quality report - Kaweah Delta Health Care District

KAWEAH DELTA HEALTH CARE DISTRICT
QUALITY REPORT
WORKING BEHIND THE SCENES TO DELIVER BETTER,
SAFER CARE PAGES 10-17
I
FALL 2012 Issue
CLINICAL QUALITY
& PATIENT SAFETY
FA L L 2 012
– OUR TOP PRIORITI E S
K
aweah Delta has made enormous
investments to support our
physicians and clinical staff in
providing high-quality and safe care
to our patients. As an example, our
Board recently heard a comprehensive
report by our clinical leaders regarding
medication safety. Literally, millions of
medications are provided to patients
each year at Kaweah Delta. We want
each medication to be safe and effective.
During the past five years alone, we have
invested in excess of $7 million in critical
technologies such as:
IN THIS ISSUE
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BLOOD, SIMPLE
KAWEAH DELTA
KNOWS SUPPORT
SEQUOIA PROMPT
CARE
WALKING
MIRACLE
From a hand to hold, to
treatment and therapy,
the Breast Center is there
There for running noses,
coughs and fevers
The amazing survival
of The Lifestyle Center’s
fit octogenarian
Patients get lab results
faster with robotic lab
10
12
14
INFECTION
PREVENTION
A PLAN IN PLACE
FOR EVERY DELIVERY
MEDICATION
SAFETY
The home team helps
reduce infection
Kaweah Delta joins
forces to give moms
and babies better care
“Smart Pumps” are
helping nurses give
the right dose
9
15
RAPID RESPONSE
Kaweah Delta’s team is
saving patients before
they get sicker
KAWEAH DELTA
EVENTS
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A BETTER CHANCE
OF SURVIVAL
KAWEAH DELTA
DIALYSIS
A SUM GREATER
THAN THE PARTS
KAWEAH DELTA
EVENTS
Survival rates are
improving for heart
failure, sepsis and
stroke patients
Visalia dialysis center
earns high marks
for care
Kaweah Delta’s
Rehabilitation Hospital:
Helping in more ways
than one
Wellness seminars,
support groups
and more
On the cover: The Kaweah Delta Infection Prevention Team,
(Pictured from left to right: Cherise McBride, Nancy McKernan,
Kathy Wittman, Evelyn Barker, and Cynthia Vander-Schuur), along
with Dr. Dan Boken, is devoted to keeping infection rates down.
By Lindsay Mann
Chief Executive Officer
READ OUR
QUALITY
REPORT
PAGES 10-17
1. Computerized Medication
Dispensing Machines – These
ensure that medications are not only
secure, but dispensed at the right
time and to the right patient.
2. Bar Coding Systems – These allow
each medication to be administered
with a double-check to ensure that
medications are provided to the right
patient at the right time, in the right
way and in the right dose.
3. Alaris IV Pumps – These very
sophisticated infusion therapy
technologies allow intravenous
medications to be administered
with great precision and with
safeguards to ensure that only proper
IV medications and dosages are
administered to patients.
4. Electronic Medical Records –
We have developed very capable
electronic medical records that
allow our physicians, nurses, and
pharmacists to communicate with
each other in “real-time” (no matter
where they are practicing in the
hospital, in their office, or at home) to
manage a patient’s medications.
5. Pharmacy Robotic Equipment –
Use of robotics in Pharmacy for the
safe and efficient selection, packaging,
and labeling of medications for
delivery to patients.
These are just a few of the key
investments that Kaweah Delta has
made to ensure the medication safety
of our patients. Beyond safety, we want
to ensure the clinical efficacy of our
pharmacy program in helping patients
get well.
The most important element of
our medication safety program rests
in our team of physicians, pharmacists,
nurses, and other clinicians who work
on committees such as our Pharmacy
and Therapeutics Committee. The
committee develops policies to
ensure that we select and administer
medications that are proven to
be safe and effective. We employ
numerous types of clinical pharmacists
in various areas throughout the
hospital. They interact in “real-time”
with physicians and nurses to provide
consultations and administer the more
complex medications in areas such as
chemotherapy, pediatrics, and infectious
diseases.
Based on these investments in key
technologies and, most importantly our
pharmacists and clinical staff, Kaweah
Delta today provides an outstanding
and safe medication program. This is
just one example of many that reflects
Kaweah Delta’s commitment to keep
patients safe and ensure that they have
outstanding health outcomes. It is
only one of a number of areas in which
Kaweah Delta is moving forward with
confidence to deliver excellent care for
our patients.
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M
Phlebotomist Tim Story.
Director David Peterson confers with
Clinical Lab Scientist Carlota Marcus.
ore than 750,000 tubes of blood flow through the Kaweah Delta Clinical
Lab every year. Each is tested, analyzed, and will determine the course of a
treatment, if not a life. Given the high volume of testing and the high stakes
involved, Director David Peterson decided back in 2008 it was time to rethink the lab.
It was taking too long for tubes of blood to be tested. They had to be loaded onto
one instrument, then another, and another.
Not any more. Now those same tubes sprint down a conveyor line where they are
plucked by robotic hands and run through a battery of tests at a speed human hands
couldn’t begin to match. Two years after its million-dollar renovation, the Kaweah Delta
Clinical Lab can process almost 500 samples an hour, or roughly one every eight seconds
at maximum capacity. The shorter turnaround time means faster treatment for patients
and a better chance of things turning out well, especially during emergencies.
“Time really isn’t of the essence if you’re an outpatient,” Peterson said. “But in the
emergency room it’s a different story. Minutes matter.”
In an emergency room that sees 80,000 patients a year, those minutes add up fast.
The new system can conduct 75 different tests on a given sample of blood, then record
and archive the results, distributing them automatically to doctors and staff. Physicians
get their results about 5 to 10 minutes faster. That amounts to a lot of minutes saved
over the course of a year, and, quite possibly, a lot of lives, Peterson said.
THREE GOOD REASONS TO MAKE
A LIST OF YOUR MEDS
BLOOD, SIMPLE
A new robotic lab gets patients’
results quicker at Kaweah Delta
You’ve just been hit by a bus.
You’re unconscious when the
medical team arrives, so you can’t tell
them you’re taking blood thinners.
Fortunately, the EMTs find a list in
your wallet detailing the medications
you take and how much of each. They
notice the blood thinners, and take
alternate measures to get you packed
off safely to the hospital.
Having a list of the medications you
take is a good idea, says Chris Patty,
Registered Nurse and Medication Safety
Specialist. Over-the-counter drugs,
prescriptions, vitamins, herbals – these
can all make a difference in your
medical care. Don’t assume your records
are available to healthcare personnel.
Make sure of it, with a complete and
current med form.
2) Adverse Reactions – Certain
everyday drugs, in combination with
others, can harm the body. Drug
allergies can also cause problems.
These can be avoided by using a
med form.
HERE’S WHY:
For more info about Kaweah Delta’s lab
and other technological advances, visit
KaweahDelta.org and read more about
Med Safety on page 14.
1)Continuity – Even conscious people
forget to take their meds. A list helps
you and your family remember.
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3) Diagnostics – Emergency personnel
can sometimes tell a lot about
your condition by knowing the
medications you take. A list can help
your healthcare team make the right
decisions faster – a big plus in an
emergency.
A med form takes only a few
minutes to create and share. You’ll find
complete directions and a ready-made
form online at www.kaweahdelta.org/
guide/med_form.asp.
V I TA L S I G N S - FA L L 2 012
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Molly De La Cruz and Breast Biopsy Coordinator
Becka Wright at the
Breast Center.
THINK PINK!
Breast Cancer
Awareness
Month
Wear pink, bake a cupcake or join us for high tea as the Kaweah Delta Breast Center
paints the town pink this October to honor and celebrate those in our community
whose lives have been touched by breast cancer. For more information: 624-2242 or
www.KaweahDelta.org
HIGH TEA
Enjoy tea, music, raffles and laughter at the
Breast Cancer Awareness Tea at 4 p.m. on
Oct. 25 at Sequoia Regional Cancer Center,
4945 W. Cypress Ave. Guest speaker: Jane
Case-Cisneros author of Bald Sweaty Bitch
With One Tit: A Memoir, A Pink Ribbon
Journey. Tickets: $15.
KAWEAH DELTA KNOWS SUPPORT
FROM A HAND TO HOLD, TO TREATMENT AND THERAPY, THE BREAST CENTER IS THERE
E
ver the optimist, it didn’t take long for
Molly De La Cruz to find an upside to
breast cancer.
“My husband thought I looked better
without hair,” said Molly, a Social Work
Assistant at Kaweah Delta Health Care
District, who was diagnosed just over a
year ago with stage IV breast cancer. “I
couldn’t believe it,” she said. “I had just run
a half-marathon. ”
The news wasn’t good. The cancer
had metastasized to Molly’s hip. Soon, she
began to ask the same questions patients at
the hospital had asked her. “All these things
start to race through your mind. You think
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about your family and you wonder, ‘Am I
gonna be here in a year?’” Molly said.
When facing cancer, hope and strength
are there for the taking through the
Kaweah Delta Breast Center, Sequoia
Regional Breast Cancer Program and
Sequoia Regional Cancer Center. Molly
called her encounters with them, bright
spots on a journey tougher than any half
marathon. Together, they provided her with
everything from digital imaging to biopsies
to the coordination of treatment and care.
The day of her diagnosis, Molly
and Sheri Leimbach, a Nurse Navigator
with the Breast Center and the Sequoia
Regional Breast Cancer Program, laid the
groundwork for the treatment and support
that Molly would need.
“Sheri was right next to me, walking
through everything with me,” Molly said.
There is a network of options for breast
cancer care in Tulare County. The new
Sequoia Regional Breast Cancer Program
brings together committed and skilled
physicians, surgeons, and oncologists to
make sure people get the best cancer care
possible.
“It can be anxiety provoking to live
with the stress of knowing you have breast
cancer,” said Robert Havard, Jr., MD. “This
program lowers hurdles for people and
helps them get from point A to point B
quickly.”
With that help, Molly pulled through
chemotherapy and a full mastectomy. She
even turned to fitness through The Lifestyle
Center’s Wellness Club for cancer survivors.
The 10-week membership is free with
physician referral.
While Molly’s spirits are back, an
upcoming mammogram will tell her
more - but she’s hopeful. She’s also intent
on stressing the importance of regular
mammograms. “If my story can help
someone else, that would be rewarding.”
WEAR PINK ON FRIDAY, OCT. 5
Wear pink to work and shout out your
support for healthy women. Pink Friday also
marks the start of a month-long series of
contests.
BEST-DRESSED “CUP”CAKES
Cupcakes entered in this contest will be
judged on uniqueness and creativity. Use
any flavor, but don’t forget the pink. Deliver
12 for judging to SRCC, 4945 W. Cypress
Ave. by 11:30 a.m. on Thursday, Oct. 25.
BEST-DRESSED OFFICE
Dress co-workers in pink and share a photo at
Facebook.com/KaweahDelta. All month,
ask friends and customers to “like” it before
Tuesday, Oct. 23. Office with the most votes
wins; winner named on Tuesday, Oct. 25.
BEST-DRESSED WINDOW/DISPLAY
Dress store windows or create a pink breast
cancer awareness display. Share your display
by photo at Facebook.com/KaweahDelta.
Ask friends and customers to “like” it before
5 p.m. on Tuesday, Oct. 23. Display with the
most votes wins; winner named on Tuesday,
Oct. 25.
HONOR HEROES
Post a special message for your
breast cancer hero on Kaweah Delta’s
Facebook page: Facebook.com/
KaweahDelta
Kaweah Delta Breast Center
4949 W. Cypress Ave.
The center is dedicated to
comprehensive imaging services for
women and is staffed with skilled
mammography technologists.
Services provided include:
• Digital screening and diagnostic
mammography
• Breast ultrasound
• Ultrasound-guided breast biopsy
• Nursing case management
• Certified Softer Mammogram Provider
• Breast cancer information and
lending library
• Community breast health education
resources
To schedule your next mammogram
and for more information about
Sequoia Regional
Breast Cancer Program,
call 624-3209 or visit
www.KaweahDelta.org
V I TA L S I G N S - FA L L 2 012
|7
Lora Keller, RN, examines
Dan Kelly’s now fully
healed hand after a severe
burn incident.
Al and Kathy Filak
hard at work at
The Lifestyle Center.
SEQUOIA PROMPT CARE
C E L E B R A T I N G A Y E A R O F M A K I N G PA T I E N T S N O . 1
COLD VS FLU
The seasons are changing which means more
runny noses, coughing, and fevers. But is that
cough and that fever a sign of the flu or is it the
common cold?
Cold: stuffy nose, sore throat, cough, sneezing.
Flu: headache, high fever (102-103 degrees), sore
throat, body aches, cough and chest discomfort,
extreme fatigue.
Most of the time, these will go away on their
own with rest, liquids, and over-the-counter
medication. But, when you experience difficulty
breathing, persistent vomiting and confusion,
get medical attention.
“A flu shot is the best defense against the flu
and upper respiratory infection,” said Dan Allain,
Director of Critical Care and Emergency Services
at Kaweah Delta.
Such vaccinations are available at Sequoia
Prompt Care so when flu season comes around,
be prepared.
Sign up for QuickPass at:
SequoiaPromptCare.org
624-4800
Have a question for Sequoia Prompt Care?
Visit its Facebook page and ask!
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A
t Sequoia Prompt Care (SPC),
patients are the number one
priority. That’s why Veteran
Dan Kelly called Sequoia Prompt Care
when he burned himself and didn’t have
time to make an appointment at the VA
hospital in Tulare or Fresno.
In 15 minutes, he was cleaned up
and ready to go home.
Dan Kelly has visited SPC three
times, the most recent for this seconddegree burn after steam from a roasting
pan seared his hand.
“I usually go to the VA in Tulare, but
you have to have an appointment. For
an emergency I would have had to go to
the VA in Fresno. So I went to Sequoia
Prompt Care,” he said.
SPC is only a block and a half away
from his front door, so Dan received
care almost immediately. “They cleaned
my hand and within four days it was
healed. That’s the fastest I’ve ever seen a
burn heal.”
The clinic is always prepared for
these and other types of minor injuries
with physicians and nursing staff always
ready to help and heal. Dan remembers
the doctor and nurse discussing the best
treatment method, and was impressed
with their vast knowledge and good
communication. “They knew what they
were doing,” Dan said.
Sequoia Prompt Care sees on
average 35 patients a day. That number
increases about 25 percent during flu
season, said Dan Allain, Director of
Critical Care and Emergency Services at
Kaweah Delta.
“We’ve aimed to fill a healthcare
need in our community. Our goal is to
treat the patient quickly and get them
back to their primary physician,”
Allain said.
SPC and Kaweah Delta Urgent
Care specialize in caring for minor
injuries and illness, like Dan Kelly’s burn.
When a patient comes in with a more
serious injury they provide them with
immediate care and get them to the
emergency department as quickly
as possible.
Patients say they appreciate SPC’s
quick and easy process. Behind these
compliments is their QuickPass system
which allows patients to skip the waiting
room by pre-registering online or by
phone. Patients get a call when their
room is ready and waiting.
WALKING MIRACLE
THE AMAZING SURVIVAL OF THE LIFESTYLE CENTER’S FIT O C TOG E N AR I AN
THE LIFESTYLE CENTER
The only medically-based fitness facility in Visalia,
The Lifestyle Center offers complete exercise
facilities for every age and ability.
EQUIPMENT
• TreadmillsI
• Bikes
• Elliptical Trainers
• Weight Machines
• Indoor Gymnasium
• Rock Climbing Wall
ADDITIONAL SERVICES
• Personal Training
• Nutrition Education
• Childcare
• Café
• Massage
• Towel Service
AQUATICS
• Two Indoor Pools
• Aquatic Classes
• Underwater Treadmills
GROUP EXERCISE CLASSES
• Zumba
• RIPPED
• Yoga
• Spinning
• Pilates
• Jiu jitsu
• Karate
• Tai chi
• Senior Fitness Classes
NOW OFFERING SILVER SNEAKERS
A great program for older adults to build strength,
flexibility, balance and friendships.
BENEFITS INCLUDE
• A program advisor to get you started
• Seminars on healthy living and eating
• Group activities
• Improved physical strength and endurance
For more information call 624-3400 or
visit www.TheLifestyleCenter.org
K
athy Filak survived a massive
brain hemorrhage, but
astonished doctors a few days
later when she decided to go to The
Lifestyle Center.
Only about 25 percent of all victims
survive a stroke and for 87-year-olds
that number is closer to zero.
Kathy is one notable exception.
“When she got out she could barely
walk,” her husband Al said. “I had to
hold her up under the arms.”
But two days later there she was
at The Lifestyle Center, working out.
Doctors still can’t explain such a rapid
recovery, but they agree that her level
of fitness played a role in her survival.
“Exercise truly is medicine. It has
been documented repeatedly that
regular physical activity is one of
the most important things that you
can do for your health,” said Patrick
Tazio, Director of The Lifestyle Center.
Exercise can help reduce the risk
of premature death, of developing
diabetes, of depression, and of anxiety,
Tazio said. With a regular exercise
routine, it’s not uncommon for people,
like Kathy, to bounce back quickly from
an illness or minor injury if their body is
healthy and strong.
Kathy and Al are indeed fit. They’ve
worked out at The Lifestyle Center for
the past 10 years, six days a week. A
typical routine starts with 10 minutes
of floor exercises, weight training,
then on to the treadmill for Kathy and
back to the floor for Al. It’s a pleasant
routine for the pair.
“Kathy’s a social butterfly,” Al said.
“She knows everybody in the place
and she talks to everyone. It gets a little
difficult to exercise sometimes because
everybody wants to know how
she’s doing.”
Kathy still has some lingering
memory loss, but the workouts are
helping with that. She can now
manage the stairs and do housework,
and she hopes to drive again soon.
Until then, she’ll ride shotgun with
Al, keep up with the exercise, and
savor the moments that make it
all worthwhile.
“We still have our scotch every
night before dinner,” Al said. “Been
doing that for 60 years.”
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W
QUALITY
REPORT
KAWEAH DELTA:
IMPROVING
INFECTION RATES
TODAY AND BEYOND
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hen a person goes to the
hospital, they expect the
very best care. For that
reason, Kaweah Delta Health Care
District has a team devoted to keeping
infection rates down.
Under the watch of Kaweah Delta’s
Infection Prevention Team, infection
rates including everything from
surgical site infections to blood stream
infections have consistently gone down.
Still, you won’t see team members
celebrating the 38 percent decrease in
hospital-acquired infections.
“We aren’t satisfied because our goal
will always be zero infections. There’s
always something we can make better
– that’s our job,” says Dan Boken, MD,
Medical Director of infectious disease at
Kaweah Delta Medical Center.
Earlier this year, the California
Department of Public Health released
annual reports on healthcare-associated
infections. Overall, the reports were
positive for Kaweah Delta. For
example, they showed Kaweah Delta’s
performance on safe central-line
placement was better than the state
average. Inserting a central line safely
helps prevent central-line associated
bloodstream infections (CLABSI).
For surgical-site infections–infections
that occur after surgery in the part of
the body where the surgery took place–
Kaweah Delta’s infection rate was the
same as the state average for C-section,
colon surgery, coronary artery bypass
graft, fracture repair and spinal fusion.
And, for central line-related infections,
the report showed that the majority of
patient locations at Kaweah Delta (nine
out of 12) had the same risk of infection
as most California hospitals.
“We’ve been working on these areas
identify specific infections, find out if
there are any reoccurring patterns, and
ask, “Did we do everything we could
have to prevent that infection?”
“Our job is to look for any gap …
any area where we can do better. It’s a
constant investigation,” said Wittman,
the only local representative appointed
to serve on the state Healthcare
Associated Infections Advisory
Committee. The committee makes
recommendations to the state on
how to prevent healthcare-associated
infections.
“Our goal will always
When Wittman and team find
be zero infections”
gaps, they take action. For example, to
get hospital-acquired infection rates
– Dan Boken, MD
down the team developed a hand
hygiene awareness program, placed
hand sanitizers in patient rooms, used
Team in Action
isolation carefully, and educated staff
While Kaweah Delta’s Infection
in the use of standard precautions for
Prevention Team is small, just six
all patients. When the team spied a
members cover Kaweah Delta’s eight
slight increase in surgical site infections
campuses, it delivers a big message,
for coronary artery bypass surgery as a
says Kathy Wittman, RN and Infection
result of a new closing device, it did a
Prevention Coordinator. Other
focus study and worked with cardiac
members include: RNs and Infection
surgeons to improve care.
Preventionists Cynthia Vander-Schurr
“The bottom line is that we do this
and Cherise McBride, Nancy McKernan,
because this is our hospital,” Wittman
Data Analyst, and Evelyn Barker, Unit
said. “You, me, our family, our neighbors
Secretary.
“If someone says, ‘Who is responsible could be patients here. It’s our job
to make sure that every nurse, every
for infection control?’ We say it’s every
doctor, every staff member is given the
single person in the organization,”
information they need to best take care
Wittman said. “We all play a role in
of them.”
infection control whether it’s making
If there’s one thing the community
sure to sanitize our hands after working
can
count on, it’s that the job of Kaweah
with a patient or not coming to work
Delta’s Infection Prevention Team is
when we are sick.”
never done, Dr. Boken said.
On a daily basis, the team pours
“Striving for zero infections is a nearly
through real-time results of blood tests,
impossible goal,” Dr. Boken said. “But it’s
wound infections and readmissions
what’s best for the patient and it’s what
for Kaweah Delta patients. With that
information in hand, the team can
they expect.”
and have achieved improvement, which
we expect will be evident in the state’s
2013 report,” Dr. Boken said.
Case in point is Kaweah Delta’s
largest Intensive Care Unit. In the
first half of 2012, the unit has had
zero central-line infections. This is
the unit wheare most patients with
life-threatening infections are initially
treated when they come to the hospital.
“That’s an improvement from where
we were a year ago,” Dr. Boken said.
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A PLAN IN PLACE FOR
EVERY DELIVERY
QUALITY
REPORT
KAWEAH DELTA JOINS FORCES TO GIVE MOMS AND BABIES BETTER CARE
P
Maternal Quality Care Collaborative.
eople don’t expect things to
go wrong in the delivery room.
Kaweah Delta adopted policies and
But if they do, it takes a team to
best practices and has already made
turn them around.
quality improvements. For example,
The team at Kaweah Delta
it’s performing fewer hysterectomies
Medical Center turned things around
for low risk women with persistent
for Aaron Story and his wife Desarie
unexpected bleeding from 0.17
on Aug. 9 when their son was born
percent to 0.05 percent.
quiet and limp.
Such changes are all about
“All of a sudden a swat team of
patients, said Tracie Plunkett, Nurse
nurses ran in and, ‘boom’ they were
Manager of Kaweah Delta’s Labor
Registered Nurses Carol Domres, Rupi Bhangoo,
working on him,” said Aaron Story,
and Delivery Department.
and Karin Reynoso.
30. “I looked at my mom and she
“This has truly been a group
gave me a look that I never want to
effort where everyone got together
department’s work with an international
see again.”
and said, ‘We’re behind this,’” Plunkett
delivery room management collaborative.
As nurses worked on the baby, Story
said. “We’re proactive and our response is
The group of hospitals has one goal: Find
grabbed his mom’s hand and prayed. At
systematic … we’re all on the same page.”
the best ways to resuscitate babies in the
“amen,” he said he heard it – his son’s cry.
Whether it’s making sure to give all
“If the nurses wouldn’t have been there delivery room to avoid conditions such
patients a risk assessment, using supplies
as Chronic Lung Disease. The condition
to do what they did, with the promptness
to measure blood loss, having carts ready
can surface when helping babies breathe
that they did … I don’t know what would
with supplies needed in the event of
injures lung tissue.
have happened,” Story said. “They were
hemorrhage, the team is armed and ready
“This is a great partnership that has
amazing to watch. They didn’t talk about a
when needed, Sawyer said.
really unified our team and improved care
game plan, everyone just knew what
“We all know what the plan is and what
for our patients,” Sawyer said.
to do.”
everyone is going to do,” Sawyer said.
Using a toolkit from the collaborative,
That display of teamwork is not
Going home
Kaweah
Delta now uses less oxygen or
uncommon inside Kaweah Delta’s
Kaweah Delta is also working to
room air to resuscitate babies, avoids
Maternal Child Health Department. The
improve the experience parents have
whenever possible the insertion of
department, which is always looking to do
caring for their newborns. Kaweah Delta
tubes into babies airways, gets babies
better for patients, has ramped up efforts
was chosen to participate in Boston
into warmers sooner to maintain
to improve quality of care for babies who
University’s national study looking at how
struggle to breathe after birth, for mothers their tempuratures, and has upgraded
parents learn to take care of their infants.
equipment. Already, Kaweah Delta has
who bleed too heavily after birth, and to
Those actions are important especially
reduced the number of days babies are
make sure parents know how to prevent
when those actions put children at risk of
on ventilators and has reduced numbers
Sudden Infant Death Syndrome.
Sudden Infant Death Syndrome, a leading
for Chronic Lung Disease, said Monty
“We’re committed to caring for
cause of death in infants.
Anderson, RN, who along with Di
mothers and their babies in ways that are
“Are they talking to doctors, learning
Hoffman, RN, work on the collaborative.
proven to be best.” said Regina Sawyer,
from family or are they mimicking what
Director of Maternal Child Health at
PostPartum Hemorrhage
they see in the hospital?” Anderson said.
Kaweah Delta.
Women who bleed heavily after giving
“If there is something we can do to
birth are getting blood products faster
improve at the bedside, we will. Those are
Better Breathers
things we look for daily.”
Babies who have trouble breathing after and more efficiently, helping their blood
clot, as a result of joining the California
birth are getting better care thanks to the
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Tammy Dunehew, RN,
takes baby Mason’s
vital signs as Aaron and
Desarie Story watch.
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John Droney stands
outside the front lobby
of Kaweah Delta,
a place he knows well.
QUALITY
REPORT
MEDICATION SAFETY
“SMART PUMPS” ARE HELPING nurses SAVE LIVES
Why It Matters?
A medication error can make a patient
ill or cause death. Medication safety
technologies lower a person’s risk of
experiencing a medication error while
in the hospital.
T
here is a “box” that sits next to beds
at Kaweah Delta Medical Center
that is every patient’s best friend.
They’re called Alaris “Smart” IV Pumps and
they help save lives. Most people don’t
know the pumps make sure the right
person gets the right medication, at the
right time, at the right dose.
John Droney is not one of those
people. The Visalia man, who was a
patient at Kaweah Delta this year, is
married to a nurse. He is well aware of the
purpose of the 3.3-inch wide, 8.9-inch tall
smart pump.
“Without a doubt I think it’s a good
thing that they are here,” Droney said,
noting that on a prior hospital visit there
was a kink in his IV that signaled an
alarm to sound. “A nurse came in and
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fixed it immediately.”
In a setting where medical errors
are the eighth leading cause of death
in the U.S., it’s important that hospitals
have safeguards in place. One in 100
medication errors is harmful; one in 1,000
errors is potentially fatal. Alaris pumps
are part of the solution at Kaweah Delta,
said Chris Patty, a Registered Nurse and
will always
“Ourbegoal
perfection.
”
CHRIS PATTY, RN and
Medication Safety Specialist
Medication Safety Specialist there.
“People make mistakes – they always
have and they always will. These pumps
are an added layer of security for patients
while they are in the hospital,” Patty said,
noting that medication errors are not
publicly reported.
The pumps are a virtual library of safe
medication dose ranges, so when a nurse
enters a dose and adds an extra digit or a
decimal point, the pump alerts the nurse.
“It says, ‘Wait. Did you really mean to
enter that? It’s more than what’s allowed,’”
Patty said.
In 2008, Kaweah Delta was one of
the first hospitals in the area to put the
pumps in place. Today, the hospital has
410 of the pumps distributing 550,000
doses of medication a year.
In 2011 alone, the pumps made 188
saves, preventing nurses from entering
doses that could have seriously harmed
patients at Kaweah Delta. One save
prevented a nurse from giving a patient
10 times more of a narcotic painkiller
than was prescribed, an error that could
have been fatal. Another prevented a
nurse from giving a patient 45 times more
of a drug to lower blood pressure. The
error could have caused a stroke or a
heart attack.
“The bottom line is that these pumps
lower risk and make it more likely that
patients won’t experience a medication
error in the hospital,” Patty said. “Our goal
will always be perfection.”
QUALITY
REPORT
RAPID RESPONSE
KAWEAH DELTA’S TEAM IS SAVING PATIENTS BEFORE THEY GET SICKER
Why It Matters?
Hospital Rapid Response Systems help
reduce hospital illness and improve
survival rates. This group of medical
professionals has a purpose: Help the
patient before they have a medical
emergency such as a heart attack.
A
team tasked with helping patients
before they get sicker is getting
high marks for saving lives at
Kaweah Delta Medical Center.
If it wasn’t for Kaweah Delta’s Rapid
Response System’s team response, “I
might be in a different situation,” Pete
Dykstra, 76, of Tulare, frequently tells his
wife, Gert.
Last year, Pete was waiting to leave
the hospital when he started coughing
uncontrollably. His wife asked him if he
was okay. He didn’t respond. His wife
alerted the bedside nurse; she went to
get help.
Enter Jeanette Callison, a nurse
and member of Kaweah Delta’s Rapid
Response Team who calls hers “the best
job in the hospital.” She was pulled from
her daily rounds to help Pete. She usually
checks in with nurses to see if patients
aren’t showing improvement. She’s
trained to look for subtle, early warning
signs of a medical emergency – elevated
breathing, cool hands, and low blood
pressure – and because they were there,
she called the team.
“Everything just clicked to save him
and I feel like one of the main reasons
was because Jeanette was there that day,”
Gert said.
Although Pete suffered a stroke,
it was caught early so he was given
medication to reverse his symptoms and
reduce disability. The couple says they are
eternally grateful.
STaRRS among us
While Kaweah Delta’s Rapid Response
Team started in 2005, it’s evolved into
a program that trains bedside nurses
to recognize and intervene early when
patients show signs of deterioration.
“It reduces complications for patients
when they are in the hospital and helps
save lives,” said Frank Sebat, MD, FCCM,
Director of Kaweah Delta’s RRS. “We’ve
Jeanette Callison,
RN, visits with
Gert and Pete
Dykstra. Pete
credits Callison
with saving his life.
designed a good system that’s getting
better and making a difference.”
Since its inception the system has
reduced, by more than half, the number
of times a hospital-wide medical
emergency or cardiac arrest alert has
been called for patients from 6.66 per
1,000 discharges in 2005 to 2.76 per 1,000
discharges in June 2012. At the same
time, nurses are intervening earlier, calling
nearly seven times more RRS alerts in
June 2012 than in all of 2006.
It may be one reason Kaweah
Delta’s mortality ratio has dropped
to .72 – that’s 28 percent better than
expected according to Thomson-Reuters,
a company that studies national clinical
outcomes. Other reasons include the
work of the hospital’s 24/7 intensivist
program, surgical programs, sepsis alerts,
the trauma team, and the hospitalist
program among others.
“Kaweah Delta has been putting
together comprehensive patient safety
and quality systems to improve patient
care and they are finally paying off,”
Sebat said.
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QUALITY
REPORT
QUALITY
REPORT
A BETTER CHANCE OF SURVIVAL:
HEART FAILURE, SEPSIS, AND STROKE
VISALIA DIALYSIS CENTER EARNS
HIGH MARKS FOR CARE
CALCULATED EFFORTS, TEAMWORK BOOST SURVIVAL RATES
Why It Matters?
percent better than expected, according to
Thomson-Reuters, a company that studies
national clinical outcomes.
“We try to see if we can beat the odds
and we’re definitely beating the odds,”
said Leland Beggs, MD, Medical Director
of Critical Care, regarding survival rates for
sepsis, a potentially life-threatening infection
reg Gray is walking proof of second
that can damage vital organs and cause
chances. Earlier this year, the 55-yeardeath. Sepsis is the “flagship” condition by
old Three Rivers man suffered his
which the adequacy of care provided in
second heart attack, but received care that
Kaweah Delta’s Intensive Care Unit is judged,
got him back on his feet.
Beggs said.
“The people in cardiac care – those
The good news is that survival rates
people are my heroes,” said Gray, who in
hospital wide for sepsis have gone from
April had blood clots removed and spent
greater than predicted in 2007 and 2008
a week recovering in the cardiovascular
to significantly better than predicted in
intensive care unit at Kaweah Delta.
2011, Beggs said. For the sickest patients in
Since 2009, through teamwork and
the hospital, survival rates for sepsis have
calculated efforts, Kaweah Delta has
improved, he said.
boosted the quality of care provided
Survival rates for sepsis are just part
to stroke, sepsis, and cardiac services,
of the story. Kaweah Delta is performing
specifically for heart failure patients. As
above or at the national average in three
a result, survival rates have dramatically
of four quality measures for heart failure,
improved with Kaweah Delta’s overall
said Mark Hettinger, a Clinical Analyst
16 at Kaweah Delta. Additionally, Kaweah
mortality rate dropping to 0.72. That is 28
Patients who come to Kaweah Delta with
a stroke, reoccurring heart problems or
with potentially life-threatening infections
are more likely to get a second chance at
life thanks to improvements in quality.
G
Thomas Mazon
receiving dialysis
treatment from Tech
Michael Reeves –
Mazon says Reeves
has a magic touch
with patients.
Delta is performing close to or better than
the best performing hospitals across the
country for stroke patients, said Cheryl Smit,
Performance Improvement Coordinator for
Kaweah Delta.
The road to improvement has included
quality committees, standardized care,
patient education, grouping or cohorting
patients with similar conditions such as
heart failure in areas of the hospital where
nurses specialize in providing care that’s
proven to be best for patients. Alerts
are also helping patients get faster care
wherever they are in the hospital. These
improvements coupled with having
Intensivists, Hospitalists, and a Trauma and
Acute Care Surgical Services team in-house
have been a benefit to sepsis patients.
“We’ve put in an amazing amount
of work to improve our patient care
processes and we’re seeing positive results,”
Hettinger said. “But there’s always room
for improvement. That’s our goal each and
every day at Kaweah Delta – improving
patient outcomes and safety for all of
our patients.”
Why It Matters?
When End-Stage Renal Disease providers
meet or exceed national performance
standards on quality, it means that patients
are getting the right mix of medication to
rebuild red blood cells, fighting off anemia.
Red blood cells contain hemoglobin
which carries oxygen throughout the
body. Hemoglobin levels in red blood cells
have to be just right otherwise patients
can suffer side effects leaving them in the
hospital, in need of transfusions, suffering
heart complications, or facing death.
I
f the average person walked into Kaweah
Delta Dialysis, they would be hard pressed
to find a halo or a set of wings. But angels
are there. Just ask patients of the Visalia
end-stage renal disease facility.
“I call the people who work here my
angels because if it weren’t for them I
wouldn’t be around,” said Thomas Mazon,
74, of Visalia, who needed dialysis following
a quadruple bypass. “Every day I thank God
and I thank them for giving me another day
of life.”
Mazon is one of the more than 4,000
people who visit Kaweah Delta Dialysis in
Visalia because their kidneys have stopped
working. Dialysis removes waste and water
from their blood so a build-up does not
become harmful.
Patients liken Kaweah Delta Dialysis
to the Ritz, describe its staff as respectful,
and score its quality of care as stellar. A
report released this year by the Centers
for Medicare & Medicaid Services agreed,
giving the center a perfect score of 30 out
of 30 points in quality measures related to
anemia and dialysis adequacy. That means
the center is providing the right balance
of medications to rebuild patients’ red
blood cells and that it’s doing what’s best
for patients by providing them effective
dialysis, said Sharon Foster, Director of Renal
Services for Kaweah Delta Health Care
District.
The report is part of the government’s
new Quality Incentive Program for
Medicare’s End-Stage Renal Disease
providers/facilities. Providers who do not
meet or exceed national quality measures
face up to a two percent reduction in CMS
payments in 2013. Kaweah Delta’s perfect
quality score saves it from a financial hit.
“If we didn’t get full payment in 2013,
every patient’s treatment in Visalia would
be affected. It would be difficult for us
to be a top facility because we would be
trying to do the same work with less,”
Foster said.
That’s good news for patients like
Mazon, who say they appreciate the care
the center provides. “We have our good
days and we have our bad days, but the
wonderful people who work here always
do their best to keep you positive,” he said.
“That helps a lot.”
Check It Out
Performance data is available through the
Dialysis Facility Compare website:
www.Medicare.gov
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KAWEAH DELTA REHABILITATION HOSPITAL:
A SUM GREATER
THAN THE PARTS
KAWEAH DELTA’S REHABILITATION HOSPITAL OFFERS A COMPREHENSIVE PROGRAM OF MEDICALLY –
SUPERVISED EXERCISE, COUNSELING AND SUPPORT – FOR SOME OR ALL OF YOUR PARTS.
Inpatient Rehabilitation: When short term inpatient care is needed, the Acute
Rehabilitation and Short Stay Rehabilitation programs provide intensive, coordinated care led by a
rehabilitation physician to get you back on the right track. Patients benefit from a team approach
in which nursing and therapy staff with specialized rehabilitation knowledge work closely with each
patient to help them return to their home and community safely.
Cardiac and Pulmonary
Rehabilitation: Those with chronic respiratory
conditions or with a history of heart attack or other cardiac
needs can often benefit from an exercise program monitored by
nurses and therapists. These outpatient rehabilitation programs
include education designed to help each participant maintain
their health and the gains they have made during the program.
Stroke: After a stroke or a brain
injury, rehabilitation can help bring back
many of the affected abilities, and will
also teach patients how to adjust to the
changes they have experienced. The
sooner you start, the better you do.
“They have made this journey
a lot easier for my family
and me. I hope they continue
helping many more people like
me in their road to recovery.”
–Gary Warner
Gary Warner and Occupational
Therapist Monica Adams.
Outpatient Therapy: Breast cancer patients often experience pain
and weakness in the shoulder. Rehabilitation helps restore range of movement
and strength. Our certified Lymphedema Specialists are skilled at reducing
swelling, while Vestibular rehabilitation can help patients regain balance and
control other symptoms.
Hand Therapy: Traumatic and occupational hand
injuries can make life difficult. The Center offers therapies aimed
at restoring motion, sensitivity and strength to hands and fingers.
“I can’t say enough good things about the care
and support I received at the Hand Center.
I appreciated the use of humor to help people
get through some difficult times.”
–Wayne Clark
“There was a personal touch and friendliness
that really brought on the healing process
through my cardiac rehabilitation. I actually
enjoyed attending each session and I looked
forward to my visits each day.”
–Dennis Stiffler
Dennis Stiffler with RN Marisa Evans.
Orthopedic Therapy Services:
For arthritis, back pain and joint problems, rehabilitation is a good
option. The center also provides full rehabilitation for major orthopedic
surgeries such as knee and hip replacements.
Deanna O’Leary with Physical
Therapist Kevin Bartel.
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| K AW E A H
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“I limped into physical therapy hoping to get relief
for a bad knee. I walked out with an education, a
renewed energy for healthy living, and a life enriched
by a group of incredible individuals who collectively
made a difference in my life.”
–Deanna O’Leary
Wayne Clark and Occupational Therapists
Karen Sorensen (left) and Lisa Arroyo (right).
Amputee: For amputees, a strong rehabilitation program promotes
the healing and strengthening of the limb as well as the proper fitting of
the prosthetic. Patients receive education and support designed to help
them return to their home and community with confidence.
Wound Care: Many people are living with hard-to-heal wounds.
For diabetics in particular, wound care can be vital to preserving limbs
and lives. A comprehensive Wound Center provides a physician directed,
team approach to healing difficult wounds.
Have a question for Kaweah Delta Rehabilitation Services? Message us on our Facebook Page.
V I TA L S I G N S - FA L L 2 012
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Oct. 4 / 5:30-7 PM
Oct. 25 / 4 PM
Nov. 14 / 12-1 PM
Diabetes Support Group
THE BREAST CENTER
Wellness & You
The Importance of
Physical Activity
Alzheimer’s vs Dementia
Breast Cancer
Awareness Tea
The Lifestyle Center
Sequoia Regional Cancer Center
5105 W. Cypress Ave.
Info: 624-2416
4945 W. Cypress Ave.
Tickets: $15
Info: 624-2242
Oct. 11 / 6-7 PM
The Lifestyle Center’s Wellness Series
Over-The-Counter Drugs
Speaker: John Booker, MD
The Lifestyle Center
5105 W. Cypress Ave.
Info: 624-3400
Oct. 22-23 / 7 AM-4 PM &
6 am-4pm
Guild Jewelry Sale
KAWEAH DELTA MEDICAL Center
400 W. Mineral King Ave.
Info: 734-3109
Speaker: Marie Espinola, Alzheimer’s
Foundation of Central California
Sequoia Regional Cancer Center
4945 W. Cypress Ave.
Info: 624-2463
Dec. 4 / 5:30-8 PM
Nov. 1 / 5:30-7 PM
Holiday Cheer
Diabetes Support Group
Enjoy Holiday Music
and Visit with Santa.
Eating Healthy During
the Holidays
Kaweah Delta Medical Center
The Lifestyle Center
5105 W. Cypress Ave.
Info: 624-2416
400 W. Mineral King Ave.
Info: 624-2463
Nov. 8 / 6-7 PM
Dec. 5 / 7 PM
The Lifestyle Center’s Wellness Series
Adjustment to Loss
Speaker: Mike Mayo, Licensed Clinical Social
Worker/Marriage and Family Therapist
The Lifestyle Center
5105 W. Cypress Ave.
Info: 624-3400
KAWEAH DELTA
Light Up A Life
Memorial ornaments: $25 donation
Visalia Convention Center
330 E. Acequia Ave.
Info: 733-0642
EVENTS