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Volume 1, Issue 4 The First Breath of News May, 2010
Happy Mother's Day! Page 1
RESPIRATORY CAREAll the News You Can Inhale
1 Editorial Comments & Employee in Focus
2 Creative Cooking Corner
3 Cinco de Mayo
4/5 Night Shift Newzzz / Essential Education
6/7 Employee Artwork / Prairie Dawn
8/9 Respiratory Care High Fives / Other Stuff
10 Credits / The Mother's Influence / Congratulations
Random Meanderingsby Terry Nuttall, Editor
Thank you to everyone who contributed tothis May's newsletter which almost was
not to be this month. I want to especially
thank Becky Riederer for her excellent
story and Becky Nichols for her completely
spontaneous artful creation which she generously agreed to
donate to this newsletter. Also thank you to Carla Riehl for the
story she found, The Mother's Influence, for Mother's Day and
Karen Jones for her ongoing food recipe column, Creative
Cooking Corner. People like you keep this newsletter going
with your contributions and is why I continue being editor of it.
Cinco de Mayo is May 5th and is a reason to celebrate withfood, fun and beer while also celebrating the experiences and
culture of those with Mexican ancestry. Milwaukee has many
activities planned for Cinco de Mayo, one being the annual
Cinco de Mayo SpringFestdowntown. Did you know the official
colors of Mexico are redand green? They symbolize salsaand
guacamole.
That is all for random meanderings for this month.
Employee in Focusby Terry Nuttall
In this month's newsletter's ongoing quest to recognizeeach invaluable employee who doesn't mind the limelight,
Becky Riederer has generously volunteered to be our
fourth subject in our series, Employee in Focus.
Becky began her education in nursing but she soonrealized that was not what she wanted to do. After her
dad passed away of lung cancer, she felt inspired to enter
a Respiratory Therapy program at Northwest Technical
College in Green Bay, from which she graduated in 2008.
Her dream since high school has been to work with
children and when her clinical training took her
to Children's Hospital of Wisconsin, the experience
confirmed her love for taking care of kids. She then knew
that Pediatric Respiratory Care was her calling. Becky
loves to interact with the kids she works with and she
loves being able to learn something new every day.
Becky grew up in Sheboygan and currently lives inManitowoc, 80 miles north of Wauwatosa. She and her
husband, Dennis, have three beautiful girls: EmmaRae is
10, Abagail is 5 and Madalynn is 4 years old. Becky loves
Continued on page 2
Becky Riederer and her beautiful family
http://www.umos.org/special_events/cinco_de_mayo.aspxhttp://www.umos.org/special_events/cinco_de_mayo.aspxhttp://www.umos.org/special_events/cinco_de_mayo.aspx -
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Volume 1, Issue 4 The First Breath of News May, 2010
Happy Mother's Day! Page 2
being a mom and finds it an extremely rewarding experience.
Also in her family are Chester the dog, Ciate (see-ah-tea) the
cat and Diego and Silver, the 2 robo hamsters.
During her spare moments, Becky likes to cook, play card orboard games, listen to music and dance with her kids as well
as do crafts with them, go for walks and bargain shopping in
addition to just spending quality time with her husband. While
watching television Becky is a fan of Desperate Housewives,
American Idol and Survivor. Striving to find comic relief in
many types of situations, Becky loves to laugh and make
others laugh too. She also loves to discover arcane facts
about interesting subjects. Did you know Wilma Flintstone's
maiden name was Wilma Slaghoopal, and Betty Rubble's
Maiden name was Betty Jean? Also, no piece of paper can be
folded in half more than 7 times. How many of you are going
to try this now? I don't know about you but I also find this stuff
fascinating.
In summertime months Becky and her family are often eitherswimming in their own pool or at the beach. They also have
started to take up camping and look forward to experiencing a
camping adventure this summer. Becky is very grateful to her
husband for introducing her to the joy of watching Packer
games in which she now often finds herself immersed in the
excitement of. Her extended family is extremely important to
her and they try to find time to be together as often aspossible.
As a slightly more tangible reward for consenting to thisexcellent story of how she came to us at CHW, here is a mug
filled with a beverage of Becky's choice. Deserving far more
than that though, I thank
Becky very much for her
support of this
newsletter and
elsewhere. We are truly
very fortunate thatBecky Riederer is with
us
Employee in Focus cont' Continued from page 1
Creative Cooking Corner
Enticing Chicken Enchiladas
2 cups cooked, diced chicken
1 can (10 oz) cream of chicken soup
1/2 cup sour cream
1tablespoon margarine
1 onion chopped
1 Teaspoon chili powder
1 small (4oz) can of chopped green chilies
1 can enchilada sauce
Salsa
Tortillas
1 cup shredded Mexican cheese
Preheat oven to 350
In small bowl mix soup and sour cream, set aside. Meltmargarine in medium saucepan over med-high heat. Add
onion and chili powder and saut until tender. Stir in chicken,
green chilies, 1/2 enchilada sauce and 2 tablespoons soup
mixture. Cook and stir until heated through.
Spread 1/2 soup mixture in a 9x13 pan. Spoon equal
amounts of chicken mix down center of tortillas. Roll up
tortillas and place seam sides down. Spoon remaining soup
mix over top, along with the remaining enchilada sauce and
dollops of salsa, sprinkle with shredded cheese. Bake 25
minutes or until bubbly and lightly browned, makes approx 8enchiladas. Muy Bien!! Great for
Cinco Del mayo, for breakfast
or for dessert! Thank you again
Karen for another delectable
recipe!
ByKaren Jones
our Krazy
Kook
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Happy Mother's Day! Page 3
After eating your Chicken Enchiladas, print this out and give this easy Cinco De Mayo crossword a go. The holidaycommemorates the Mexican army's unlikely victory over French forces at the Battle of Puebla on May 5, 1862, under the
leadership of Mexican General Ignacio Zaragoza Segun. In the U.S. this date is used to celebrate the culture and
experiences of Americans of Mexican ancestry. (FromWikipedia) Answers are at bottom of page upside down.
http://en.wikipedia.org/wiki/Cinco_de_Mayohttp://en.wikipedia.org/wiki/Cinco_de_Mayohttp://en.wikipedia.org/wiki/Cinco_de_Mayohttp://en.wikipedia.org/wiki/Cinco_de_Mayo -
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Happy Mother's Day! Page 4
Night Shift Newzzz...By Anthony
E O S 2 0 1 0!
What has been done?
Im involved in decisions that affect my work
Before viral season began, we asked staff what their
preferences were in scheduling during this busy time. Were
continuing to do rounding to not only make sure you have what
you need for your job, but how can things work better. Were
on the eve of starting a clinical practice work group which will
be a golden opportunity to have input on clinical areas that
effect you work. The new trauma team is continuing to form,
which is a great opportunity to advance your skills and give
input on this fast paced environment.
Balancing work and family
The biggest change that was done to help balance work and
family is offering staff meetings on the night shift, as well as, on
Friday evenings. This has not only helped the weekend staff,
but also allowing people to attend staff meetings without
coming in on their days off. Both Julie and I have evaluated our
PPL guidelines to maximize the amount of vacations that are
taken. For the past 5 months, Ive asked staff to pick their
overtime shifts when needed. This has been widely received.
When last minute shifts have been needed, the hours have
been posted.
When staph drops by, visiting hours are over!
Im starting to map out orientations for the remainder of the
year. Currently, Todd Schleef is finishing up his PICU
orientation. Danielle will be starting in the NICU shortly. Elisa
will be starting in the PICU in August. If you have a desire to
be trained in the NICU, please let me know.
Oh I Got This!Riddle:
If April showers bring may flowers, what do May flowers
bring? Thanks to my son Kaden for the idea)
The first correct answers wins a Starbucks gift certificate.
Send your answer to:[email protected]
Congratulations to Katie, Beth & Becky R. who won last
month's Oh I Got This! answer: Runaway by Love and Theft.
______________________________________
CHW REPIRATORY NIGHT SHIFT______________________________________
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overall, doing well. Please remember to always bill (the old
way) and complete the order.
The rounding project has been successful so far with over40 patients rounded on. Keep up the good work we are
being noticed out there!
Ed Days are planned and coming next week with the firstclass being 5/4. We have made some slight modifications to
the content and currently they are all on the following topics:
Congenital Heart Defects
De-Escalation
Trauma Education
Head and renal saturation monitoring
Non invasive mask fitting
Pulmonary Professional Development Committee all arewelcome to attend. We meet the 3
rdThursday of the month,
currently from 1630-1730. Next meeting scheduled 5/27
right before Ed day.
As mentioned last month, we have a few different subgroups.. If you are interested, please let me know..
Mentoring
Community Involvement
Respiratory Care Week Planning
Remember you dont have to come to the main meetingto be a part of the sub group.
I need some volunteers to help with Ed days. Please help!
Here is what I need5/27: Someone to teach non invasive mask fitting from
2000-2030. Korina Flint, the non invasive specialist from
sleep lab will train the trainer prior to this half hour session.
6/17 and 8/26: Someone to teach trauma education for
hour from 2030-2100 or any half hour from 2100-2200 Time
to be determined based on another speaker that I am
awaiting confirmation from.
I will let you know what the trauma education consists ofwhen you let me know that youll help.
Thank you for considering!!
Essential Education
by Heather Knez
Get Unstuck when you are in a crucial conversation
We have all been there you know when you are having avery important conversation with someone and that
conversation is going nowhere fast You immediately
recognize that you are stuck because you keep arguing back
and forth about an issue, or the dialogue turns into a debate.
So, what do you do?
Well, you dont want to roll your eyes! That is surely onlygoing to make matters worse (trust me Im speaking from
experience here). You need to take a deep breath, step back
and re-evaluate the situation. Ask yourself and or the person
you are speaking with.. What is our mutual purpose here?
What do we both want to happen with this conversation (or
dialogue)? Once you have this evaluated, it is smooth sailing!
So, a few things that cause people to be stuck in
conversations are these:
When we dont stay focused on what we really want
but instead move from sharing ideas to trying to win.
When we fail to notice that safety is at risk and people
are either attacking or withdrawing.
When we care a great deal about a topic or point and
use debate tactics such as speaking abrasively and
not persuasively.
And finally, when we fail to turn crucial conversations
into action; we dont clarify whats going to happen
next and who is going to do it. Long story short holding each of us accountable for our own actions.
Our ABL 80 competencies are mostly done. If you dont haveyours done, remember, it goes in your file and will be evaluated
at eval time as it was a mandatory requirement with a
deadline.
For those of you who have been running tests, good job on theprogress! We are missing a few things here and there, but
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Thank you Becky Nickels for this very creative interpretation of the classic Tootsie Pop
commercial, created freehand during her 'off-hours'. For the full video visit Classic
Tootsie Roll Pop Commercial (Link does not work in-hospital due to Internet filter.)
http://www.youtube.com/watch?v=yzhB0gF5GTIhttp://www.youtube.com/watch?v=yzhB0gF5GTIhttp://www.youtube.com/watch?v=yzhB0gF5GTIhttp://www.youtube.com/watch?v=yzhB0gF5GTIhttp://www.youtube.com/watch?v=yzhB0gF5GTI -
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Study Updates
The Lucinactant study has concluded. We had zero patientsenrolled in this study over the last two years. As you can guess,
the enrollment criteria and enrollment window were both very
narrow and it made it difficult to qualify patients.
The Calfactant study in the PICU is still on-going. CHW hasenrolled 11 patients in the last two years. There has been a
change to the enrollment criteria. They will now only enroll
patients over 12 years old unless they are Oncology pts.
Oncology pts of any age can be included. We expect there to
be fewer patients for this study from now on. Gregg Hack, Mike
Paquette, and Heather Knez are all study administers. You
may be asked to help with one of these; they will explain your
role when you are needed.
The Unplanned Extubation study in the PICU is still ongoing.We have enrolled 10 pts since February 1
st. We are on pace to
see about 35 - 45 UPE events this year! Everyone is doing a
great job getting all of the paper work completed thanks!
Remember that you need to fill in your years of experience and
your workload (number of points - your charge RCP can help
you figure that out). Bob Todd has done a great job keeping the
W3 ventilator days up to date and counting all the ventilator
days for that unit. March had 252 ventilator days - wow! I still
need volunteers for the other two units. If interested, please
see me or Bob so that you can understand the job
responsibilities.
Ventilator Volume Guarantee
A couple of RCPs working in NICU noticed that volumeventilation is becoming more popular in the NICU. They wanted
to share some interesting facts about volume ventilation with
the Evita ventilators.
Volume modes for the Evita are volume guaranteed. This
means that the machine is looking for a returned (exhaled)
volume that equals the set volume.
The advantage to this is that you can set your 4-7ml/kg volumesand be assured that you are not under-ventilating the pt or
causing a volu-trauma to the pt by using too high of volumes.
For non-leak situations, everything works perfectly.
For leak situations, the machine keeps adding volume above theset volume in order to see the desired returned volume. For
instance, if you have a set VT at 7 mls, your inspired volumes
may read 10-15 mls so that you are getting 7 mls exhaled.
It is likely that, as more volume is required, your peak inspiratory
pressure will increase. We can usually protect the patient from
occasional high pressures by setting the high pressure alarm
but this causes the breath to dump. When we dump the breath
continuously, the volume guarantee becomes meaningless andwe are essentially ventilating the child in a pressure mode only.
In leak situations, you need to be aware of a few things:
Always compare your inspired tidal volumes to your expired tidavolumes. The comparison can tell you how much of a leak you
have. The higher the leak %, the more trouble you may have
ventilating the patient. Sometimes, if you can express the
leakage in a % or # form, the docs may better understand the
situation. Always make sure that it is actually the pt that is
leaking and not the circuit. Micro cracks in the circuits can causevolumes to be way off. A check of the circuit can be done in
about 30 seconds in the set up menu by doing the leakage
test.
Always look at your peak inspiratory pressure and criticallyassess your high PIP alarm. Are most of the breaths able to be
administered without dumping the breath? Can I safely
increase my high pressure alarm? If not, there should be a
conversation with the MDs about what is happening.
Suggestions could include increasing the airway pressure alarm.Consider changing the mode of ventilation to a pressure so thatyou are once again in control of the ventilation. And finally
consider changing the ETT to another size or a cuffed tube.
Obviously, the final goal is to ventilate the patient adequately
while not having nuisance alarms if you can do that in volume
Prairie DawnBy Khris O'Brien
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President's Challenge targets all, frominfrequent exercisers to 'champions'
Save your own life
May is the month of the President'sChallenge. It's a great opportunity
to have fun and get fit, individually or
with a group. Whether you are
presently inactive, seldom exercise,
or will be one of The President's
Champions, the challenge could put
you on the road to fitness and
strength.
The Active Lifestyle ProgramIf you are active less than 30 minutes a day, five days a week, thisprogram is what you need to strengthen your heart, increase your
endurance and give you a more positive outlook on life. The
program helps you set goals that encourage fitness for a lifetime.
You can choose from all kinds of activities. You'll get a personal log
to guide you on the way toward the Presidential Active Lifestyle
Award. The program asks you to be active five days a week for six
weeks.
The Presidential Champions Program
If are already active for 30 minutes a day, five days a week, theChampions Program will test just how high you can raise youractivity level. The guidelines are simple and you can choose from a
number of activities. The Champions also get a personal activity log
to help track their progress. There is a special segment for
performance athletes and others who want to train at advanced
levels. In either case, the goal is to see how many points you can
earn by being active. You could earn the Bronze award or keep
going for a Silver or Gold. You don't need an invitation to join. Just
go toPresident's Challengeand sign up.
Submitted by Deb Bakalarski
Thank a nurseMay 6-12, National Nurses Week
During National Nurses Week, we are reminded thatnurses are a pivotal component of medical care for people
of all ages. Here is a moving prayer written by an
unknown author, asking for the serenity and wisdom to
perform her nursing duties while under stress from sources
over which she has little control.
A Nurse PrayerUnknown Author
Dear Lord, Grant me the Serenityto accept the things I cannot change,
The courage to change the things I can,and the Wisdom
to hide the bodies of those DoctorsI had to kill because they pushed me too far
More than ever, as years go by, patient outcomes areknown to be more positive when skilled and sensitive
nursing is involved.
Because a "patient" may be an individual, a family, or acommunity, patient outcome is a broad term that is
amenable to change. Nurses are a positive influence in
these outcomes.
In addition to May 12 which is International Nurses Day,National Nurses Week also includes May 8, National
Student Nurses Day and Wednesday of Nurses Week,
National School Nurses Day.
http://www.presidentschallenge.org/http://www.presidentschallenge.org/http://www.presidentschallenge.org/http://www.presidentschallenge.org/ -
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Honoree
Name
Submitted
byComments
Jason Ousey Karrina MaherThanks to Jason for doing all of the CFr's on the floors since we had a sick call tonight and I was
covering all of acute care. (Even though you were in W3) Much appreciated.
Julia
Halvoson
Anthony
Martinez
Excellent job following up on the incident reports while I was on vacation. I appreciate all the
time and effort.
Deborah
BakalarskiCarol Wegner
Thank you so much for your wonderful work while Lori was on medical leave. You showed such
commitment and caring for the children/families--plus you did a great job of teaching me.
Deborah
BakalarskiCynthia Gore
Thank you, Deb, for your tremendous hard work and job well done while covering Lori's 6 -week
leave! The trach-vent program ran seamlessly because of your efforts!
Deborah
BakalarskiLori Leiser
I just wanted to thank you for doing such a great job covering for me while I was off for the past
6 weeks.
Wendy
RobinsonKarrina Maher
Thank you Wendy for helping me out on the 15th when I was alone in acute care. You are
always willing to help out. It is much appreciated.
Katherine
HalvorsonKarrina Maher
Katie, thank you for checking to see if I needed help/or was doing okay the night of the 15th.
Also for being so concerned about my assignment.
Wendy
Robinson
Wendy
Sinjakovic
I just wanted to send a little shout out to Wendy for always helping out~ "W" --you are the best
PRN RT EVER!!!
Becky
Riederer
Anthony
Martinez
Becky is always willing to help out, but on a day when the noc shift had 2 call-ins, she took care
of 3 bid tx's and did another q6 tx early so that I wouldn't be overloaded with the first 4 hours of
my shift. Thanks again Becky!!!
Katie
HalvorsonBetsy Lane
Thanks Katie for being a part of our weekend. It's always nice to know you and Mike have the
NICU. You two work so well together.
Michael
Wolter Betsy Lane
Thanks for being so supportive and helpful Mike. You and Katie make a great team, and I can
always breathe a little easier when I know you guys are here
Mary Multhauf Betsy LaneThanks for being so helpful and willing to take on a student Sunday. Taking the transport
allowed me to stay with my patients, and be available for the other therapist.
Richard
NelsonBetsy Lane
On Sunday 4/25 - You were such a help. Thanks so much for everything you did to help when
things were so hectic.
Respiratory Care ServicesHigh Fives
Con ratulations to All!
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C R E D I T S
Thank you very much to everyone who has contributedmaterial, support and ideas to this newsletter. It is your
contributions that make this possible.
Becky Riederer
Rebecca Nickels
Anthony Martinez
Khris O'Brien
Karen Jones
Grace Flanagan
Deb Bakalarski
Carla Riehl
Rhonda Duerst
Heather Knez
CALENDAR EVENTS
Clean Air Month
Lupus Awareness Month
Lyme Disease Awareness Month
Melanoma and Skin Cancer Detection Month
Mental Health Month
National Asthma and Allergy Awareness Month
National Bike Month
Jewish American Heritage Month
National Salad Month
National Physical Education Week: May 1 - 7
Be Kind to Animals Week: May 2 - 8
National Nurses' Week: May 6 - 12
National Stuttering Awareness Wk: May 10-16
Emergency Medical Services Week : 4th week
Save the Rhino Day: May 1
Cinco de Mayo: May 5
National Day of Prayer: May 6
Mother's Day: May 9
Lost Sock Memorial Day: May 9
Armed Forces Day: May 15
Shavuot: May 19
National Employee Health Day: May 19
Memorial Day: May 31
World No Tobacco Day: May 31
Congratulations Chas for passing your RRT!
Congratulations Khris O'Brien!
Khris OBrien has been appointed as Co-Chair of the Joint ClinicalPractice Council for CHW. The purpose of the council is to approve
CHW patient care P&Ps and guidelines. This council is also arecommending body for defining and recommending Standards of
Practice/Care to the Vice President of Patient Care Services. This is a
great honor for both Khris and the
department. She is the first
non-nurse who has been appointed
Co-Chair of this council -Rhonda
The young man who has forsaken the advice and influence of hismother has broken the last cable and severed the last tie that binds him
to an honorable and upright life. He has forsaken his best friend, and
every hope for his future welfare may be abandoned, for he is lost
forever. If he is faithless to mother, he will have but little respect for wife
and children.
The young man or woman who love their home and love their mothercan be safely trusted under almost any and all circumstances and their
life will not be a blank, for they seek what is good. Their hearts will be
ennobled, and God will bless them.
Search Lights On Health, Light On Dark Corners by Professor B.G. Jefferis M.D.,PHD. and J.L. Nicholas, A.M. Published by J.L. Nicholas & CO. Naperville, IL
1920 Copyrighted 1895
THE
MOTHER'S
INFLUENCEby Carla Riehl
http://www.holidayinsights.com/moreholidays/May/saverhinoday.htmhttp://www.holidayinsights.com/moreholidays/May/saverhinoday.htm