Testing a New Tool for Keeping Staff and Patients Safe in the Pediatric Emergency Department

This week I would like to highlight some outstanding work being done in our pediatric Emergency Department led by Mark Fisher, MSN, RN, CEN, TCRN, Senior Nurse Manager of Emergency and Pediatric Services.  

Our Pediatric ED team is actively redesigning care to improve the experience of behavioral health patients and their families. 

Because of an increase in violence in Emergency Departments, particularly against nurses and nursing assistants, de-escalation techniques are being used to manage aggressive and agitated patients.  Triage nurses, who are charged with assessing the patient, use screening tools to identify the patient who may become aggressive.  One of these tools is STAMP (Staring, Tone and volume of voice, Anxiety, Mumbling, and Pacing). Knowing when a patient is likely to become violent is imperative to enacting de-escalation strategies. 

Using the tools of our Lean Management System (LMS), the Peds ED is testing the implementation of STAMP as one of their areas of focus (Include pic of chart). Mark recently responded to some questions to give us a better idea of their work and what they are learning.  

Q:  How did you hear about STAMP and how long have you been using it in the peds ED?
A:  We performed a literature review on the best predictive tools for pediatric violence in behavioral health. In addition, we reviewed Joint Commission materials for best practices and they showed STAMP as a validated tool. We are using the Model for Improvement to test its value.

Q: What are some of the lessons you have already learned since its implementation?
A:  The tool allows for easier end-user interpretation of current behaviors of the pediatric patient.  

Q: As part of LMS what are you measuring when it comes to STAMP?
A: Our goal is to predict potential violence to better place our patients within our care settings for safety.

Q:  As part of your improvement work, are you comparing STAMP to what you had been using previously?
A:  Our current standard work includes using the Broset violence score, which is intended for use in adult patients. We identified this gap in practice using LMS and therefore we are on this journey of improvement. 

I want to thank Mark and his team for their hard work and their test of change. We look forward to the results after they have been analyzed.  

Let’s thank… 
This week is Pastoral/Spiritual Care Week.  Please join me in thanking Chaplain J. Joseph Hart and all the members of our Spiritual Support team for their hard work and dedication to meeting the spiritual needs of our patients. No matter the faith, our Spiritual Support team is always there to provide compassion and comfort to patients and their families as they face a serious illness or life-threatening injury. To learn more about our Spiritual Support Services, please visit their web page.

Greater Baltimore Health Alliance Leads the Pack in the Maryland Primary Care Program

This week I would like to highlight the fantastic work being done by our Patient Centered Medical Homes led by Dr. Gregory Small, Medical Director of GBMC Health Partners Primary Care.

The Maryland Primary Care Program (MDPCP) was created by the Centers for Medicare and Medicaid Innovation and the State of Maryland to improve health outcomes and the care experience while reducing costs for Medicare beneficiaries. MDPCP provides funds to practices which, for example, hire care managers to work with providers to improve health outcomes. Since 2019, the program has helped create more advanced primary care practices that are better equipped to keep patients with chronic diseases, such as diabetes, out of the hospital and as healthy as possible.

The run chart demonstrating the performance on diabetic outpatient management (Hemoglobin A1C rate out of range), an internal measurement across all practices for diabetes control, demonstrates that we are doing very well against national comparisons. Also, six out of the 10 GBMC primary care practices that participated in the MDPCP in 2020 were at or above the 75th percentile for diabetes control compared to all the other practices in MDPCP – now numbering approximately 400.

Dr. Small attributes this success to the development of a dedicated diabetes care pathway. Spearheaded by a diabetes committee in which he chairs, the pathway outlines how to approach a poorly controlled diabetes patient and deploy a care team, specifically our RN care managers. Our care managers are important partners on the team with physicians, advanced practitioners, and medical technicians, working with patients to ensure the necessary care and  that they are following evidence-based protocols to maximize their health.

The team also leverages technology to increase patient engagement. Tools including electronic  flowsheets that are visible to patients and the care team allow for more effective communication beyond what happens during office visits. 

Blog readers know that advanced primary care is a fundamental building block of the GBMC HealthCare System. The PCMH is critical to preventing disease and coordinating care for people who already have chronic disease. Let me thank Dr. Small and all of our primary care teams!

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International Infection Prevention Week

This week is International Infection Prevention Week (Oct. 17-23). This is  a time to highlight the importance of infection prevention and raise awareness of everyone’s role in protecting the public from healthcare-acquired infections. Infection prevention initiatives include hand washing, employee education related to safety and infection control, sharing best practices, and tracking improvements in performance.
GBMC is fortunate to have an incredible Infection Prevention Department and they have been tremendously important during the pandemic.

I want to thank our Infection Prevention team members for all they do every day!

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GBMC Team…Please get your flu shot!

Studies have shown that as many as 1 in 2 infected people never show classic flu symptoms but can shed virus for 5-10 days. This means that asymptomatic personnel can unknowingly spread influenza to a patient, co-worker, and personal contacts. If an employee contracts influenza they put patients, fellow staff, and their own family at serious risk.  For this reason, the annual flu vaccine has become a standard of care for healthcare providers. 

GBMC employees and volunteers are required to be immunized (those few who are not required to be immunized are required to wear masks during the flu season) to protect ourselves and our patients.  Getting your flu shot is even more important as the challenges of the COVID-19 pandemic remain.

The deadline for influenza vaccination for all employees, contractors, volunteers, and students is Friday, Oct. 29.   We have two vaccination events coming up:

• Sunday, October 24: 2:00 p.m. - 10:00 p.m., EHS Clinic, Room 4904
• Friday, October 29: 7:00 a.m. – 3:00 p.m., Civiletti Conference Center

A valid GBMC ID badge must be presented at all flu vaccination events.

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October is National Cyber Security Awareness month 

Our ITS team continues to do an outstanding job in defending our networks while preserving the efficient delivery of healthcare services.

We learned a lot from last year’s cyber-attack and we will continue to become stronger because of it. Please remain vigilant and do not click on links unless you are sure they are safe. Please remember to always bring a questioning attitude to your use of e-mail, the electronic record, and other applications. Do not click links unless you are sure they are  safe, do not go to websites you aren’t familiar with, and ask IT for guidance if something doesn’t quite “seem right.” The cyber-attack we experienced started with a phishing email, so it is critical to report any suspicious emails to IT. Together, using simple internet safety precautions, we can help keep GBMC safer from cybercrime.

I want to thank Dave Hynson, GBMC’s Chief Information Officer, and his team for all their hard work in addressing the issues and keeping our systems safe.

GBMC Meets Our Mission with Outstanding Support from the Community

Last Wednesday, patients at the Sandra and Malcolm Berman Cancer Institute at Crossroads were given cupcakes by the owners of Saffer Plumbing, Heating, and Electric.  This special treat was to commemorate Breast Cancer Awareness Month and was well received by our patients and staff.  And, the company’s generosity doesn’t end there!

Saffer Plumbing, Heating, and Electric, with the help of their specially decorated pink truck, is donating a portion of their business revenue to our Oncology Support Services to help our cancer patients meet travel-associated expenditures. Unfortunately, many of GBMC’s cancer patients need a ride to receive their scheduled treatments but lack consistent means of transportation. National statistics show that more than 60 percent of cancer patients missed or were late to an appointment because of transportation issues.

Under this new partnership, Saffer will donate about $5,000 a year to GBMC. The Saffer family chose GBMC because of close connections that include the hospital being the place where their children were born, and they have a family member who was a longtime physician at GBMC.

Brandon Costantino, manager of our Oncology Support Program at GBMC’s Sandra and Malcolm Berman Cancer Institute, recently answered some questions regarding this wonderful collaboration and its importance to our cancer patients.

Q: Can you give some details about our Oncology support program and how it helps our patients?
A:  Our Oncology Support Services department provides a wide variety of assistance including helping our patients get to and from their treatments. We also offer free counseling, education, and connections to organizations that can help patients and families shoulder the burden of treatment. Our goal is to reduce barriers to care. We want patients to be able to get their treatments on time, as scheduled, to achieve the best health outcomes possible. 

Q: What is the average cost for our patients who turn to public transportation or rideshare companies to get to their appointments?  How will this partnership help our cancer patients meet some of their transportation costs for coming to and from scheduled treatments?
A:  Some of our patients turn to public transportation or rideshare companies to get to and from their treatments.  The average cost per ride is $23.02, meaning that patients can spend an average of about $46.00 per visit. The average GBMC cancer patient requires at least 14 rides monthly. Most of us have had a family member, friend, or someone close battling cancer. Treatment is never easy, and at times the financial toll is overwhelming. 

The funds donated by Saffer Plumbing go into a restricted fund and can only be used for transportation. We then use those funds to provide rides to breast cancer patients who need transportation.  This donation will help provide over 200 rides to breast cancer patients. Again, we want to do everything we can to help meet basic financial needs, decrease stress levels, and allow patients with cancer to focus on healing. A donation like this makes a huge difference in our patients’ lives. 

Q: Whose idea was the pink truck?
A:  The pink truck belongs to one of the company’s plumbers whose grandmother is a breast cancer survivor.  When asked to participate in this endeavor he was honored.  One of his recent customers, when informed that part of the proceeds from that day’s work would go to helping breast cancer patients, was really touched.  It meant a lot to her being a cancer survivor herself.  This truly shows the value of this initiative.

Thank you, Brandon, for the valuable information and my gratitude to Saffer Plumbing, Heating, and Electric for doing what they can to help our patients get to their cancer treatments. 

Another Group Helps Our Cancer Patients
Recently, members of the Alpha Kappa Alpha Sorority, Inc. - Upsilon Epsilon Omega Chapter, donated chemo care packages to our patients. The care packages included a journal, lotion, Queasy Pops, hand sanitizer, socks, snacks, and more! 

People living with cancer benefit from the power of human connections. These carefully selected products are geared to help ease the short-term side effects of treatment and brighten a cancer patient’s day.

I would like to thank Dawn C. Stefanik, AA, MLT, BSN, RN, OCN, Nurse Manager- Infusion & Infusion Pharmacy at our Sandra & Malcolm Berman Cancer Institute, for helping to coordinate this work.

Again, we are so grateful for the generosity of the community and truly appreciate their help in brightening the day for our cancer patients. 

Thank You!
There is no question that Emergency Department nurses have some of the hardest jobs and make an immense difference when every second counts. They have the expertise in caring for all emergencies, across all stages of life, and they work very hard. 

Last week we celebrated Emergency Nurses Week. I want to thank our ER nurses for making a difference in the lives of people every day, every shift. Now more than ever, it’s important to recognize and appreciate their commitment in caring for our patients.

Celebrating Gilchrist’s New Home in the City

Last week I had the pleasure of attending the ribbon cutting ceremony at the Gilchrist Center Baltimore’s new Inpatient Hospice facility at Stadium Place. 

By the end of October, we will start to provide respectful end-of-life care to many in need in the city of Baltimore. The new center will continue to be the only residential hospice in Baltimore and the only pediatric inpatient hospice unit in the state. 

The 30,000 square-foot William L. and Victorine Q. Adams Gilchrist Center Baltimore will contain 18 private adult rooms and four pediatric rooms for inpatient residential hospice and respite care. The center has been designed with the warmth and comfort of Gilchrist’s other inpatient centers in Towson and Howard County, with home-like areas for families who are visiting. Each patient will have access to the full spectrum of hospice care, including medical, emotional, spiritual, and personal care, with a focus on quality of life. Music therapy, veteran salutes, counseling, and bereavement services will also be available free of charge. 

My deepest gratitude to Cathy Hamel, President of Gilchrist and Vice President of Continuing Care at GBMC HealthCare, and Dr. Tony Riley, Chief Medical Officer of Gilchrist, and their entire team for their devotion to their patients and families. I congratulate them once again for this milestone occasion.  

Thank You!
Earlier this week, we had an unfortunate incident on our medical campus.  Thankfully no one was physically injured or harmed. The safety of our staff, patients, and entire GBMC family is of the utmost importance. I want to thank our security team and incident command center for their quick response and action to protect our staff, volunteers, patients, and visitors. 

Celebration…
Last Thursday, we held our annual employee and volunteer barbeque. Normally, we hold this event during the summer, but we thought that having it in September would be a welcomed change, especially given the pandemic. The great weather and the spectacular karaoke performers and bean toss participants helped make it a really a fun time!

I would like to acknowledge our Human Resources Team, led by Anna-Maria Palmer,  Vice President of Human Resources and Chief Human Resources Officer, and her executive assistant, Richelle Tighe, as well as the Marketing and Communications Team and our Philanthropy Team, led by Jenny Coldiron, for putting on a fabulous day-long barbecue! I also want to give a special shout out to Cristie Nickel, Community Relations and Events Specialist, and Kim Davenport,  Director of Communications and Event Management Strategy, for their hard work on this year’s events.

October is American Pharmacists Month
At GBMC, we have always had outstanding pharmacists and technicians who really care and work hard. Over the years, our pharmacy team, led by  director, Yuliya Klopouh, has done an outstanding job at making our medication delivery highly reliable. They were phenomenal after the cyber-attack. They really showed their expertise at redesign. Please join me in thanking them for all that they do to drive us closer to our vision. 

Happy Anniversary, Times Two!
Last Friday (October 1st), we hit two major milestones. It was GBMC’s 56th anniversary and it was also the five-year anniversary of going live with Epic – our electronic medical record (EMR) across the GBMC HealthCare System. I can’t believe how time has flown.  It is clear that “one patient, one record” has been a major benefit for our patients and for the GBMC HealthCare System.