Transformation

Antimicrobial stewardship 2

Physician communicators 3

Clinical/Education News

Grand Rounds 4

ACT graduation 5

General News

Earth Day 2010 7

VNA’s Evergreen IIoffers adult day program 15

Volunteers deserve thanks 18

F O C U SChristiana Care nationallyrecognized for innovation

Christiana CareHealth System

has been named the2010 AllianceInnovation Awardwinner from theAlliance ofIndependentAcademic MedicalCenters (AIAMC), anational organiza-tion made up of 69major academicmedical centers andhealth systems.

The award recog-nizes Christiana Care for innovativeapproaches to medical education andresearch that result in better patientoutcomes.

Christiana Care received the award fordeveloping and implementing an inno-vative graduate-level, 12-week course.The curriculum focuses on inter-profes-sional learning through collaborationon quality improvement projects. Theaim of the course is to produce measur-able improvements in quality andpatient safety.

“We are honored to receive theInnovation Award,” says Robert J.Laskowski, M.D., MBA, president andCEO of Christiana Care. “It validatesthe dedication of so many of my col-leagues at Christiana Care to providequality education aimed at transform-ing the way we deliver care.”

“Christiana Care has been an activeparticipant and leader in the AIAMC

National Initiative: Improving PatientCare through Graduate MedicalEducation since 2007,” says KimberlyPierce-Boggs, AIAMC executive direc-tor. “Christiana Care serves as anexcellent example of the successfulintegration of graduate medical educa-tion and quality. The AIAMC board ofdirectors is delighted to presentChristiana Care with this award.”

Dr. Laskowski accepted the award onbehalf of Christiana Care at theAIAMC’s annual meeting on March 26in New Orleans, La.

Present in New Orleans to accept the2010 AIAMC’s Innovation Award were(from left) Robert J. Laskowski, M.D.,Theresa Fields, Loretta Consiglio-Ward,RN, MSN, Samantha DeCouto, D.O., LeeAnn Riesenberg, Ph.D., RN, ElizabethKunkel, D.O., Carol K. Moore, RN, MS,Matthew Stofferahn, M.D., SarahSchenck, M.D., and Brian W. Little, M.D.,Ph.D.

T R A N S F O R M A T I O N

Successful ASPs require the talent anddedication of multiple disciplines. AtChristiana Care, prescribers will beable to order antimicrobials as usual,but the ASP will review charts everyweekday for patients receiving selectedantimicrobials using ASP/P&T-approved criteria. ThIs will enable reg-ular assessment of whether continua-tion of therapy is justified or warrantsASP intervention.

Timely follow-upTimely follow-up will assess the statusof all ASP recommendations. If one iswarranted, the physician who wrotethe order will be informed by tele-phone or a note on the official ASPintervention form (found in theprogress note section of the chart). Theform will allow practitioners to pro-vide a rationale for continuing treat-ment if it differs from ASP recommen-dations and will not remain a perma-nent chart document but will beremoved upon patient discharge.

ASP recommendations will promoteappropriate, evidenced-based practiceto ensure optimal outcomes anddecreased costs for our patients. Datawill be collected both pre- and post-implementation to assess trends inantimicrobial use and prescribing pat-terns that can be used to create specificChristiana Care antimicrobial treat-ment guidelines.

Roughly 50 percent of antimicro-bial agents are misused. One neg-

ative result of their misuse is that anantibiotic can lose effectivenessagainst the disease-causing microbesthey were designed to combat, a phe-nomenon known as antimicrobialresistance. The result can be lost lives,rising costs and the weakening of ourhealth care delivery system.

The World Health Organization(WHO) says this phenomenon couldthreaten global stability and nationalsecurity. In response, Christiana CareHealth System will be launching anew stewardship program to helpdirect antimicrobial use and do ourpart to curb the main cause of micro-bial resistance, the overuse and mis-use of antibiotics.

Demonstrated successThe implementation of antimicrobialstewardship programs (ASPs) haveconsistently demonstrated decreasesin antimicrobial use, improved clinicaloutcomes and reduced costs withoutincreasing harm from drug resistance,

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ASP committee members include:Carol Briody, Infection Control; MarciDrees, M.D. - Infection Control/Epidemiology; Michael Kalina, M.D.,Intensivist/Surgery; James Ley, M.D.,Infectious Diseases; Sarojini Misra,MS, SM, Microbiology; AnandPanwalker, M.D., Infectious Diseases;and Tuhina Raman, M.D.,Intensivist/Pulmonary.

toxicity and medication-related ad-verse events.

During this era of multi-drug resistant(MDR) infections, the InfectiousDisease Society of America has beenpromoting “Bad Bugs No Drugs” andthe 10 new antibiotics by 2020 (“10 x20”) campaign to emphasize the needfor development and funding of newantibiotics with new mechanisms ofaction to target MDR pathogens. Overthe past 25 years there have been sig-nificant decreases in the number ofantimicrobials introduced to the mar-ket. That is why health care systemASPs play a crucial role in preservingour limited antibiotic selection, as wellas improving patient care and holdingthe line on health care costs.

Goals/Mission Numerous professional organizations,including the IDSA, the Society forHealthcare Epidemiology of Americaand the Society of Infectious DiseasesPharmacists, support establishingASPs. At Christiana Care, the ASP is ajoint commitment between PharmacyServices, the Infectious DiseasesSection of Medicine, InfectionPrevention/Epidemiology andMicrobiology with the common mis-sion to promote judicious and appro-priate use of antimicrobials within thehealth system. Our main objectives areto optimize clinical outcomes, mini-mize the development of antimicrobialresistance, and reduce overall costsassociated with misuse of antibiotics.

This involves not only assessing theactual prescribing patterns of antimi-crobials, but also ensuring that treat-ment options consist of optimal selec-tion, dose, route and administration ofthe most narrow and cost-effectivetreatments.

New program improves patient safety

ASP co-chairs John Piper, M.D., andElizabeth Marino, Pharm.D., BCPS.

T R A N S F O R M A T I O N

It’s 10 o’clock on a Thursday nightand a patient in the Emergency

Department is admitted to the hospitalwith chest pains.

Soon after, the patient’s primary careprovider receives a call or fax from thePhysician Communicator Service, aprogram that keeps doctors informedabout their patients’ care.

Before launching the service in 2008,there was no plan in place that noti-fied doctors about their patients beingadmitted through the ED. To date,physicians havereceived morethan 30,000admission notifi-cations.

“Doctors wouldtake care of apatient for 20years but theyhad no way ofknowing that someone was in the hos-pital,” says Michael Cinkala, managerof Physician Relations. “The doctorsfound that very frustrating and told usso—and we heard them loud and clear.”

Hours: weekdays 7 a.m.-11:30 p.m.The Physician Communicator Serviceinitiated immediate, transformationalchange. Two full-time staffers work atthe call center from 7 a.m.-11:30 p.m.,Monday through Friday, phoning pri-mary care providers to let them knowtheir patients have been admitted, thenature of their complaints and who isattending them in the hospital. Afterhours and on weekends, the informa-tion is faxed to doctors’ offices.

Cinkala notes that about two-thirds ofcommunity doctors do not follow theirpatients in the hospital. The PhysicianCommunicator Service keeps thosedoctors informed during their hospital

Physician Communicators improve doctor-hospital relationsstay. To serve those doctors, the com-municators also notify primary careproviders who usually do admit theirown patients and follow them in thehospital if and when one of theirpatients is admitted by another physi-cian, such as a hospitalist.

“If someone calls and says, ‘my momis in the hospital,’ it is reassuring tothem that we are aware of the situa-tion,” says John Fenice, M.D., ofHeritage Medical Associates, a pri-mary care, gerontology and podiatrypractice in Wilmington.

Now includes discharge noticesThe well-received program expandedin November 2009 to include dis-charge notifications. The primary careprovider receives a discharge summa-ry, including a list of medications,within 72 hours after a patient goeshome. So far, more than 2,600 notifica-tions have been sent.

Cinkala says the discharge summarieshelp doctors to prepare more effective-ly for patients’ follow-up visits. Thesummary also relieves some of thepressure on the patient to report newprescriptions or therapies.

Feedback on the system from doctors andpractice administrators has been positive,improving follow-up and patient care.

“When we receive a discharge notifi-cation, our nurse practitioner calls thepatient and makes an appointment forhim to come into the office,” Dr.Fenice says.

Effective communication also gives doc-tors an opportunity to provide care witha personal touch, says David Curran,CEO of Brandywine Medical Associates,a family practice with locations in PikeCreek, North Wilmington andWilmington.

“The notification program is the steppingstone for greater communication withinour community, increasing the qualityof care to all patients,” say Curran.

✔ Doctors who would like to make certainthe Physician Communicator Program hastheir most up-to-date contact informationand admission preferences, can callPhysician Relations at 302-733-2899.

Physician communicatorsMonique Medley (left) and LizSteward keep primary carephysicians informed whenevertheir patients are admitted toChristiana Care.

“The notification program is the steppingstone for greater communication within ourcommunity, increasing the quality of care toall patients.”

David Curran, CEOBrandywine Medical Associates

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Grand Rounds

E D U C A T I O N W E E K

Residents whofeel inadequate-ly educated intheir specialtiesare fueling aflight to sub-specialtieswhere they canreceive addi-tional training,says ThomasNasca, M.D.,MACP, CEO oftheAccreditationCouncil of

Graduate Medical Education, the private, nonprofitgroup that evaluates and accredits residency pro-grams in the United States.

“American graduate medical education is broken.”

The ACGME is working with review committees andspecialty boards to develop specific benchmarks ofskills and knowledge that residents in every specialtymust achieve at certain stages in their residencies,such as the third month, first year and second year.These milestones will document residents’ growth inmastering core competencies.

“People start at different points and progress at dif-ferent rates,” Dr. Nasca says. “We want to be able toeffectively remediate poor performers.”

He noted that the federal government will spend $90billion over the next 10 years to measure physicianeffectiveness and expects a return on its investment.

Dr. Nasca also says revised standards for duty hoursestablished by the ACGME in 2003 are not effective.New standards are being developed that will focus onthe residents’ level of supervision, as well as the widerange in individual sensitivity to fatigue.

MedicalThomas Nasca, M.D.

Thomas Nasca, M.D.

Surgical Julie G. Nyquist, Ph.D.

Specific feedbackfrom attendingphysicians is anessential compo-nent in educatingresidents, saysJulie G. Nyquist,Ph.D., a professorin the Division ofEducation at theKeck School ofMedicine at theUniversity ofSouthern California.

“Effective role modeling is really key.”

Nyquist encouraged doctors who are teaching residentsto make brief notations about residents’ performance sothey can provide more detailed observations on resi-dents’ progress.

“If you’re not taking notes, they aren’t going to get thekind of feedback they deserve.”

Residents also should take advantage of technologiesthat enable them to review learning experiences.

“Your new [Virtual Education and Simulation TrainingCenter] has a magnificent ability to videotape for you.”

Without feedback, mistakes go uncorrected and badhabits begin to form—and good habits can slip awaybecause they are not reinforced, Nyquist says.

Residents and attending physicians gave examples offeedback they had received over the years.

A negative example: “I am going to do everything in mypower to get you fired from this program.”

On the positive side, a text message: “Good job on thatgallbladder today.”

Nyquist noted that neither comment offered guidancethe resident could learn from and that even compli-ments should offer substantive feedback.

“They make us feel all glowy inside but they don’t takeyou to the next step,” she says.

Julie G. Nyquist, Ph.D.

✔

A C H I E V I N G C O M P E T E N C Y T O D A Y

From left, front row, Renee Kottenhahn, M.D.,FAAP, Elizabeth Mitchell, MS, RN, EllenMochache, MS, APN. Back row, Sajid Noor,D.O., Toby Thomas, Pharm.D., Seema Dattani,M.D., Elaine Turochy, RN.

ACT graduates largest class yet

Thirty-five colleagues graduatedfrom the Achieving Competency

Today (ACT) course March 31—thelargest graduating class since itsinception in 2004.

The 12-week graduate level courseteaches quality and team skills whileteams develop projects that promoteinterdisciplinary interaction, with theoutcome of five new performanceimprovement projects. A certificate ofcompletion was also presented toChristine Chastain-Warheit for com-pleting the ACT course facilitatortraining program.

Christiana Care is a recent recipient ofthe 2010 Alliance of IndependentAcademic Medical Centers (AIAMC)Innovation Award for demonstratingan organization-wide change in thedevelopment and/or implementationof innovative education programs forresidents, physicians and other staff.This prestigious award exemplifiescreative approaches to medical educa-tion and research, such as ACT, thatresult in better patient outcomes.

A recent Christiana Care residentgraduate and ACT course participantreported that the knowledge and skillsacquired in the course was a majortopic of discussion during job inter-views. “It’s nice to know that I’ve hadsuch great learning experiences atChristiana Care and I wanted to sharethis positive feedback with you,” shesays.

THE PROJECTS

“Promoting Well Child Check-ups: It'snot just about the shots!”This team focused on increasing thenumber of well child check-ups sched-uled at Wilmington Hospital’sPediatric Practice Program. Baselinedata revealed that approximately 75

percent of patients coming to the prac-tice were in compliance with theAmerican Academy of Pediatrics rec-ommended well child visit schedule,while 25 percent were not up to date.By standardizing a process for nursesto routinely evaluate the need for sucha visit and to prompt scheduling whilea child is in the office for a sick visit,95 percent of eligible patients over atwo-week rapid cycle test were appro-priately scheduled. To help supportthis process, an information sheet wascreated to remind parents and care-givers of the importance of a wellchild check-up, which is more compre-hensive than immunizations alone.

“The Amazing Race…”Through research and surveys, thisteam identified a need within theorganization for a more standardizedapproach to urgently responding tothe declining pediatric patient notonly on the pediatric unit, but in allareas where pediatric patients areserved. The goal of the project was todevelop a Pediatric Rapid ResponseTeam (PRRT). The team was able todevelop a PRRT policy, design a flowchart, and identify an education andevaluation plan to track results. Theproject has been transitioned to a pre-identified implementation team. Atleast three members of the ACT teamremain involved as well. The PRRTwill be piloted at Christiana Hospital.

“I’m taking what?!”The goal of this project was toimprove a patient’s confidence in dis-cussing their discharge medicationswith their health care provider and toimprove their understanding of dis-charge medications by providing atake-home medication card completedby the resident physician involved intheir care. The team analyzed data

From left, front row, Mary Ann Quinn, RN,Jessica Apel, D.O., Ariel Arandia, RN, AmyLittle, D.O. Back row, Earl Lacy, MLS (ASCP),Dennis Harris Jr., RN, Thomas Sargent, D.O.,Matthew Judd, D.O. (team facilitator).

It’s Magnetic!

“Forces of Magnetism”

Force 14: Professional Development

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from a survey of patients in theEmergency Department and foundthat only 25 percent could providea complete list of medications thatthey were taking. The team alsodeveloped a survey to measurethe patients' confidence in dis-cussing their discharge medica-tions with their health careprovider. Although the goal ofimproving confidence by 25 wasnot met in this rapid cycle test, theteam found that 100 percent of the

patients surveyed thought the medica-tion discharge card was helpful andplan on using it.

“Only YOU can prevent unnecessary1:1 safety sitters”This team sought to ensure that thecontinuing need for a safety sitter isreviewed by a physician every 24hours. They surveyed nurses on sever-al floors and found that 40 percent ofnurses agreed or strongly agreed thatsafety sitters remain in place longerthan necessary. A form was placed oneach patient’s chart to facilitate a con-versation between physician andnurse about whether a sitter was stillneeded. They achieved their goal ofhaving the need for a sitter reviewedevery 24 hours in 100 percent ofpatients. The potential for savings is

tremendous and they hope to showthat the duration of sitter cases willdecrease as a result of their success.

“MIND THE GAP: Improving transi-tions from the ED to theprimary care office”Patients and caregivers experiencechallenges with moving from one caresetting to another. This team evaluatedthe current process of notificationfrom the Emergency Department tooutpatient practice setting followingemergency care visits of AdultMedicine Office (AMO) patients.Interventions implemented weredesigned to improve the patients’ abil-ity to identify the AMO as their med-ical home and create a notificationprocess for the primary care physicianwith the ultimate goal of effecting fol-low-up care and improved clinicaloutcomes.

ACT graduates largest class yet

A C H I E V I N G C O M P E T E N C Y T O D A Y

From left, front row, Matthew Stofferahn,M.D.; Patty Blair, RN; Ken Birkentall, EDAdministration Coordinator. Back row,Andrea Read, D.O., Jennifer Grilli, M.D.,Suhani Shah, PharmD; Samantha DeCouto,DO; and Loretta Consiglio-Ward, MSN,RN, team facilitator.

From left, front row, Evan Guthrie, M.D.,Kim Proctor, RN II, Justin Morea, D.O.Back row Karla Testa, M.D., ElaineMorris, RN, Carmen Pal, RN(team facilitator), Wendy Gault, BS,CMD, Amy Whalen, RN.

AC T, C O N T I N U E D

From left, front row:Jessica White, M.D.,Cynthia Griffin, MS.RN, CPHQ, AnitaSymonds, MS, BSN,RN. Back row AnnPrincipe, MSM, CPAN;Raymond Carter, MD;Leena Kansagra,PharmD; O. GeorgeBillings, MDiv, BCC

✔ The next ACT course begins Sept. 8and runs to Dec. 1, 2010. Applications aredue by July 30. For more information,please e-mail Theresa Fields,tfields@christianacare.org. CME andCECH credits are available.

Earth Day 2010 marks another yearof demonstrating caring for our

planet by reducing, reusing and recy-cling things that would have turnedinto waste.

At Christiana Care many statisticspoint to our “green” improvements.Last year our health system reduced:

n Medical waste by 34 percent.n Air emissions by 49 percent.n Use of standard plain white paper7.5 percent—a whopping 64,000pounds.

We also recycled 1.4 million pounds ofpaper, cardboard, plastic, cans andbottles in 2009. And, by reusingsharps containers, we reducedplastics waste.

Our efforts to reduce waste and reuse

and recycle materials have been recog-nized in the past year by key agencies,including:n Practice Greenhealth Awards.

- Making Medicine Mercury Free -Wilmington Hospital. (ChristianaHospital earned the honor in 2007.)

- Partners for Change - ChristianaHospital.

n EPA Trailblazer Award.

Helping sustain our green efforts isthe Environmental StewardshipCommittee, led by Bob Mulrooney,vice president, Facilities Engineering,with support from environmentalchampions throughout the health sys-tem. Unit champions are staff mem-bers or volunteers dedicated to help-ing the committee on environmental

activities and initiatives by educatingemployees and reinforcing committeeinitiatives. Unit champions also areresourceful, providing new ideas andinitiatives, and a direct link to commit-tee members.

Champions:n Liaison between the environmentalstewardship committee and units ordepartments.

n Promote sustainable workplace prac-tices.

n Encourage recycling, reducing andreusing.

n Explore opportunities for wastereduction, energy conservation, andwiser use of resources.

n Participate in systemwide projects.

Environmental Stewardship Committee members and others who turned out to put finishing touches on the new ChristianaCare Green Garden for its Earth Day dedication included, from left, standing, Nora Protokowicz, Ann Darwinski, BarbaraGayton, Michelle Lauer, Jason Funyak, Deb Dibert, Burt Wilson, Bob Mulrooney, Nadia Hellenga, Jeff Krebs, Jill Karpinskiand Laura Schaeffer; kneeling, Willie Wright, Mary Kate Itzstein, Mike Frawley, Marcus Suhr, Sandy Reddy and Kim Frey.Michele Lauer, who coordinates efforts of our environmental champions, singled out Patient Escort Supervisor, Lisa Abbott,OR Nurse Deb Dibert, RN, and Lab Tech Willie Wright for going above and beyond in their efforts to support the program.

That Christiana Care:

n Purchased 40% of its energy this year from a wind farm?

n Has more than 50 environmental champions who encouragesustainable activities throughout our health system?

n Partnered with the Delaware Nurses Association this year to collectmore than 508 lbs. of unwanted or expired medications for disposal?

CelebratingEarth Day2010

what makes Christiana Care a GreatPlace to Work. Locate the answersby visiting and navigating the newHR Online Web site. Correctly com-pleted questionnaires will be addedto a pool by department for a draw-ing. There are three drawings—oneeach for Christiana Hospital,Wilmington and Satellite facilities.The prize is a $250 gift card for thewinning department.

Prize Patrol TeamBe on the lookout for ChristianaCare’s own Prize Patrol Team.Employees are randomly selectedand recognized for their contribu-tions each day during the week witha token of appreciation.

You could be next!

Soft pretzels and water iceEmployees can receive soft pretzelsand water ice at a variety of loca-tions during the week.

Look for a calendar on the Portalshighlighting dates and times.

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Christiana Care’s 3rd annual GreatPlace to Work celebration takes

place May 9-15, coinciding withNational Hospital Week.

The celebration recognizes everyone’sdaily efforts to make Christiana Care aGreat Place to Work. With its competi-tive salaries, range of benefits and work-life balance programs, Christiana Care iscommitted to being one of the best

Dr. Masters receives his award at theASCO annual meeting June 4-8 inChicago.

Nicholas J. Petrelli, M.D., Bank ofAmerica endowed medical director ofthe Helen F. Graham Cancer Center,received the Statesman Award in 2008.

Gregory A. Masters, M.D., FACP,medical oncologist at the Helen F.

Graham Cancer Center at ChristianaCare, is a recipient of a 2010 StatesmanAward from the American Society ofClinical Oncology (ASCO).

ASCO is the world’s leading profes-sional organization representing physi-cians who care for people with cancer.With more than 27,000 members,ASCO seeks to improve cancer carethrough scientific meetings, education-al programs and peer-review journals.

Dr. Masters received the honor for his“extraordinary volunteer service, dedi-cation and commitment to ASCO,”according to the organization.Recipients of the Statesman Awardhave volunteered at least 20 years ofservice to ASCO.

Dr. Masters is also director of theMedical Oncology Fellowship programat Christiana Care. He is a member ofMedical Oncology HematologyConsultants, PA.

Gregory Masters, M.D., receivesASCO Statesman Award

Gregory A. Masters, M.D., FACP

places to work in the Mid-Atlantic region.

During the week-long celebration, thereare team contests, exciting prizes andrandom give-aways. And, there’s free softpretzels and water ice for everyone.

Here are some highlights:

HR Online Scavenger Hunt contestAll employees have the opportunity toparticipate in completing a question-naire consisting of questions related to

Great Place to Work celebration

A G R E A T P L A C E T O W O R K

Upcoming events

Concepts in Respiratory Critical CarePresented by Christiana Care Health SystemRespiratory Care Department, Friday, May14, 7:30 a.m. - 3:30 p.m. at the John H.Ammon Medical Education Center,Christiana Hospital.View conference details or directions onlineat www.christianacare.org/rtconference.

CalendarWednesday, May 5n Gifts for Nurses will be distributedthroughout the week on the unitsn Healthy Work EnvironmentWebinar 11:30 a.m. - 12:30 p.m..Thursday, May 6n Liz Jazwiec, author of “Eat ThatCookie.” 2-3 p.m., John H. AmmonMedical Education Center main audi-torium.n Nursing Excellence AwardCeremony – Education CenterAuditorium 4:30-8 p.m.Keynote speaker : Liz Jazwiec*By invitation only for Award winners

and their guestn Christiana Care’s Annual NursingStory Contest winners announcedFriday, May 7 n Gift basket raffle winners will beannounced by e-mail. Sponsored bythe System Shared Decision MakingCouncils. Saturday, May 8thn Unit-based celebrations.Monday, May 10 (Ammon Center) andTuesday, May 11 (Wilmington HospitalConference Center)n Nursefest! 11:30 a.m. - 2:30 p.m.Come and visit tables showcasingyour neighboring units. Free food,Giveaways, and Raffles!

American Nurses Association2010 Nurse’s Week - May 5-12“Nurses: Caring Today for a Healthier Tomorrow.”

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The Patient Protection andAffordable Care Act signed into

law on March 23 includes a largenumber of health-related provisions totake effect over the next four years.The provisions include:n Expanding Medicaid eligibility.n Subsidizing insurance premiums.n Providing incentives for businessesto provide health care benefits.n Prohibiting denial ofcoverage/claims based on pre-existingconditions.n Establishing health insuranceexchanges.n Supporting medical research.Changes coming soonSome near-term changes to expect :n An end to coverage denial due topre-existing conditions and ending ofcoverage once people get sick.n Children can stay on their parentsinsurance until age 26. n No policy can be more than threetimes the lowest policy cost in its ageband rating.n Insurance companies are subject toa tax if they do not expend 85 percentof their premium revenue on medicaland related services. Future changesStates will set up insurance exchangesso people can compare and shop forpolicies. In addition, people will berequired to get health insurance orelse face phased-in financial penalties.Similar penalties will be phased in forlarge employers who do not offerinsurance to their employees. Peoplewith low incomes will receive premi-um subsidies.Cost control measures in the bill

include both positive and negativesides, such as:n Programs that provide incentivesand support to improve quality ofcare.n Penalties for hospitals with highreadmission rates.n Reduced reimbursement for somespecialties, such as imaging and radi-ology, to discourage over-use.MedicareIn terms of Medicare, the Act:n Starts to phase out the coverage gapunder the Medicare prescription drugbenefit, with a view to closing the gapby 2020.n Changes how Medicare Advantagepayments are determined and createsan incentive system to reward highquality plans with higher payments.n Moves up reductions in paymentsto disproportionate-share hospitals to2014 and reduces the cuts. n Changes the assumptions used tocalculate Medicare reimbursement foradvanced imaging services (assumingthe machines are in use 75 percent ofthe time rather than 50 percent).n Increases funding for the HealthCare Fraud Abuse Control program.

MedicaidIn terms of Medicaid and CHIP, theAct:n Increases primary care physicianpayment rates for selected patienttreatments.n Revises the definitionto make makethe average manufacturer price moreclosely reflect the manufacturers’ aver-age prices.n Delays the effective date of the

At a Glance: Historic Health Reform Legislation

Community First Choice Option.n Changes state FMAP rates fornewly eligible populations, andchanges income counting rules for cer-tain populations.n Increases the territories’ spendingrate caps beginning with the secondquarter of FY2011.n Provides additional programintegrity funding through indexing ofthe Medicaid Integrity Program for fis-cal years beginning with 2010.n Modifies Medicaid disproportion-ate-share hospital payment reductions.Coping with more access and demandTo help cope with the demand expect-ed from this expansion of access, andto encourage more doctors to enter thefield and physicians to participate inthe programs, primary care physicianswill get higher reimbursements. Therewill also be workforce incentives,including loan repayment, for primarycare physicians in underserved areasor in the expanded public health serv-ice corps. The number of available res-idency slots expands.Trauma and long-term careThe Community Living AssistanceServices and Supports, or CLASS Act,and the National Trauma Care Actalso were included in the new legisla-tion. The latter authorizes fundingsupport for trauma centers, while theCLASS Act provides the foundationfor more widespread purchase oflong-term care insurance to help peo-ple care for the disabled. It has a vol-untary, long-term care program thatpays cash to enrollees who suffer atleast two limitations in daily activities,such as eating, bathing and dressing.

H E A L T H C A R E A D V O C A C Y

When Christiana Care plannersbegan considering a fourth

operating room in Labor & Delivery,they chose to invest in a larger, spe-cially equipped facility.

Possibly the first of its kind in thecountry, the state-of-the-art OR is spe-cially equipped to handle Caesareandelivery for multiple births, particular-ly triplets. Christiana Hospital hasbeen home to more than 500 multiplebirths in the past five years.

More options for C-sectionBefore it was added in October 2009,the three existing ORs were scheduledfor Caesarean sections more than 80percent of the time, says L&D medicaldirector Gregory DeMeo, D.O.

“Now, there is much greater choice for

Triplets? We’re preparedOR offers moms and doctors more options

doctors and their patients in schedul-ing Caesarean delivery,” he says. “Wenow have the ability to manage thesepatients in the safest, most appropri-ate manner.”

The OR is outfitted with a lift to safelyplace patients with special needs,such as mothers delivering multiplebirths, paraplegic mothers and otherswith conditions that may cause prob-lems in the three existing ORs. Theextra-wide operating table is equippedwith boom-mounted fetal monitorsand lights, and can support up to1,000 pounds.

The number of twin births increased70 percent between 1980 and 2004.Births of triplets, quadruplets andmore multiples quadrupled during

that period. Since the OR opened, morethan 50 sets of twins and four sets oftriplets have been born there.

“It is large enough to accommodate allthe extra pediatric staff that is presentfor multiple births so the parents aren’tseparated from their children,” Dr.DeMeo says. “It is a beautiful place.”

U.S., Canadian agencies praise Christiana Care innovations

Christiana Care was one of an elitegroup of about 30 hospitals and

health systems to come together in ajoint, by-invitation consensus meetingin March of the Agency for HealthcareResearch and Quality and theCanadian Patient Safety Institute atAHRQ headquarters in Rockville, Md.

The mission was to explore applyinghigh-reliability concepts health careand to create systems that are safe,efficient and responsive. The modelwas developed by businesses thathave high risks yet are reliable, suchas the aviation and nuclear powerindustries.

“Immediately, we gravitated towardthe common goal of how these con-cepts might be applied to improvepatient safety,” says Michele

Campbell, RN, MSM, CPHQ, FABC,corporate director, Patient Safety andAccreditation Services. “The enthusiasmof sharing our experiences and per-spectives across borders was contagious.”

Three Christiana Care innovations noted n The Patient Safety Mentor Program,designed to engage frontline staff insharing and communicating importantsafety behaviors, practices and infor-mation.

n The Sepsis Alert Campaign, in whichsepsis is identified and treated earlierin the Emergency Department withpre-packaged antibiotic kits on rapid-response carts.

n The eCare System, technology thatenables remote teams to monitorpatients in the intensive care unit, pro-

viding an additional level of supportand care.

“Christiana Care is right up there withthe leaders in patient safety and nowhas international recognition of ourinnovations,” Campbell says.

Going forward, the participants willestablish a learning network throughwhich they can share expertise andinformation to improve quality andpatient safety.

“This type of collaboration and crossfertilization is intensely enlightening,”says Kathleen McNicholas, M.D., med-ical director for PerformanceImprovement and Surgical UtilizationManagement. “There is much to belearned by taking this pool of knowl-edge and applying it to health care.”

Christiana Care offers a variety ofresources to help make getting andstaying healthy a part of daily life foreveryone. Christiana Care’s commitmentto helping employees adopt healthylifestyles is based on reasoning that bet-ter health enables our staff to lead hap-pier more productive lives.

Employee Health Services (EHS). EHSprovides services to our employeesthrough:

n Direct care and Education. Therewere more than 28,000 EHS visits in2009 and EHS supported seasonalinfluenza inoculation during the recentcampaign to prevent the spread of theH1N1 virus, providing more than 14,000vaccinations.

n Counseling. The Tobacco CessationProgram provides employees face-to-face counseling and free nicotinereplacement therapy to employees andtheir spouses.

n Employee fitness centers. ChristianaCare’s fitness centers at ChristianaHospital and Wilmington campus nowhave more than 1,300 members who takeadvantage of the top-quality equipmentand convenient locations of these twofacilities to get the regular exercise need-ed to improve and maintain goodhealth. The fitness centers offer a myriadof classes, including 25 cardio- andstrength-training weekly classes rangingfrom pilates to cardio weight lifting, tointerval training, yoga, zumba anddance fitness programs.

Christiana Care also offers a variety ofhealth and wellness programs, includ-ing:

n Biometric Testing and Health RiskAssessment. This annual assessment

Assessment provides employees withbasic information on their overall healthstatus and recommendations for improv-ment. Feedback from biometric testingand risk assessment includes bloodwork results from measuring cholesteroland blood sugar, blood pressure andbody mass index determined by heightand weight.

n Weight loss assistance.

n Employee Assistance Program.

n Nutrition services.

n Diabetes education.

n Exercise services.

Other programs offered throughEmployee Health & Wellness includeweight management programs such asLose for Life, Walking for Fitness andthe “Caught You Exercising” programand a new Wellness Champion Programthat connects employees who wantencouragement and support to staycommited to their fitness goals. In addi-tion, wellness stations developed andadopted by some departments serve as aconstant reminderthat fitness is impor-tant to happiness and productivity.

✔ For details on any of the above programsand much more, visit your portal, HROnline, Health & Wellness.

Agreat place to work is a better andeasier place to work. Many of the

initiatives taken to advance patient carequality and safety also improve ourwork environment and help us maintainour focus on excellence. Changes ininformation, clinical and business tech-nology all contribute to making ourhealth system more attractive to the bestemployees and helps us transform ourwork place from good to great.

Here are some of the ways we’veimproved:

n Computerized Provider Order Entry(CPOE) and EMAR (Electronic

Medication Administration Record)implementation at both Wilmington andChristiana hospitals position ChristianaCare at the forefront of hospitals focusedon improved patient care and quality ofservices.

n Vergence (Tap and Go) BadgeReaders and the new Lock Featureinstalled throughout both hospitals pro-vide access to clinical applications with aswipe of the employee/physician badge.

n Symbiq Smart Infusion Pumps, joint-ly implemented by Pharmacy, Nursing,Clinical Engineering, MaterialsManagement and Information Servicescalled for designing a better distributionmethod to improve pumps’ availabilityand facilitate maintaining drug librarieson each pump.

n The GetWell Medication IntegrationProject enables patients to view and clickon their personalized medication list toreceive additional information abouttheir drugs and watch available videos.

n Five maternity units at ChristianaHospital began using the BedManagement System to better enablenursing and organizational leaders tomake patient discharge and occupancydecisions.

n The Mother’s Own Milkbank System(MOMS) implemented in 2009 addressespatient safety issues coming from thePatient Safety Committee. MOMS han-dles the barcoding, inventory andenhanced administration of milk to ourNICU babies and alerts if the right milkis not scanned to the correct infant.

n A Refrigerator/Freezer TemperatureMonitoring System now in use at bothhospitals in Pharmacy and Food &Nutrition refrigerators and freezers auto-matically alerts if temperatures deviatefrom defined ranges and logs refrigera-tor/freezer temperatures at defined inter-vals, saving the extensive manual effortrequired in the past.

n A new Food & Nutrition point-of-salesystem makes cash registers atChristiana’s West End Café and eCafe,

A G R E A T P L A C E T O W O R K

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Better & Easier

Health & Wellness

This annual update focuses on keyareas where Christiana Care concen-

trates efforts to make and maintain ourhealth system as a Great Place to Work.

the Cancer Center’s Lakeview Café, andthe Wilmington campus cafeteria able toaccept M/C, Visa, Discover cards.

n Chart Completion enables providersto look at the paper chart viaaccessANYware within 48 hours of dis-charge.

n Acute Care Redesign ensures safeand timely delivery of care to patientspresenting to the Emergency Depart-ment by redesigning processes, remov-ing waste and improving coordinationof care by the treatment team to reducethe overall length of stay.

n Labor Management Reporting makesit easier for cost center managers to com-plete reports on budgeted and actualwork hours per unit.

As a learning organization,Christiana Care continually trans-

forms itself to stay in alignment with itsidentity, mission and strategic goals.Learning accelerates transformationthrough experiential, continuous, inter-active, innovative and informal experi-ences to promote thinking and growth atall levels of the organization.

To facilitate transformation efforts, oursystemwide Learning Council has devel-oped a common agenda for learning andmeasurement and a two-year strategicplan to enhance communications,accountability and cultural competency.

To further the professional growth andcareer goals of employees at all levelswe have:

n Researched and identified a premiercareer development website solution toprovide greater employee self-serviceoptions. The new functionality includesskill assessments that match skills and

career interests with health care jobs andopportunities, and more robust careerexploration opportunities.

n Continued to offer many learning anddevelopment programs, includingSchool at Work (SAW), Expanding YourCareer and Healthcare Opportunities(ECHO), Working, and FrontlineLeadership.

n We continue to enhance our on-board-ing process with the creation of ajourney of excellence template that pro-vides a checklist for employees andmanagers of first-year events.

Talent managementChristiana Care’s talent managementstrategy focuses on the programs andprocesses needed to build strong lead-ers, address the anticipated shortages oftop talent in health care, prepare internalcandidates to fill upcoming leadershipvacancies, and implement programs toincrease education and developmentopportunities for employees at all levels.

This year, we have focused on quarterlytransforming leadership forums foster-ing a learning community within ourleaders, 360-degree assessments, thenew Leadership Behaviors in Actionprogram, and the continuation of ourWhole Brain Thinking program.

A new Leader as Coach programlaunched in March helps leaders toenhance their leadership coaching capa-bilities. In addition, specialized pro-grams are continuing for nurse man-agers and are being launched for physi-cian leaders.

Development planning was extended toall employees, and succession planningexpanded to all levels of leadership withthe identification of high-potential leaders.

The Leadership Knowledge Center pro-vides many valuable resources for lead-ers, including online simulations, e-learning, and e-Books.

B E T T E R & E A S I E R , C O N T I N U E D

Learning and Development

Diversity, inclusion and health care equityA key theme at Christiana Care is theTransformation of Patient Care—bring-ing our mission and core values to lifeso we can provide the best patient expe-rience and outcomes. This includesmeeting the health care needs of theincreasingly diverse communities ofDelaware. A Diversity and InclusionCouncil comprising employees from dif-ferent levels and backgrounds is work-ing to develop an inclusive culture thatrespects and leverages the diversity ofour colleagues to enhance innovation,quality of care, teamwork and value sowe can deliver the best care for ourpatients as individuals.

✔ To learn more about the programs men-tioned above and new programs for the com-ing year, please visit the System Learningsite and the online Education Center, bothaccessible through the employee portalEducation drop-down menu.

A G R E A T P L A C E T O W O R K

GET HELP WITH

TOBACCO CESSATION

Dr. Rosenthal named chairmanof Family & Community Medicine

Appointed a full professor at JeffersonMedical College in 2006, he wasawarded the Dean’s Citation forExcellence in Faculty Mentoring in2008 and the Dean’s Citation forExcellence in Medical Education in2004.

Dr. Rosenthal first arrived at ThomasJefferson University Hospital as aFamily Medicine resident in 1980. Hereceived a Faculty DevelopmentFellowship in Family Medicine atJefferson Medical College and beganhis medical teaching career as aninstructor in 1983.

He received his medical degree fromthe University of Medicine &Dentistry of New Jersey, RutgersMedical School, and graduatedsumma cum laude in Biology from theUniversity of Pennsylvania.

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Michael P. Rosenthal, M.D., will bethe new chair of the Department

of Family and Community Medicinefor Christiana Care Health System.

Dr. Rosenthal joins us after leaving hispost as the vice chair of AcademicPrograms and Research for theDepartment of Family andCommunity Medicine at JeffersonMedical College, Philadelphia.

“On behalf of Christiana Care and theDepartment of Family andCommunity Medicine and ResidencyProgram, I wish to thank DavidBercaw, M.D., for his leadership whileserving as interim chair while we con-ducted our search for a permanentDepartment chair,” says JamesNewman, M.D., Christiana Care chiefmedical officer.

Dr. Rosenthal brings more than 25years of experience in medicine andmedical education to Christiana Care.

Michael P. Rosenthal, M.D.

The Delaware Academy of FamilyPhysicians Annual Scientific

Assembly will be Saturday, May 8 atArsht Hall, Wilmington Campus,University of Delaware, 2600Pennsylvania Ave. Registration beginsat 7:45 a.m. Cost is $50 per person,which includes continental breakfastand lunch. There is no charge forFamily Medicine residents.

The assembly will be followed by theAcademy’s Annual Dinner andInstallation of Officers, May 8 at 6p.m. at Wilmington Country Club,4825 Kennett Pike, Wilmington, Del.✔ Mail a check made payable to theDelaware Academy of Family Physicians,P.O. Box 8158, Wilmington, DE 19803-8158. For more information call 302-479-5515.

Need a gift but don’t have time togo shopping?

The Glass Box gift shop at ChristianaHospital and the Window Box giftshop at Wilmington Hospital mayhave just what you are looking for,whether it’s flowers, balloons,refreshments, reading materials or aspecial gift for a loved one, co-work-er or baby.

The gifts shops are run by the JuniorBoard of Christiana Care and featurea great selection of reasonably pricedmerchandise. The gift shops alsohave convenient hours for ChristianaCare employees on the go. Profitsfrom both gifts shops benefitChristiana Care programs.

Glass BoxChristiana Hospital302-733-1100Monday – Friday, 9 a.m. to 7 p.m.Saturday and Sunday, 11 a.m. to 4p.m.

Window BoxWilmington Hospital302-428-2246Monday – Friday, 9 a.m. to 4 p.m.Saturday and Sunday, 11 a.m. to 2 p.m.

Gift stores offer convenient shopping

Coupon Coupon

VNA launches Milford Adult Day Care and Memory Center

Caregivers searching for adult dayprograms in the Milford area no

longer have to look far. ChristianaCare Visiting Nurse Association(VNA) has expanded services toinclude an adult day care at itsEvergreen II Center to allow care-givers to enjoy some needed time offwith the assurance that their lovedone is in good hands.

“Delaware is a popular retirement des-tination, with a large portion ofretirees residing in Kent and Sussexcounties,” says Mary Fox, RN, BSN,program director for VNA’s AdultDay Care and Evergreen MemoryCenter.

Nearly one in four residents within a20 mile radius of Milford is retired,she says. “This aging populationneeds regular, medical adult day pro-gramming.”

Quality care close to homeAdult day care offers a friendly respitefor caregivers and a good alternativeto placing loved ones in long-termcare. Finding a facility close to homealso is a plus for families with lovedones that need additional support.

VNA offers full- and part-time adultday care options, as well as periodicrespite care. The program is open toindividuals 18 and older who do notrequire 24-hour nursing care, but havemental, emotional or physical needsdue to age or illness. Daily program-ming focuses on recreational activitiessuch as games, exercise, music andcrafts. Clients socialize, discuss currentevents, share meals and enjoy fellow-ship.

Alzheimer’s services still availableThe Evergreen II Memory Centercontinues to provide structured, thera-peutic care for individuals with

Alzheimer’s disease and relateddementias. The Memory Center is acooperative effort between VNA andthe Delaware Health and SocialServices, Division of Services for Agingand Adults with Physical Disabilities.

VNA Adult Day Care and EvergreenMemory Center is open Monday-Friday from 8 a.m. - 4:30 p.m.Transportation is available through theDART system.

VNA accepts Medicaid waiver, statecaregiver dollars, long-term care insur-ance and private pay.✔ For more information, call Mary Foxat 302-422-1575 and visit the VNA webpages on www.christianacare.org.

VNA’s Evergreen Centers’ daily adultday programming focuses on recreation-al activities such as games, exercise,music and crafts. Above, a patientenjoys a dance with an Evergreen stafferat the New Castle County facility.

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Clinical Considerations Associated with Protease Inhibitors in Regards to Acid Suppressive Agents

By Jaclyn M. McGinness, Pharm.D.

Pharmacologically, proton pump inhibitors (PPIs) are acid suppressive agents that cause gastric alkalinization through inhi-bition of the gastric H+/K+-ATPase. Histamine-2 receptor antagonists (H2RAs) similarly decrease the production of gas-

tric acid by inhibiting the action of histamine on parietal cells in the stomach. PPIs are the most potent acid suppressiveagents and generally have a longer duration of action than H2RAs. Acid suppressive agents also demonstrate a dose-relatedeffect. The type of acid suppressive medication, the dose and the timing of administration of each drug should be considered whenplacing patients on antiretroviral therapy, in particular with protease inhibitors (PIs).

There have been several studies performed among patients infected with HIV, and acid suppressive medications have beenused extensively in this patient population. Of all the PIs, atazanavir (Reyataz®) has been studied the most extensivelyregarding drug-drug interactions with acid suppressive therapy. Atazanavir requires an acidic environment for absorptionand dissolution. Concomitant use of acid suppressive agents and atazanavir could result in subtherapeutic plasma concen-trations of atazanavir which, in turn, can eventually lead to treatment failure. It is important to separate the administrationtime of atazanavir-based therapy from calcium- or magnesium-containing antacids by 1-2 hours.

Recommendations for administration of atazanavir with PPIs and H2RAs are listed below:

Atazanavir has been evaluated the most extensively and the recommendations specified above should be followed onlywhen placing a treatment-naïve patient on a PPI. It is crucial to note the more conservative recommendations in treatment-experienced patients (i.e., prior antiretroviral therapy with protease inhibitors) as these patients generally require higher con-centrations to inhibit viral replication and thus are more susceptible to the impact of these interactions.

There is a clear lack of clinically significant data regarding potential drug-drug interactions with PPIs and other PIs, includ-ing lopinavir/ritonavir, darunavir/ritonavir, indinavir, indinavir/ritonavir, and saquinavir/ritonavir, and thus can safely be co-administrated. Early data suggested that fosamprenavir might be susceptible to drug-drug interactions with acid suppressiveagents, but this research has been disproven. Another PI that has been studied with PPIs which has clinical significance isnelfinavir (Viracept®). Co-administration of nelfinavir with PPIs can potentially significantly reduce nelfinavir concentrationsby approximately 40 percent. Nelfinavir does not require an acidic environment for adequate absorption, so the mechanismof this interaction is unclear. However, co-administration of PPIs with nelfinavir could result in a decrease in virologicresponse as well as development of resistance and is therefore contraindicated. Nelfinavir however, can be safely adminis-tered with H2RAs as there are no documented clinical significant interactions. In addition, all protease inhibitors can besafely administered with H2RAs as long as they are staggered as per manufacturer recommendations.

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Therapeutic Notes

Hassan

Focus on Excellence – Best Practice Review – April 2010

Consistent with our strategies for engaging staff in continuous improvement and best practices, we regularly reviewimportant topics in Focus to help reinforce safe-practice behaviors. These tips reinforce information and enable staff tobetter articulate our safety practices during an unannounced survey.

Computer Workstation Use & Security

Q. Why is it important to keep computer workstations secure?

A. It is important in order to keep patient information confidential and accessible only to those who are involveddirectly in the patient’s care. It is also essential to protect yourself from other staff, patients and visitors who can useyour login to search for unauthorized information (e.g., patient information, e-mail, Internet).

Q. Is it important to keep passwords confidential?

A. Yes. Do NOT share them or allow someone else to use the computer under your password. Passwords establish indi-vidual accountability. Staff will have a unique identifier (or login ID) and password for use in logging into informationsystems where confidential information will be accessed. You are responsible for the use of your individual account andshould keep your passwords confidential.

Q. When should computer screens be minimized?

A. Whenever staff is no longer using that computer screen or it is in the view of the public. Confidential informationmust be protected from anyone other than those specifically authorized to have access based upon need-to-know toperform one’s job. Computer screens should ALWAYS be minimized or workstations locked when not being used.Special attention should be made to the easy access of the Computers On Wheels (COWS). They must be kept frompublic view and shut down when not in use.

Q. Is there a way to minimize the screens on Medication and Patient Care Technician Carts?

A. Yes. There is a button (a lightbulb—"privacy") on the med cart computer. It must be used when the cart is unattend-ed and/or if information is in view of the public. Due to the "portability" of the carts, this needs to be reinforced.

To ask questions, contact the content expert: Dawn Romano, 623-7106. To reach the Safety Hotline, call SAFE (7233)from within Christiana or Wilmington hospitals. From outside the hospitals, call 302-623-SAFE. Further information is

available on the portals in the Archives of Best Practices. From your portal, choose Focus on Excellence, JointCommission Readiness, Ongoing Strategies, Educational Strategies, Monthly Q&A.

Christiana Care Security Department’s first K-9 trooper, Hassan,died recently after a prolonged illness. Placed in service about 10

years ago, Hassan was a very social German shepherd and enjoyedinteracting with staff and patients. “Hassan will be missed,” saysBruce Blackburn, chief of Public Safety.

His handler and partner, Cpl. Marine has a new K-9 named of Ingo.Christiana Care has four K-9 units, and each is certified in bombdetection and patrol.

B L E S S O U R V O L U N T E E R S

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Dear Christiana Care Volunteers:

Especially during National Volunteer Week, wewant to thank you for your unique and valuableservice.

Your creativity and commitment make a differenceevery day in the lives of our patients and our staff.We could not accomplish what we do without you.

Thank you for all you do at Christiana Care!

Best regards,

Robert J. Laskowski, M.D., MBAPresident and Chief Executive Officer

Robert J. Laskowski, M.D.

Three days a week, March of DimesFamily Support Specialist Kelly

Cover offers helping hands and sym-pathy to the families of ChristianaCare’s tiniest patients in our neonatalintensive care unit.

‘A very gentle soul’“She is a very gentle soul and a goodlistener, so families of all kinds gravi-tate toward her,” says Fern Butler, MS,RNC, NICU nurse manager. “We can-not imagine the nursery withoutKelly.”

Cover works with parents, siblingsand grandparents who are waiting forthe day when they can bring home thelatest addition to the family.

She understands their worries andfears. Nine years ago, her daughterMarina was born prematurely and wasa patient in Christiana Care’s NICU forthree weeks.

“Going home without your baby is avery hard thing,” she says. “Havingbeen there as a mom, I know what it islike to sit in those rocking chairs, hourafter hour.”

Positive impact“Kelly has made a very positiveimpact,” says Butler. “She supportsboth the family and the staff who areworking with the family.”

Cover, who has a master’s degree incounseling psychology, helps familiesfill those hours in positive ways, fromorganizing potluck suppers, to helpingparents network, to scheduing holidaycelebrations for couples on Valentine’sDay and Easter egg hunts for siblings.

She encourages grandparents to createscrapbooks of the babies’ progress andreaches out to the youngest mothers,with makeup demonstrations, givenby another mother whose own babyhas been a NICU patient.

Cover distributes tote bags filledwith educational materials and ababy journal to as many parentsas she can reach. Siblings receivegoodie bags with toys, snacks andcoloring books.

The program is an important andmuch-appreciated service, saysDot Fowler, MSN, RNC, director,Patient Care Services, Women andChildren.

“We are grateful to the DelawareMarch of Dimes for the NICU FamilySupport Specialist Program and mak-ing it possible for Kelly to work withparents in our NICU,” she says.

Graduates come back to helpCover stays in touch with some of theparents she has helped during thethree years she has worked in NICU.She calls them “graduates.”

Like the mom who demonstratesmakeup, graduates come back to help

Partnering with March of Dimes

with programs for other parents. “It’sgood for parents who are going throughit to know there is life e after NICU,”Cover says.

✔ The March of Dimes will hold its annualMarch for Babies to raise money for programsto prevent prematurity on April 25 in NewCastle County. To learn more, visit www.mar-chofdimes.com/delaware.

March of Dimes Family support specialistKelly Cover serves a hot potluck meal andsome TLC for parents Paul Waterman andMonique Cannon in the NICUconferenceroom at Christiana Hospital.

Neonatal crew takes Polar Bear Plunge The Neo Bears, a bravegroup of Christiana Careneonatal nurse practition-ers, along with several RNs,physicians and clerks fromChristiana Care and otherhospitals, raised $1,550 forthe Special Olympics ofDelaware by plunging intothe 42-degree waters of theDelaware Bay March 14 inLewes.2,323 people jumped in andhelped raise more than$500,000 for June 11-12 eventat the University of Delaware.

(From left) Laura Holloway NNP, Linda Marsiglia, NNP,Patty Boesenberg, Wendy Felts, NNP, Wendy Sturtz,M.D., Linsay Fanelli, NNP, and Kathy Leef, NNP, alongwith (not shown) Ana Arias NNP, Neonatal FellowRaquel Gomez, M.D., Teresa Klingler, RN, Lisa Marra,RN, and Amanda Koronik, jumped in the Delaware Bayon March 14 to support the Special Olympics of Delaware.

(From left) Janet Davis, Tom Trezise, Emily Penman, M.D., Christiana Care BreastCenter surgeon, Jane Vincent, Betsy Rawls, Sylvia Banks, Diana Dickson-Witmer,M.D., Christiana Care Breast Center surgeon, Carolyn Burger, Barbara UbertiManerchia, and Irene Shadoan Lott, celebrate a $53,000 donation from Swingin’With a Star.

Annual golf tourneyfills special needs

Christiana Care’s Breast CenterSpecial Needs Fund received a

$53,000 donation from Swingin’ WithA Star (SWAS), Delaware’s most pres-tigious and profitable amateurwomen’s golf tournament.

The SWAS contribution represents aportion of proceeds from the organiza-tion’s 2009 golf tournament, held lastJune at the DuPont Country Club.

Christiana Care’s Breast Center SpecialNeeds Fund offers much-neededfinancial support to eligible patientsfor medical expenses while deliveringthe breast care they need.

Net proceeds from the tournamentestablished in 1992 have totaled morethan $1.2 million.