Franciscan Health System

Connections
Franciscan Health System
Jan.
2012
Published for our Medical Staff
St. Joseph Medical Center • St. Francis Hospital • St. Clare Hospital • St. Elizabeth Hospital • St. Anthony Hospital • Franciscan Medical Group
Franciscan will open 12-chair
outpatient dialysis unit in East Tacoma
Inside
Quality & Safety:
Beta-blockers
2
Meet our
Club 100 members
3
Pharmacy News
5–6
Medical Staff
and CME calendar
Happy
New Year
Connections January 2012
8
Franciscan Health System is
continuing for about four hours.”
making access to its outpatient kidney
This will be the fourth Pierce County
dialysis services more convenient for
location at which the Franciscan organipatients by opening a dialysis unit at
zation provides dialysis. The others are
72nd Street and Portland Avenue in
St. Joseph Medical Center in Tacoma
east Tacoma.
(inpatient and outpatient); St. Joseph
Called Franciscan Dialysis Center
Dialysis in Gig Harbor (outpatient); and
Eastside, the unit is scheduled to open
St. Joseph Dialysis in Puyallup (outpalater this month. It will include 12 state- tient). Franciscan also provides in-home
of-the-art dialysis stations with heated
dialysis throughout the region.
recliners for patients, and amenities
The address of Franciscan Dialysis
such as free wireless Internet and flat
Center Eastside is 1415 E. 72nd St. It will
screen televisions. Additionally, there
serve patients from 6 a.m. until 10:30
will be plenty
p.m. Mondayof free parking,
Saturday. To refer
Franciscan Dialysis Eastside
and transportaa patient or get
1415 E. 72nd St., Tacoma
tion shuttles can
more information,
Service Hours: 6 a.m.–10:30 p.m.
drop off or pick
please call 253Monday–Saturday
up individuals at
476-5110.
Phone: 253-476-5110
the facility’s front
Clinical Manager: Linda Miller, RN, CNN
Franciscan
Email: lindamiller@FHShealth.org
door. Public
Health System is
transportation
one of the largest
is also readily available, with a Pierce
sources of renal dialysis in the region,
County bus transfer station nearby.
providing more than 65,000 treatments
“Comfort and convenience are
every year. In addition to the dialysis
essential for our patients who are
stations at its new clinic in east Tacoma,
undergoing outpatient renal dialysis,”
there are 38 dialysis stations at St. Joseph
says Kevin Jenkins, regional director of
Medical Center, 12 at the Puyallup clinic
St. Joseph Dialysis Services. “Each indiand nine stations in Gig Harbor.
vidual has, on average, three treatment
sessions every week, with each session
Advanced Medicine. Trusted Care.
www.FHShealth.org 1
Quality & Safety
Medical staff Leadership
Franciscan Medical Executive Committee
William B. Cammarano III, MD John J. Jiganti, MD
Medical Staff President
Member-at-Large, SAH
Vice President, SJMC
Peter R. Kesling, MD
Jason W. Allen, MD
Member-at-Large, SAH
Vice President-elect, SAH
Charles Leusner, MD
Ulrich Birlenbach, MD
Member-at-Large, SCH
David L. Brown, MD
Member-at-Large, SFH
Steven G. Duras, MD
Vice President-elect, SCH
Donald L. George, MD
Vice President, SAH
W. Mark Hassig, MD
Vice President-elect, SFH
William Hirota, MD
Member-at-Large, SJMC
Vice President, SFH
Navdeep S. Rai, MD
Member-at-Large, SFH
Yolanda J. Richardson, MD
Vice President-elect, SJMC
Maggie Sekeramayi, MD
Member-at-Large, SCH
Wendy Weeks, MD
Member-at-Large, SJMC
Allen H. Yu, MD
Vice President, SCH
Franciscan Credentials Committee
Richard K. Gould, MD, chair
Norman H. Burns, MD
Michele R. Campbell, DO
David S. Cho, MD
Youl Choi, MD
Jeffrey M. Cortazzo, MD
Paul W. Hildebrand, MD
Byron Hutchinson, DPM
Maureen A. Nuccio, MD
Bruce Wilson, MD
H. James Yamashita, MD
Mark Yuhasz, MD
Aaron J. Zima, MD
St. Joseph Medical Center Section Chiefs
G. Gordon Benjamin, MD
Diagnostic Imaging
Donna Payne-Snyder, CNM
Midwifery
Linda D. Burkhardt, MD
Lab/Pathology
J. Dale Howard, MD
Mental Health
William B. Cammarano III, MD Tejinderpal Singh, MD
Medicine
Anesthesia
Eugene S. Cho, MD
Surgery
Allister Stone, DO
Emergency Medicine
Martin V. Cieri, MD
Pediatrics
Gail C. Venuto, MD*
Eve Cunningham, MD*
OB/GYN
*co-chairs
Keith E. Demirjian, MD
Family Practice
St. Francis Hospital Section Chiefs
Mohinder S. Badyal, MD
Pediatrics
Linda D. Burkhardt, MD
Lab/Pathology
Jeffrey M. Cortazzo, MD
Emergency Medicine
Michael S. Davidov, MD
OB/GYN
William Cammarano III, MD
Anesthesia
W. Mark Hassig, MD
Medicine
Charles Leusner, MD
Diagnostic Imaging
Linda M. Petter, DO
Family Practice
Kevin J. Ward, MD
Surgery
St. Clare Hospital Section Chiefs
Linda D. Burkhardt, MD
Lab/Pathology
Youl Choi, MD
GYN
David R. Kennel, MD
Family Practice
Kim L. Moore, MD
Emergency Medicine
David R. Munoz, MD
Medicine
Charles M. Piatok, MD
Anesthesia
shown that continuing beta-blockers
perioperatively, with no interruption
in dosing, yields lower mortality rates.
Therefore, titration of beta-blockers
to maintain steady heart rate control
should be the provider’s goal in the
care of these surgical patients (reference: CMS Specifications Manual 4.0b
[discharges 01-01-12 – 06-30-12]).
For more information about quality measures or to order a free copy
of the Franciscan Quality Indicator
booklet, contact Whende Martin, RN,
Clinical Effectiveness, 253-552-5779 or
whendemartin@FHShealth.org.
“Quick Tip” is published in each edition
of this newsletter to help Franciscan Medical
Staff members achieve 100 percent compliance with CMS clinical quality indicators
for acute myocardial infarction, pneumonia, heart failure, and the Surgical Care
Improvement Project (SCIP). Physicians and
other providers who achieve full compliance
for three consecutive months become members
of the Franciscan Club 100. See the newest
list of Club 100 members on page 3.
Todd Willcox, MD
Surgery
Franciscan Medical Staff Additions
Mark S. Yuhasz, MD
Radiology
(Listed by name, specialty, primary hospital)
Cynthia M. Mosbrucker, MD
Surgery & GYN
Amy Calimlim, DO
Emergency Medicine
St. Clare Hospital
Sabrina Shaheen, MD
Cardiovascular Disease
St. Joseph Medical Center
Brian Levy, MD
Internal Medicine
St. Francis Hospital
Glen Shapiro, MD
General Surgery
St. Joseph Medical Center
Charles M. Piatok, MD
Anesthesia
Gary R. Pingrey, DO
Family Practice
St. Elizabeth Hospital Medical Staff Officers
Jude Verzosa, MD
Medical Staff President
Changes to the CMS core measure quality indicator, titled “Surgery
Patients on Beta-Blocker Therapy Prior
to Arrival Who Received a Beta-Blocker
During the Perioperative Period,”
took effect beginning with Jan. 1, 2012
patient discharges.
Change: The perioperative period
is now defined as the day prior to surgery through postoperative day two
(POD 2).
Details: This measure evaluates the
administration of more than one dose
of a beta-blocker the day prior to or
the day of surgery and on postoperative day one (POD 1) or postoperative
day two (POD 2), unless reasons for
not administering the medication are
documented. Documentation to “hold
all meds” or to “hold all PO meds”
postoperatively alone is not acceptable.
Reason(s) to withhold a beta-blocker
must be explicitly documented in the
patient’s medical chart.
Rationale: The perioperative period
has been extended to improve patient
safety and outcomes. Evidence has
Keith A. Weissinger, MD
Pediatrics
St. Anthony Hospital Section Chiefs
Jason W. Allen, MD
Radiology
Linda D. Burkhardt, MD
Lab/Pathology
Raed N. Fahmy, MD
Medicine
Thomas J. Minter, MD
Emergency Medicine
100
Club
Quick Tip
Change in SCIP beta-blocker
quality indicator takes effect
Steve Atkinson, MD
Vice President
Franciscan Health System is guided by the Ethical and
Religious Directives for Catholic Health Care Services.
2 www.FHShealth.org
Advanced Medicine. Trusted Care.
January 2012 Connections
100
Club
Members
Congratulations to Franciscan Club 100 members
The following Franciscan Medical
Staff providers achieved 100 percent
compliance with CMS clinical quality
measures for three consecutive months
(April-June 2011). Club 100 members
prefixed with an asterisk* achieved 100
percent compliance for the entire fiscal
year (July 2010-June 2011).
*David W. Gauger, MD
*Cynthia Geddes, MD
Donald L. George, MD
*Erik M. Gerdes, MD
*Hani A. Ghali, MD
David E. Gibson, MD
*Paul H. Gibson, PA-C
*Emad N. Girgis, MD
*George F. Gleva, MD
Rafael A. Gonzalez-Vizoso, MD
*Robert C. Gramann, MD
*Richard E. Gray, MD
*James H. Greene, MD
Source: Franciscan Department of Clinical
Effectiveness
-H*Margaret L. Hall, DO
*Elhami Hannan, MD
Ellen M. Hardin, MD
*Teresa M. Harding, ARNP
Mary Harris-Tucker, PA-C
*Olaf Hedrich, MD
Maecenas B. Hendrix, MD
*Lisa M. Hile, MD
*Thomas Hirai, MD
*Phoebe F. Ho, MD
*Robert A. Hodge, PA-C
Michelle Holm, MD
*Russell R. Holtz, MD
*Jane M. Houtz, MD
Bradley S. Howeiler, MD
Yi Hsieh, MD, FACS
*David H. Hunter, MD
-A*Mohamed A. Ahmed, MD
Fadi Alhafez, MD
*Fizzah M. Ali, MD
*S. Jameel Ali, MD
*Carey L. Anderson, CCP
Ryan J. Anderson, MD
*J. S. Andrew MD
Yasmeen N. Ansari, MD
*Amir Aref, MD
*Christopher S. Arroyo, MD
*Julian S. Arroyo, MD
*Simeon W. Ashworth, DO
*Eugene S. Cho, MD
Youl Choi, MD
*Paul Y. Chung, MD
*Gail L. Clifford, MD
*Leslie A. Cohen, MD
*Lisa L. Coons, PA-C
Spencer A. Coray, MD
*Jeffrey M. Cortazzo, MD
*Andrea Covault, PA-C
Ian D. Cowan, MD
Thomas L. Cross, DO
*Marco Cruz, MD
*Randal C. Cupp, PA-C
-B*Thomas F. Babson, DO
*John B. Bak, MD
*John H. Bargren, MD
*Ramon R. Basa, MD
Tavinder Basra, MD
*Keith F. Batts, MD
*Clifton T. Baylor, MD
*Kristin N. Beck, PA-C
*W. B. Bede, MD
*Nathanial C. Beitz, PA-C
Teresa D. Bell, MD
*Sharon I. Bennett, PA-C
Bhavana Bhanot, MD
Gurdip S. Bhatia, MD
*Himanshu Bhutani, MD
Ulrich Birlenbach, MD
*David H. Bishop, MD
*Sanders S. Blakeney, MD
*Karin Boone, PT
*Gregory Brammer, MD
Gene L. Brenowitz, MD
Kimberly T. Brooker, MD
*Peter G. Brown, MD
*Anne W. Brucker-Busso, MD
Charles P. Buck, MD
*Norman H. Burns, MD
*Oscar M. Busso, MD
*James D. Buttorff, MD
-DLucia Y. Dai, MD
Viet-Nam B. Dang, MD
Donald A. Dashiell, MD
*Lakshmi Datla, MD
*Michael S. Davidov, MD
Douglas T. Davidson, MD
A. J. Dawood, MD
*David W. Dempster, MD
*Melody C. Denson, DO
*Glenn A. Deyo, MD
*John N. Diaconou, MD
*Holly A. Dickson, MD
*Stacey A. Donion, MD
*Omar K. Dorzi, MD
-C*Lyle T. Calcamuggio, MD
*Robert L. Caldwell, MD
David A. Cameron, MD
William B. Cammarano, MD
*John A. Campbell, MD
*Michele R. Campbell, DO
*Anthony P. Caruso, MD
Michael K. Cavanagh, PA-C
*Roger F. Chamusco, MD
*Brandon J. Chandos, MD
*Pawan Chawla, MD
*Tobun T. Cheung, MD
Connections January 2012
-E*Andrew M. Elizaga, MD
*John T. Ensley, MD
Pieter V. Esterhay, MD
*Robert L. Evans, MD
-FRaed N. Fahmy, MD
*Guoping Feng, MD
*William S. Finnerty, ARNP
*Radu A. Florea, MD
*James S. Floyd, MD
*Dennis M. Ford, MD
Anthony J. Forte, MD
Stephen D. Fowler, MD
*Michael J. Franceschina, DO
*Patricia A. Franklin, MD
*Austen E. Freeda, MD
*Mark A. Friedman, MD
*Stephen E. Friedrick, MD
*Lore Friend, MD
*Theresa L. Froelich, DO
*James K. Fulcher, MD
-G*Prashanthi Ganathi, MD
Patrick H. Garvin, MD
-I*Paul T. Inouye, MD
Theodore Inouye, MD
*Stanley S. Ip, MD
*Manuel G. Iregui,MD
Sarah C. Iregui, MD
*Richard G. Irigoyen, MD
*Lenora M. Ivanek, PA-C
*Suzette W. Iverson, PA-C
-J*Robert C. Jacoby, MD
*Kurt W. Jensen, MD
Robert W. Jensen, MD
*Kaleb K. Jenson, MD
*Tonia L. Jenson, DO
John J. Jiganti, MD
*Emily E. Johnston, MD
*Joshua A. Johnston, MD
*Andre C. Joseph, MD
*Frank M. Jung, MD
-K*Richard A. Kahlstrom, MD
*E. E. Kang, MD
*Giao N. Kaplan, MD
*Adam W. Kassner, MD
*Saifuddin M. Kasubhai, MD
*Michael J. Kelly, MD
*Peter R. Kesling, MD
Ahsan M. Khan, MD
*Muhammad B. Khan, MD
*David M. Kieras, MD
Todd K. Kihara, MD
*Peter V. Kilburn, DO
*Jesse H. Kim, MD
*Stephen H. King, MD
Lance W. Kirkegaard, MD
*Borislav T. Kirov, MD
Gordon R. Klatt, MD
*Steven M. Kodama, MD
*Nikolay G. Kolev, MD
*Helen S. Korman, MD
*Mary Kouri, MD
*Samakshi Krishna, MD
Bahirathan Krishnadasan, MD
*Cora E. Krouse, PA-C
*Mathew Kummerfeldt, PA-C
-LRajneet S. Lamba, MD
*Timothy S. Larson, MD
*Ann M. Lee, MD
*David H. Lee, MD
David E. Lee, MD
Gabriel Y. Lee, MD
James B. Lee, MD
*Tobias T. Lee, MD
*Felix V. Leshchinsky, MD
*Paul A. Lester, MD
*Barbara S. Levy, MD
*Suyang Li, MD
*Donald D. Lillegard, MD
*Dan Liu, DO
*Jorge L. Llera, MD
*Fredric T. Lo, MD
*Edwin C. Lopez, PA-C
*Emily E. Luerssen, MD
Robert P. Lynch, MD
-M*Brian S. Maine, CRNA
*Vinay Malhotra, MD
Rick J. Marino, MD
*Daniel P. McIlmail, MD
Anna McKeone, MD
*James P. McMahon, PA-C
*Mohammad S. Memon, MD
*Vidya Menon, MD
*Lorette I. Meske, MD
Matthew T. Metsker, PA-C
*Joshua S. Meyer, PA-C
Robert T. Middleton, MD
*James F. Miller, MD
Joseph P. Miller, MD
Todd R. Miller, MD
*Yuko K. Miller, PA-C
*Thomas J. Minter, MD
*A. A. Mohit, MD
*Charles M. Momah, MD
*Kingson I. Momah, MD
*Gregory P. Moore, MD
*Kim L. Moore, MD
Milan S. Moore, MD
*Albert C. Morriss, PA-C
Cynthia M. Mosbrucker, MD
*David R. Munoz, MD
*Mohammed M. Muraywid, MD
-NMousumi Nandy, MD
*Craig A. Nattkemper, DO
*Daniel G. Nehls, MD
*Michelle J. Nelson, PA-C
Lee J. Newkirk, MD
*Judith D. Nielsen, MD
*Vivian C. Nkwonta, MD
*R. S. Norton, MD
*Mark R. Nyreen, MD
-OMatthew D. Olsen, DO
*Robert Ostericher, MD
Matthew Otto, MD
Linda Pai, MD
*Terry L. Paladinetti, MD
*Timothy S. Panzer, MD
Advanced Medicine. Trusted Care.
*Jerry J. Papson, PA-C
*David K. Patterson, MD
*B. G. Perczak-Dudkowska, MD, PhD
Timothy M. Phillips, MD
*Charles M. Piatok, MD
Edson G. Ponraj, MD
*Dana W. Pope, MD
*Richard N. Pulido, MD
*Venkata A. Punyapu, MD
-R*Matthew A. Radel, PA-C
*Jose Jeffrey T. Reasol, MD
*Nallathimmayyagari S. Reddy, MD
*Luke Requa, PA-C
*Stephen A. Resnick, DO
*Kirin M. Rice, DO
*Yolanda J. Richardson, MD
*Karen E. Robinson, MD
*Michelle D. Rockwell, MD
*Myong J. Roe, MD
*Timothy F. Rogers, DO
*Michael P. Rome, MD
Jeffrey S. Rose, MD
*Douglas C. Rossi, PA-C
*Anthony D. Rudd, MD
*Michael Tepper, MD
*Theresa M. Terem, MD
Olmedo Alexander R. Tesoro, MD
Michael K. Thompson, MD,
FACEP
*Bob B. Thong, MD
Arinder Tiwana, MD
*Jennifer A. Tobin, PA-C
*Larry D. Todd, MD
*Kathryn M. Tonder, MD
*Rebecca A. Townsend, MD
*Al M. Truscott, MD
-U*Richard L. Urbon, MD
*Junaid Q. Usman, MD
-V*Patrick J. Vaughan, MD
*R. L. Vercio,MD
*Jude Verzosa, MD
Michael W. Vier, MD
-W*Gary L. Wagner, CRNA
*John D. Wagoner, MD
Jean M. Walsh, MD
*Helen J. Walton, CRNA
*Benny Y. Wang, MD
Jiakun Wang, MD
*Kevin J. Ward, MD
*M. C. Wasicek, MD
*Barbara Y Watanabe, MD
*Deryck S Watermeyer, MD
J. D. Wells, MD
*Edward Weng, MD
*Scott D. Werden, DO
Young J. Whang, MD
*Sandra L. Wilcox, MD
Alison K. Willam, MD
Bruce A. Wilson, MD
James A. Wilson, MD
*Alan B. Wood, MD
*Nathanael R. Wood, MD
*Chelsea L. Woods, PA-C
*Robert C. Wright, MD
Daniel A. Wuthrich, MD
-STariq Salam, MD
Maan G. Salloum, MD
*Lindsay K. Sanders, MD
*Elizabeth G. Sanford, MD
*Martin Schaeferle, MD
Richard A. Schilb, MD
Nathaniel R. Schlicher, MD
*Greg A. Schmale, MD
*Christian Schmalz, CRNA
Dan N. Schneeweiss, MD
*Lisa M. Schomogyi, MD
*Roberto A. Secaira, MD
*Maggie Sekeramayi, MD
Dustin L. Shawcross, MD
Ajainder Shergill, DO
Lawrence D. Sherman, MD
Sean M. Shipley, PA-C
Ashwin B. Shivakumar, MD
Matthew J. Shiveley, MD
*Ashok B. Shroff, MD
*William A. Silva, MD
-YStephen Sim, MD
H. J. Yamashita, MD
Tejinderpal Singh, MD
*Robert A. Yancey, MD
*Paula L. Smith, MD
*Stirling B. Smith, DO
*Kenneth Y. Son, MD, MPH
Donald H. Song, MD
*Mary E. Stanton-Anderson, MD
*John D. Stewart, MD
*Allister G. Stone, DO
*John V. Stoneman, PA-C
*Michelle L. Strong, MD
*Rajesh Subramanian, MD
James A. Suero, MD
Frans G. Swart, MD
Melissa Swenson, MD
Christina L. Szigeti, MD
-TJessica W. Tam, MD
*Tarun Tandon, MD
*Sarah M. Templin, ARNP
Lisa D. TenEyck, MD
www.FHShealth.org 3
News notes
Tacoma Digestive Disease
Center is now Franciscan
Digestive Care Associates
Tacoma Digestive Disease Center
recently joined the Franciscan Medical
Group, significantly expanding
Franciscan’s services for diagnosing and
treating disorders of the digestive system. The medical practice is now called
Franciscan Digestive Care Associates.
As part of the transition, the Tacoma
Endoscopy Center and Harbor
Endoscopy Center in Gig Harbor
have been renamed the Franciscan
Endoscopy Center. Those outpatient
surgery suites are being remodeled
and will reopen in the spring of 2012.
Meanwhile, outpatient procedures are
scheduled and performed at St. Joseph
Medical Center in Tacoma, St. Clare
Hospital in Lakewood and St. Anthony
Hospital in Gig Harbor.
To refer a patient to Franciscan
Digestive Care Associates in Tacoma,
call 253-272-8664; in Lakewood, call
253-582-9335; in Gig Harbor, call
253-858-5433; or in Puyallup, call
253-445-5750.
St. Joseph Ball sets records
for giving, attendance
The 36th annual St. Joseph Medical
Center Ball set event records for both
attendance and the amount of money
raised to benefit the hospital.
The fundraiser, attended by nearly
700 people, generated a net $405,000
to support expansion of cardiothoracic
services at St. Joseph Medical Center.
The annual charity ball, one of the
premier events in the South Puget
Sound region, doubled its major underwriting goal and increased overall net
revenues by 15 percent from last year’s
record-setting event.
“Our hearts are filled by the generosity of all who attended this very special
event and supported the Franciscan
organization,” said Dianna Kielian,
senior vice president for mission and
interim president of the Franciscan
Foundation. “As a non-profit organization, community support is essential
to our ability to meet the needs of the
communities we serve.”
Baiya Krishnadasan, MD, and his
wife, Deborah, served as co-chairs of
the St. Joseph Ball Committee. Dr.
Krishnadasan is medical director for
cardiothoracic services at the 343-bed
medical center.
Hospice and Palliative Care
now uses EMR technology
Franciscan Hospice and Palliative
Care has launched its electronic
medical record (EMR) technology,
which includes billing and inventory
management.
The Cerner system, designed specifically for hospice providers, will improve
information-sharing among providers
and service coordination to benefit
delivery of inpatient and in-home care.
This year, Franciscan Health System
begins deploying the Epic electronic
health record throughout all its clinics
and hospitals. The organization is evaluating when
and how the new Epic technology will
interface with the Cerner BeyondNow
application used by Hospice and
Palliative Care.
Honored for nursing excellence
Christine Anderson, RN, of St. Joseph Medical
Center holds the 2011 March of Dimes Nurse of
the Year Award she received in the Rising Star
category. The award for nursing excellence was
presented at the Western Washington Nurse
of the Year Awards Ceremony on Dec. 8. The
nominator praised Christine for how quickly she
learns to work with a variety of patients, while
demonstrating skillful ease and compassion.
Christine was also praised for her leadership
skills. She is pictured with St. Joseph Medical
Center President Syd Bersante (second from
left), Director of Medical-Surgical Services
Lois Erickson (far left) and nurse Manager
Lori Pelland (far right). Photo by Chris Willard
4 www.FHShealth.org
Advanced Medicine. Trusted Care.
January 2012 Connections
Pharmacy News
1 Nurses are not
agents of physicians
Physicians sometimes forget
to write a discharge prescription
and call it in to a nurse prior to
discharging the patient, so the
nurse can transcribe the telephone
order to the multiple prescription
discharge form.
This is not legal under
Washington State regulation. The
hospital-based nurse is not an
agent of the physician and is prohibited from writing a telephone
order for a discharge prescription.
The options are for the physician 1) to phone in the prescription
to the patient’s pharmacy, 2) send
it electronically to the patient’s
pharmacy, 3) or come back to the
unit and write the prescription on
the multiple prescription discharge
form for the specific patient.
Please follow this process when
an add-on prescription is required.
The nurse does need to be
aware of the prescription if it is
a new medication so it can be
added to the discharge medication
list. It is also important that it be
dictated into the discharge summary so complete information is in
the patient’s chart and medication
reconciliation list.
2 Franciscan LASA List:
Improving Patient Safety
The LASA (Look Alike/Sound
Alike) List was originally required
to be a minimum of 10 combination
products with 10 selected from
JCAHO lists. Now it must be based
upon a review of LASA medications
published by ISMP (Institute for
Safe Medicine Practices). We are
required to take action to prevent
errors due to interchange of medications on our list.
The updated list for 2012 was
approved at the Franciscan PT&T
Committee meeting on Nov. 11,
2011. The complete list includes
drug names, potential errors and
consequences, and specific safety
strategies. General safety strategies to help manage look-alike and
Contact: Franciscan Pharmaceutical Services, 253-426-6692
sound-alike drug names are listed
at the end of the table and can be
used for implementation with each
of the problematic names.
Table A lists the new drugs added
to the Franciscan LASA List for
2012. One note: the Pyridoxine and
Pyridium medication pair has been
mixed up at Franciscan. This mix-up
was reported to ISMP. Computer
changes have been implemented
to prevent it from recurring. Please
keep these medication pairs in mind
as you write medication orders or if
they are prescribed as a telephone
order. This is an important safety
initiative for Franciscan, and all hospitals, to prevent medication errors
and improve patient care.
3
Peptamen
Bariatric®
added to enteral formulary
Peptamen Bariatric is a specialized formula for the acutely ill
obese critical care patient. This is
a Nestle nutrition product. Abbott
is the Health Trust/CHI/Franciscanapproved enteral manufacturer, but
Abbott does not manufacture an
equivalent enteral product.
Candice Gallagher, dietary manager at St. Joseph Medical Center,
presented a trial of Peptamen
Bariatric conducted at the St.
Joseph Medical Center critical care
nursing units during July 18-Sept.
30, 2011. The aim of the study was
to reduce nursing time in giving protein modulars for acutely ill obese
patients and provide correct calorie/protein balance by meeting RDIs
(recommended daily intake).
Prior to the study, acutely ill
obese patients required 15-20 ml
per hour of the Abbott formula along
with 4-6 packets per day of protein
modulars. Also, 20 to 30 minutes
daily were required of nurses to give
the modulars. The modulars were
often not given completely, which
led to patients not meeting RDIs.
Twenty-nine patients were given
Petamen Bariatric during the trial.
Patients met their RDIs and did not
require additional protein modulars,
Continued on page 6
Table A
Potential problematic
drug names
Generic and brand
Potential errors and consequences
Specific safety strategies
BuPROPion and BusPIRone
BUDEPRION (bupropion) and
BUSPAR (buspirone)
Generic names are very close, could be confused.
BuPROPion used for depression; busPIRone
also used for depression as well as nicotine
dependence. Both dosed very differently.
Continue to use tall man lettering for generic
names; see general comments below.
PENTobarbital and PHENobarbital
NEMBUTAL (pentobarbital) and
phenobarbital
Generic names are very close, could be confused.
PENTobarbital used for sedation, anesthesia,
and seizure; PHENobarbital used for epilepsy
and sedation.
Use tall man lettering for generic names;
see general comments below.
penacillAMINE/ penicillin
penacillAMINE
penicillin
Generic names are very close, could be confused.
Use tall man lettering for generic names;
see general comments below.
pyridoxine and pyridium
PYRIDOXINE (vitamin B6) and
PYRIDIUM (phenazopyridine)
Names are very close and both available in
100 mg doses, could be confused.
Modify computer entry to read “vitamin B6
pyridOXINE”; use generic entry for Pyridium
Continue to use tall man lettering for pyridoxine;
see general comments below.
Risperidone and ropinirol
RISPERDAL (risperidone) and
REQUIP (ropinirol)
FDA reports of hospitalization required when
patients given Risperdol instead of Requip and
visa versa. Similarities in both generic and brand
name. Similar carton and packaging.
Use brand and generic names when ordering;
could write indication on order; see general
comments below.
Connections January 2012
Advanced Medicine. Trusted Care.
www.FHShealth.org 5
Pharmacy News, from page 5
thereby saving nursing time and
ensuring that RDIs were met with
the Peptamen Bariatric
formula only.
The PT&T Committee approved
discontinuing use of the combination of the Abbott enteral formula
and protein modulars for obese
patients and added Peptamen
Bariatric to the enteral formulary
so all Franciscan facilities have
access to this product. The product
cost is comparable to the current
Abbott enteral formula plus protein
modulars.
4
Adverse
Drug Reaction
Review: Jan. 1-July 31, 2011
A) Five of 18 potentially preventable ADRs (adverse drug reactions)
were steroid-induced hyperglycemia. The patients were admitted
with COPD and were receiving high
doses of steroids, but with no blood
sugar checks or insulin corrective
scale initiated.
Blood sugar checks and insulin
corrective scale addition will be
discussed at a future meeting of
the COPD Expert Order Set Team or
the Glycemic Control Expert Order
Set Team. Earlier monitoring and/or
addition of corrective insulin orders
to the COPD order set may help
address this issue earlier in the
patient’s stay.
B) Four cases of IV contrastinduced renal impairment were
resolved by discharge. The
Hydration Protocol was not initiated
in those cases. The recommendation is to have IV fluid infused
before and after IV contrast as
per the Hydration Protocol Oder
Set No. 683. Further education
is needed to ensure that this happens consistently. This issue was
taken to the Hospitalist Leadership
Team Meeting in November for
discussion and is printed here as a
6 www.FHShealth.org
reminder to follow the Hydration
Protocol. In addition, diagnostic
imaging and nursing staff can
help make sure that the protocol
is followed.
C) A third highlight from the
ADR report was that a number of
patients were getting larger doses
of narcotics after surgery than
should have been initiated due to
the patients being opioid-naïve.
In these instances, over-sedation
resulted, mainly in elderly patients.
The recommendation is to initiate dosing at the lower end of the
range and titrate up as needed.
This was shared at the Hospitalist
Leadership Team meeting in
November and is printed here as
a reminder to initiate pain control
in this manner in order to prevent
over-sedation.
5
Stress
ulcer prophylaxis
pilot planned in St. Joseph ICU
Rationale for Study: Critically ill
patients are at high risk for stressrelated mucosal damage. Stress
ulcer prophylaxis (SUP) with pharmacotherapy, such as histamine-2
receptor antagonists (H2RAs), is
commonly used as an effective
preventative strategy. The literature
demonstrates that arbitrary use of
SUP with proton pump inhibitors
(PPIs) can result in higher risks for
adverse events.
Pantoprazole and famotidine will
be targeted in the pilot since these
products are overused in many hospitals. Overuse raises risks for drug
interactions, adverse reactions and
medication costs increases. The
pilot program will allow for streamlining these medications.
The goals of the pilot program
are to: Establish appropriate use of
stress ulcer prophylaxis; decrease
the incidence of patients being
unnecessarily discharged on
histamine-2 receptor antagonists
(H2RAs) and proton pump inhibitors; decrease costs associated
with these medications; educate
staff; and eventually implement
the new order set and guidelines
across all Franciscan hospitals. This
will be accomplished by monitoring
patients started on IV pantoprazole
and famotidine in ICU units 5C, 5D,
6C and 6D.
The patients’ histories will be
reviewed to determine if use of
these agents is appropriate. If a
change is needed, the physician
will be contacted for approval.
The Franciscan PT&T Committee
endorsed this pilot program. It will
begin in early 2012. Megan Field, a
Franciscan pharmacy resident, will
lead the study.
6 Drug Shortage Update
Drug shortages are a daily challenge for Franciscan hospitals and
clinics, as well as for hospitals
and clinics across the nation. The
situation has attracted congressional and presidential action, and
rightly so as the drug shortages are
affecting patient care and patient
safety. There is a bi-weekly drug
shortage call within Catholic Health
Initiatives (CHI) and product is being
shared across the country.
We are communicating shortage issues on a daily basis with
the FDA. Shortages are affecting
nearly every drug class at this time.
Some medications are not available at all or are severely restricted
(i.e., Doxil, bleomycin, Fabrazyme,
leucovorin, and cytarabine). Other
medications (such as lorazepam,
midazolam, diazepam, fentanyl,
hydromorphone, morphine, oxytocin, vitamin K both 1 mg and 10
mg injection, ondansetron, bupivacaine, ketoralac and sufentanil) are
available in only minimal strengths
and sizes, if at all. Various strengths
and sizes of lidocaine have been in
Advanced Medicine. Trusted Care.
very short supply.
At times, we have had to draw
up unit doses of injectable agents
when the vials or amps have not
been available. There are more than
200 medications in short supply or
not available at all. This is the worst
drug shortage situation in more
than 30 years.
At CHI and Franciscan, we are
supporting legislation in Congress
to address the shortage issue. A
couple of recent perspective articles in the New England Journal of
Medicine dealt mainly with oncology drugs, but they are indicative
of the shortages that are affecting
many different drug classes.
We were nearly out of levofloxacin IV at Franciscan recently.
One manufacturer’s product was
not approved by the FDA, and that
has led to a very short supply of
injectable product. Bioequivalency
of oral levofloxacin is nearly 100
percent compared to IV levofloxacin, so no efficacy is lost as long as
the patient can absorb
levofloxacin orally.
Please be patient during these
times of short supply. We will continue to communicate to all stakeholders affected by these shortages
as information becomes available.
We will never purchase from the
“gray” market. We don’t know the
pedigree of products supplied in
that market. For patient safety and
other reasons, it is inappropriate to
buy from these sources
—Mike Bonck, pharmacy manager for quality, information and
technology. Phone: 253-426-6692;
Email: mikebonck@FHShealth.org
January 2012 Connections
Connections January 2012
Advanced Medicine. Trusted Care.
www.FHShealth.org 7
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Nonprofit Org.
U.S. Postage
Paid
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Connections
Medical Staff Calendar
1717 South J Street, Tacoma 98405
January
2
Journal Club, cancelled for holiday
Academic Affairs and Medical Staff Offices, closed for holiday
3
Neuro/Gamma Knife Conference,
SJMC, 7–8 a.m., Neuro/Gamma Knife
Conference Room
CME Committee Meeting, SJMC,
cancelled for holiday
4
Tumor Board, SJMC, 7–8 a.m.,
Dining Room 2
SJMC Medical Staff Operating Committee, 6 p.m., Portview
Conference Room
SFH Medical Staff Operating Committee, 6 p.m., Outpatient Center Conference Room
5
Pierce County Breast Conference, Carol Milgard Breast Center, 7 a.m.,
3rd Floor Conference Room
9
Credentials Committee, SJMC, 7 a.m., Portview Conference Room
11 Thoracic Tumor Board, SJMC, 7–8 a.m., Dining Rooms 1&2
Tumor Board, SAH, 7-8 a.m.,
Larson Conference Room
12 Pierce County Breast Conference, Carol Milgard Breast Center, 7 a.m.,
3rd Floor Conference Room
17 Neuro/Gamma Knife Conference,
SJMC, 7–8 a.m., Neuro/Gamma Knife Conference Room
Pierce County Breast Conference, Carol Milgard Breast Center, 7 a.m.,
3rd Floor Conference Room
18 Tumor Board, SJMC, 7–8 a.m.,
Dining Rooms 1&2
Breast Care Conference, SFH, 12–1 p.m., Garden Room
Grand Rounds, SJMC, 12:30–1:30 p.m., “Surgical Options for Abdominal Wall Hernias,” Norman Burns, MD,
Lagerquist A&B
SFH Medical Staff Social, SFH, 6 p.m., MOB Conference Room
19 Pierce County Breast Conference, Carol Milgard Breast Center, 7 a.m.,
Breast Care Conference, SFH, 12–1 p.m., 3rd Floor Conference Room
Outpatient Conference Room
Breast Care Conference, SFH, 12–1 p.m., Grand Rounds, SJMC, 12:30–1:30 p.m., Garden Room
“Treatment of Severe Asthma:
20 Tumor Board, SFH, 12 p.m.,
Pharmaceutical & Non-Pharmaceutical Outpatient Conference Center
Options,” Navdeep Rai, MD, Lagerquist A&B FHS Medical Executive Committee, SJMC, 6 p.m., Lagerquist A&B
23 Journal Club, SCH, 12:30–1:30 p.m., Classrooms A&B
13 FHS PT&T Committee, SJMC, 7 a.m., Dining Rooms 1&2
24 Medical Research Evaluation Committee, SJMC, 12 p.m., Lagerquist C
25 Tumor Board, SJMC, 7–8 a.m.,
Dining Rooms 1&2
Grand Rounds, SFH, 12:15–1:15 p.m.,
“Aortic Stenosis: A Malignant Disease Inadequately Treated,” Craig Hampton, MD, MOB Conference Room
16 Journal Club, SCH, 12:30–1:30 p.m., Classrooms A&B
Tumor Board, SAH, 7–8 a.m.,
Larson Conference Room
26 Performance Quality Leadership
Group, SJMC, 7 a.m., Lagerquist A&B
27 Grand Rounds, SFH, 12:15–1:15 p.m., “Chronic Ankle Pain,” Byron Hutchinson, DPM, MOB Conference Room
30 Journal Club, SCH, 12:30–1:30 p.m., Classrooms A&B
Legend: SJMC=St. Joseph Medical Center;
SFH=St. Francis Hospital; SCH=St. Clare Hospital;
SAH=St. Anthony Hospital; SEH=St. Elizabeth Hospital;
MOB=Medical Office Building; Carol Milgard Breast Center
is at 4525 S. 19th St., Tacoma
More Information:
Franciscan Academic Affairs
253-426-6035
diannwinkcompleck@FHShealth.org
Printed on Recycled Paper
8 www.FHShealth.org
Advanced Medicine. Trusted Care.
January 2012 Connections