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September 17, 2015

BMC Celebrates Employees at the Annual Service Awards

Do you remember the first day you walked into BMC as an employee? For some of us, it might have been a year ago. For others, it has been much longer, and for one employee, that first day was 50 years ago. No matter how long you've been at BMC, your time here has probably been memorable. BMC's first 50-year employee was one of the many celebrated at the annual Service Awards on September 10, which honor BMC staff at different stages of their hospital tenure, from 5 to 50 years.

Lisa Kelly-Croswell, Senior Vice President of Human Resources, kicked off the awards, which she jokingly called the "Kate Walsh dance party." On a more serious note, Kelly-Croswell told the employees being honored that "time is a gift and how and where we choose to spend it is important. I am honored that you choose to spend your time here at BMC."

Walsh then took the stage to honor employees and highlighted the major popular culture, news, sports, and BMC events of each year these employees started at BMC. Video screens around the tent reminded us of the (sometimes terrible) fashion, album covers, and headlines associated with these events. For each year, attendees heard some of the most popular songs of the year – one of which, Rapper's Delight, was performed live by Walsh, Kelly-Croswell, Dave Maffeo, Senior Director of Support Services, and Charles Green, Associate Director of Food and Nutrition Services, with backup dancing from Nancy Gaden, RN, Chief Nursing Officer.

"The service awards have to be one of my favorite hospital events; I look forward to them every year," said Walsh. "Today, we're honoring 660 of our colleagues who are celebrating a collective 9870 years of service to our hospital and our patients, working in every corner of our organization. No matter whether you are at the bedside every day or spend your time in a kitchen, an office, a lab, a pharmacy or keeping the hospital clean, wherever you work, you make it possible for us to deliver great care and provide exceptional care without exception. And this past year was a great example of that. Whether it was during the installation of our new eMERGE electronic health records system, scares about Ebola, the ongoing construction work on our campus, or snow, snow and more snow, you made sure our patients and their families got great care, no matter what."

Three of the honorees were being celebrated for 45 years of service. Frankie Odoms-Brown, a now-retired medical laboratory technician, was honored by Chris Andry, PhD, Vice Chair of Pathology and Laboratory Medicine. Clementine Reese, a CNA in Labor and Delivery, was honored by Ginny Combs, RN, Nurse Manager of the Mother-Baby Unit. Donna Kenney, a charge nurse in the ED, was honored by Cathy Fanning, Nurse Manager in the ED.

The final honoree, who spent 50 years at BMC, was Marie Rizzo, who could not attend the event, but was enjoying a vacation. Rizzo started doing staffing and recruiting in the Nursing Department in 1964 and has been a member of Human Resources since 1988. According to Walsh, "her colleagues call Marie the go-to person, hard-working, making sure the job gets done right, and sharing her institutional knowledge with all. Marie is proud of her extended family and loves to share stories and always interested in other's stories."

"Every year, I stand up here and not only do I have a wonderful, wonderful time, but every year it makes me so proud to work with all of you," said Walsh in closing. "You're all extraordinary."

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A Night in the Emergency Department

It's 1 a.m. on September 1, and so far has been a quiet night in the Emergency Department – but no one likes to use that word. With a small but experienced team of 18 nurses, two attending physicians, and eight residents to see the approximately 40 patients who come into the ED each night, plus the patients already in the ED when the shift starts, no one wants to risk jinxing things or speaking too soon. But night after night, quiet or not, this team sees some of the most difficult cases from around Boston.

"Of course days can be extremely different, but we see so many things you don't see during the day," says Steve Slaney, RN, a charge nurse in the ED. "BMC is a catchall for the city, so in addition to normal medical and trauma cases, we see people who can't get into shelters and have nowhere else to go, for example."


Emergency Department Featured in ABC News Series
Save My Life, the ABC News medical documentary series featuring emergency and trauma care at BMC, Massachusetts General Hospital, and Brigham and Women's Hospital, ended its six episode run on August 30. The series featured a range of cases at BMC, from a woman who got hit by a car to a drug overdose to a girl who fell 25 feet from a bell tower. Numerous staff members made it on to the show, showcasing not just the diversity of cases at BMC, but also the expertise and compassion of our caregivers.

On this quiet night, the first few cases to come in were a drug overdose, a patient with a face laceration, someone who had been in a motor vehicle accident, and a patient with psychiatric issues. As the night picked up, the range of cases became broader, from more accidents to patients with chest pains to a patient with a dangerously racing heart.

"We see different things from the day shift, some of which are quite unbelievable," says Judy Dyson, RN, a night nurse in the psychiatric ED.

The goal for the night shift in the ED is the same as during the day: to properly stabilize, diagnose, and treat their acute medical conditions, and to do the best we can to help with other needs that many patients may have. Eventually, patients will either be put into beds in the hospital or treated and discharged. However, the night shift comes with different challenges, such as the fact that it's often harder to reach families and loved ones at night.

Despite the inherent challenges of working the night shift, it does provide opportunities for staff members. For some, the night shift has provided an entry into employment at BMC, while others prefer the greater autonomy that comes at night, and many work at night because it's more convenient for them. This is the case for Slaney, who started out at BMC working the 3 p.m. to 3 a.m. shift. "My kids are getting older, and my wife works a 9-5 job, so working nights was the easiest way to make sure the kids could get to school and all their activities," he says.

Regardless of why someone started working on the night shift, it becomes the preferred shift for many who do it. Many nurses told the BMC Brief that they could never work anywhere else now.

"You are or aren't a night nurse," says Sean Roper, RN. "You work nights, but you and the rest of the world have to live days, so the transition can be tough. The rest of the world is waking up and making noise when you get home, which makes it difficult. But if you like the night shift, it's hard to work anywhere else."

Night shift workers have various ways of coping with their altered sleep schedule. Snacking is a common way, with staff members taking breaks to go on runs to Cumberland Farms together. The 24-hour gift shop was also a boost for night shift employees, as well as families of patients, who can spend long hours in the ED.

The camaraderie among those who work on the night shift is clear, and the best way to cope with schedule, according to everyone who spoke to the Brief. According to Kim Carreira, RN, in a sentiment echoed by the other nurses, "It's a very cohesive group. You could have anything come in at any time, and if necessary, everyone drops things and puts their differences aside to work together and do what's needed for the patient."

Just half an hour later, at 1:30 a.m., the stream of patients picks up significantly. Two of the trauma rooms – where more critical patients are stabilized – are in use, and tough calls have been made on where to put patients with less clear medical needs. While it's still relatively quiet, things tend to get busier from 2 a.m. to 5 a.m. The night shift, with its unusual patients and staff, continues on.

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Why Do You Ride?

On September 26, the 66 members of Team BMC participating in the Rodman Ride for Kids will bike 25, 50, or 100 miles to raise money for various pediatric programs at BMC. These team members represent employees across the BMC system, including physicians, residents, staff, Boston University School of Medicine students, and BMC HealthNet Plan employees, as well as friends of BMC. Team BMC riders will be part of the thousands participating in the annual Rodman Ride, which is an umbrella matching gift charity, raising funds for youth-focused social service agencies in Massachusetts.

Team BMC members ride for many reasons, from the personal to the professional, and everything in-between. Here are some of those reasons:

"I am looking forward to participating in this year's Rodman Ride on behalf of the Autism Program at BMC. I have my health, my legs and my bike - why would I not want to support one of the most needed and worthwhile programs that we have? I am honored to be able to do so."
Robert Oates, MD, Urology

"Since 1984, the Kids Fund has been quietly performing little miracles for some of the neediest children in the Greater Boston area. The Kid's Fund provides assistance for children's most basic needs. Over the years, I have witnessed some of the wonderful ways the Kid's Fund has made a difference in the lives of children, such as providing mattresses to a family whose home was consumed by fire, providing funds to help send a city-bound kid to summer camp, allowing them to escape the environmental dangers they face each day, and providing a portable crib to a baby who does not have a safe place to sleep. I want to help the Kids Fund do everything possible to give children a chance to grow up healthy with a bright future."
Laurie Douglass, MD, Director of the Pediatric Epilepsy and EEG program and Associate Director of the Pediatric Neurology residency program

"This is my fifth year riding in the Rodman Ride and the event serves to bring us together to support our programs and to highlight the work of the Department of Pediatrics. With our fundraising, we are able to give resources to programs that provide special services and support our families. Our department has, for many years, gone beyond the scope of care that is provided at most institutions and the Rodman Ride allows our department to continue to provide these special programs to our families and the children we serve."
Bob Vinci, MD, Chief of the Department of Pediatrics

"This is my first year working at BMC and participating in the Rodman Ride. The Child Protection Team serves as an additional safety net at this safety net hospital. My husband and I are both riding because we want to support the care of the most vulnerable of children."
Kimberly Schwartz, MD, Medical Director of the Child Protection Team

"Rodman for Kids is an outstanding organization that truly delivers on their mission to support at-risk kids. They also put on a very well organized and fun event on ride day. To be able to raise money for BMC's pediatric programs -- many of which provide our patients and their families with critical services day in and day out with very little fanfare -- while doing something I enjoy is a win-win."
Dave Steger, Communications & Marketing Manager, Department of Surgery

"The Rodman Ride provides me the motivation to do two important things: to raise money for the BMC Kids Fund, which I access on a regular basis to help my primary care patients, and to get in shape to do the century ride. Plus, it's inspiring, and it's fun!"
Alan Meyers, MD, BMC Pediatrics

Team BMC is still accepting donations. Visit the website for more information and to donate.

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BMC Looks to Expand Naloxone Use and Medication-Assisted Treatment to Fight Opioid Epidemic

The growing epidemic of opioid misuse and overdose has been a constant topic in the news and given its long-standing expertise in addiction prevention, research and treatment, BMC has positioned itself as a leader in fighting the epidemic. In April, The BMC Brief highlighted a variety of the services and programs BMC offers to those who need help with addiction. Recently, BMC has expanded those services with grants aimed at increasing both naloxone (Narcan) accessibility and the availability of medication-assisted treatment for pregnant women. In addition, new residents, fellows, and interns at BMC have been trained how to use naloxone to reverse an overdose.

Partnering with CVS Health and Rhode Island Hospital on Naloxone Pilot Program
In August, BMC announced that the hospital has partnered with CVS Health and Rhode Island Hospital to examine the use of pharmacy-distributed naloxone to combat opioid overdose. The three organizations have been awarded a three-year grant from the Agency for Healthcare Research and Quality (AHRQ) for a demonstration program in which they will track and analyze data from CVS, BMC, and Rhode Island Hospital pharmacies throughout Massachusetts and Rhode Island that distribute naloxone rescue kits.

"With the growing severity of the opioid misuse epidemic, we have to move faster and improve naloxone access across the region," says Traci Green, PhD, MSc, Deputy Director of the Injury Prevention Center at BMC. "We have a good start, but many communities lack community-based programs that offer naloxone, and still others don't have the reach they need to reverse the epidemic. It was a natural idea to bring pharmacies to the table and have them supplement these excellent community programs by providing naloxone. Having CVS on board is huge. People see the potential in naloxone distribution as safer opioid medication management, so I hope we can learn and disseminate information about pharmacy naloxone provision quickly."

Through focus groups with pharmacists, opioid (prescription and nonprescription) users, and caregivers, as well as analysis of pharmacy sales data, the partners in this collaboration will develop best practices for a national pharmacy-based naloxone rescue kit program, including pharmacist training, policy, and patient education. For example, says Green, they will look at whether pharmacists should be trained to talk to patients about naloxone if they're filling prescriptions for certain drugs, or if the patient should have to ask for it. The ultimate goal of the program is to understand how to make naloxone more accessible to patients using best practices.

BMC was the first hospital in Massachusetts to provide naloxone to patients upon discharge from the Emergency Department in 2009. Since January 2015, the hospital has been providing naloxone rescue kits to anyone who asks under a standing order from Alexander Walley, MD, MSc, an internal medicine physician at BMC, the medical director of the Massachusetts Naloxone Program and a co-investigator on this study. CVS has been stocking naloxone since September 2014 in Rhode Island and since April 2015 in Massachusetts. None of the grant money will be used to purchase naloxone.

"Drug overdose is the leading cause of injury death in the United States – more people die of overdose than care accidents," says Green. "By understanding, demonstrating, and cataloging the best ways to get naloxone to those who need it, we can help make a difference in those numbers – and save lives."

Expanding Drug Treatment Services for Pregnant Women
Recently, the Massachusetts Department of Public Health (DPH) announced a 3-year, $3 million grant from the federal Substance Abuse and Mental Health Services Administration to expand the availability of medication assisted treatment (MAT) for pregnant women with opioid use disorders in Massachusetts. The grant also aims to improve linkage to comprehensive services for recovery support for women currently receiving MAT. As part of the Moms Do Care project, BMC will provide the training and technical support in caring for women with opioid dependence requiring medication. BMC will facilitate trainings for obstetrics providers to learn about the management of opioid dependence with medications. These trainings will allow providers with prescriptive authority to obtain waivers to treat opioid dependence within their practice.

The Moms Do Care project, led by the DPH, is a collaborative effort between the Department of Children and Families, MassHealth, Advocates for Human Potential, Boston Medical Center, Institute for Health and Recovery, Habit Opco, Spectrum Health Services Inc., Cape Cod Healthcare Inc., and UMass Memorial Hospital.

The grant will be used in a two-pronged approach designed to identify pregnant women in need of MAT and to engage those already receiving MAT. Moms Do Care will work to ensure that both of these groups are linked to comprehensive and coordinated services and recovery support, which helps treatment engagement and retention. Services will include trauma-informed care integrated with pre- and post-natal primary, mental health and addiction services and the treatment teams, which will work in a multidisciplinary approach coordinated across service systems, will include physician prescribers, nurse care managers and Recovery Moms, who will work to support recovery, medication management, supporting efforts to maintain custody and contact with their children. The goals of the grant are to identify and provide treatment to opioid dependent women, educate more providers, and decrease the stigma of the workforce.

"Educating and engaging more OB providers on the benefits of evidence based practices for opioid dependence will facilitate expanded access to treatment in pregnancy and improve outcomes for Moms and babies," says Colleen LaBelle, BSN, RN-BC, CARN, Nurse Manager of the Office-Based Addiction Treatment (OBAT) program.

Training Interns and Residents to Use Naloxone
Every July, new residents, fellows, and interns come to BMC, ready to finally care for patients. While they learn many new things throughout their time at BMC, this year there was something new: orientation day training on how to administer intranasal naloxone.

"The number of overdoses we are seeing at the hospital is increasing, and I felt that residents should be able to help with this problem," says Lauren Nentwich, MD, an attending physician in the Emergency Department. "It's really important for them to know how to help someone who has overdosed, and this was a great opportunity to teach them."

Nentwich, along with Natalie Rizzo and Clare Eichinger, both second year medical students at BUSM, and Ludy Young, John Cromwel, and Moses Williams from Project ASSERT, worked with the Graduate Medical Education staff to set up a booth at orientation where residents, fellows, and interns could be trained on how to administer intranasal naloxone and learn more about where to get it and what the drug is used for. Anyone who participated in the training was also given a survey to gauge the effectiveness of the training.

During resident/fellow orientation, 23 people were trained, only one of whom had used intranasal naloxone before. According to the survey, 100 percent of those trained felt that it was useful. During intern orientation, 107 out of 120 interns were trained, five of whom had used intranasal naloxone before. Again, everyone who was trained felt that it was useful for their future patient care and patient well-being. Based on these results, Nentwich plans to run the training again at orientation next year.

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What do you do, Clinical Documentation Department?

What does your department do?
We are responsible for looking at inpatient records and following patients as they move throughout the hospital. So I might be assigned to a particular patient and I will follow that patient the entire time they're in the hospital, through their electronic medical record. We watch the documentation in that record to see if doctors, dietitians, or whoever else treats the patient, are writing what's actually going on with the patient. This means we watch clinical cues for specificity and accuracy of documentation to reflect how sick a patient is, and will often query the physician or care team to ask for clarification.

In today's world where each hospital's data is published and scrutinized, we want BMC to take credit for the great care they give. In the past, abbreviations, acronyms, arrows, etc. were good enough to capture what was going on with the patient, but nowadays, insurance companies and the broader public really want to see the actual words that describe what's going on with your patients and how you're treating them. We make sure that's happening in patient charts.

What's a typical day like for your department?
We each get an assignment of about 8-10 new patients a day, and follow 20-30 patients at a time. We follow these patients from the time they are admitted to the time they are discharged. As we're reviewing the records, we're in dialogue with doctors, nurse practitioners, residents, and everyone else who has their hands on the medical record. If there's a question about a diagnosis or a code isn't specific enough, we'll follow up with the doctor. Physicians at BMC are really great at documenting and are very responsive to inquiries from our team.

What's one thing staff probably don't know about the Clinical Documentation Department?
All seven of our clinical documentation specialists are nurses. Most people think we're coders or administrators, but we're hired based on our clinical experience and number of years of nursing. We use these clinical backgrounds to determine accuracy. There's particular language and values we're looking for to meet certain standards for diagnosis.

ICD-10 is going live in October. How will that affect your work?
We started training two years ago, when ICD-10 was originally supposed to go live. We work closely with coders and are under the same umbrella, so we've been trained on the changes that are coming. We'll also be part of the education piece to help doctors with the new codes.

For the last month, we've been functioning as if ICD-10 is already live. We've been capturing diagnoses and querying physicians based on ICD-10 expectations, so we're hoping that this will ease our transition. We all feel that we've had really good training, and we will continue to be educated by our coders as to what's still not being specified as well as it could be in the charts.

September 14-18 is Clinical Documentation Improvement Week. Will you have any activities for that?
Clinical Documentation Improvement Week was founded in part to increase public awareness of the clinical documentation profession. To this end, we'll outside the cafeterias during that week to tell employees more about us and what we do.

What do you like most about working at BMC?
The diverse population. You see such fascinating cases and such an interesting world population. In addition, the down-to-earth physicians are great to work with. When you're reading a medical record, you're really reading intimate details of an episode of the patient's life and to see how well patients are treated gives us a real sense of pride. Everyone is treated equally, and it's inspiring.

BMC has given great support and resources to our department. Our program for clinical documentation is cutting-edge, thanks to organizational support from the beginning.

How do you maintain a healthy work/life balance?
We are very fortunate to work a combination of on-site days and remote days. Working remotely is huge, but we also see and talk to each other very often through conference calls and instant messaging. It's a nice blend of home and work environment, which helps us maintain our comradery. It's great for morale and productivity.

Do you know a staff member who should be profiled? Send your suggestions to [email protected] .

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News of Note

Kenny Chesney Visits With Boston Marathon Bombing Survivors
United States Senator Country superstar Kenny Chesney, who was in town for the final two concerts on his Big Revival 2015 Tour at Gillette Stadium, stopped by Boston Medical Center on August 27 for a reunion lunch with Boston Marathon bombing survivors Celeste Corcoran, Sydney Corcoran, Adrianne Haslet-Davis, Steve Woolfenden, and Jeff Bauman. During his visit, he presented a $100,000 check to the ‪Spread The Love Fund‬ — an ongoing fund he established with BMC to help support individuals severely injured by the tragedy.‬‬‬

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Awards and Accolades

BMC Received HealthTrust Innovation Award and Grant
Boston Medical Center has received an innovation award and grant from HealthTrust, an organization which provides cost management solutions to health care organizations. The grant sponsors and rewards new, scalable ideas for advancing health care by improving care delivery, health outcomes, cost savings, and/or operational efficiency. BMC will receive $25,000 in grant money and $25,000 of HealthTrust service line consulting expertise.

The grant application, which was written by Kevin Monahan, MD, a cardiologist, detailed plans to cultivate best practices for device management that improve operational efficiencies, reduce errors, improve patient outcomes, and increase patient and clinician satisfaction. The grant money will be used to offset development costs of the pilot device management program. The consulting resources will be used to analyze existing guidelines on perioperative device management, address training needs, summarize data, establish and test metrics, and provide strategic, process, and financial guidance.

Diane Gauthier, RNP, Receives Clinical Excellence in Nursing Award
Diane Gauthier, RNP, a nurse in Cardiology, was selected as this year's recipient for the Heart Failure Society of America (HFSA) Award for Clinical Excellence in Nursing. The award honors her demonstrated excellence in clinical practice, her integral role in BMC's heart failure program development, and her mentorship of students, peers, and other professionals in comprehensive management of heart failure patients.

Gerard Doherty, MD, Elected President of the International Association of Endocrine Surgeons
Gerard Doherty, MD, Surgeon in Chief, has been elected as the next President of the International Association of Endocrine Surgeons (IAES). He is currently President Elect for two years and will become President at the 2017 annual meeting in Buenos Aires, presiding through the 2019 annual meeting in Krakow.

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