Welcome to eFocus.  Our goal is to provide you with timely, informative and useful short summaries and links about UM UCH related news, issues, or events.  Feel free to contact us if you have news to share, story ideas or any other feedback. As always, your comments are welcome.

eFocus, September 2017 topics include:  


Welcome

Helping my son with his 7th grade math homework has made me realize that sometimes going back to the basics is not easy. Coupling this with the time I have been spending in our Operating Rooms has caused me to have a real moment of reflection. We have become numb to the incredible work that everyone is doing. I walked past one room where someone is getting his cervical spine fused so that he can have a better quality of life. In the next room, an AV fistula was placed so the patient can have dialysis. I stayed in a room where a patient, because his wife nagged him, was finally getting a hernia repaired. A symphony of people from EVS, techs, nurses, first assists, anesthesia, surgeons and more work together to care for these patients, flip the room and then do it over again. All the while, trying to make sure we do no harm – primum non nocere.  As I am writing this, University of Maryland Upper Chesapeake Health has had 9 Healthcare Associated Infections for FY 2018, a significant reduction over last year. Take a look at that graph in this month’s eFocus and see how we are tracking as compared to last year. 

We have a packed issue for you but would like to highlight the visit from the past Surgeon General of the United States of America, Dr. Vivek Murthy, who recently visited UM Upper Chesapeake Medical Center to discuss the opioid epidemic. He was impressive and made me feel like an underachiever as he is only 40 years old. The opioid epidemic continues to rage on and our duty as physicians must be to abide by responsible opioid prescribing practices to prevent the disease, improve screening and to help connect those patients that already have the substance use disorder with treatment. Dr. Murthy emphasized the science of the substance use disorder - a biochemical pathway inside the brain. A disease that requires treatment and management like diabetes. We are working on some initiatives both within the community and within our hospital to attack the epidemic. More to come but we all must remain diligent. When we look at our children or our grandchildren, we know we have to do better.

Fermin Barrueto, Jr., M.D., M.B.A.
Senior Vice President/CMO
Medical Staff Affairs 


Announcements

Dr. Leonardo Girio-Herrara Named Medical Director of Infectious Disease

As of September 5, 2017, Dr. Leonardo Girio-Herrera has been appointed the new Medical Director of Infectious Disease. Dr. Girio-Herrera received his D.O. at Ohio University College of Osteopathic Medicine in 2009. His residency in Internal Medicine was completed at Riverside Methodist Hospital in Columbus, Ohio from 2009 – 2012. Dr. Girio-Herrera completed a fellowship in Infectious Diseases at University of Miami/Jackson Memorial Hospital in Miami, Florida from 2012 – 2014. Board Certified with the American Board of Internal Medicine and the American Board of Internal Medicine, Infectious Disease Subspecialty, Dr. Girio-Herrera has been with UM Upper Chesapeake Health since 2015.

System Leadership Changes

Please note the new roles of the following UMMS leaders.


Safety Updates

Healthcare Acquired Infections: The Latest

 CAUTI Prevention Updates for Meditech

The CAUTI Prevention team has worked on streamlining the ordering process for IUCs and related nursing documentation to support appropriate use of IUCs and patient care. The planned go-live date is October 31, 2017. A summary of the updates is included below.

  • We will have 4 main orders for indwelling urinary catheter (IUC):  Insert, Maintain, Discontinue, Change Chronic (8 were removed)
  • New- change chronic catheter order that allows the provider to discontinue the old chronic catheter and insert the new catheter in the same order
  • Orders allow for selection of the type of catheter, including 2-way vs. 3-way, straight vs. Coude tip, and hematuria catheters
  • Ability to order CBI directly from the insert order (separate CBI order will remain for cases where this is being ordered without IUC insertion)
  • Opting in/out of the IUC removal nurse-driven protocol (NDP) triggers additional interventions down the line to provide clinical decision support to nursing?
  • Reduced the number of clicks by defaulting pre-selected options

If you have questions, please speak to our Infection Prevention team. If you have documentation/ordering questions, please call extension 2763 (CPOE).

The HPV Epidemic: Are You Vaccinating Your Pediatric and Young Adult Patients?

Despite advances in awareness and prevention, human papilloma virus (HPV) remains a major public health threat. HPV is a group of more than 150 related infectious viruses. Each of the HPV viruses are given a number which is called its HPV type. HPV is named for the papillomas that some HPV types can cause. More than 40 HPV types can be easily spread through direct skin to skin and sexual contact. HPV infections are the most common sexually transmitted infections in the United States. Sexually transmitted HPV types fall into two categories:

  • Low-risk HPVs, which do not cause cancer but can cause skin warts (technically known as condylomata acuminata) on or around the genitals and anus. For example, HPV types 6 and 11 cause 90% of all genital warts. HPV types 6 and 11 also cause recurrent respiratory papillomatosis, a less common disease in which benign tumors grow in the air passages leading from the nose and mouth into the lungs.
  • High-risk HPVs, which can cause cancer. About a dozen high-risk HPV types have been identified. Two of these, HPV types 16 and 18, are responsible for most HPV-caused cancers. About 14 million new genital HPV infections occur each year. In fact, the CDC estimates that more than 90% of men and women will be infected with at least one type of HPV at some point in their lives. Most HPV infections occur without any symptoms, go away within 1 to 2 years, and do not cause cancer. Some HPV infections, however, can persist for many years. Persistent infections with high-risk HPV types can lead to cell changes that if untreated can progress to cancer. CDC reports that 100% of cervical cancers are caused by HPV; additionally, 80+% of anal cancers, 60-90% of vaginal cancers, and 45% of penile cancers are caused by HPV. One of the most concerning statistics is the increase in the number of throat cancers that are being diagnosed as HPV related. 65% of oropharyngeal cancers are associated with HPV. Vaccinating against HPV is the number one prevention strategy for reducing the increasing number of HPV associated cancers.

The HPV vaccination is the first cancer prevention vaccination. It has been proven to be a safe and highly effective form of protection against the infectious disease. Large scales studies on HPV vaccination has shown little to no side effects other than usual arm redness and/or soreness associated with all vaccines. It is recommended for both males and females. The American Academy of Pediatrics and the Advisory Committee on Immunization Practices (ACIP) recommends the HPV vaccination to be given to females ages 11 – 26 and males ages 11 – 21. The vaccine is a 2-dose schedule for boys and girls who initiate the vaccine between ages 11 – 14 and a 3-dose series for ages 15 – 26. 

HPV vaccination rates continue to lag behind those of other preventable diseases. Health care professionals play the most important role in getting patients vaccinated. According to the CDC, the lack of provider recommendation is a major reason for non-vaccination. A sizeable portion of physicians report not strongly recommending the vaccination, and many young adults and parents report receiving little to no information about the vaccine from their providers. Because of the span of age where the vaccination is recommended, Pediatricians, Family Practice, Primary Care and GYN doctors are all recommended to inquire about their patients’ HPV vaccination status and get them vaccinated. 

The Department of Community Outreach and Health Improvement, along with the Kaufman Cancer Center, the Harford County Health Department and the Harford County School System, are working on a collaborative HPV vaccination program. The goal of the program is to increase the HPV vaccination rates here in Harford County and ultimately reduce HPV related cancers in our community. Currently the rate for vaccination in the eligible age group is approximately 33%. The rate of vaccination for the other preventable diseases is three times greater. Remember: the HPV vaccination is a cancer prevention vaccination! 


Quality Updates

Red Blood Cell Transfusion Guidelines

It is good practice to consider the hemoglobin level, the overall clinical context, patient preferences, and alternative therapies when making transfusion decisions regarding an individual patient.

  • AABB RBC Transfusion Guidelines
    • Hemoglobin 7 g/dL
      • Recommended for hospitalized adult patients who are hemodynamically stable, including critically ill patients, rather than when the hemoglobin level is 10 g/dL.
    • Hemoglobin 8 g/dL
      • Recommended for patients undergoing orthopedic surgery, cardiac surgery and those with preexisting cardiovascular disease.
    • These recommendations do not apply to patients with acute coronary syndromes, severe thrombocytopenia (patients treated for hematological or oncological reasons who are at risk for bleeding) and chronic transfusion-dependent anemia.
  • Procedure for Administration 
    • Red blood cells should be ordered 1 unit at a time in non-urgent settings. The patient should be reassessed (symptoms, clinical examination, hemoglobin level) before additional units are ordered.
    • Dose (for routine transfusion)
      • In adults, 1 unit typically increases the hemoglobin level by approximately 1 g/dL and increases hematocrit by 3%.
    • The initial portion of each unit transfused should be infused cautiously and with sufficient observation to detect the onset of acute reactions.  Thereafter, infusion can be more rapid as tolerated.  Infusion must be completed within 4 hours.

For more information, call 443-643-1451 or email dking@uchs.org.

19th U.S. Surgeon General Visits UM UCH

Dr. Vivek Murthy, America's 19th Surgeon General, visited UM UCH on Thursday, Sept. 14 to have a discussion on Facing Addiction: The Epidemic of Substance Use Disorder. Board member Donald Mathis, President/CEO of the Community Action Partnership of Washington, D.C., served as moderator.

As the Vice Admiral of the US Public Health Service Commissioned Corps, Dr. Murthy commanded a uniformed service of 6,600 public health officers globally. During his tenure, he launched the TurnTheTide campaign, catalyzing a movement among health professionals to address the nation's opioid crisis. He also issued the first Surgeon General's Report on Alcohol, Drugs, and Health, calling for expanded access to prevention and tratement and for recognizing addiction as a chronic illness, not a character flaw. An internal medicine physician and entrepreneur, Dr. Murthy has co-founded a number of organizations: VISIONS, and HIV/AIDS education program in India; Swasthya, a community/health partnership in rural India training women as health providers and educators; software company TrialNetworks; and Doctors for America.

Read more about the opioid epidemic on the CDC Opioid Resource Website.

**If you're reading this: How many people died from opioids in 2015 in the U.S.? (Answer in URL above). The first five people to email fbarrueto@uchs.org  with the correct answer will be entered into a drawing to win a gift certificate to Birroteca.

UM UCH Joins Center to Advance Palliative Care

UM UCMC and UM HMH recently became members of the Center to Advance Palliative Care (CAPC) and one of the benefits of membership is unlimited access to CAPC Central, an online education portal for physicians and front line staff. CAPC Central provides an online CME / CEU curriculum that covers the following 5 clinical categories: 

  • Pain Management
  • Communication Skills
  • Symptom Management
  • Relief of Suffering Across the Disease Trajectory
  • Preventing Crises Through Whole-Person Care

Anyone with a uchs.org e-mail address can sign up for a free account and complete CME / CEU courses. In addition, CAPC offers a designation in pain management, symptom management and communication skills. Sign up for a CAPC account HERE and please share this information with your teams.

Contact Nate Albright, nalbright@uchs.org, with any questions.


Empathy Updates

Dr. Kim Cass Talks Teen Suicide on MPT

Tragically, more kids are choosing suicide as an option than ever before. The suicide rate among teenage girls hit a 40-year high in 2015, according to the CDC. Suicide rates doubled among girls and rose by more than 30 percent among teen boys and young men between 2007 and 2015. Depression and suicidal thoughts are a serious medical problem among youth today. How are our kids affected by stress, bullying and mental health issues? What can parents and grandparents do about it? Dr. Kim Cass, Chair of Pediatrics at UM UCH, recently visited the set of Maryland Public Television's Direct Connection “Your Health” program discussing these issues and offering some expert advice and guidance. You can check out the video online HERE.


MEC and P&T Summaries

The following items were approved during the MEC meeting held on September 13th.


Upcoming Meetings and Events

Mark your calendars for important standing meetings and special events.

Special Events

  • 1st UM UCMC Emergency Nursing Conference: Victories and Challenges of Emergency Nursing in the Current Era
    October 12, 7 a.m. - 4 p.m.
    UM UCMC, Chesapeake Conference Center
    To learn more or to register, call x2144 or x2120.

  • The Breast Center at UM UCMC presents: Breast Cancer: Sexual Health and Recovery
    October 17, 4:30 - 7:30 p.m.
    KCC, Streett Conference Room
    Guest Speaker: Sage Bolte, PhD, LCSW, OSW-C, CST
    Call 443-643-3350 for more info and registration brochure.    

Standing Meetings

  • Pediatric Grand Rounds: Held the first Wednesday of every quarter (Jan., Apr., July, Oct.) from 7 - 8 p.m. Guest lecturers present different topics in pediatric medicine, including common dermatologic conditions, effects and management of obesity in children, pediatric head injuries, and more.  
  • Multidisciplinary Thoracic and General Conferences: 12 Noon, Alternates Every Thursday (e.g., Thoracic is 11/3, General is 11/10)
    UM UCMC, KCC Streett Conference Room
  • Multidisciplinary Breast Conference: 8 a.m., Every Tuesday
    Radiology/Oncology Conference Room
  • Pharmacy &Therapeutics (P & T) Committee: 7:30 a.m., Third Wednesday of each month
    UM UCMC Maryland Room 
  • Credentials Committee 7:30 - 9 a.m., Third Friday of each month
    UM UCMC, MSCR 
  • Medical Staff Leadership  8 - 9 a.m., Fourth Thursday of each month
    UM UCMC, Fallston Room/UM HMH, MSCR
  • Metabolic Bariatric Surgery Committee: 5 p.m., Quarterly, Wednesdays
    HMH MSCR and UCMC Fallston Rm
    Upcoming dates: March 15, June 21, Sept 20, Dec 20

  • Allied Health Practitioner Committee:8 – 9 a.m., Third Tuesday of each month
    UM UCMC, MSCR