Connections Franciscan Health System

Connections
Franciscan Health System
Oct.
2009
Published for our Medical Staff
St. Joseph Medical Center • St. Francis Hospital • St. Clare Hospital • Enumclaw Regional Hospital • St. Anthony Hospital • Franciscan Medical Group
Changes to Medical Staff bylaws
designed to improve patient care
Inside
St. Clare plans
ER triage remodel
2
Medical Staff Update
3
Club 100: Quick Tip
Pharmacy News
Medical Staff and
CME Calendar
4
5–7
8
By Tony Haftel, MD
Vice President for Quality
Associate Chief Medical Officer
Several changes to the
Franciscan Health System’s Medical
Staff bylaws, rules, regulations and
medical policies and procedures took
effect on Oct. 1, 2009. We are confident
these changes will allow for significant
improvements in patient care. We ask
for your full cooperation in their implementation.
n
Timing of all entries in the medical
record: Based on recent rulings by CMS
and The Joint Commission (TJC), provider timing and dating of all medical
record entries has now become manda-
Pediatric infectious disease
expert will speak at
Yoder Lecture on Nov. 13
Steve Kohl, MD, a clinical
professor of pediatrics at Oregon
Health Sciences University in
Portland, will be the featured speaker
at the Edwin C. Yoder Honor Lecture
on Friday, Nov. 13 at St. Joseph
Medical Center.
Dr. Kohl will make a pair of pre-
Connections October 2009
Advanced Medicine. Trusted Care.
tory. In the past,
TJC allowed hospitals to decide
the issue of timing
entries. Based on
new agreements
T. Haftel, MD
between CMS and
TJC, there will be no opportunity for
exceptions. All orders must be signed,
dated and timed.
n
Provider Suspension for Chart
Delinquency: The amount of hospital
billings either postponed or denied
based on provider chart delinquency
has skyrocketed. The Franciscan
Medical Executive Committee and
Board of Directors have endorsed the
Continued on page 2
sentations at this
special program
for physicians.
The first is titled
“Variolation to
Virosomes: 500
S. Kohl, MD
Year of Progress
in Immunization,” which will be followed by “Jenner to Jenny—Anti-vaccine Issues and Answers.”
He is an internationally recogContinued on page 7
www.FHShealth.org 1
Medical staff Leadership
FHS Medical Executive Committee
Kim L. Moore, MD
Donald D. Lee, MD
Chair & Medical Staff President Vice President, SCH
Allen C. Alleman, MD
Vice President, SFH
Gabriel Y. Lee, MD
Member-at-Large, SJMC
Kasra R. Badiozamani, MD
Member-at-Large, SFH
Neville A. Lewis, MD
Member-at-Large, SJMC
Kevin E. Braun, MD
Vice President-elect, SCH
Robert T. Middleton, MD
Vice President-elect, SFH
Brian A. Folz, MD
Member-at-Large, SAH
Thomas J. Minter, MD
Vice President-elect, SAH
Byron L. Hutchinson, DPM
Member-at-Large, SFH
Daniel G. Nehls, MD
Vice President-elect, SJMC
Juan C. Iregui, MD
Vice President, SJMC
William F. Roes, MD
Vice President, SAH
Peter R. Kesling, MD
Member-at-Large, SAH
Micheal W. Vier, MD
Member-at-Large, SCH
Ann M. Lee, MD
Member-at-Large, SCH
FHS Credentials Committee
Richard K. Gould, MD, Chair
Youl Choi, MD
Brian Folz, MD
W. Mark Hassig, MD
Paul W. Hildebrand, MD
Maureen A. Nuccio, MD
Lysa S. Ward, MD
Bruce Wilson, MD
Mark Yuhasz, MD
St. Joseph Medical Center Section Chiefs
Gail C. Venuto, MD
OB/GYN
William B. Cammarano III, MD
Anesthesia
Keith E. Demirjian, MD
Family Practice
Giao Kaplan, MD
Emergency Medicine
Dorie Hahn, CNM
Midwifery
J. Dale Howard, MD
Mental Health
Eugene S. Cho, MD
Surgery
Linda D. Burkhardt, MD
Lab/Pathology
Tejinderpal Singh, MD
Medicine
Martin V. Cieri, MD
Pediatrics
G. Gordon Benjamin, MD
Diagnostic Imaging
St. Francis Hospital Section Chiefs
Jeffrey M. Cortazzo, MD
Emergency Medicine
Walter M. Hassig, MD
Medicine
Linda M. Petter, DO
Family Practice
Kevin J. Ward, MD
Surgery
Michael S. Davidov, MD
OB/GYN
Charles Leusner, MD
Diagnostic Imaging
Martin J. Kubeja, MD
Anesthesia
Mohinder S. Badyal, MD
Pediatrics
Linda D. Burkhardt, MD
Lab/Pathology
St. Clare Hospital Section Chiefs
David R. Kennel, MD
Family Practice
Borislav Kirov, MD
Medicine
Youl Choi, MD
GYN
Mark S. Yuhasz, MD
Radiology
Linda D. Burkhardt, MD
Lab/Pathology
Kim L. Moore, MD
Emergency Medicine
Keith A. Weissinger, MD
Pediatrics
Charles M. Piatok, MD
Anesthesia
Steven G. Duras, MD
Surgery
St. Anthony Hospital Section Chiefs
Gary R. Pingrey, DO
Family Practice
Raed N. Fahmy, MD
Medicine
Cynthia M. Mosbrucker, MD
GYN
Jason W. Allen, MD
Radiology
Linda D. Burkhardt, MD
Lab/Pathology
Paul W. Hildebrand, MD
Emergency Medicine
Charles M. Piatok, MD
Anesthesia
Robert A. Yancey, MD
Surgery
Enumclaw Regional Hospital Medical Staff Officers
David Rice, MD
Medical Staff President
Jude Verzosa, MD
Vice President
Franciscan Health System is guided by the Ethical and
Religious Directives for Catholic Health Care Services.
2 www.FHShealth.org
Franciscan Foundation begins
capital campaign to support
St. Clare ER triage remodel
St. Clare Hospital plans to
remodel and expand the triage area of
its busy emergency department later
this year so it can better serve patients
and their families.
The $1.2 million project will include
adding a triage room, giving the hospital two triage rooms in all; enlarging
the triage rooms to allow space for inroom testing; and replacing curtains
with walls and doors so patients can
have more privacy.
One of the goals is to shorten the
time that walk-in patients must wait
before being seen by a physician or a
physician assistant.
To support the project, the
Franciscan Foundation has launched
a $1.2 million capital campaign and is
accepting donations from the public,
businesses and other organizations.
Gifts to the campaign will help raise
the $750,000 required to activate a
$500,000 “challenge grant” from a
major donor. The capital campaign is
Medical Staff bylaws, from page 1
following action:
• In addition to the current rule for
suspension (20 delinquent charts older
than 30 days), a new ruling places a
provider on suspension when any chart
reaches 60 days delinquency. Chart
suspension prohibits the provider from
scheduling new cases or admitting new
elective patients to Franciscan hospitals.
It does not relieve the provider from
emergency department call, however.
n
Delay in Patient Medication: Qualis,
the Washington State quality improvement organization, has cited Franciscan
for significant issues related to medication reconciliation. This has necessitated an action plan requiring that the
Advanced Medicine. Trusted Care.
co-chaired by brothers Toby Murray
and Jamie Murray, who are Lakewood
residents and local business leaders.
“Our emergency department
receives approximately 50,000 patient
visits every year, and we expect that it
will become even busier over time,”
says St. Clare Hospital President Kathy
Bressler. “We need to provide our medical and nursing staff with the space they
need to quickly provide the right care
at the right time, while also ensuring
that our patients are comfortable, safe
and given as much privacy as possible
within the clinical setting.”
St. Clare has the second-busiest
emergency department among the
five Franciscan Health System hospitals; only St. Joseph Medical Center
in Tacoma treats more emergency
patients.
Support St. Clare Hospital
For more information or to make a
donation, contact the Franciscan
Foundation at 253-428-8467 or email
[email protected].
admitting physician complete admission medication reconciliation within
12 hours of the patient’s admission. Our
nursing staffs have been instructed to
call the provider before 12 hours have
elapsed if the provider has not already
completed the admission medication
reconciliation process. This function
may be completed over the phone so
long as the information is read back
to provider, who then must confirm its
accuracy.
n
Next Day Prospective Discharge: The
rules and regulations of the Medical
Staff bylaws have been changed to facilitate “next-day prospective discharge.”
This replaces the daily requirement for
Continued on page 7
October 2009 Connections
Medical Staff Update
By Gregor y Semerdjian, MD
Transitions occur in our Medical Staff Leadership
As we begin another year for our Medical Staff Leadership, I thank the outgoing members of
the Medical Executive Committee for their outstanding work. I want to especially acknowledge
outgoing Medical Executive Committee Chair and Medical Staff President Thomas S. Keskey,
MD, and St. Joseph Medical Center Vice President William Hirota, MD, who exceeded their
two-year obligations by serving for three years each.
Also completing their terms in August
were John S. Wendt, MD, and Venkatesh R.
Kandallu, MD, both representing St. Francis
Hospital; and John D. Wagoner, MD, and Peter
Y. Chen, MD, representing St. Clare Hospital.
Welcome new Medical Executive
Committee members
We are pleased to welcome the new
Medical Executive Committee members: Daniel
G. Nehls, MD, representing St. Joseph Medical
Center; Neville A. Lewis, MD, also representing
St. Joseph; Robert T. Middleton, MD, Byron L.
Hutchinson, MD, and Kasra R. Badiozamani,
MD, representing St. Francis; Kevin E. Braun,
MD, and Michael W. Vier, MD, representing St.
Clare; Thomas J. Minter, MD, and Brian A. Folz,
MD, who represent St. Anthony Hospital. This
represents the largest number of new members
to our Medical Executive Committee in recent
memory.
Kim Moore, MD, from St. Clare Hospital,
will serve as chair of the Medical Executive
Committee for the next year and Allen Alleman,
MD, from St. Francis Hospital, will serve as vice
chair. Medical Executive Committee members
who are continuing to serve another year are
Juan Irequi, MD; Ann M. Lee, MD; Donald D.
Arthur Maslow, DO, named
medical director for
Franciscan women's services
As Robert Snyder, MD, assumes
greater leadership responsibilities for
Connections October 2009
Medical Staff Rules and Regulations
are amended
At the last Medical Executive Committee
meeting, several amendments to the Medical
Staff Rules and Regulations were approved.
These changes are significant and will bring
our organization into compliance with Joint
Commission requirements for several issues,
including the dating and timing of medical
records. Please see the cover story of this
newsletter for more information about these
important changes.
executives in the Puget Sound region who’ve
expressed an interest in this critical position. If
we are unable to find the experience level and
skill set we need for this key position within
our complex and evolving organization, then
we will engage a recruiting firm to conduct a
national search.
Our goal is to recruit the best-qualified individual by the spring of 2010. It will take someone with great experience to continue the good
work that Dr. Newcomb did during his 10-year
tenure. He elevated this position to one that is
now nationally recognized. His medical leadership was exemplary.
In closing, I thank our Medical Staff members
for your commitment to excellence and for
your support of the Franciscan Health System. I
know many of you are already looking forward
to the upcoming Thanksgiving and Christmas
holidays. I wish you and your loved ones the
very best.
Search for a Chief Medical
Officer is underway
Our search for a Senior Vice President
and Chief Medical Officer to succeed Mike
Newcomb, DO, is underway. We are talking with experienced, physician health care
Gregory Semerdjian, MD
Interim Chief Medical Officer
Office: 253-426-6974
Email: [email protected]
Lee, MD; Gabriel Y. Lee, MD; William F. Roes,
MD; and Peter R. Kesling, MD. We look forward to their leadership of, and support for, our
Medical Staff over the next year.
You can read the complete list of our Medical
Executive Committee members, the Credentials
Committee members, and Hospital Section
Chiefs on page 2 of this newsletter.
the Franciscan Medical Group, Arthur
Maslow, DO, has stepped into the role
of medical director for the Franciscan
Health System’s women’s service line.
He is a board-certified perinatologist
who specializes in fetal ultrasound, a
Advanced Medicine. Trusted Care.
published author, and a member of the
American College of Obstetricians and
Gynecologists. Also, Dr. Maslow has
served as a departmental director at
several hospitals.
www.FHShealth.org
3
Community-Acquired
Pneumonia Quality Measure:
Initial antibiotic selection in
immunocompetent patients
This quality indicator measures the CAP patients who receive an
initial antibiotic regimen consistent
with current guidelines during the first
24 hours of their hospitalization.
Pre-printed provider order No. 608,
“Community Acquired Pneumonia,”
provides the antibiotic options for each
type of patient. Adherence to these
orders will ensure compliance with this
quality measure.
If Zosyn is used, then the pseudomonal risk box must be checked.
Med/Surg Admission:
nLevofloxacin (Levaquin) 750 mg every 24 hours PO or IV
OR
nAzithromycin (Zithromax) 500 mg every 24 hours PO or IV PLUS
Franciscan wins state approval
to provide in-home hospice
throughout Kitsap County
Franciscan
Health System
has been selected
by the Washington
State Department
of Health to begin
providing in-home M. Rake-Marona
hospice services in Kitsap County.
Franciscan received official notification
on Sept. 17.
The state decided there is a need
for a second in-home hospice provider
in Kitsap County based on its own
data for population growth and other
demographics. The agency initiated a
certificate-of-need process and invited
4 www.FHShealth.org
nCeftriaxone (Rocephin) 1g IV every 24 hours
PCU/ICU Admission:
nCeftriaxone (Rocephin) 1g IV every 24 hours PLUS
nAzithromycin (Zithromax) 500 mg IV every 24 hours
OR
nCeftriaxone (Rocephin) 1g IV every 24 hours PLUS
nLevofloxacin (Levaquin) 750 mg IV every 24 hours
If zosyn used, then the patient must
meet medical-necessity indication for
pseudomonal risk and
this risk must be documented in the medical
record (such as bronchietasis, COPD with repeated antibiotics or chronic corticosteroid
use):
nPiperacillin/tazobactam (Zosyn) 3.375 g IV every 6 hours PLUS
nLevofloxacin (Levaquin) 750 mg IV every 24 hours
Add to all regimens for suspected aspiration:
nClindamycin (Cleocin) 900 mg IV every 8 hours
If CA-MRSA is suspected:
Vancomycin 1.25 g IV times 1 dose,
then per Pharmacy protocol
For more information about quality
measures or for a copy of the Franciscan
Quality Indicator Booklet, contact Jill
Smith, RN, Clinical Effectiveness, at
253-426-6329 or via email at jillsmith@
FHShealth.org.
Note: The Club 100 Quick Tip is
published monthly to help
Franciscan Medical Staff
members achieve 100
percent compliance with
CMS clinical indicators.
Quarterly, the names of Medical Staff
members who achieve full compliance
are published as the newest members of
Club 100.
Club
100
Quick Tip
hospice providers to apply. Until now,
Hospice of Kitsap has been the only
in-home hospice provider in Kitsap
County.
Franciscan’s application to begin
providing in-home hospice throughout Kitsap County was opposed by two
other providers—Hospice of Kitsap
and Heartland Hospice Services.
“We are hopeful that both of those
organizations will accept the state’s
selection of Franciscan so that Kitsap
County residents can have access to the
breadth and selection of hospice services that they need and deserve,” says
Mark Rake-Marona, regional director of
Franciscan Hospice and Palliative Care.
Franciscan is the largest and most
experienced provider of in-home and
inpatient hospice and palliative services
in Washington state.
Advanced Medicine. Trusted Care.
Learning at Franciscan
Anesthesiologist Angelo Poblete, MD, recently
traveled from The Philippines to learn about
Franciscan’s Hospice and Palliative Care services. During his month-long stay, Dr. Poblete
consulted with hospital-based physicians
and spent several days at Franciscan Hospice
House in University Place. Here, he consults
with Linda Lepape, ARNP, at Hospice House. Dr.
Poblete, a pain-management specialist, is helping to establish a palliative-medicine program
at a hospital in Manila.
October 2009 Connections
Pharmacy News
1 Review of albumin DUE
results prompts education
campaign
The Franciscan PT&T
Committee evaluated the use of
albumin at St. Joseph Medical
Center, St. Francis Hospital and
St. Clare Hospital using the
PT&T-approved Catholic Health
Initiatives (CHI) guidelines.
The period studied was
between September and
December 2008. Thirty charts (10
from each facility) of patients with
any record of albumin use were
randomly selected and retrospectively reviewed for the study.
FHS
Findings were mixed
Of the 30 patient charts
reviewed, 13 had documented
uses of albumin that met the
guidelines.
The most common reason cited
for not meeting the guidelines was
starting albumin without the prior
use of hetastarch.
For 11 of the 17 uses of albumin
that did not meet criteria, hetastarch was the second-line agent
and albumin was the last-line
agent, but the use of hetastarch
was bypassed in these cases. In
the cases of hemorrhagic shock,
non-hemorrhagic shock and postoperative cardiac surgery volume
expansion, the guidelines require
a trial of hetastarch prior to using
albumin.
Other uses of albumin that did
not meet criteria included non-
Connections October 2009
Contact: Franciscan Pharmaceutical Services, 253-426-6692
Table 1: Indications for which albumin prescribed
Indication
Number of
cases
Met criteria?
Yes
No
Cirrhosis/Paracentesis
6
6
Nephrotic syndrome
5
5
Peripheral edema
1
1
Plasmapheresis
1
1
Nonhemorrhagic shock
3
3
Hetastarch was not used prior to albumin
Hemorrhagic shock
1
1
Hetastarch was not used prior to albumin
Malnutrition and to “mobilize
gut edema”
1
1
Hetastarch was not used prior to albumin
Post-cardiac surgery volume
expansion
6
6
Hetastarch was not used prior to albumin.
Crystalloid was used in 1 case prior to albumin. In some
cases, the use of crystalloid might have not been
warranted.
Non-hemorrhagic shock
1
1
Not sure why albumin was used; patient not edematous;
crystalloid not used
Post-op bariatric surgery
malabsorption
1
1
Patient on hemodialysis, cardiogenic shock s/p CABG
Intradialytic blood pressure
support
1
1
No paracentesis
Ascites, cirrhosis
2
2
No edema noted; given for hypoalbuminemia and if BP<100.
Hypoalbuminemia/Sepsis
1
1
Total
30
hemorrhagic shock without a trial
of crystalloid solution; prescribing
albumin for hypoalbuminemia, low
blood pressure and malabsorption
due to postoperative bariatric
surgery; intradialytic blood pressure support; and ascites/cirrhosis
without paracentesis. See Table 1.
Nineteen uses of albumin were
initiated in the ICU, five in PCU and
six in the medical/surgical unit
or elsewhere within the hospital.
Also, the average number of days
13
Comment
Trial of albumin with furosemide since thought edema
was due to hypoalbuminemia. Discontinued after 1 day.
17
albumin was prescribed was three.
Additionally, 23 of the 30
prescribed orders included a stop
time. The longest uses of albumin
corresponded to the orders that
did not have a stop time. One
patient was prescribed albumin for
14 days due to severe peripheral
edema with free-water deficit.
Another patient was prescribed
albumin for seven days for
postoperative bariatric surgery
malabsorption. Both of these
orders were without a stop time
and represented the two longest
uses of albumin in this evaluation.
Even though the outcome was not
directly assessed, it was noted
that at least five of the 30 patients
were subsequently referred to
hospice or palliative care.
Guidelines for use not always
followed
The results indicate that more
Continued on page 6
O ur mission
O ur vision
O ur S trategies
O ur V alues
To nurture the healing ministry of the Church by
bringing it new life, energy, and viability in the 21st
century. Fidelity to the Gospel urges us to emphasize
human dignity and social justice as we move
toward the creation of healthier communities.
We are the South
Sound’s first choice
for healing of mind,
body and spirit.
Best Place to Heal
Best Community Health Resource
Best Place to Work
Best Performance
Reverence
Integrity
Compassion
Excellence
Advanced Medicine. Trusted Care.
www.FHShealth.org 5
PHARMACY NEWS, from page 5
than half (57%) of the charts
reviewed were not using albumin
according to the Franciscanapproved CHI guidelines. It seems
that prescribers favored albumin
over the use of hetastarch.
Hetastarch was not prescribed
in any patients reviewed in this
evaluation.
Not using crystalloid solution as
the first-line agent or hetastarch
as the second-line agent before
using albumin were the most common reasons cited for not meeting
criteria. Still, most albumin orders
did have a stop time, indicating
that prescribers were evaluating
the patient’s need for albumin on a
daily basis. It seems that having a
stop time on albumin orders would
prevent prolonged use without
an adequate evaluation from the
prescriber.
Education campaign supported
The PT&T Committee endorsed
education campaigns reinforcing
the appropriate use of albumin
according to Franciscan-approved
CHI guidelines; discussion at the
pharmacy’s critical-care core group;
and publishing information in the
nursing newsletter.
In addition, clinical pharmacists
are encouraged to review each
order for albumin and evaluate the
patient to ensure that prescribing
albumin is in accordance with
guidelines. In instances where
orders are not prescribed according
to guidelines, a phone call will be
placed to the prescriber.
2 Updated daily amikacin
protocol approved
The PT&T Committee approved
an updated amikacin daily-dosing protocol at its Sept. 11, 2009
meeting. The following outlines the
protocol and the Hartford nomogram (see page 7) that are used for
6 www.FHShealth.org
patients' individualized dosing. This
revision brings the protocol into
alignment with Franciscan’s other
approved daily-dosing protocol for
gentamicin and tobramycin.
A.Patient-Exclusion Criteria
1. Estimated creatinine
clearance less than 20 ml/
min (order “stat” serum
creatinine if unavailable within previous 48 hours)
2. Patients with marked ascites
3. Burn patients (greater than 20% of body surface area)
4. Pregnancy
5. Hemodialysis patients
6. Patient age less than 12 years
7. Monotherapy for gram
positive infections
8. Patient with infections
susceptible to other
aminoglycosides
B.Dose determination
ABW:IBW less than 1.19:
15 mg/kg x ABW
ABW:IBW 1.2 or greater:
15 mg/kg x DBW*
*Dosing Body Weight (DBW) = IBW + 0.4(ABW-IBW)
IBW = ideal body wt., ABW = actual body wt.
Initial dose is a “ONE-TIME” order. Subsequent dose and frequency are determined by the following steps:
C.Interval determination
1. Obtain a single “random” level 6-14 hours (typically 10 hours) after the first dose. Divide the level by two and evaluate per the Hartford nomogram (see below).
2. If the level falls in the area designated q24h, q36h or q48h, the dosing interval should be 24, 36 or 48 hours, respectively. If the point is on the line, choose the longer interval.
3. If the “random” level
indicates a dosing interval greater than 48 hours, then the physician is to be
contacted and the patient removed from the protocol.
4. If a random level is not
available within 24 hours of the initial dose, subsequent dosing of amikacin can be done empirically based on
creatinine clearance.
n CrCl > 60
Q24-hour interval
n
CrCl: 40-60
Q36-hour interval
n CrCl: 20-40
Q48-hour interval
D.Therapy Monitoring
1. Serum creatinine “stat” if a baseline level is
unavailable (baseline defined as within 48 hours of protocol initiation)
2. Serum creatinine every two days for duration of therapy
3. Initial “random” level 6-14 hours after first dose
4. Subsequent “random” level every four days for the
duration of therapy
5. “Random” levels may be repeated more often if renal function changes
significantly during therapy (change in serum creatinine greater than 0.5 mg/dl).
6. WBC and Tmax will be followed to determine
efficacy. Cultures and
sensitivities will be followed to determine
appropriateness.
If nephrotoxicity occurs as
indicated by an increase of SCr greater than 0.5 and/or a “random” level which
necessitates an increase in
dosing interval, then the
physician will be contacted and Advanced Medicine. Trusted Care.
therapy stopped if so ordered.
E.Dosing Modification Considerations
Higher doses than those
specified above may be
necessary in certain cases to ensure that levels are not
below the MIC for a period exceeding the post-antibiotic
effect (PAE). Consider the
following when determining if a dose increase is necessary:
1. “Random” level less than
4 mcg/ml
2. Disease state/site of
infection (e.g., decreased drug distribution with
pneumonia)
3. Renal function status
4. Most importantly, lack of clinical response
3
FDA
article focuses on
dosing of zolendronic acid for
treatment of osteoporosis
The FDA Drug Safety Newsletter
(Vol. 2 No. 2 2009) includes an
article concerning reports of
acute renal impairment and failure associated with once-yearly
intravenous dosing of zolendronic
acid (Reclast®) for osteoporsis in
postmenopausal women.
Twenty-four cases of renal
impairment and acute renal failure
have been reported after Reclast
use. The median time-to-onset
from the infusion until the event
was 11 days. More than half the
patients had underlying medical
conditions (such as diabetes, congestive heart failure, chronic kidney
disease) that may have contributed
to their risk of renal impairment or
acute renal failure.
Many patients improved following IV fluid administration or other
supportive care. Three patients
required hemodialysis during
hospitalization. Seven deaths were
Continued on page 7
October 2009 Connections
PHARMACY NEWS, from page 6
reported; the cause of death was
reported as acute renal failure in
four cases. Lessons to be learned
from this compilation of FDA safety
information include:
nAvoid the use of Reclast in patients with severe renal
impairment (creatinine
clearance less than 35ml per minute). Franciscan staff
(nurses and pharmacists) will enforce this warning.
nMonitor serum creatinine before each dose of
Reclast. This is Franciscan Health System policy and must be followed.
nConsider interim monitoring
of serum creatinine in at-risk patients; transient increase in serum creatinine may be
greater in patients with impaired renal function.
nEnsure that patients are adequately hydrated prior to administration of Reclast; this is a joint responsibility of the prescribing physician and the outpatient infusion center staff.
nInfuse Reclast over at least
15 minutes; this is done at Franciscan infusion clinics.
nReport cases of renal
impairment and acute renal failure in patients receiving Reclast to the FDA’s Med
Watch program at www.222.
fda.gov/medwatch.
4 FDA requires black-box
warning for promethazine
injection
Promethazine injection now
has a black-box warning required
by the FDA. At Franciscan Health
System, we already have warnings in Pyxis and in our policy for
how to infuse promethazine. At
Franciscan, this is a second-line
agent for treatment of nausea and
vomiting.
Following are the Franciscan
Health System guidelines that
have been in place since 2006. In
addition, as you can see, we give
it more slowly than what is sug-
gested in new black-box warning
and we have specific dosing limits
for patients:
nFranciscan only carries
25mg/ml strength
nDose: 12.5-25mg for patients age 65 and younger; 6.25-
12.5mg for patients over 65
years old
nUse only the large-bore vein
(no hand veins, foot veins, etc.), and preferably the ante-cubital Medical Staff bylaws, from page 2
Yoder Lecture, from page 1
rounding with a daily requirement for
rounding which can be excepted if the
patient is physically discharged within
24 hours of the provider’s last visit.
Consequently discharge orders may be
written the day before based on appropriate conditions (e.g., am Hct >30,
Temp<100 and eating, etc.), and take
effect without the provider visiting on
the day of discharge (as long as 24 hours
have not elapsed since the provider’s
last visit).
If you have questions, please call
the Franciscan Medical Affairs Office
at 253-426-6974 during regular
business hours Monday–Friday or
email your comments to
[email protected].
nized educator in pediatric infectious diseases and immunizations. He
served four years on the Vaccine and
Related Biological Products Advisory
Committee for the Food and Drug
Administration and six years on the
Committee on Infectious Diseases
(Redbook Committee) for the
American Academy of Pediatrics.
A national and international lecturer,
Dr. Kohl has also authored numerous
book chapters, reports, reviews, articles, letters and abstracts.
The recipient of numerous awards,
Dr. Kohl has been listed in publications such as the Best Doctors in
America, International Who's Who
in Professionals, and Who's Who in
America.
Connections October 2009
Advanced Medicine. Trusted Care.
vein mid-arm, or PICC
nMust be given through the tubing of a running IV or
mixed with 10ml of 0.9% sodium chloride and given slow push over at least 2–4
minutes (6.25mg-12.5mg/min) with constant monitoring for vein patency and report of pain by the patient.
Franciscan Academic Affairs has designated the Yoder Honor Lecture as an
educational activity for a maximum of
two Category 1 hours.
Reserve your seat for the
Yoder Lecture by Nov. 4
Reservations are required by Nov. 4 for
the Edwin C. Yoder Honor Lecture. Contact
Diann Winkcompleck via email at
[email protected] or
call the Franciscan Office of Academic
Affairs, 253-426-6035.
www.FHShealth.org 7
Franciscan Health System
Nonprofit Org.
U.S. Postage
Paid
Ta c o m a , WA
Permit No. 412
Connections
Medical Staff Calendar
1717 South J Street, Tacoma 98405
October
1
Pierce County Breast Conference, Carol Milgard Breast Center, 7 a.m., 3rd Floor Conference Room
2
Tumor Board, SFH, 12 p.m., Outpatient
Conference Room
5
Credentials Committee, SJMC, 7 a.m., Bayview Conference Room
Grand Rounds, SCH, 12:30–1:30 p.m., “H1N1 Influenza “A” in Pregnancy,” Art Maslow, DO, Classrooms A&B
6 Neuro/Gamma Knife Conference, SJMC,
7–8 a.m., Neuro/Gamma Knife Conference Room
CME Committee Meeting, SJMC, cancelled
7
Tumor Board, SJMC, 7–8 a.m., Lagerquist C
SFH Medical Staff Operating Committee, SFH,
6 p.m., Outpatient Center Conference Room
Pierce County Breast Conference, Carol Milgard Breast Center, 7 a.m., 3rd Floor
23
Breast Care Conference, SFH, 12 p.m., Outpatient Conference Room
Grand Rounds, SJMC, 12:30–1:30 p.m., “Thoracic Surgery/Robotics,” Baiya Krishnadasan, MD, Lagerquist A & B
8
FHS Medical Executive Committee, SJMC,
6 p.m., Lagerquist A&B
Grand Rounds, SJMC, 12:30–1:30 p.m., “H1N1 Influenza “A” in Pregnancy,” Art Maslow, DO, Lagerquist A&B
Grand Rounds, SFH, 12:15–1:15 p.m., “Vena Cava Filters—Indications and Complications,”
Omar Dorzi, MD, MOB Conference Room
Genitourinary (GU) Conference, SFH, 12 p.m., Outpatient Center Conference Room
26
Journal Club, SCH, 12:30–1:30 p.m.,
Classrooms A&B
SJMC Medical Staff Operating Committee, SJMC, 6 p.m., Dining Rooms 1&2
27
Medical Research Evaluation Committee, SJMC, 12 p.m., Lagerquist C
Pierce County Breast Conference, Carol Milgard Breast Center, 7 a.m., 3rd Floor Conference Room
9
Grand Rounds, SFH, 12:15–1:15 p.m., “Thoracic Surgery/Robotics,” Baiya Krishnadasan, MD,
MOB Conference Room
12
Journal Club, SCH, 12:30–1:30 p.m.,
Classrooms A&B
14
Tumor Board, SJMC, 7–8 a.m., Lagerquist C
29
15
Pierce County Breast Conference, Carol Milgard Breast Center, 7 a.m., 3rd Floor Conference Room
November
FHS/MHS Joint Formulary Committee,
Jackson Hall-Tacoma General, 7 a.m.
SFH Medical Staff Social, SFH, 6 p.m., MOB Conference Room
2
Credentials Committee, SJMC, 7 a.m.,
Bayview Conference Room
Journal Club, SCH, 12:30–1:30 p.m.,
Classrooms A&B
3
Neuro/Gamma Knife Conference, SJMC,
7–8 a.m., Neuro/Gamma Knife Conference Room
CME Committee, cancelled
4
Tumor Board, SJMC, 7–8 a.m., Lagerquist C
Pierce County Breast Conference, Carol Milgard Breast Center, 7 a.m., 3rd Floor Conference Room
SAH Medical Staff Operating Committee, SAH, 7 a.m., Larson Conference Room A
19
Journal Club, SCH, 12:30–1:30 p.m.,
Classrooms A&B
20
Neuro/Gamma Knife Conference, SJMC,
7–8 a.m., Neuro/Gamma Knife Conference Room
5
Neurological Sciences Grand Rounds, SJMC,
6 p.m., Lagerquist A&B
21
Tumor Board, SJMC, 7–8 a.m., Dining Rooms 1&2
22
9
Pierce County Breast Conference, Carol Milgard 11
Breast Center, 7 a.m., 3rd Floor Conference Room
Performance Quality Leadership Group, SJMC, 7:30 a.m., Lagerquist A
Breast Care Conference, SFH, 12 p.m., Outpatient Performance Quality Leadership Group, SJMC, 7:30 a.m., Lagerquist A&B
Center Conference Room
12
Breast Care Conference, SFH, 12 p.m., Outpatient Center Conference Room
FHS Medical Executive Committee, SJMC,
6 p.m., Lagerquist A&B
13
FHS PT&T Committee, SJMC, 7 a.m.,
Dining Rooms 1&2
Yoder Program, SJMC, 2–5:15 p.m.; Lecture 1 —“Variolation to Virosomes—500 Years of
Progress in Immunization;” Lecture 2—“Jenner to Jenny,” Steve Kohl, MD, Lagerquist A, B & C.
Physicians only. Reservations required:
253-426-6035
Grand Rounds, SFH, cancelled (due to Yoder
program)
16
Journal Club, SCH, 12:30–1:30 p.m.,
Classrooms A&B
17
Neuro/Gamma Knife Conference, SJMC,
7–8 a.m., Neuro/Gamma Knife Conference Room
Medical Research Evaluation Committee, SJMC, 12 p.m., Lagerquist B
Neurological Sciences Grand Rounds, SJMC,
6 p.m., Lagerquist A&B
18
Tumor Board, SJMC, 7–8 a.m., Lagerquist C
19
Pierce County Breast Conference, Carol Milgard Breast Center, 7 a.m., 3rd Floor Conference Room
20
Tumor Board, SFH, cancelled
23 Journal Club, SCH, 12:30–1:30 pm,
Classrooms A&B
26–27 Thanksgiving holiday, Medical Staff Office closed
SCH Medical Staff Annual Meeting, SCH, 6 p.m., 30 Tumor Board, SCH, 8–9 a.m., Classrooms A&B
Classrooms A&B
Journal Club, SCH, 12:30–1:30 p.m.,
Journal Club, SCH, 12:30–1:30 p.m.,
Classrooms A&B
Classrooms A&B
Tumor Board, SJMC, 7–8 a.m., Dining Rooms 1&2
Pierce County Breast Conference, Carol Milgard Breast Center, 7 a.m., 3rd Floor Conference Room
SCH Medical Staff Operating Committee, SCH, 6 p.m., Classrooms A&B
Note: SJMC=St. Joseph Medical Center; SFH=St. Francis Hospital;
SCH=St. Clare Hospital; ERH=Enumclaw Regional Hospital;
SAH=St. Anthony Hospital; MOB=Medical Office Building
Printed on Recycled Paper
8 www.FHShealth.org
Advanced Medicine. Trusted Care.
October 2009 Connections