caring january 20, 2005 - massachusetts general hospital · january 20, 2005 urses, maria roche,...

Inside:Jan Duffy Retires ..................... 11111

Jeanette Ives Erickson ............ 22222¸ Healing After the Tsunami

in Southeast Asia

¸ Flu Vaccine Update

Fielding the Issues .................. 33333¸ Electronic Medication

Administration Process

Marie C. Petrilli Oncology

Nursing Award ..................... 44444

Clinical Narrative .................... 66666¸ Laurie Miller, RN

Clinical Nurse Specialists ....... 88888¸ Theresa Cantanno-Evans,

RN, and Joanne Empoliti, RN

Quality .................................. 1010101010¸ Swiss Cheese and Patient

Safety

Educational Offerings ........... 1111111111

Professional Achievements . 1212121212

CaringCaringJanuary 20, 2005

H E A D L I N E S

Working toMGH P

Duffy retires to tributes,tears, and testimonials

hen they coined the phrase, �All good things mustcome to an end,� surely they were talking aboutJan Duffy�s distinguished career and the countless

accomplishments and contributions she made dur-ing her 23 years at MGH. On Friday, December 17,

2004, Jan Duffy, RN, officially retired, taking with her fondmemories and fond farewells from the many colleagues, pa-

tients, families, and friends whose lives she touched withher skill, professionalism, kindness, and grace.

Wcontinued on page 5

(Photos by Abram Bekker)

Jan Duffy, RNJan Duffy, RN

Duffy with Rosemary O’Malley, RN (top right); Rosalie Tyrrell,RN (lower left); and MGH president, Peter Slavin, MD

gether to shape the futureatient Care Services

January 20, 2005January 20, 2005Jeanette IvesEricksonJeanette Ives Erickson

n the aftermath ofthe tsunami thatdevastated South-

east Asia and partsof Africa, what UN

secretary-general KofiAnnan called, �a naturaldisaster of unprecedentedmagnitude,� the MGHChaplaincy and admini-stration co-sponsored aspecial service of healingand reflection. Many ofyou were able to attend,but for those who werenot, it was a wonderfulopportunity to cometogether to grieve for this

Healing and helping after thetsunami in Southeast Asia

Above:Above:Above:Above:Above: Seedlings

representing new

life were offered as

a symbol of hope.

At right:At right:At right:At right:At right: Marianne

Ditomassi, RN,

executive director

to the office of

senior vice president

for Patient Care,

sounds gong in honor

of countries affected

by the tsunami.

I unimaginable loss of lifeso far away, and to sharehope and prayers for thesafety and healing ofsurvivors everywhere.

MGH president, Pe-ter Slavin, MD, thankedthe MGH community forthe outpouring of con-cern and generosity inthe form of money, sup-plies and needed services.There were readings andhymns; members of theChaplaincy led the gath-ering in song; and part ofthe service was reservedfor the sounding of a

gong in honor of eachcountry affected by thetsunami.

Jeff Davis, seniorvice president for Hu-man Resources, read thisshort poem by ClarissaPinkola Estes, entitled,�The Ultimate Faith.�

New seedis faithful.It roots deepestin the placesthat aremost empty.

Despite the fact thatthis tragedy happenedon the other side of theworld, we are all affect-ed. I�d like to thank theChaplaincy for their ef-forts in bringing us to-gether to support andcomfort one another inthe wake of this horrificevent.

MGH has been invit-ed to participate in acollaborative humanitar-ian effort with ProjectHOPE to help provide

medical support forteams already serving inthe area.

There is a request fornurses and doctors tovolunteer to staff operat-ing rooms, intensive careunits, and medical unitson the US Mercy (a USNaval hospital ship).Susan Briggs, MD, dir-ector of the MGH Inter-national Trauma andDisaster Institute; LarryRonan, MD, director ofthe MGH Durant Fel-lowship; Jeff Davis;Theresa Gallivan, RN,associate chief nurse;and I will co-direct theMGH response. Ourparticipation in the reliefeffort is expected to lastapproximately threemonths with teams ofvolunteers serving 30days at a time.

Many of you haveasked how you can help.We will do our best toensure that any MGHvolunteer who wants tobe involved is able to doso. (All volunteers will

need approval from theirdepartment supervisors.)

Food, medicine, mo-ney, and supplies willcontinue to be needed inthe days and monthsahead. MGH is estab-lishing a tsunami relieffund to contribute much-needed money to helpsurvivors. A committeehas been formed to eval-uate and coordinate thedistribution of moniesfrom this fund. To makea contribution to theMGH Tsunami ReliefFund, visit http://is.partners.org/mghintra net/tsunami/index.htm (nospaces). Donations canbe made on-line.

Flu Vaccine UpdateI want to remind every-one that despite theshortage of flu vaccineearlier in the season,there is now ample sup-ply for all MGH patientsand employees. All re-strictions for receivingflu vaccine have beenlifted, and it�s not too

Jeanette Ives Erickson, RN, MSsenior vice president for Patient

Care and chief nurse

continued on next page(Photo by Paul Batista)

received (and EMAPinformation can be view-ed by more than oneperson, in more than onelocation, at a time). Butonly one clinician is ableto administer and docu-ment medications at anygiven time.

Question: What systemsneed to be integrated orupdated in order to im-plement this program?Jeanette: Pharmacy isinstalling a new comput-er system called Misys,which will be electron-ically linked to POEeliminating the need formanual transcription. Thenew Misys system needsto be in place beforeEMAP can be imple-mented, and that install-ation is expected to becomplete by late 2005.

time frame for imple-mentation?Jeanette: EMAP com-mittees have been meet-ing for the past severalmonths. Focus groupshave been held withnurses and respiratorytherapists to provideinput about EMAP andour current work flow.More focus groups areplanned for the future.

The next event willbe a product fair whereclinicians will have anopportunity to learn moreabout potential EMAPsystems. Then a vendorwill be selected and inte-gration with POE andMisys will begin.

For more informationabout the EMAP initia-tive, contact staff special-ist, Rosemary O�Malley,at 6-9663.

Jeanette Ives Ericksoncontinued from previous page

late to benefit from theprotection the vaccinecan provide.

This winter saw amild start to the flu sea-son, but in recent weeksthere has been a dramaticincrease in the number ofcases reported. It is anti-cipated that flu activitywill continue to increaseduring the months ofJanuary and February.

All MGH patientsand staff are encouragedto get a flu shot. Vaccineis available from Occu-pational Health Services(6-2217) and on all in-patient units.

MGH patients shouldcontact their doctors toask about being vacci-nated. Patients may alsobe vaccinated at theMGH Medical Walk-InUnit Mondays�Fridays,from 10:00am�3:00pm.The cost of a flu shot is$11, but many insurancecompanies cover the cost.

Please help spreadthe word, and not the flu.Thank-you.

Updates

I�m pleased to informyou that Susan Morash,RN, has accepted theposition of nurse man-

ager for the White 11General MedicineUnit.

Chris DonahueAnnese, RN, hasaccepted the positionof staff specialist toTheresa Gallivan,RN, associate chiefnurse for Medicine,Cardiac, and Emer-gency Nursing.

Katie Farraher hasaccepted the positionof senior project spe-cialist in the Office ofQuality & Safety.

Keith Brinkleyhas accepted the po-sition of operationscoordinator for Elli-son 14 and the BMTInfusion Unit.

January 20, 2005January 20, 2005Fielding the IssuesFielding the IssuesEMAP: the Electronic Medication

Administration ProcessQuestion: Can you tell usmore about the new elec-tronic medication systemI�ve been hearing about?Jeanette: The ElectronicMedication Administra-tion Process (EMAP) isa new quality and safetyinitiative I�m sponsoringalong with associatechief nurse, Jackie Som-erville.

Question: What prompt-ed this initiative?Jeanette: We are alwayslooking for ways to im-prove quality and ensurethe continued safety ofour patients. Recently,the Institute of Medicine(IOM) recommended theuse of both computerizedPOE and bar-coded med-

ication-administrationsystems to decrease med-ication errors in the hos-pital setting. POE is de-signed to reduce errors inthe ordering process.EMAP ensures accurateelectronic medicationtranscription, distribu-tion, administration, anddocumentation.

Question: How doesEMAP work?Jeanette: Medicationorders will flow electron-ically from POE to thenew EMAP informationsystem, eliminating theneed for OAs to manual-ly transcribe orders ontoMedication Administra-tion Records (MARs).Nurses will be able to

use the computer to seewhat medications wereordered and when theyneed to be administered.After retrieving the med-ication, nurses go to thebedside with a portablecomputer, scan the medi-cations, scan the patient�sidentification band, andscan the nurse�s identifi-cation badge. If all iden-tifiers are confirmed, thenurse may proceed inadministering the medi-cation. At this point,EMAP automaticallydocuments the time themedication was admini-stered and the name ofthe clinician who admin-istered it.

In the event that adiscrepancy is detected,

the nurse would receivean alert indicating a mis-match. For example, if apatient was supposed toreceive 40mg of Lasix,and the nurse only scan-ned 20mg, an alert wouldbe triggered.

Question: How will thiswork on patient careunits?Jeanette: Each nurse willhave a portable comput-er, which will allow him/her to use the EMAP sys-tem, access POE, CAS,and all other functionscurrently available ondesktop computers. Res-piratory therapists willuse the system to admin-ister and document themedications they admin-ister. Nurses, physicians,therapists, and all othermembers of the team willbe able to see which med-ications a patient has

Last year, the FDAmandated that pharma-ceutical companies startbar-coding medicationsas an added safety pre-caution (currently 50%of all medications arebar-coded). The MGHPharmacy is in the pro-cess of bar-coding medi-cations not previouslybar-coded, and this workmust be completed be-fore EMAP can be imple-mented.

The wristband ini-tiative, which will con-vert current patient IDbands to bar-coded wrist-bands must be imple-mented before EMAP;and Smart Pump tech-nology, which is comingto MGH in the future,will also need to be inte-grated into the EMAPsystem.

Question: What is the

January 20, 2005January 20, 2005

urses, Maria Roche,RN, and Lisa Tufts,RN, were recipients

of the 2004 Ma-rie C. Petrilli OncologyNursing Award in recog-nition of the high-qualitycare, compassion, andcommitment they showin their practice withoncology patients.

The Marie C. PetrilliOncology Nursing Awardwas created by Al Petrilli(Marie�s husband) andhis brother David, whofounded the Marie C.Petrilli Cancer Researchand Treatment Fund tohelp raise money and

awareness around cancerand cancer research.Money from this fundhas also supported ourSocial Services depart-ment in providing fundsfor patients in need andcompleting renovationson Bigelow 7.

Recipients were hon-ored at two separate cer-emonies, one at the an-nual Petrilli fund-raiserat the Winthrop YachtClub on October 1, 2004,and one in the HackettConference Room onNovember 16th.

Nurses can be nomi-nated by patients, family

members, nurse mana-gers, colleagues, or phy-sicians.

Roche has been anurse for 14 years, nineas a nurse practitioner. Ina letter of recommenda-tion in support of Roche,Dr. Carolyn Krasner said,�Maria is able to developan excellent and impor-tant rapport with herpatients. During theirfirst visit with her, pa-tients air their deepestfears. Maria provides acalming influence as shehelps them discuss theirpain and treatment op-tions. Maria is able to

guide them through themany ups and downs ofcancer treatment, andsupport patients andfamilies through hospicecare. And she continuesher involvement withbereaved families.� SaidDr. Krasner, �Manyyoung people who cometo work here with aninterest in medicine and/or research, leave to pur-sue nursing after work-ing with Maria.�

Tufts came to MGHin 1996 and held a num-ber of positions prior toher present role as staffnurse on Ellison 18. No-minated by Ellison 18nursing colleagues andclinical nurse specialist,Mary Lou Kelleher, RN,her letter of recommend-

ation read, �Lisa alwayslooks first at the patientas a person/child/ado-lescent in the context ofa family and then in thecontext of the diagnosis.She connects instantlyand sets the foundationfor a strong relationship.She is a committed pri-mary nurse but has aspecial fondness forpediatric oncology pa-tients. Lisa is alwaysamazed by the courageand resiliency of pedi-atric oncology patientsand realizes the impor-tance of the role of theprimary nurse with pa-tients and families.�

Said nurse manager,Judy Newell, RN, �Lisabrings a �can-do� atti-tude to every situation.She has the ability tokeep the uniqueness ofher patients and familiesat the center of all deci-sions, fostering the verybest in her practice.�

Other nurses nomi-nated for the Marie C.Petrilli Oncology Nurs-ing Award this yearwere:¸ Jennifer Casey, RN¸ Jean Kracher, RN¸ Kimberly MacGregor¸ Patricia McGrail, RN¸ Kathleen Megan, RN¸ David Miller, RN¸ Connie Roche, RN¸ Ann Snow, RN¸ Gail Umphlett, RN

For more informa-tion about the Marie C.Petrilli Oncology Nurs-ing Award contact, JulieGoldman, RN, profes-sional development co-ordinator, at 4-2295.

RecognitionRecognitionRoche, Tufts, receive Marie C.

Petrilli Oncology Nursing Award�by Julie Goldman, RN, professional development coordinator

N

(Photos by Abram Bekker)

At far left:At far left:At far left:At far left:At far left: co-founder

of the award, Al Petrilli

At left: At left: At left: At left: At left: Petrilli award

recipients, Lisa Tufts,

RN (left), and Maria

Roche, RN

Below:Below:Below:Below:Below: award

recipients with Petrilli

family members (l-r):

Karen Cavaleri, Pamela

Weeks, Paul Citro

(back), Roche,

Susan Neuner (back),

Christine Citro, Paula

Cavaleri (back),

Tufts, Al Petrilli, David

Petrilli, and senior vice

president for Patient

Care, Jeanette Ives

Erickson, RN


Duffy Retirescontinued from page 1

Among many admir-ers attending a receptionin Duffy�s honor, wasMGH president, PeterSlavin, MD. Said Slavin,�Jan and I both beganour careers at MGH on theMedical Service. It didn�ttake long for me to re-alize the depth of herclinical and managerialexpertise. I remember tothis day the ease andagility with which sheoversaw day-to-day op-

Above:Above:Above:Above:Above: Jan Duffy with

senior vice president for

Patient Care, Jeanette

Ives Erickson, RN.

At right: At right: At right: At right: At right: Duffy with

associate chief nurse,

Theresa Gallivan, RN,

and husband, John,

at special reception

in her honor. Duffy

was a 23-year

veteran of MGH.

erations. She was a pio-neer in the area of quali-ty and safety; it wasunder her watchful eyethat the Clinical Policy& Procedure Manualgrew into the interdisci-plinary tool it is today.Jan�s �can-do� attitudehas always been behindthe scenes driving us tobe the best we can be.

�Jan, on behalf ofMGH, I thank you foryour unwavering com-mitment to this hospital.�

Staff nurse, SuzanneAlgeri, RN, spoke about

Duffy as, �a true advo-cate for patients and nurs-ing.� She used wordslike integrity, character,disciplined, thoughtful,and reliable. Algeri re-called a time when Duffymade an observationabout another well-re-spected colleague�s retir-ement, saying, �Replac-ing her is going to be likereplacing the Queen ofEngland.� Said Algeri, �Iwouldn�t be surprised ifsomeone is saying thesame thing about youright now.�

Theresa Gallivan,RN, associate chief nurse,and the person to whomDuffy reported at thetime of her retirement,gave a heartfelt tribute toher long-time friend andcolleague. Said Gallivan,�Like most of us whocan name colleagues,mentors, and role modelswho�ve had an enormousimpact on our develop-ment as practitioners,professionals, and hu-man beings, I was in aweof Jan Duffy. Her repu-tation for excellencepreceded her.

�She is the consistentrole model, quietly teach-ing, guiding, and men-toring. She�s constantlyraising the bar, carefullyresearching the issues,considering all perspec-tives, collaborating withand generously creditingothers, getting the jobdone, and all the whilemaintaining so muchenergy.

�Jan, thank-you forall you�ve contributed,all you�ve taught us, andmost importantly, allyou�ve inspired us to be.�

Senior vice presidentfor Patient Care, JeanetteIves Erickson, RN, fram-ed her remarks around acomparison of Duffy�sexquisite career to theexquisite nursing sundialsculpture that adorns theBulfinch lawn. The threefigures in the sculpturecarry a lamp, represent-ing the past, a book, rep-resenting the importanceof scientific knowledge,and a globe, representingdiversity and intercon-nectedness. Said IvesErickson, �Like the threefigures on the sundial,Jan has �shown us theway,� she has used evi-dence-based practice toguide our clinical ad-vancement, and she hassuccessfully broughtpeople together to createa network of policies,programs, and an infra-structure that supportsnurses today, and willcontinue to guide thenurses of tomorrow.�

Presenting Duffy witha signed picture of thenursing sundial, IvesErickson said, �Jan, weall wish you and yourfamily health, happiness,and harmony as you em-bark on this new chapterin your life.�

In a packed WalcottConference Room, in hertrademark, soft-spokenmanner, Duffy thankedeveryone for coming andfor the privilege of beingpart of the MGH commu-nity for 23 years.

Said one teary-eyedcolleague, �It�s not everyday that a �Jan Duffy�walks through your frontdoor.�

You�ll be missed, Jan.


Laurie Miller, RNstaff nurse, White 12

M

continued on next page

Diffusing a difficult situationwith confidence, caring, and

a positive attitude

ClinicalNarrativeClinicalNarrative

y name is LaurieMiller, and I ama staff nurse on

White 12. Iwas working the 3-11shift as charge nurse oneevening when I receiveda new admission. Thepatient was a 73-year-oldman who was coming infrom a community hos-pital with severe backpain. During a phoneconversation with thereferring nurse, she toldme, �The patient is fine.The family is anotherstory.� According to thenurse, the family hadbeen very demandingboth physically and emo-tionally, and staff wasglad that a transfer wasin progress.

I was also told thatthe patient had a historyof lung cancer. In thework-up at the otherhospital, lesions hadbeen discovered on hiskidney, liver, and thora-cic spine. From what thenurse told me, I knew thatpain was going to be aprimary concern, notonly for the patient butalso for his family.

I�ve dealt with manydifficult patient and fa-mily situations in my 17years as a nurse on White12. Experience hastaught me that these sit-uations need to be ap-proached with openness.As I began to plan forthis man�s admission, Ithought how stressful itmust be for him and his

family. Not only werethey coping with thehospitalization of theirfather and husband, theywere also facing the pos-sibility that this could bea metastatic process witha poor outcome. I ima-gined myself in theirsituation and began tothink how we might beable to help them holis-tically.

A short time later,Mr. D arrived by ambu-lance. He was thin andfragile in appearance andseemed frightened. Isettled him into his bedand his wife and threedaughters arrived a shorttime later. Their stresslevel was obvious. Thedaughters all had medi-cal backgrounds, onehad been a nurse yearsago at MGH.

They asked to see thephysician and chargenurse immediately. Iknew that the first step indiffusing a potentiallydifficult situation was tobe prompt and confident.It became evident duringthis meeting with thefamily that they wereunder a great deal ofstress. They were acutelyaware that this could bea metastatic process, andtheir primary concernwas maintaining Mr. D�scomfort. They told methey had not yet sharedthe prognosis with him,and they were consider-ing a number of ideas asto how best to do that. Itbecame clear that Mr. D

had been a very active,independent, and stoicman. The level of pain hewas experiencing fright-ened him as well as hisfamily. They were allconcerned that his painhad not been adequatelyaddressed at the otherhospital. In considera-tion of this, the familyasked that we touch himas little as possible andavoid providing any phy-sical care without firstpre-medicating Mr. D.

I realized that Mr. D�sfamily was going to re-quire a lot of emotionalsupport. I knew it wasgoing to be crucial todevelop a trusting rela-tionship with all of them.I reassured them that Mr.D�s pain would be ad-dressed and managed. Ihad to accomplish a lotin a short period of time.Fortunately, it was thebeginning of a 12-hourshift for me, giving methe time I needed.

The family and I dis-cussed a number of me-thods of short- and long-term pain-control and thevarious team memberswho would be involvedin the process. Since thiswas clearly a priority, Ibegan by asking the ad-mitting physician for apain consult. The painteam agreed to see himurgently, and shortlythereafter Mr. D wasstarted on a PCA to con-trol his short-term pain.This seemed to give Mr.D and his family a sense

of control. It reassuredthem that we were ableto manage his pain re-gardless of how quicklyit came on. Next, we dis-cussed and initiated MSContin for longer-actingcontrol. Mr. D�s familywas relieved by this,knowing we were ad-dressing both his short-and long-term needs.

I established a planthat included non-med-icinal treatment modesfor Mr. D�s pain. Thisincluded taking him totesting areas in his bedrather than transferringhim to a stretcher. Taskssuch as bathing and oth-er ADLs were coordinat-ed around medicationtimes to maximize hisability to perform themwhile minimizing pain.

I still needed to dealwith the family�s anxiety.With their medical know-ledge, they knew therewas a high probabilitytheir father had metasta-tic cancer and were fa-miliar with the regimenof chemotherapy, radi-ation, surgery, or pallia-tive care that would fol-low. I placed a call to our

social worker who beganregular visits with thefamily every day.

Another measure Iemployed to minimizetheir anxiety was to limitthe number of caregiversinvolved in Mr. D�s careto foster continuity andtrust. This was accom-plished by the chargenurse who ensured thatMr. D was assigned thesame group of nursesand PCAs on every shift.I was able to secure a cotfor the family in Mr. D�sroom, providing themwith unlimited visitinghours, and allowing themongoing involvementwith Mr. D�s care.

Each morning whenthe pain team rounded,the attending physicianwas usually present. Thenurse, social worker, andphysicians would meet atthe nurses� station toreview any issues or con-cerns. This added to thecontinuity of care, as allmembers of the teamwould be knowledgeableabout the plan whenmeeting with Mr. D orhis family.


Call for AbstractsNursing Research Day

May 4, 2005

The Nursing ResearchCommittee is calling for posterabstracts for Nursing Research

Day 2005.

This is an opportunity toshare nursing research,

evidence-based practicemodels, and creative

approaches used to improve thenursing care of patients

and their families

To submit an abstract, go to theNursing Research Committeewebsite at: www.mghnursingresearchcommittee.org (nospaces), select “Abstract

Submission” and follow thesubmission guidelines.

For more information contact:www.mghnursingresearch

committee.org

Submissions are due byJanuary 31, 2005

Call for ProposalsThe Yvonne L. Munn, RN,

Nursing ResearchAwards

Staff are invited to submitresearch proposals for the

annual Yvonne L. Munn, RN,Nursing Research Awards tobe presented during Nurse

Week in May of 2005.

Proposals are due byMarch 1, 2005. Guidelines

to assist in developingproposals are available at:

http://pcs.mgh.harvard.edu/CCPD/cpd_award_munn.asp

(no spaces)

For more information,contact Virginia Capasso, RN,

at 726-3836 or by e-mail [email protected]

Nurse Week 2005 willbe celebrated at MGH

May 1–6, 2005

Within a few days,the family�s anxiety levelhad significantly de-creased, and they haddeveloped a trustingrelationship with staff.Mr. D�s pain significant-ly improved, and he be-gan getting out of bed toactively participate inPhysical Therapy.

At the time of dis-charge, Mr. D was able toambulate in the hallwayswith supervision and theuse of a walker. His fam-ily had stopped stayingovernight but took veryactive roles in his phy-sical care, assisting himwhen necessary, but help-ing to foster his indepen-dence.

This patient-familyinteraction clearly dem-onstrates the importanceof developing a trustingrelationship early in thecourse of a patient�s hos-pitalization. It also illus-trates the need for caring

for a patient and familyfrom a social, emotional,psychological, and phy-sical perspective. Pain-relief was the prime con-cern for Mr. D and hisfamily, and I made it apriority from the momentthey arrived on White12.

The family�s con-cerns about sharing Mr.D�s diagnosis with himwere effectively manag-ed by involving the so-cial worker from thebeginning. Emotionalsupport was provided toMr. D and his familythroughout his hospital-ization and through theprocess of dealing withtheir inevitable loss.

Years of experiencehelped me quickly iden-tify and assess the needsof this patient and hisfamily, establish a planthat met their physicaland psychological needs,and follow through with

a plan that included con-sistency among membersof the healthcare team. Ibelieve my early inter-ventions on the first dayof Mr. D�s hospitaliza-tion contributed to apositive outcome forhim, his family, and forstaff.

Comments by JeanetteIves Erickson, RN, MS,senior vice presidentfor Patient Care andchief nurse

�Difficult� is in the eyeof the beholder. WhenLaurie received report onMr. D she could have letanother caregiver�s im-pressions carry over intoher own perceptions ofMr. D and his family.But she did not. Lauriesuspended judgment, putherself in their place, andquickly assessed what

Clinical Narrativecontinued from previous page

Hand Hygiene Championof Champions Award

Nominations are now being acceptedfor the 2004 Hand Hygiene Champion ofChampions Awards to recognize handhygiene champion(s) from patient care

units. The award honors champions whohave worked creatively and diligently to

promote awareness around hand hygiene.

Applications are available in the Bigelow 10and Founders 108 Nursing offices.

Deadline for nominationsis January 31, 2005.

For more information, call RosemaryO’Malley at 6-9662 or send e-mail.

Spanish for healthcareproviders

Register now for winter classes.Five levels of classes offered from beginner

to advanced. Classes start the weekof February 1, 2005.

$75 for MGH employees;$150 for non-MGH employees.

Payment must be made at time ofregistration. Register in person at MGHTraining, 100 Charles River Plaza from

8:00am–500pm. Classes are heldonce a week for 16 weeks

For more information call 4-3241;call Natalia Cepeda at HablEspaña,

(617) 426-4868 ex.201; or [email protected]

Registration ends Tuesday, January 25th

she could do to ease theirsuffering. Knowing thatit was a priority for thefamily, she took immedi-ate steps to address Mr.D�s pain. She allayedtheir fears by invitingfamily members to stayovernight. And she pro-moted continuity by en-

suring Mr. D had a con-sistent team of caregiv-ers.

With honesty andopenness, Laurie turnedwhat could have been acontentious interactioninto a powerful, unitedworking relationship.

Thank-you, Laurie.


dvance direc-tive is a gener-

al term used todefine two categories

of legal documents�treatment directives andproxy directives. A treat-ment directive providesspecific instructions aboutfuture medical care foran individual, while aproxy appoints anotherindividual to make healthdecisions when the ap-pointor is incapable ofmaking decisions inde-pendently.

Confusion sometimesarises when decidingwhich directive is moresuitable in a given state.

Each state has uniqueguidelines for advance-directive planning. InMassachusetts, for ex-ample, a healthcare proxyhas been the preferredform of advance direc-tive for many years.

In 1983, advancedirectives were introduc-ed to assist the public inaddressing end-of-lifeissues. However, it wasn�tuntil 1990 when the Pa-tient Self DeterminationAct was created that themeasure really took hold.The Patient Self Deter-mination Act came inresponse to Cruzan vs.the Missouri Department

of Health, a landmarkend-of-life-care legaldecision. The govern-ment felt it was time tocreate clearer guidelinesto clarify states� roles inthese situations. SenatorsDanforth (of Missouri)and Moynihan (of NewYork) introduced the billto Congress with supportfrom Representative Lev-in (of Michigan) in Oc-tober of 1989.

The Patient Self De-termination Act was en-acted in 1990 and imple-mented in 1991. Part ofthe Omnibus BudgetReconciliation Act, itrequired that all facilities,hospitals, home-healthagencies, skilled nursingfacilities, HMOs, andhospice organizationsreceiving Medicare andMedicaid funds providepatients with informationregarding advance direc-tives and inform them oftheir right to completeone. Additional supporthas come in the form ofJCAHO standards andrequirements.

Three key provisionsof the Patient Self Deter-mination Act speak dir-ectly to advance-direc-tive planning. Healthcarefacilities are to providewritten information topatients about their deci-sion-making rights whileensuring compliancewith state law. Facilitiesare to maintain policiesand procedures for ad-vance-directive planning

and document whether apatient has completed adirective. And facilitiesare to educate staff andthe community aboutadvance-directive plan-ning. The Patient SelfDetermination Act didnot create new rights forpatients, just affirmedthe rights guaranteedunder the FourteenthAmendment.

At MGH, all patientscapable of making deci-sions should be asked ifthey have completed anadvance directive. If theyhave, a copy should beplaced in the designatedsection of the medicalrecord. The originalshould remain with thepatient (and it�s suggest-ed that agents, primaryphysicians, and familymembers receive copies).The admitting nurseshould document that acopy has been obtained,and the physician shoulddiscuss the directive withthe patient.

If a patient has notcompleted an advancedirective, informationshould be provided about

Ethics and practice: anoverview of advance directives

�by Theresa Cantanno-Evans, RN, and Joanne Empoliti, RN

ClinicalNurseSpecialistsClinicalNurseSpecialists

A

the Massachusetts HealthCare Proxy. Assistancein completing the formshould be offered at thistime and, if necessary, infollow-up visits. A cur-rent understanding of thepatient�s wishes by theassigned agent is criticalto the success of ad-vance directives. Com-munication between allinvolved parties shouldbe encouraged.

Resources at MGHthat might be helpful topatients include SocialServices, ethics commit-tees, Chaplaincy, theBlum Patient & FamilyLearning Center (foraccess to advance direc-tives in other languages),and The Clinical Prac-tice & Procedure Man-ual. Advance care plan-ning is a work in pro-gress and continues to bethe collaborative focusof many at MGH.

For more informa-tion about advance dir-ectives, contact TheresaCantanno-Evans, RN, at4-6010, or Joanne Em-politi at 6-3254.

clinical nurse specialists, Joanne Empoliti, RN (left),and Theresa Cantanno-Evans, RN

Healthcare proxy vs.durable power of attorney

for health careSome of the terminology surrounding advancedirectives can be confusing. For instance, ahealth care proxy in one state is virtually thesame thing as a durable power of attorneyfor health care in another state, which is thesame as medical power of attorney in others(see: www.partnershipforcaring.org for moreinformation). The phrase, ‘power of attorney,’can be misleading because in other situationsit carries legal implications. Many people be-lieve, like estate planning, they need a lawyerto create an advance directive. That is not thecase in Massachusetts. When an individualappoints a power of attorney for health care,it shouldn’t be confused with a power of at-torney for other matters, such as finances.The latter requires notarization and is com-pletely separate from healthcare planning.For this reason, Massachusetts uses the termhealth care proxy to avoid confusion. Anyhealthcare advance directive can and shouldbe prepared with the help of a healthcareprovider.

January 20, 2005

January 20, 2005

Next Publication Date:February 3, 2005

Published by:Caring Headlines is published twice eachmonth by the department of Patient Care

Services at Massachusetts General Hospital.

PublisherJeanette Ives Erickson RN, MS,

senior vice president for Patient Careand chief nurse

Managing EditorSusan Sabia

Editorial Advisory BoardChaplaincy

Reverend Priscilla Denham

Development & Public Affairs LiaisonVictoria Brady

Editorial SupportMarianne Ditomassi, RN, MSN, MBAMary Ellin Smith, RN, MS

Materials ManagementEdward Raeke

Nutrition & Food ServicesMartha Lynch, MS, RD, CNSD

Office of Patient AdvocacySally Millar, RN, MBA

Orthotics & ProstheticsMark Tlumacki

Patient Care Services, DiversityDeborah Washington, RN, MSN

Physical TherapyOccupational Therapy

Michael G. Sullivan, PT, MBA

Police & SecurityJoe Crowley

Reading Language DisordersCarolyn Horn, MEd

Respiratory CareEd Burns, RRT

Social ServicesEllen Forman, LICSW

Speech-Language PathologyCarmen Vega-Barachowitz, MS, SLP

Volunteer, Medical Interpreter, Ambassadorand LVC Retail Services

Pat Rowell

DistributionPlease contact Ursula Hoehl at 726-9057 for

all issues related to distribution

Submission of ArticlesWritten contributions should be

submitted directly to Susan Sabiaas far in advance as possible.

Caring Headlines cannot guarantee theinclusion of any article.

Articles/ideas should be submittedin writing by fax: 617-726-8594or e-mail: [email protected]

For more information, call: 617-724-1746.

Please recycle

Backup ChildcareCenter

February Vacation Club

The MGH Backup Childcare Centerannounces February Vacation Club, fromFebruary 22–25. The cost for the programis $220 for the 4-day week; individual days

can be reserved for $60 per child.

The program is available for childrenage 6–12, and will include:

¸ a visit from “Bugworks” (Tuesday)¸ a trip to the Omni Theater (Wednesday)¸ a skating party on the Frog Pond (Wed-

nesday)¸ a Pizza Party at the center (Friday)

For more information or to make areservations, call Patty at 724-7100

Nursing CareerExpo

Patient Care Services Human Resources

will be hosting a Nursing Career Expo.

Please invite your friends and colleagues

to attend and learn more about positions

as staff nurses (new grad and

experienced), clinical nurse specialists,

nurse managers, and project

managers.

Sunday, January 23, 200512:00–3:00pm

North and East Garden Dining Rooms

For more information, contactSarah Welch ([email protected])

at 617-726-5593

Women’s health researchdatabase

The Women’s Health CoordinatingCouncil has launched a new website to

help clinicians find clinical researchrelated to the care of women at MGH.The site features a database of clinical

studies that include women; relate to healthissues experienced by women; or address

specific health concerns of women.

For more information, visit: http://is.partners.org/mghintranet/whcc/index.htm

The Different Faces of QualityImprovement: Creating an

Environment of Quality and SafePractice

All members of the MGH communityare invited to attend this educationaloffering to learn how to create and

maintain the safest possible environmentfor patients, families, visitors, and

employees. Topics will include:

Strategic PlanningPatient Safety Goals for 2005

The Role of Patient Safety RoundsPlanning a Project Improvement Initiative

Hand Hygiene

Keynote speaker, Anita Tucker, DBA,will speak on,

“The Impact of Operational Failures onNurses and their Patients”

Monday, February 7, 20058:00am–4:30pm

O’Keeffe Auditorium

CEUs availableFor more information, call 6-3111

On-site/On-line RN toBSN degrees in Nursing

MGH nurses seeking a baccalaureate(BSN) in Nursing, come learn more about

opportunities to earn degrees throughon-site and on-line programs.

On-site program offered by NortheasternUniversity

On-line (distance learning) programoffered by St. Joseph’s College of Maine

Information SessionMonday, February 7, 2005

6:30am–8:00pmMain Corridor

For more information, contactMiriam Greenspan, RN,

on-site/on-line education coordinator inThe Center for Clinical & Professional

Development at: 4-3506pager: 3-0724or by e-mail.

(Next class session in late March)


HarHarHarHarHarmmmmm

HazarHazarHazarHazarHazardsdsdsdsds

Defenses, barriers,Defenses, barriers,Defenses, barriers,Defenses, barriers,Defenses, barriers,and safeguarand safeguarand safeguarand safeguarand safeguardsdsdsdsds

Say �Cheese!��by Georgia Peirce, director of PCS Promotional Communications and Publicity

and National Patient Safety Leadership fellow

Quality & SafetyQuality & Safety

Whether you real-ize it or not, Swiss

cheese and health-care safety go hand in

hand. That is, at least, accord-ing to one of the better knownmodels used in by healthcareexperts.

In 1990, James Reason,noted British psychologist,published the landmark book,Human Error, todayconsidered the Bibleof error theory. In it,Reason suggestsSwiss cheese as amodel for understandinghuman error. He proposesthat errors are principallycaused by the conditions inwhich people work�theroot cause being the system,not the people.Put another way:good people canwork withinflawed systemsor under flawed conditions.

To shield patients frompotential harm, we must in-corporate barriers, or layers ofdefenses, into our systems ofcare. Reason compares theselayers of defenses to slices ofSwiss cheese. Examples ofinstitutional defenses mightinclude Provider Order Entry(POE), pop-up warnings onclinicians� computer screens,alarms for IV pumps, bar-coding, etc. While these mea-sures don�t completely elimi-

nate the possibility that anerror will occur, they are de-signed to reduce the proba-bility that errors will have anyimpact on patients. In practice,these defenses consistentlycatch or prevent nearly allpotential errors, keeping harmfrom coming to patients.

In the case of POE, for

example, if a physician order-ed a potentially harmful doseof a specific medication, priorto filling the medication order,a pharmacist would review theorder (this would happen 24hours a day, 7 days a week).The pharmacist would recog-nize the problem, call the phy-sician immediately, and deter-mine the appropriate course ofaction. This built-in defenseworks, and the patient is pro-tected from harm.

However, (this is where theSwiss-cheese analogy comes

into play) the defenses them-selves can contain undetect-able holes or flaws. For ex-ample, what if a new IV pumpneeds to be programmed usinga specific, multi-step processin a specific, unalterable se-quence. Programming currentpumps doesn�t require such anexact sequencing process. Un-beknownst to the caregiver or

thesupplier, a

software flaw willmis-program the device if

certain steps are performed outof order, incorrectly deliveringthe entire contents of the IVsolution to the patient. Whilethe chances of this happeningare rare, even remote, the re-sults of an unforeseen error ofthis kind could be disastrous.

Generally, a problem likethis will be caught before everreaching the patient; the safetydefenses work. But on rareoccasions, those tiny holes inthe lines of defense line up�if only for a moment�and letharm through, leading to cata-strophic consequences.

Reason recognizes that,�Unlike Swiss cheese, theholes [in our defenses] arecontinually opening, shut-ting, and shifting their loca-tion.� We work in a dynamicenvironment with new tech-nologies introduced all thetime; patient volume andacuity fluctuating on a daily,if not hourly, basis; multiplecaregivers contributing tothe care of every patient; andcountless other variables that

impact care-delivery everyday. With somany moving

parts and changing condi-tions, the potential for erroris an unavoidable reality inour environment. While wecan never completely elimi-nate the possibility of errorsoccurring, we can greatlyminimize the probability thaterrors will affect our pa-tients.

Safety in health care willalways be an ongoing chal-lenge. Each of us plays animportant role in protectingthe quality of our systemsand the safety of our patients.Be vigilant in looking for theholes in the Swiss cheese. Bevigilant in preventing thatline-up of circumstances thatcould lead to potential er-rors. Be proactive in fixingproblems as they arise, orfinding someone who can.

W

Educational OfferingsEducational Offerings January 20, 2005January 20, 2005

2005

2005

For detailed information about educational offerings, visit our web calendar at http://pcs.mgh.harvard.edu. To register, call (617)726-3111.For information about Risk Management Foundation programs, check the Internet at http://www.hrm.harvard.edu.

Contact HoursDescriptionWhen/WhereBasic Respiratory Nursing CareEllison 19 Conference Room (1919)

- - -January 2812:00�4:00pm

CINAHL: Cumulative Index to Nursing and Allied HealthFND626

1.2January 289:30�11:30am

Special Procedures/Diagnostic Tests: What You Need to KnowO�Keeffe Auditorium

TBAJanuary 318:00am�4:00pm

BLS Certification for Healthcare ProvidersVBK601

- - -February 18:00am�2:00pm

CPR�American Heart Association BLS Re-CertificationVBK 401

- - -February 37:30�11:00am/12:00�3:30pm

Different Faces of Quality Improvement: Creating an Environmentof Quality and Safety PracticeO�Keeffe Auditorium

TBAFebruary 78:00am�4:30pm


- - -February 87:30�11:00am/12:00�3:30pm

New Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0(for mentors only)

February 98:00am�2:30pm

Intermediate ArrhythmiasHaber Conference Room

3.9February 98:00�11:30am

Pacing: ConceptsHaber Conference Room

4.5February 912:15�4:30pm

Nursing Grand Rounds�Continuous Opoid Infusions.� Sweet Conference Room GRB 432

1.2February 911:00am�12:00pm

OA/PCA/USA Connections�Breaking down myths about psychiatric illness.� Bigelow 4 Amphi-theater

- - -February 91:30�2:30pm

On-Line Clinical Resources for NursesFND626

- - -February 151:30�2:30pm

New Graduate Nurse Development Seminar IITraining Department, Charles River Plaza

5.4 (for mentors only)February 238:00am�2:30pm

Nursing Grand Rounds�Electronic Medication Records.� O�Keeffe Auditorium

1.2February 241:30�2:30pm

Preceptor Development ProgramTraining Department, Charles River Plaza

7February 258:00am�4:30pm

Basic Respiratory Nursing CareEllison 19 Conference Room (1919)

- - -February 2512:00�4:000pm

- - -Advanced Cardiac Life Support�Instructor Training CourseO�Keeffe Auditorium. Current ACLS certification required. Fee: $160for Partners employees; $200 for all others. For more information, callBarbara Wagner at 726-3905.

February 288:00am�4:00pm


- - -March 37:30�11:00am/12:00�3:30pm

Congenital Heart DiseaseHaber Conference Room

4.5March 38:00am�12pm and 12�4:00pm

16.8for completing both days

Advanced Cardiac Life Support (ACLS)�Provider CourseDay 1: O�Keeffe Auditorium. Day 2: Wellman Conference Room

March 4 and March 218:00am�5:00pm


CaringCaringH E A D L I N E S

Send returns only to Bigelow 10Nursing Office, MGH

55 Fruit StreetBoston, MA 02114-2696

First ClassUS Postage PaidPermit #57416

Boston MA

Professional AchievementsProfessional AchievementsPerry has paper published

Donna Perry, RN, professionaldevelopment coordinator in The Center

for Clinical & Professional Development,published the paper, �Transcendent

pluralism and the influence of nursingtestimony on environmental justicelegislation,� in the February, 2005,Policy, Politics & Nursing Practice

Hughes co-authors article inJournal of Emergency Nursing

Maryfran Hughes, RN, nurse managerfor the Emergency Department, co-authored

the article, �Recognizing Excellence inNursing Service: a First-Hand Report

from an ED Manager at a MagnetHospital in Boston,� in the December,

2004, issue of Journal ofEmergency Nursing.

Dahlin, Billings serve on PalliativeCare Steering Committee

Connie Dahlin, RN, and AndrewBillings, MD, of the MGH Palliative

Care Service, were selected by their peersto serve on a national Steering Committee

to establish voluntary ClinicalPractice Guidelines for Quality

Palliative Care.

Anderson, Kelly, andMichaelidis certified

Bridget Anderson, RN, of Ellison 12;Nancy Kelly, RN, of Ellison 12; and

Anastasia Michaelidis, RN, of White 12recently passed the Neuroscience

certification exam tobecome CNRNs.

Fitzmaurice, Mian and Warchalpresent in San Diego

Joan Fitzmaurice, RN, PatriciaMian, RN, and Susan Warchal, RN,

presented the research paper, �Impact ofMulti-Faceted Interventions on Nurse and

Physician Behavior Attitudes and BehaviorsToward Family Presence During Resusci-

tation,� at the Emergency NursesConvention in San Diego, California,

on October 1, 2004.

Coughlin, Galley-Reilleycertified

Eleanor Coughlin, RN, staff nurseon Blake 6, and Jayne Galley-Reilley, RN,transplant coordinator for the AbdominalTransplant Program, recently passed theCertified Clinical Transplant Nurse exam

given by the International TransplantNurses Society.

Millar serves on AONEEducation Committee

Sally Millar, RN, director of theOffice of Patient Advocacy and PCS

Information Systems, will serve on theAONE Education Committee for a one-yearterm in 2005. The committee advises AONE

in the planning and implementing ofeducational programs.

The Employee AssistanceProgrampresents

Elder Care MonthlyDiscussion Groups

presented by Barbara Moscowitz,LICSW, geriatric social worker

Caring for an aging loved one canbe challenging. Join us for monthly

meetings to discuss care, legal,medical, coping and other issues.

Next meeting: February 15, 200512:00–1:00pm

Bulfinch 225A Conference Room

For more information, contact theEAP Office at 726-6976.

The Employee AssistanceProgrampresents

Domestic Violence SupportGroup

Announcing a confidential, 10-weekeducation and support group for

women employees who have beenaffected by domestic violence.Weekly discussions will help

promote strength and healing.Meetings are free and confidential.

Starts January 20, 20054:30–6:00pmLocation TBA

For more information, contact theEAP Office at 726-6976.

Back issues of Caring Headlinesare available on-line from the Patient

Care Services website at:http://pcs.mgh.harvard.edu/(click on ‘Caring Headlines’)

For assistance, contact Jess Beaham,web developer, at 6-3193

caring january 20, 2005 - massachusetts general hospital · january 20, 2005 urses, maria roche,...

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