spine - Trauma M&M, 7:00a to 8:00a,
Trauma Conference Room, EW 310
• Trauma Morbidity & Mortality 8:00a to 9:00a,
Trauma Conference Rm, EW 310
Editor: Barbara Barrett, CPMSM
Director, Medical Staff Services
Printer: Banyan Printing
Crimson
Crimson
Clinical
Advantage
Clinical
Advantage
Crimson
FAQs
CRIMsON
FAQs
Crimson -- -FAQs
What are the Crimson comparison groups?
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data from the Nationwide Inpatient Sample (NIS), based on the availability of that data.
• National and Regional/State - These comparisons use the most recently loaded benchmark
Comparison scores are based on adjustments for each measure, such as APR-DRG and
data
from the Nationwide Inpatient Sample (NIS), based on the availability of that data.
Hospital type
(teaching/non-teaching).
Friday, March 7
• CANCELLED Neuroscience Case Studies,8:00a
to 9:00a, Administrative Boardroom
• Congenital Heart Multidisciplinary
Rounds, 8:30a to 9:30a, Palm Room
•
Friday, March 14
• Neuroscience Case Studies
8:00a to 9:00a, Administrative Boardroom
• Congenital Heart Multidisciplinary
Rounds 8:30a to 9:30a, Palm Room
No. Many industry stakeholders - regulators, rating agencies, patients—already have access
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on
cost
and
quality
performance.
Crimson provides physicians the opportunity to see the underlying data that feeds these reports.
Wednesday, March 19
• Trauma Multidisciplinary Grand Rounds,
8:00a to 9:00a, Cypress Room
• Pediatric Tumor Conference
12p to 1p, Cypress Room
Thursday, March 20
• Trauma Team Journal Cub,8:00a to 9:00a,
Trauma Conference Room, EW 310
•
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Does Crimson
share
profile with other agencies?
Hospital
typemy
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What is “Crimson
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There Is No Such Thing as “Crimson Data”
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same data that is being reported to the Centers for Medicare/Medicaid Services and other payers.
Why should
I View
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or opportunity
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Crimson
provide
to see a comprehensive picture of their performance
• Crimson provides
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to help physicians with rising costs and
treating patients
at the
hospital,
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to include in
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identify opportunities for growth.
• Regular review of physician performance now mandated by Joint Commission’s new standard
for Ongoing Professional Practice Evaluation.
TENET MONTHLY CRIMsON FACT
Friday, March 21
• Neuroscience Case Studies
8:00a to 9:00a, Administrative Boardroom
• Congenital Heart Multidisciplinary
Rounds, 8:30a to 9:30a, Palm Room
Topic: What’s the source and Process of “Crimson” Data?
START:
Patients enters hospital
(admitted as Inpatient,
Observation, or
Emergenecy Department,
or Same Day Surgery)
Wednesday, March 26
• Perinatal Grand Rounds
7:30a to 8:30a, Cypress Room
Thursday, March 27
• Perinatal Grand Rounds
2:00p to 3:00p, Cypress Room
Friday March 28
• Neuroscience Case Studies
8:00a to 9:00a, Administrative Boardroom
• Congenital Heart Multidisciplinary
Rounds, 8:30a to 9:30a, Palm Room
• Infectious Disease Grand Rounds,
12p to 1p, Cypress Room
FOR INFORMATION, Darlene Bosking,
561-882-4534,
[email protected]
DOCUMENTATION:
END:
Tenet releases data to
hosptial end-users
including physicians
Tenet-Crimson Date
Monthly Cycle
All physicians treating
patients in either admitting,
attending, consulting,
performing role document all
procedures and diagnosis
associated with patient care
VALIDATION:
CODINNG:
Tenet goes through
validation process for patient
data and sends to Crimson to
upoad into the Crimson
module. Data sources
include: Internal Data
Access, ECHO, PBAR, and
Quantros
After patient discharge,
credentialed Tenet-employed
coders review all
documentation in the chart
and feeds it into a system that
is used nationally to assiged
final patient Diagnosis Related
Gorups (DRGs)
In short, Crimson data is similar to
the patient billing data that is sent
to CMS and other 3rd party payers.
The roles of Admitting, Attending,
Consulting and Performing physicians that are tagged to the patient
care are all a part of the patient bill
and Crimson will allow you to see
the entire patient’s outcome. This
is referred to as ‘Patient-Centric
Data’.
Crimson is a tool that will outline
‘Directional Data’. This is meant
to help physician and other healthcare leaders identify variations in
practice patterns across similar
patient types and disease states.
Due the process of sending Crimson our Tenet billing data, you can
expect about a 45 day lag-time after patient discharge for the data to
be populated in Crimson. The retrospective data is severity adjusted
and used to maintain or improve
quality patient care.
For questions or more information
contact Dr. Davis.
In short, Crimson data is similar to the patient billing data that is sent to CMS and other 3rd party payers. The roles of
Admitting, Attending, Consulting and Performing physicians that are tagged to the patient care are all a part of the
patient bill and Crimson will allow you to see the entire patient’s outcome. This is referred to as ‘Patient-Centric Data’.
www.stmarysmc.com • (561) 844-6300 • www.palmbeachchildrenshospital.com