May 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, May 2017 topics include:  


Welcome

Hard to believe that when you read this summer edition of eFocus, I will have been here for one year as your CMO. Time flies when you are having fun. We've had several innovative and exciting programs implemented this year like Language of Caring, Biofire and a Coronary CTA Program. A recent addition to the list of innovative programs is the recent implementation of a Tele-Infectious Disease consultation service for Harford Memorial Hospital. We bid farewell to Dr. Shabnam Naseer, ID consultant at HMH, which forced us to look for innovative alternatives. Now, every ID consultation since May 10th is done through a Tele-link with Dr. Leonardo Girio-Herrera at UCMC. We are tracking quality measures to ensure high quality care continues. It is an exciting look into future alternative methods for health care delivery to the Harford and Cecil County areas. Excellent work by Jean Almacy, Priscilla Price, Dr. Younus, Dr. Girio-Herrara, Rick Casteel and the rest of the team that made this happen.

We have a full eFocus this month for everyone and it is heavy on the opioid epidemic that has stricken the nation. Unfortunately, we have an announcement about the first carfentanil death in Harford County as well as a statement from Dr. Julie Stancliff regarding opioid stewardship. We do have some uplifting announcements regarding acknowledging our inspirational, high performing leaders that won Nurse of the Year awards. And, we have the summary announcement of the Letter of Intent for the Behavioral Health Pavilion which is another stepping stone to the transformational realignment of health care that we call Vision 2020. There is, of course, a clue embedded for a Starbucks $20 gift card so keep an eye out. We have one more month to close out the fiscal year. Cue the Rocky Balboa music and let’s finish this out on a high note!      

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


Opioid Stewardship

Everyday we see the statistics, billboards and articles in The Aegis illustrating the devastation that opiates have upon our Harford County community and the rest of the nation. How can we, as prescribers, make any impact on this epidemic?

First, before prescribing controlled substances health care providers should review the Maryland Prescription Drug Monitoring Program (PDMDP). Beginning July 1, 2018, prescribers must review PDMP prior to initially prescribing an opiate or benzodiazepine AND at least 90 days thereafter as long as the course of opiate/benzodiazepine treatment continues. Prescribers must document the PDMP date in their medical record.

Second, prior to initiating any controlled substance, screen for addiction. Easy to use tools include AUDIT, DAST_10, SBIRT (which is reimbursable) and the CAGE AID. Consider obtaining urine drug screen on the first visit and subsequent visits during the course of treatment.

Lastly, before prescribing any controlled substance, screen for depression and anxiety. According to NAMI, a third of all people experiencing mental illness and half of people living with severe mental illness also experience substance abuse. Tools such as PHQ-9 and GAD-7 are reliable and useful tools.

Review the CDC’s new guidelines on opiate and pain; opiates should be not be the first line or the only treatment for patients that present with chronic non-cancer pain. Your awareness and participation in opioid stewardship can have a big impact on this epidemic in our community.

Related: First fatal overdose involving carfentanil reported in Harford

*According to the CDC, how many people have died in the U.S. from opiate overdoses since 2000? (Hint: it's in the 'related' article above). The first 5 people to send the correct answer to [email protected] will be entered in a drawing to win a $20 Starbucks gift card.


U-500 Drug Safety Change

There are notable revisions to our Humulin R U-500 order set. This insulin is 5 times more concentrated than U-100 insulin. There is a high risk of dosing errors when converting between dosage in pens, U-100 syringes, and now the new U-500 syringes. As a result, health care providers will require a documented conversation with our on-call endocrinology team prior to ordering. This involves an additional task to your already busy day, but is a necessary step to ensure the safety of our diabetes patients.


UM UCH Takes Next Step Toward New HdG Medical Campus

The next step in our plan for reshaping the delivery of health care in Harford and Cecil Counties progressed last week as the Health System filed a letter of intent with the Maryland Health Care Commission to create a Behavioral Health Pavilion/special psychiatric hospital, as part of its proposed new medical campus on 97 acres at Bulle Rock in Havre de Grace. “Filing the required letter of intent with the state enables us to continue moving forward with our Vision 2020 plans," said Lyle E. Sheldon, President and CEO.  "Our vision is simple--to reshape health care by providing the best possible care to our community. Vision 2020 encompasses planning for the health care needs of our community, and one of the most pressing needs today and into the future is behavioral health support.”

The Behavioral Health Pavilion is one component of an estimated $160 million plan to build a new multi-services medical campus on our Bulle Rock property located at Interstate 95 and Route 155 in Havre de Grace, and to expand inpatient and surgical services at UM UCMC. Other components of the proposed Bulle Rock Medical Campus include a Freestanding Medical Facility, encompassing a full-service Emergency Department, short-stay medical observation beds, as well as outpatient and ambulatory care services, within an on-campus Medical Office Building. The proposed new medical campus at Bulle Rock and expansion of UM UCMC will replace the existing UM HMH.

The submission of the letter of intent with state health regulators is part of an extensive series of reviews and public hearings that are required for the construction of new health care facilities in Maryland. The Health System must receive a Certificate of Need and a Certificate of Exemption for the overall project at Bulle Rock before it can begin construction.

The opening of the new medical campus in Havre de Grace is projected to take place in 2020. For more information, visit umuch.org/vision-2020.


Nurse of the Year Accolades

Nurses are critical in shaping our patient and family centered model of care and culture of excellence focusing on safety, quality, empathy and efficiency. Please join me in congratulating the 2017 Nurse of the Year Award recipients:

  • Casey Michaelis, UM HMH Clinical Nurse of the Year
  • Pattie Diegert, UM UCMC Clinical Nurse of the Year
  • Allen Siegel, UM HMH Clinical Support Nurse of the Year
  • Deborah Scheihing, UM UCMC Clinical Support Nurse of the Year
  • Patricia Thompson, UM HMH Leadership Nurse of the Year
  • Jerry Creighton, UM UCMC Leadership Nurse of the Year

Lab Updates

  • The lab will be going live with the Biofire respiratory panel on 6/5/17. This test can only be ordered if approved by an Infectious Disease provider and requires special transport. The lab will need to be contacted for the transport media and they will forward to the needed location via the PEVCO system. The Biofire respiratory panel includes the following organisms/viruses: Adenovirus, Coronavirus HKU1, Coronavirus NL63, Coronavirus 229E, CoronavirusOC43, Human Metapneumovirus, Human Rhinovirus/Enterovirus, Influezna A, Influenza A/H1, Influenza A/H3, Influenza A/H1-2009, Influenza B, Parainfluenza Virus 1, Parainfluenza Virus 2, Parainfluenza Virus 3, Parainfluenza Virus 4, Respiratory Syncytial Virus, Bordetella pertussis, Chlamydophlia pneumoniae, and Mycoplasma pneumoniae.
  • The Biofire meningitis panel has been live since 4/4/17. It has come to the lab’s attention that there is some duplication in test requests if the Biofire meningitis panel is reflexed and the physician has ordered viral testing on a CSF. Moving forward, if a Biofire meningitis panel is reflexed, and separate viral tests that are included in the panel have been ordered individually, those tests will be canceled and the results will be with the Biofire results in the patient’s medical record. The viruses included in the Biofire meningitis panel are: Cytomegalovirus (CMV), Enterovirus, Herpes simplex virus 1 (HSV1), Herpes Simplex virus 2 (HSV2), Human herpesvirus 6 (HHV-6), Human parechovirus, Varicella zoster virus (VZV). If the Biofire meningitis panel does not reflex, the viral testing will be sent to our reference lab to be performed.
  • The lab will be moving to a new reference lab on 6/26/17. Our new reference lab will be ARUP (Associated Regional and University Pathologists) which is located in Salt Lake City, Utah. This transition should be seamless but reports will now indicate that ARUP is the performing site for these send out tests.

Provider Social Recap

The April 27 Provider Social at Stone's Cove Kitbar was a great night of networking, introductions and opportunity to softly promote ChoiceOne, DocHalo, WATCH, Healthy Harford and other programs and services. Fifty providers attended, with nearly 65 in total attendance. Join us for our next Provider Social at the July 14th Aberdeen Ironbirds game (6 p.m. game). Providers may bring their spouse/significant other and children, but tickets are on a first come, first served basis as there are only 60 tickets available. Please RSVP to Stephanie Paradise-Brown at [email protected] or text 410-382-7747.   



UCMC Receives Stroke Quality Award

UM UCMC recently received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award with Target: StrokeSM Honor Roll. The award recognizes the hospital’s commitment to providing the most appropriate stroke treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

Hospitals must achieve 85 percent or higher adherence to all Get With The Guidelines-Stroke achievement indicators for two or more consecutive 12-month periods and achieve 75 percent or higher compliance with five of eight Get With The Guidelines-Stroke Quality measures to receive the Gold Plus Quality Achievement Award.

To qualify for the Target: Stroke Honor Roll, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability.

These quality measures are designed to help hospital teams follow the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients.

In addition, UM UCMC and UM HMH have met specific scientific guidelines as Primary Stroke Centers featuring a comprehensive system for rapid diagnosis and treatment of stroke patients admitted to the emergency department.


In Case You Missed It

Have a minute or two? Check out these quality articles recommended by David Branch for a little light reading:

  1. In Conversation with...Brent C. James, MD, Intermountain Healthcare: https://psnet.ahrq.gov/perspectives/perspective/97
  2. Secret Data On Hospital Inspections May Soon Become Public: http://www.npr.org/sections/health-shots/2017/04/18/524513837/secret-data-on-hospital-inspections-may-become-public-at-last

Pharmacy Updates

  • MEC (5/10/17) has approved the DELETION of ciprofloxacin IV/PO from formulary:
    • Order sets with Ciprofloxacin are being revised, go-live date for order sets is 6/6/17
    • Pharmacy will continue to dispense ciprofloxacin IV/PO until our supply is depleted, then Pharmacy will autosub as below


  • Currently, we are only able to procure methylene blue 0.5% solution. The 1% solution is not currently commercially available. It is used in our facilities for a dye but its FDA use is methemoglobinemia. Pharmacy can calculate the appropriate dose if necessary.  

MEC and P&T Summaries

The following items were approved during the MEC meeting held on May 17th.

• Drug Abuse Panel: Oxycodone and Buprenorphine being added for FAMILY BIRTHPLACE only
• CAUTI Reduction Committee – order sets will be revised to reduce catheter ordering options
• Order Sets – biennial review

  • ADM BHU
  • CRRT Heparin – ICU only
  • CRRT Citrate – ICU only
  • CAUTI
  • PCA IV & Adjunct Orders
  • Admit Certification Physician Order
  • ED CCTA Pre-Procedure / CCTA Pre-Procedure Inpatient Orders

• Ibravidine Formulary Addition with restriction to cardio only
• UMMS Initiative: IV Synthroid – Recommend waiting 5 days if patient is NPO then IV can be initiated
• ASP Guideline Revision: ASP report will be changed to DOT (days of therapy) instead of DDD (defined daily dose) as suggested by the CDC. Also deleting ciprofloxacin (systemic) from the formulary with autosub by pharmacy from ciprofloxacin to levofloxacin.  
• Biofire Algorithm: Treatment algorithm developed based on hospital antibiogram.


Upcoming Meetings and Events

Mark your calendars for important standing meetings and special events.

Special Events

  • 4th Annual Amanda Hichkad CCA Celebration Walk: Annual community fundraising event that honors and memorializes family and friends in the fight against cancer, while supporting Cancer LifeNet at the Kaufman Cancer Center.
    Saturday, June 3rd, 7:30 a.m. (day-of registration opens) and 8 a.m. (ceremonial program and walk begins)
    Ripken Stadium, Aberdeen 

  • Senator Bob Hooper House Hospice Regatta: A magical evening that supports hospice care. Guests will enjoy the annual sailboat race, a delicious meal, live music, gaming wheels and live auctions. Contact The Foundation for more info at 443-643-3460.  
    Saturday, June 3rd, 5-10 p.m., next to Concord Point Lighthouse in Havre de Grace.

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