rcs newsletter april 2010

8/9/2019 RCS Newsletter April 2010

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Volume 1, Issue 3 The First Breath of News April, 201

Happy Easter! Page 1

RESPIRATORY CARE All the News You Can Inhale

1 Editorial Comments & Employee in Focus

2 Creative Cooking Corner & Crucial Conversations

3 Night Shift News

4/5 Managing with Rhonda / Photos & Arbor Day

6/7 Education / Let's Get Physical / Resp Technology

8/9 Prairie Dawn / Respiratory Care High Fives

10 Credits and Other Stuff

Editorial Commentsby Terry Nuttall

Thank you very much to everyone whohave contributed to the content of thisnewsletter. Hopefully someone outthere will find something useful. Onthat note I must relate some importantinformation that I just learned from the pharmacy department.There is now an acute shortage of 3% Saline within the hospitalused to treat cerebral edema in head injury patients. The 3%saline that RT uses is drawn from the same hypertonic salinebags used for head injuries, resulting in the acute shortage.Apparently this was precipitated by the over-usage of 3%Saline in non-bronchiolitis patients and in bronchiolitis patientsin excess of what studies suggest. Physicians have beenrequested to limit respiratory orders for 3% Saline tobronchiolitis patients only and with a frequency not exceedingQ8 o. Apparently, studies indicate that 3% IV saline solution ismore effective for cerebral edema than as an aerosol deliveredto patients for whom there is no evidence of benefit, such asthose with pleural effusions, mucus in the back of the throat orto head injury patients with pulmonary contusions.

Employee in Focusby Terry Nuttall

In our monthly newsletter's ongoing quest to recognizeeach invaluable employee who doesn't mind the limelight,Grace Flanagan has kindly volunteered to be our thirdsubject in our series, Employee in Focus.

G race came to us in June of 2007 after graduating fromNorth West Technical College in Green Bay with JasonMattern, who also became an employee of ours thatsame year. After initially attending nursing school for ayear, Grace decidedthat nursing was not agoal that she wanted topursue and her friend,Jason, informed her ofthe field of RespiratoryCare, the existence ofwhich she was unaware

until then. They thenattended Respiratory Careschool together during which Grace had such a greatexperience with her Clinical Training at CHW'sRespiratory Care department that she asked to comehere again for a second Clinical. Since she enjoyed hersecond CHW clinical equally well and loved working withchildren, Grace knew that she wanted to work with usfrom that point forward and so moved to the Milwaukeearea, persuading Jason to come with her.

G race's life outside of work closely involves her familywho lives in Green Bay to which she travels often to stayin close touch. Grace can't wait for the warmth ofsummer to arrive so that she can head north to herfamily's cottage, relax and fish. Meanwhile she loves theBrewers and happily anticipates Opening Day! She also

Continued on page 2

Grace with friend, Jason


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is a big Packer fan.

For Grace's courage in consenting to be the focus of thiscolumn and for the three excellent years of service that Graceand Jason has given to the Respiratory Care ServicesDepartment at CHW we are thrilled to present them with apersonalized beer mug image, filled with their favorite coldfrothy beverage. Congratulations Grace and Jason! We arefortunate that you are a part of our team!

Employee in Focus cont' Continued from page 1

Creative Cooking Corner

Appetizing Apple Raisin Bread Pudding Three tablespoons melted butterOne1lb loaf of day old cubed cinnamon raisin breadThree cups chopped and peeled tart applesSeven eggsTwo and 1/2 cups milk3/4 cups sugarThree teaspoons vanilla extract

Vanilla Sauce:2/3 cups sugarOne tablespoon cornstarch1/8 teaspoon saltOne cup cold water

One tablespoon butterOne teaspoon vanilla extract

P re heat oven to 325 degrees. Pour melted butter into 13x9baking dish. Combine bread crumbs and apples, sprinkle overbutter. In large bowl whisk eggs, milk, sugar and vanilla. Pourover bread. Bake uncovered @ 325 degrees for 40-45minutes

In small saucepan combine sugar, cornstarch, salt and wateruntil smooth. Bring to a boil over low heat, stirring constantly.

Cook and stir for 1-2 minutes or until thickened. Remove fromheat. Stir in butter and vanilla.Serve with warm breadpudding and savor the taste!Watch for next month'sdelicious recipe by the KrazyKook. Till next time,bon apptit!

By Karen Jones

our Krazy Kook

Crucial Conversationsby Julia Halvorson

S tart with Heart How to stay focused on what you reallywant! When conversations turn crucial, three things happen:we become blind to our own role in the problem, our motivesdegrade and we limit our choices. Stay focused on what youreally want.As much as we want to fix others, its not the place to start.Me first!

I know meI have access to meI can change meI can take responsibility for my own behavior

When conversations fail, ask yourself:What am I acting like I want?What do I really want?How should I behave if I really want those things?

The first thing that degrades during a crucial conversation isnot our behavior --that comes second-- but our motive. We allneed to learn how to stay focused on what we really want andget better results.


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5 Things That Can Make You Happier

1. Be grateful -- People who were asked to write lettersof gratitude to people who had helped them in someway reported a lasting increase in happiness -- overweeks and even months -- after implementing thehabit.

2. Be optimistic -- People were asked to visualize anideal future and describe the image in a journal entry.After doing this for a few weeks, these people tooreported increased feelings of well-being.

3. Count your blessings -- People who practicewriting down three good things that have happenedto them every week show significant boosts inhappiness. The act of focusing on the positive helpspeople remember reasons to be glad.

4. Use your strengths -- Another study asked peopleto identify their greatest strengths, and then to try touse these strengths in new ways. This habit, too,seems to heighten happiness.

5. Commit acts of kindness -- It turns out helpingothers also helps ourselves. People who donate timeor money to charity, or who altruistically assistpeople in need, report improvements in their ownhappiness.

When staph drops by, visiting hours are over !Doris Deida 0.6 PRN

Jennifer Polenska 0.9 PRNTodd Schleef currently training in the PICU

We want to welcome Ted Box to our Night Shift Team! Hestarted on 3/15. He moved here from Florida where hegraduated. Hes currently in orientation and will b e working0.9 Nights.

Wii Bowling League Sign Up!

Just a reminder that the Wii Bowling League sign-up sheetis on the door in the conference room. You dont have tohave a Wii System to play. Spend a couple hours a monthhaving some fun and throwing do wn some food! Wed liketo get rolling by the end of April, so sign up today!

Oh I Got This! Name the artist and song:

I put the pedal to the metalas the sun goes down.

Leave everybody sleepinin this sleepy town tonight.

The first three correct answ ers wins a McDonalds giftcertificate. Send your answer to: [email protected]

Congratulations to Karen who won last month's Oh I GotThis! answer: Night Train.

___________________________________

CHW REPIRATORY NIGHT SHIFT

Night Shift Newzzz..By Anthony
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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The month of March has been a busy month. We have hadmany things to celebrate within our department. On March 11th Iattended the CHHS Recognition Dinner. The following staff werehonored this year: Deb Boettcher, Kim Dey, Julia Halvorson,Gregg Hack, Charlene Williams, Khris O'Brien, Ann Zarnik andKay Fischer (she was not able to attend since she was in Caboson vacation).

Also, on March 18th we held a retirement celebration forCharlene Williams. She is retiring after almost 30 years at CHW.She brought her daughter Marlana, son Marvin "Strawberry", herdaughter in law, sister and grandson along to help her celebrate.It was a very nice party that was attended by many RCS staff,physicians, and other staff from the hospital. She was very happyand stated she misses all the staff. She is getting morecomfortable with not working and has been spending her time atchurch. She mentioned she is hoping to either volunteer or helpat the school with 1st or 2nd graders. I brought the picture ofStew performing PFT's on Charlene's daughter Marlana at the

old hospital. Boy how the years have gone by. Charlene's familyenjoyed the picture. Marlana was so young and Stew was alsomuch younger. It is hard to believe how time flies.

I also received notification that our department received theQuality Respiratory Care Recognition (QRCR) designationawarded by the AARC. This was a great honor and our wholedepartment should be proud of the work you do. We have a greatdepartment that provides quality care to our patients and families.We will be hanging this award with in the office area on ourrecognition wall.

The other large celebration coming up will be the 1 yearanniversary of opening of the new tower. On April 6th of last yearwe moved critical care into the west tower, on April 26th the AcuteCare areas moved and the Herma Heart Center moved in earlyMay. Kay Fischer will host a 1 year celebration on April 6th.Kay's husband will again be cooking and serving Critical Care and

Managing WithRhonda

by Rhonda Duerst

Respiratory staff food on both days and nights. Hope you willbe able to attend. As many have noticed, we continue tohave construction in the hospital. Surgery area has beenundergoing much growth and construction.

We have had 2 new staff start in our department: Ted Boxcomes to us from Florida and Amy Mailandt comes to us fromSt. Lukes. Please take the time to introduce yourself tothem. We are happy to have them as members of our team.

RCS has a goal of increasing the number of RRT staffwithin our department. Ronda Stratman passed her RRT thismonth and I want to congratulate her. She is the secondperson to accomplish this since we implemented the

requirement of all staff who graduated since Jan 1, 2001 tobecome RRT by August 1, 2010. We have many others whoare working to achieve their RRT by August 1st. In Augustwe should have 80% of our staff credentialed as a RRT.CHW is not alone in requiring staff to become RRT. This iswhat most departments are requiring of their staff. When wehire new staff they are required to be RRT or have 1 year toobtain their RRT.

Another important date to remember is June 30th. This iswhen all of our RCP licenses expire. We should receive

notification in May regarding renewal of our license. This willcost $141 which will provide our license until June 30, 2012.

Managing with Rhonda, cont'

Charlene with congratulatory award for 30 years of service at her retirement celebration.

More photos on page 5


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Charlene's daughter, Marlana, next to photo of Stew performing PFT on her as a child

Recognition Dinner with Ann, Ann's Mother, Rhonda and Khris

Recognition Dinner with Julie, Kim, Deb B. and Greg

Rita's amazing ultrasound of Samuel James Tyeptanar, dated

3/26/10, due to be brought into the world on August 1, 2010. Note

that Samuel is already sucking his thumb!

A new tree can add beauty to your landscape and value to yourhome, but choosing its location can be tricky. First, it should beplaced to avoid contact with power lines and buildings. Somequestions to ask when selecting a tree:

How high will this tree grow and how wide will it be? Acolumnar tree requires less space. Round and V-Shaped species provide more shade.

Will it lose its leaves in the winter? What temperatureextremes will it tolerate?

How long will it take for it to reach its full height? Slow-growing species typically live longer. Fast growersprovide beauty and shade in just a few years.

Are the soil, sun, and moisture requirements of this treecompatible with where I want to plant it?

Will this tree have flowers, and would that create messydroppings on a driveway or sidewalk?

Celebrate Arbor DayApril 30. Plant 'the

right tree' for your yard


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overseeingCommunity involvement leaded by KirkSmikowski (PFT) with HK overseeingRCS week planning leaded by Mark Finfrock(Transport) with HK overseeing

If any of these things interest you then please get involved.You can even send suggestions to any of us via e-mail or

just let us know in passing.

We are almost done with student rotations for the spring.You have all been doing a really good job at preceptingthem. MATC Madison will start their internship 4/26 5/11.There will only be 2 students here during this rotation andthey have chosen our facility for their rotation so they havean interest in pediatrics. Also, MATC Milwaukee will bedoing a specialty rotation through here starting 4/26 5/18,but their rotation will be on pms and nights. We are hopingthat this will help to decrease interference with our orienteesand the MATC Madison rotation. There will be more to comeon the MATC Milwaukee rotation as we discuss it more withthe school affiliate. Hang in there its almost over.

If any of you take a CPR, NRP or PALS course throughanother organization please let me know so that I can getyour expiration date updated in Childrens University. Also,if you are an instructor of NRP and you certify or re certify astaff member, please let me know so I can update thatexpiration date as well.

P lease welcome Ted Box and Amy Mailandt as they rollthrough their orientation. They start precepting 3/30 andthey will be starting their critical care orientation on oraround 5/24. Also, please welcome Todd Schleef andBreanne Foerch to critical care .

Essential Education

by Heather Knez

Within Respiratory, Transport, Sleep and PFT we have apulmonary professional development committee that reallyneeds your help! This committee is responsible for planningRCS week, participating in community involvement such as

speaking to high school classes, health fairs etc. and overallmeshing of our profession into this organization. Manydepartments have a professional development committee andall of those committees report to the main committee of PCEC(Patient Care Executive Committee).

As the chair of the pulmonary professional developmentcommittee I am asking for your help. The committee is doingsome restructuring. We need new members as many of thecurrent members have been part of the committee for manyyears. We have had a few members resign and we have

plenty of room. If at any time you would like to just come andsee what its about you are always welcome. If you areinterested, please see me. We meet the 4 th Thursday of everymonth from 1630-1730.

If you are not interested in being a part of the committee, butwould like to help with things related to your profession thenyou can do that too. We have developed sub groups from theoriginal committee that will allow people to help with otheractivities and be involved without having to come to any extrameetings and without having to attend the main pulmonary

professional development committee. All plans, activities andgoals for each subgroup will need to be reported to me so thatI can report that to the main committee and then up to thePatient Care Executive Committee. The sub groups arecurrently:

Mentoring leaded by Kathy Semrad with HK

Continued next column

I'm stillwaiting formy coffee...


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Get Our Bodies Moving

by Carla Riehl

Its week four of the Spring Into Action Challenge. If you haventstarted participating yet, you still have plenty of time. This is an

extended challenge 24 weeks long. Find all the challengedetails, requirements and tracking forms atCHHSHealthySteps.org.

Need help getting started? Enroll in a Healthy Living Programon the Healthy Steps Web site. These six-week, personalizedprograms can help you make small changes that lead to bigresults. There are 12 programs. Heres a sample:

Get In Shape Program: This program helps everyone,from beginners to experienced exercisers, boost their

existing regimen. Easy Start Program: Dont know where to begin?

Sometimes the hardest part of getting healthier andmore physically active is getting started. This programgives you simple guidelines to help change your dietand get more active, and then shows you where to gofrom there.

Your Healthy Living Program: If youre makingprogress and want an easy way to access your toolsand trackers, this maintenance program is made foryou. It provides motivation and tools to help monitor

your progress, set goals and stay informed. You canuse the program for as long as you like. You mustcomplete at least one other Healthy Living Programbefore you begin this one.

If you havent done so already, visit CHHSHealthySteps.org totake the pre-c hallenge survey (its worth two bonus points in thechallenge ).

Respiratory TechnologyUpdates

by Deb Bakalarski

The Handhelds are Gone, The Handhelds are gone, HI HOthe Cherry-O, the Handhelds are gone. Okay, sorry NICUyou are still stuck with them but everywhere else they aregone! I am doing a dance because I will not have to searchfor our handhelds or take back the floor ones we took fromnursing (you know who you are! -- Inside joke to oneoffender).

Here is the exciting new information:NICU is going to be getting a handheld at every single bed

space. They have started adding them 3/30; I am guessing itwill be done in a matter of days so watch for it. They willhave backup handhelds located in the unit. But if one isntworking it would be fairly easy to borrow the one in the roomnext to you since there will be 6 of them in each pod insteadof 2.

For the rest of the building if you have a room where thescanner doesnt work, your backup plan by tower is: Eastand Center tower will have a few backup handhelds in eachunit. West tower will just pull a COW into the room. In all

cases you must call the HELP desk so they can send in aticket for to fix the scanner in the room .
http://www.chhshealthysteps.org/http://www.chhshealthysteps.org/http://www.chhshealthysteps.org/http://www.chhshealthysteps.org/


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Continuous Aerosol Clarifications

We have discovered that we are not using a standardmethod of obtaining continuous aerosol medications from themed select. Because of these variations, we decided to takethis opportunity to completely re-vamp the process andimplement a practice improvement change at the same time.Beginning on April 1 st :

Complete an assessment for your asthma patient. Ifthey score for a continuous treatment and have notreceived a treatment within the last 30-60 minutes,give them a stat treatment.

At the same time you order a single stattreatment, order a continuous treatment (this orderhas been defaulted to stat too). This will cause thepharmacist to get the order to the top of his worklist.He will release the order and TUBE UP a 4 ML vialof Albuterol.

Once you have finished giving the stat treatment,you will go get your continuous nebulizer suppliesand then stop at the tube on your way past to grabthe 4 ml vial of Albuterol.

Please use the 4ml vial to draw up the dose for yourpatient. This vial will have the correct label on it toallow you to properly scan the medication.

Do not worry about wasting Albuterol in this formit is very cheap and does not incur extra cost to thepatient.

For a pilot period, the 4ml dosages will not be available inthe med-select, so be sure to stop at the tube system to pickup your 4 ml vial. Because we're not consistently using the 4ml dosages from med-select, we were unable to determinethe units with the highest need. It is not cost effective to keepthis dosage stocked in all of the med-selects, so pharmacy

offered the tubing alternative . Please let me know if you have any issues with the 4 ml vial getting tubed to you in a timely manner or if you think there are specific units which

should have the 4 ml doses stocked because of increased

usage .

The pilot will become permanent after the first asthmaseason if we find the process is working. If we discover thereare too many issues with this process, we will tweak it duringthe asthma season until we come up with a better way . Staytuned to e-mail and the newsletter for updates!

Rumors, rumors, rumors ...

What is happening in MRI?!? A few of you may have heard a rumor that George Hoffmanis doing something strange in MRI. This time the rumor millis true, something is going on and it like George - is acrazy sort of genius.

This is the problem. Whenever they do MRIs for cardiackids, they need to stop breathing every time they capture aslice of the chest. This can take 50-60 seconds. There aremany episodes of paused ventilation (approximately 2 hoursworth) during a typical chest scan. This causes manyepisodes of increased PCO 2, which causes a decrease inPH, which can cause changes in blood flow in the chest aswell as oxygen redistribution. All bad things! Not to mentionhow much time it takes to do a scan in which you areconstantly pausing and then quickly hyperventilating to getthe CO 2 back down.

S o George thought that there must be a way to accomplishhis goals, which are:

1. Be able to provide anesthetic gas to the pt.2. Reduce the number of times when CO 2 swings

occur in the pts blood

3. Have minimal impact of the quality of the MRI scan.4. Bonus: Reduced time for the pt on anesthesia.

What he is doing is connecting the oscillator on theexpiratory limb of the anesthesia circuit. He does this bypositioning the oscillator outside the MRI room and puttingthe circuit through the port hole. Using low compressible

Continued next column

Prairie DawnBy Khris O'Brien

Continued on Page 9


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HonoreeName

Submittedby

Comments

GraceFlanagan

DanielleSeguin

Grace went above and beyond and finished patient's second BID tx for night shift when she foundout they would be short staffed. It was a huge help and is greatly appreciated!

SandraCharles

DanielleSeguin

Sandy went above and beyond and finished patient's second BID tx for night shift when she foundout they would be short staffed. It was a huge help and is greatly appreciated!

RobertJopke

DeborahBakalarski

Thanks so much for helping me switch a NICU baby over to the home vent. The NICU is not myarea of expertise at all and you helped me feel comfortable there. So thank you so much for all thehelp you gave me and the time you spent out of your busy day

JoAnnaMcCauley

KatherineSemrad

Thank-you to Joanna for stepping up and helping others with treatments and assessments. Nopatients were missed and service was timely.

MaryMulthauf

KatherineSemrad

Thanks to Mary for helping out with Protocol checks when we were short staffed. You gladly cameout of your unit to help others.

RichardNelson

Robert ToddRick was working on a different floor tonight and when I was busy and running behind he camedown and bailed me out. Thanks, Rick!

WayneBarta

SharolynParry

Wayne, 512's guardian angel sent you our way even when we didn't think we needed you! Yourpresence was a real blessing! Thank you for your help, support, reassurance, and calm,competent demeanor. I'm very happy to have had you as our RCP yesterday. You are a wonderful"teacher" to all around you. Thank you, once again, Wayne!

Lynn KlichAnthonyMartinez

Thank you Lynn for going the extra mile to help cover sick calls tonight. I appreciate your effortsand it made West 5 run smoother!

HilaryLedbetter

AnthonyMartinez

Thanks Hilary for coming in and helping cover some sick calls! Your help is greatly appreciated.

Respiratory Care ServicesHigh Fives

Con ratulations to All!

tubing, he connects it directly to the expiratory limb of the MRI circuit. His exact configuration is always changing and he has notcome up with a final product yet. However, he has had some pretty good outcomes. The MRI scan is virtually indistinguishablefrom the paused breath scan. It reduces his total scan time from 2 hours to only about 45 minutes. He can deliver his anestheticgas and the CO 2 rises slowly over about 45 minutes (only one time).

We are still working out a BUNCH of details and we will keep you posted as to how this progresses. In the meantime, this by nomeans suggests that we can take an oscillator patient to MRI for a scan. The ventilation is not nearly enough to ventilate apatient with diseased lungs for an extended period of time.

If you should get a call requesting an oscillator setup for George, Do not take a new circuit . He will have one for us to use(circuits cost $400 each and we dont have a way to bill for it yet). He currently does not know how to OVP it, so we will need toOVP it for now with his circuit. Do not leave the oscillato r vent in MRI over night or weekends because even security will not letus in to retrieve it. Thank you very much!

Rumors, continued from Pg 8


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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.Anthony Martinez

Julia Halvorson

Rhonda Duerst

Khris O'Brien

Heather Knez

Karen Jones

Grace Flanagan

Jason Mattern

Deb Bakalarski

Carla Riehl

Rita Tyeptanar

CALENDAR EVENTS

Cancer Control MonthNational Donate Life Month

Prevention of Animal Cruelty Month

National Humor Month

Stress Awareness Month

Sexual Assault Awareness Month

April Fool's Day/One Cent Day: April 1National Walk to Work Day: April 2Good Friday: April 2National Peanut Butter & Jelly Day: April 3Don't Go to Work Unless it's Fun Day: April 3Easter Sunday: April 4Brewer's Opening Day: April 5International Moment of Laughter Day: April 14National Pediatric NP Week: April 11-17Administrative Professionals Day: April 21Earth Day: April 22Take our Kids to Work Day: April 22Lover's Day: April 23Tell a Story Day: April 27Arbor Day: April 30

Employee AnniversariesCongratulations to these invaluable individuals !

Employee Name Years of Service

Bob Jopke 22

Deb Boettcher 21

Rhonda Duerst 23

Julia Halvorson 11

Karen Jones 8

Anthony Martinez 5

Bob Todd 1

Congratulations Ronda and Ron for your RRT!

This occasion would not be complete without awarding all of theseexemplary individuals a somewhat more tangible award than the moretraditional personalized coffee mug. Therefore I hope you all enjoy thiscomplimentary rock. Due to cost saving measures we can offer you onlyone, so please share this among you in the spirit of teamwork you areknown for.

Employee Name Birthday Ted Block April 11

Scott Kruger April 29

Eye Hear it's YourBirthdayEnjoy!

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