March 2017

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Welcome to eFocus.  Our goal is to provide you with timely, informative and useful short summaries and links about UM UCH related news, issues, or events.  Feel free to contact us if you have news to share, story ideas or any other feedback. As always, your comments are welcome.

eFocus, March 2017 topics include:  


Welcome

We are knocking on the door to spring and it seems like it was just yesterday that we were preparing the Command Center for a potential blizzard. The OR flood feels like it was ages ago, though I know many from our OR staff probably still twitch when thinking about those days. Through these crises, it has been impressive to see how well our teams work together.

Several new interventions and programs are getting started. The “Daily Briefs," occurring every weekday at 9 a.m., have provided a wealth of information and inspiration. Each morning for approximately 15 minutes hospital leaders meet to discuss the events of the past 24 hours. This has improved our situational awareness and my response time to specific medical staff issues.

You might have noticed that a mobile CT scanner is adjacent to the Ambulatory Care Center. This is temporary as we are currently replacing our outpatient CT scanner. Sequentially, we will then replace the Emergency Department/Inpatient CT Scanner with the “Big Daddy” 256-slice CT scanner that will be the workhorse for the Coronary CT Angiogram program. We will have a slow roll out of that program in May with a full go-live date for July 1st.

eFocus has a multitude of hot topics this month so make sure you take a good look--from changes to opioid prescribing to the Maryland Patient Safety Center Award for our Antibiotic Stewardship Program. There is, of course, the hidden clue embedded in one of our articles. This month the prize is a pair of Orioles tickets celebrating the start of the baseball season. We have one more quarter left in fiscal year 2017; let us push each other to knock it out of the park (pun intended) and end the year on a high note!

Fermin Barrueto, Jr., M.D., M.B.A.
Senior Vice President/CMO
Medical Staff Affairs


Maryland Patient Safety 'Circle of Honor' Winner

Together, Jennifer Bui, Pharm D and Faheem Younus, MD, received a Maryland Patient Safety Center 'Circle of Honor' selection for their submission "Antibiotic Stewardship: A Journey Toward the Triple Aim." The aim of establishing an antibiotic stewardship program (ASP) at UM UCH was to rectify anecdotal evidence pointing to occasional and inappropriate antibiotic use at our two hospitals. 

Drs. Bui and Younus presented their submission as a poster at the recent Maryland Patient Safety annual conference in Baltimore. You can view it online here. Congratulations!

*The first person to send the four program goals of the Antibiotic Stewardship at UM UCH to fbarrueto@uchs.org will win a pair of Orioles tickets.


Nominate a Top Doc

Baltimore magazine's 31st annual Top Doctors Survey is underway and we encourage all physicians to participate. This is historically one of the best-read features (and most sought-after back issues) of Baltimore. The magazine is asking you to refer several physicians in 100-plus specialties to whom you would send a member of your own family for treatment. UM UCH had a good showing in the 2016 survey (26 doctors, 3 of whom were named in multiple categories) and we're hoping to do even better this year!

You can take the survey online at baltimoremagazine.net/about/top-doctors-survey; tentative deadline is July 1st.


Changes to Opioid Prescribing Policies

All providers will have to have to register for the Prescription Drug Monitoring Program through CRISP. Provider education will be coming and must be completed by July 1st.  To expedite the process with CRISP, Single Sign On (SSO) will be coming soon.  The policy changes were made in response to the increasing number of opioid-related deaths in Maryland.  Click here for the changes.


New Physician Leadership Positions

I am pleased to announce the approval of two new physician leadership positions at UM UCH: Chief Quality Officer and Chief Medical Informatics Officer. We are looking for inspirational leaders who are able to work collaboratively and drive change in the organization.  Interested candidates may find out more information and apply via the links below.


Meningitis Panel Coming to BioFire

Effective April 4th, the BioFire meningitis reflex panel will be active for bacterial and viral meningitis. The test will be reflexed if WBC > 5 or protein >50. It is not available in order entry. 


Diversity Day Luncheon

A Diversity Day luncheon was hosted by the hospitalists at UM UCMC on March 20th. Food served represented each provider's country of origin or a personal favorite of his/hers. The team also placed pins on a map indicating where they are from. 


Disclosure of Adverse Events & Informed Consent

Did you know that a “Chain of Errors” occurs in 77% of adverse patient events?

  • 80% of cases include miscommunication

    • 44% communication breakdowns with patients or colleagues

    • 21% misinformation in the medical record

    • 18% mishandling patient requests and messages

    • 12% inaccessible medical records

    • 5% inadequate reminder systems

Clinical Staff, please join us for a presentation on "Necessary Conversations: Disclosure of Adverse Events & Informed Consent" on Thursday, April 6 at the following times:

  • 1-2 p.m., UCMC CCC (video conferencing to HMH Admin Conference Room)
  • 5-6 p.m., UCMC CCC (video conferencing to HMH Med Staff Conference Room)

Food Provided & AMA CME (1 credit)


MEC and P&T Summaries

The following items are from the MEC meeting held on March 8.

  • Approval of Informed Consent Policy; antibiotic desensitization was previously added to the list of therapies/procedures requiring informed consent
  • Doc Halo Policy; orders cannot be given via Doc Halo per CMS regulations. 
  • Anesthesia referral form was approved (a consult will be placed to Anesthesia for mobidly obese patients to determine if care needs to be managed at a different facility)
  • The following order sets are advancing from P&T:
    • CRRT Heparin
    • CRRT Citrate Orders
    • ED Adult Provider standing orders and Downtime Standing Orders
    • Hip Fracture ADM
    • Hip Fracture Postop
    • Warfarin Initial Therapy Orders
    • ED Sepsis Orders (Process change)
    • Comfort Care Orders
    • Ampicillin Desensitization Orders
    • Bactrim Desensitization Orders
    • Desensitization Guidelines
    • Desensitization Informed Consent
  • The following order sets are advancing directly to MEC with no medication changes: PEG Post Procedure, Inpatient **Rewording approved to say: G-tube may ONLY be used for medications (with a 30ML flush) UNTIL GI provides an order clearing g-tube use for other purposes
  • The following order sets are being submitted for consideration prior to P&T approval: Declot PICC/CVC Orders – Inpatient orders and process algorithm
  • The following order sets are being submitted with minor changes: Chemotherapy biennial review; ADM request preliminary orders (white card); PCA epidural obstetric orders


Upcoming Meetings and Events

Mark your calendars for important standing meetings and special events.

Special Events

  • Necessary Conversations: Informed Consent and Disclosure of Adverse Events …what to say, when, and how… legally, morally and ethically. 
    Save the date for a discussion on topics that will include Adverse Events and Medical Error, Unanticipated Outcomes vs Known Complications—the power of a solid informed consent conversation.  Also, Disclosures through Transparent Communications, “Apology” according to Maryland’s Apology Law, and UM UCH Policy and Your Legal Responsibilities.
    Thursday, April 6
    UCMC: 1-2 pm and 5-6 pm, Chesapeake Conference Center
    HMH: 1-2 pm (Admin Conference Room) and 5-6 pm (Medical Staff Conference Room)
    Credits: 1hr AMA Category 1 credit 
    Sponsored by UM UCH Risk Management and Medical Mutual of NC (formerly HPIX)  

Standing Meetings

  • Pediatric Grand Rounds: Held the first Wednesday of every quarter (Jan., Apr., July, Oct.) from 7 - 8 p.m. Guest lecturers present different topics in pediatric medicine, including common dermatologic conditions, effects and management of obesity in children, pediatric head injuries, and more.  
  • Multidisciplinary Thoracic and General Conferences: 12 Noon, Alternates Every Thursday (e.g., Thoracic is 11/3, General is 11/10)
    UM UCMC, KCC Streett Conference Room
  • Multidisciplinary Breast Conference: 8 a.m., Every Tuesday
    Radiology/Oncology Conference Room
  • Pharmacy &Therapeutics (P & T) Committee: 7:30 a.m., Third Wednesday of each month
    UM UCMC Maryland Room 
  • Credentials Committee 7:30 - 9 a.m., Third Friday of each month
    UM UCMC, MSCR 
  • Medical Staff Leadership  8 - 9 a.m., Fourth Thursday of each month
    UM UCMC, Fallston Room/UM HMH, MSCR
  • Metabolic Bariatric Surgery Committee: 5 p.m., Quarterly, Wednesdays
    HMH MSCR and UCMC Fallston Rm
    Upcoming dates: March 15, June 21, Sept 20, Dec 20

  • Allied Health Practitioner Committee:8 – 9 a.m., Third Tuesday of each month
    UM UCMC, MSCR