Swedish/Edmonds medical staff rules and regulations state that

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1 35 August 2011 Medical Staff Swedish/Edmonds VitalSigns this issue P.1 Verbal Telephone Orders P.2 Campaign for Swedish Patient Satisfaction Survey Comments P.3 Welcome New Physician CPDI Report P.4 CME Corner P.5 Physicians Named Top Docs Need a New Badge? Hospital Statistics P.6 Cancer Support Services P.7 Inpatient Pharmacy Using Closed System Devices Outdoor Movie Night Verbal/Telephone Orders, Authentication of Orders The recent Joint Commission survey at Swedish/Edmonds revealed issues related to verbal order authentication, specifically meeting the policies surrounding authentication. Below are some responses to frequently asked questions on this topic. Verbal/telephone order FAQ's Why am I asked to time and date my verbal/ telephone orders, authenticate verbal/ telephone orders within 24 hours and hear verbal/telephone orders read back to me? Timing and dating of verbal/telephone orders Timing and dating of entries establishes a baseline for future actions or assessments and establishes a timeline of events. Many patient interventions or assessments are based on time intervals or timelines of various signs, symptoms or events. Swedish/Edmonds medical staff rules and regulations state that Therefore, it is necessary for a physician or other practitioner to date and time the authentication of a verbal/telephone order. The receiver of the verbal/telephone order should clearly record the order directly onto an order sheet in the patient's medical record. Also, the receiver should date, time, "read back," and sign the verbal/telephone order. The prescriber or another licensed independent practitioner responsible for the care of the patient must then verify, sign, date and time the order as soon as possible. May I authenticate a verbal/telephone order via fax? Yes, faxed or electronic signatures may be used to authenticate a verbal/telephone order. Authentication of a verbal/telephone order may occur in writing or electronically. What is the ordering practitioner's accountability for a verbal/telephone order if a practice partner authenticates the order? P.8 Welcome New Physicians All verbal/telephone orders for medications and restraints must be authenticated within 24 hours. Continued on page 6 See Verbal/Telephone Orders All orders, including verbal/telephone orders, be legible, complete, dated, timed and authenticated.

2 The Campaign for Swedish: Supporting Swedish/Edmonds The $100 million Campaign for Swedish was officially launched in 2007 and to date, has raised nearly $80 million from the community. Priorities at Swedish/Edmonds are included in the campaign with every dollar raised for the Edmonds campus invested in caring for patients at Swedish/Edmonds. To build awareness of the need for community support at Swedish/ Edmonds, you will soon see posters encouraging people to Help Change A Life by supporting the Campaign for Swedish. The new signage helps to highlight Swedish s nonprofit mission and to encourage those Swedish serves to partner with us. As a physician, you may be asked questions by patients and community members about the Campaign for Swedish. The Foundation can provide you with the tools to appropriately broach the subject of philanthropy and articulate why a contribution to Swedish/ Edmonds is a good investment. Donors living in Edmonds and surrounding areas will be excited to learn how their gifts will help improve the quality of care provided to them, their family and future generations of patients throughout the region. To learn more about the Campaign for Swedish, please contact Kate Purcell at kate.purcell@swedish.org or Congratulations These providers were mentioned by name in the May Press Ganey Patient Satisfaction Surveys and complimented for their great work. Anita Chopra, M.D. Swedish Internal Medicine at Edmonds Charles Daly, M.D. Radia Medical Imaging, Inc. FBIC Medical Staff Meetings Swedish/Edmonds medical staff is invited to attend the First Hill, Ballard, Issaquah and Cherry Hill (FBIC) Quarterly Medical Staff Leadership Council meetings. The next meetings are Sept. 20 and Nov. 17 from 6 p.m. - 8 p.m. at the Swedish/Cherry Hill Education and Conference Center. Representation from all Swedish hospital campuses is especially appreciated. A buffet dinner is available at 5:45 p.m. DJ Wardle, DPM Stevens Foot and Ankle Clinic Elena Geamanu, M.D. Swedish Edmonds Specialty Clinic Jeffrey Bray, M.D. Sound Women s Care Jeffrey Remington, M.D. Edmonds Orthopedic Center Jennifer Peterson, M.D. Edmonds Family Medicine Jinfeng Guo, M.D. Puget Sound Gastroenterology Joe Skariah, DO Birth & Family Clinic Katrina Erickson, M.D. Birth & Family Clinic Keith Luther, M.D. Swedish Internal Medicine at Edmonds Linda Strong, M.D. Swedish Internal Medicine at Edmonds Michael Lau, M.D. Edmonds Women s Clinic Michelle Sinnett, M.D. Surgical Associates of Edmonds Rachel Reinhardt, M.D. Cascade Eye Richard Baxter, M.D. Richard A Baxter Plastic Surgery Clinic Shari Engstrom, M.D. Emergency Services Timothy Roddy, M.D. Urology Northwest 2

3 Preventive Care, Mother Inspires New Physician Swedish/Edmonds is welcoming a new physician to the medical staff Zerin Rahman, M.D. Dr. Rahman is board certified in internal medicine and is a hospitalist at Swedish/Edmonds. She diagnoses and treats a variety of medical conditions and is dedicated to taking care of a patient through his or her entire stay at the hospital. Being a hospitalist can be fastpaced and challenging, but it s also very rewarding because the care I provide is immediate, says Dr. Rahman. Hospitalists often get to see the results of their work and see their patients get better. Dr. Rahman completed her residency in internal medicine at St. Mary Medical Center, UCLA, in Long Beach, California. She received her medical degree from Dhaka Medical College at the University of Dhaka in Bangladesh. Dr. Rahman says it was her mother, and her mother s wish for women to have better access to health care, that motivated her to become a physician. The world I came from, women don t have access to the kind of care we get here, says Dr. Rahman. My mother was bothered by that and so she thought I could help women if I were a doctor. Dr. Rahman enjoys helping and educating patients. Especially about preventive care and the importance of taking responsibility for your health, she says. Taking good care of yourself now, means you re less likely to get sick later. Zerin Rahman, M.D., is a new hospitalist at Swedish/Edmonds. In addition to English, Dr. Rahman is fluent in the Indian languages of Hindi and Bengali. She began caring for patients at Swedish/Edmonds in July. When she s not at the hospital, she enjoys cooking and gardening CPDI Report: June Concurrent / Retrospective Total Reviews: 317 / 595 Total Queries: 40 / 14 Response Rate: 100% / 83% June s Top 5 Queries: 1. Anemia 2. Congestive Heart Failure 3. Document Clarification 4. Sepsis 5. Pneumonia Most Effective Query: Congestive Heart Failure Impact of most effective query: Revenue: $15,481 Case mix: Physician Agree Rate: 83% / 71% Total Case Mix Index for Medicare and Managed Medicare: Thank you to the medical and surgical staff for taking the time to respond to these queries. Please contact Melanie Westerinen, CPDI Program Supervisor, at with any questions. 3

4 CME Corner John Arveson CME Program Coordinator New Regulations for Chronic Pain Grand Rounds 4 Treating patients suffering from chronic pain has always been a difficult proposition and most physicians know there is a delicate balance between the under treatment and over treatment of chronic non-cancer pain. There has also been a growing concern over the past decade or so about the dramatic increase in prescription opiates sold in Washington state and the increase in unintentional opiate overdoses and deaths. According to the Drug Enforcement Administration, the estimated doses of hydrocodone and oxycodone sold in the state have more than doubled over the past 10 years. The incidence of overdose and deaths has also increased. In Snohomish County, unintentional poisonings is the third leading cause of unintentional mortality, with legal and illegal drugs accounting for 97 percent of those deaths. The largest number of unintentional drug related deaths was due to opioids. In King County, prescription drugs have largely displaced illegal drugs as a cause of overdose deaths. About 54 percent of drug-caused deaths in King County last year involved prescription opiates. With numbers like that,you can pretty much bet that the government will come to help. And it did. The 2010 legislature passed a bill that required licensing boards to adopt regulations by June 30, 2011.The Medical Quality Assurance Commission (MQAC) also recently adopted regulations that will take effect on January 2, The 12-page rules are very detailed and will affect every physician who treats patients for chronic pain. They detail what is required in the way of patient evaluation, a written treatment plan, providing informed consent, having a written agreement with the patient, the frequency and depth of periodic review, consultation requirements, and continuing medical education requirements. There is even a section on episodic care providers (e.g. emergency physicians) that could have them making reports to the patient s treating physician if the patient seeks drugs during an ER visit. The requirements for physicians caused by the new regulations, and some practical tips on how to comply, will be discussed at the Physician Well-being 2011 Friday, Sept. 9 Swedish CME Events Sept. 21 Grand Rounds, which will be held from 12:30 p.m. 2 p.m. in Auditorium B at Swedish/Edmonds. The speakers will include Mimi Pattison, M.D., who is a member of Medical Quality Assurance Commission (MQAC), and Mike Schiesser, M.D., who is board certified in addiction medicine and is the president of the state chapter of the American Society of Addiction Medicine. Dr. Schiesser also chairs the Washington Pain Alliance and has also served on Attorney General Rob McKenna s Prescription Drug Task Force. Plan to attend this timely presentation. Register by sending me an at john.arveson@swedish.org or by calling me at Seventh John L. Locke, Jr., Preventive Cardiology Symposium Friday, Sept.16 An Intensive Update in Neurology Thursday and Friday, Sept th Annual Pain Management Symposium: Taming the Pain Friday, Sept. 30 For the most up-to-date information, visit:

5 Swedish/Edmonds Physicians Named Top Docs Two Swedish/Edmonds physicians are among the best physicians in the Puget Sound Region according to Seattle Magazine s annual Top Doctors survey. Arthur Castagno, M.D. and James Spiegel, M.D., were nominated by their peers and selected by Seattle Magazine as among the very best in their fields. Dr. Castagno is a radiologist and medical director of radiology at Swedish/Edmonds. Dr. Spiegel is a radiation oncologist with Swedish Cancer Institute and chairperson of the Swedish/ Edmonds Ethics Committee. Their names appeared in the July issue of Seattle Magazine Arthur Castagno, M.D James Spiegel, M.D. Need a New Badge? If you need a new Swedish/ Edmonds badge, please contact the hospital s Security Department. Human Resources is no longer responsible for new badges. Security is located on the hospital s first floor in the Education Department and will replace or modify badges on the second and fourth Thursday of the month during the following times: Second Thursday 7:30 a.m. 9 a.m. Fourth Thursday 3:30 p.m. 5 p.m. You may also schedule an appointment with security by calling If you have questions, please contact Mark Nunes, director of facilities and hospital safety officer for Swedish/Edmonds at June Hospital Statistics June-11 June-10 % Change Average Daily Census % Admissions % Total ER Visits 3,522 3, % Total Surgeries % Deliveries % Divert Time 0.3% 0.1% 200.0% 5

6 Cancer Support Services Available If you know of a patient in need of cancer support services, here s a reminder that free help is available at the American Cancer Society (ACS) Cancer Resource Center at Swedish/Edmonds. The Resource Center is located on the second floor of Swedish Cancer Institute (formerly the Stevens Oncology building). It s staffed by well-trained volunteers who can help patients find cancer treatment doctors locally, lodging and transportation assistance, support groups, finance and insurance counseling, as well as referrals for prescription drug assistance. The center provides patients with free, comprehensive cancer information, referrals to other community organizations offering day-to-day guidance and assistance, and emotional support. Some of the support programs and services available at the Resource Center include: Look Good Feel Better Reach to Recovery (breast cancer support) Road to Recovery (free transportation to and from cancer treatments) If you d like more information about Cancer Resource Center programs and services, please visit the ACS s website at The American Cancer Society Cancer Resource Center at Swedish/Edmonds provides free information about cancer support programs and services. Verbal/Telephone Orders (continued from page 1) 6 The ordering practitioner's accountability for a verbal/telephone order is not decreased if another practitioner authenticates the order. When a practitioner authenticates a verbal/telephone order that he or she did not give, the practitioner accepts responsibility for the order and is validating that the order is complete, accurate, and final based on the patient's condition. If the practitioner does not agree with the orders he/she is authenticating, then he/she should discontinue the previous order and write a new replacement order. Can verbal/telephone orders be used during a medical emergency? Yes, during an emergency situation, verbal/telephone orders should be documented, dated and timed by someone other than the ordering practitioner and then authenticated, dated and timed by the ordering practitioner once the patient has been stabilized. During an emergency situation, the person administering a medication is also expected to repeat the verbal/ telephone order back to the ordering practitioner. Who is responsible for verbal/ telephone orders that have not been authenticated? The practitioner giving a verbal/ telephone order is responsible for the order whether it is authenticated or not. However, incomplete or incorrectly transcribed verbal/ telephone orders present a risk to the patient's health and well-being. If a verbal/telephone order for a onetime medication is not documented completely and accurately, patient harm can occur. Therefore, we believe that the authentication of verbal/telephone orders impacts patient safety and quality of care. If you have questions, please contact Helen Morrison, director of patient care services at Swedish/ Edmonds, at helen.morrison@swedish.org or

7 Inpatient Pharmacy Using Closed-System Devices In June, the Swedish/Edmonds Inpatient Pharmacy began using closed-system devices for handling hazardous drugs. By hazardous drugs, we primarily mean chemotherapy drugs, says Katy Schmitt, inpatient pharmacy operations manager. Closed-system devices are plastic tips and tubing, specially designed to attach to medication vials and syringes. Whether a medication is being prepared for use by a pharmacy technician, transported to a hospital floor or is being administered to a patient by a nurse, closed-system devices prevent particles of the drug from escaping into the air. In the pharmacy, we have a specially equipped IV room with a contained space in which to prepare chemotherapy drugs, Katy says. But even in that space, without the use of a closed-system device, there s the potential for droplets of a drug to be released into the air. These devices now prevent any droplets from escaping, and protect hospital employees from exposure to the drugs. Continued exposure to even small amounts of chemotherapy and other hazardous drugs could be potentially harmful to a person s health. In April, Washington was the first state in the U.S. to enact legislation requiring health-care organizations who administer hazardous drugs to begin using closed-system devices. According to Katy, the devices are convenient and don t require the use of needles with syringes, so there s no more risk of needle-sticks to pharmacy technicians or nurses and less waste. The nurses are very happy with the devices and the pharmacy technicians especially like not having the needles, she says. One tech An example of a closed-system device used at Swedish/Edmonds. The plastic tips and tubing protect health-care workers from exposure to hazardous drugs told me she feels more comfortable now when mixing chemotherapy drugs. In addition to Swedish/Edmonds, closed-system devices are also used at Swedish s First Hill and Cherry Hill campuses, and will soon be in use at the new Issaquah campus when the hospital opens in November. Outdoor Movie Night at Swedish/Edmonds Connecting with the community is important at Swedish/Edmonds, so on August 12 we launched outdoor movie night. We invited the community to bring the family and join us on the café patio to watch Toy Story, originally released in Join us on Friday, August 26 for the next free, family friendly movie featured in the outdoor movie series. Swedish/Edmonds will offer complimentary popcorn and lemonade. Chair seating will be available on the café patio for the first 250 people. Moviegoers may also bring a blanket and sit on the lawn above the patio area. Tell a friend! Bring the family! It s movie night at Swedish/Edmonds. Community members enjoy the first outdoor movie night at Swedish/ Edmonds on August 12. Comments included what a great program we re looking forward to the next film. 7

8 Newsletter Access Vital Signs is available on our website. Visit the Medical Staff section swedish.org\edmondsmedicalstaff and select Physicians Links & Resources from the menu on the left. Contributions Any medical staff member with an article or item for the newsletter should contact Amy Morrow, marketing copywriter, at (425) or by the 1 st of the month. WELCOME New Swedish/Edmonds Medical Staff July Name Group Specialty John Brandabur, M.D. Swedish Gastroenterology Gastroenterology Lisa Caylor, M.D. Swedish Neuroscience Specialists Neurology Marcio Sotero de Menezes, M.D. Swedish Pediatric Neuroscience Center Pediatric Neurology Michael Doherty, M.D. Swedish Neuroscience Specialists Neurology Lonnie Fuller, Jr., M.D. Swedish Internal Medicine at Edmonds Internal Medicine Benjamin Jones, M.D. CEP America Emergency Medicine Nilufer Norsworthy, M.D. Center for Wound Healing & HBO Hyperbaric Medicine Michael Reyes, M.D. Kruger Orthopedics Orthopedics Drew Schembre, M.D. Swedish Gastroenterology Gastroenterology Ednea Simon, M.D. Swedish Neuroscience Specialists Neurology Jehuda Sepkuty, M.D. Swedish Neuroscience Specialists Neurology To Admit a Patient to Swedish/Edmonds, Call Vital Signs Issue 35 August th Avenue West, Edmonds, WA 98026