Friday, October 3, 2008

A Word About Nurse Champions

By Susan Hecht, RN
Nursing Rehabilitation Liaison

A nurse is one who plays a role in the responsibility for treatment, safety and recovery of ill or injured people. A champion is an ardent defender or supporter of a cause. While each nurse has a unique background we share the same passion for nursing.

A Nurse Champion works usually within their unit (but not limited to) to support change. It is not always battling the odds but a superb opportunity to develop professionally. According to the Center for Studying Health System Change, “Nurses are the largest deliverer of health care in the U.S.” One of the most important outcomes in being a Nurse Champion is an increased comfort in working with projects, increasing job satisfaction and stronger team relationships.

What makes a Champion Nurse? I believe you have to like challenges. They focus on health and wellness, they advocate for their patients, they always have a mission, they consider their work to be a privilege, they are innovative and creative, they are opportunistic people always looking for a chance to improve, they take pride in their nursing, and last but not least, they support the mission of their organization.

Prior to coming to Saint Francis Hospital I worked as an LPN for 5 years in a Long Term Facility. I have been at Saint Francis for 9 years. I have been an LPN, RN, Nursing Rehabilitation Liaison and I’m currently going for my BSN. Through every turn in my 9 years I have felt the desire to take on challenges. I enjoy taking on a challenge and running with it. I enjoy teaching and advocating for my patients and the community.

According to the September 2008 American Journal of Health System Pharmacists, “More than 2 million Americans are affected by Deep Vein Thrombosis (DVT) annually, with 600,000 developing PE (pulmonary embolism) leading to 60,000 deaths. Venous Thromboembolism (VTE) is recognized as the most preventable cause of inpatient mortality.”

I am a Nurse Champion for DVT Prevention.

· I have arranged in-service luncheons on DVT Prevention for student nurses to promote awareness and prevention.
· I have attended health fairs for Saint Francis Hospital promoting DVT Awareness and Prevention.
· Every March (DVT Awareness month) I initiate a hospital-wide effort to raise awareness of this condition within out organization.
· I spear-headed an event in September 2007 bringing Melanie Bloom to the hospital to speak on the subject. She joined the Coalition to Prevent Deep Vein Thrombosis and became its national spokesperson following the death of her husband, David (an NBC correspondent and father of three) from PE while covering the Iraq War. The event with Melanie brought more than 250 to our Community Conference Center.
· I was recently involved in updating our Admission Nursing Assessment form to include a VTE component.
· As part of my pursuit of a BSN at SUNY New Paltz, I am engaged in an education project regarding DVT Awareness, Prevention and Prophylaxis.

I believe in my ability to take on new challenges, embrace them and grow from them, as well as continue to educate and allow experiences to open new doors for me.

I believe in the term Nurse Champion!

Thursday, August 28, 2008

Some Facts About Medicare

By Frances T. Traver
Manager, Clinical Services
Saint Francis Home
Care Services, Inc.

Saint Francis Hospital’s Home Care Services, Inc., the Certified agency, often receives calls about types of assistance available for those recovering from an illness or injury.
While we accept Medicare payments, Medicare requires that your condition meets certain requirements before we can assign you a nurse or therapist.
Your physician must agree you need home care services and needs to guide our staff regarding your needs. We stay in contact with your physician throughout your care.
Second, the care you receive may require the skill of a professional nurse or therapist. Medicare has guidelines. For example, a nurse may help you with wound care or injections. Medicare would also cover a nurse to assess the status of your illness. If you have a heart condition for which you were recently hospitalized, Medicare would cover for a nurse to come to your home to assess blood pressure and heart rate. However, once you are doing better Medicare would no longer cover a nurse to assess the condition.
Medicare also would cover a professional nurse to teach you to manage your illness. Our staff demonstrates good outcomes with their ability to teach patients to care for themselves at home. A nurse may teach a diabetic how to use a glucose monitoring machine or teach a client about medication and how to better manage their side effects. Medicare will also cover for a nurse to teach you to inject insulin at home. But not to come to your home to give insulin injections.

You must be “homebound” to receive home care services in your home. Medicare defines homebound as taxing for you to leave your home. This does not mean you need to be in bed. But if you leave home it can only be for short durations or to receive medical treatments, such as chemotherapy.

Just as important as what Medicare benefits will pay, is what Medicare benefits will not cover. They will not cover aide services unless you have one of the skilled services discussed above. Medicare will only pay for the aide to assist with personal care, such as bathing. Medicare will not pay for housekeeping services.

Medicare benefits are there when you need them in the home. Saint Francis Home Care Services, Inc (Certified agency) can bill Medicare directly to cover needed services. Please feel free to call us (845-483-5550) about your Medicare benefits for home care services. You may also call your Medicare office for more information about home care benefits.

Friday, August 15, 2008

Yogurt Sense

By Joanne Chaconis, RD
Chief Clinical Dietician

It’s been around forever and it is a real powerhouse food. With calcium, protein and probiotics, yogurt “packs a punch.“ But as with most foods we find in our grocery aisles, there are many varieties to choose from. I hope the following guidelines are helpful:

The choice is up to you – whether you choose plain, unflavored, a traditional flavor like vanilla or strawberry, or some of the more contemporary flavors like kiwi lime pie, just use the following as guidelines for making an educated choice (per eight ounces) :

1.) No more than 200 calories. Remember that yogurt is processed mainly from milk (skim milk being about 80 calories per cup ). That means that extra ingredients should not be contributing an abundance of extra calories.
2.) Four grams of fat or less. No other fat is added to yogurt. If a label says more than four grams of fat, that means that whole milk or even cream was used.
3.) 30 grams of sugar or less. Milk naturally contains about 12 grams of sugar (lactose) per cup. Anything over that comes from fruit, honey, or sugar.
4.) At least six grams of protein. Less than that would suggest that the protein has been watered down with ingredients, such as sugar.
5.) At least 20 % of your daily value for calcium. That equals to 200 mg. (based on 1000 -1200 mg daily ).

Also, look for live active cultures. Known as “probiotics,” they may boost immunity and help prevent or manage constipation, diarrhea, bloating. Look for L. acidophilus and/or B. bifidum as these are the more potent forms.

Other points to consider: fruit flavored yogurts do not count as a fruit serving. If that is your aim, just add a cup of sliced fresh fruit to a small container of plain, fat free yogurt. If you prefer a drinkable yogurt, use the aforementioned points as your guide. And if you prefer or need to choose a soy yogurt, go ahead. Aside from it being made from soy rather then cow’s milk, the benefits/content are usually the same.

Friday, August 8, 2008

Maintaining Independence At Home

By Nicole Peluse Gesh,
Manager, Licensed Home Care

One of the greatest desires heard by home care professionals is to maintain independence and remain at home. This is why home care continues to expand its service menu. It is estimated that more than half of all falls resulting in injury occur at home. There are several preventative measures to help prevent falls from occurring:
- Tack rugs and flooring so they are flat.
- Be sure carpets and runners are fully attached to stairs.
- Do not stand on a chair to reach things. Keep regularly used items within easy reach.
- Be sure and have lights easily turned on when getting out of bed.
- Use canes and walkers as directed by your healthcare provider.
- Understand medications that can cause dizziness or drowsiness.
- Exercise regularly as directed by your healthcare provider.
The Lifeline personal care system can not only help save a life, but help preserve a cherished way of life by giving seniors the confidence to continue living in their own homes. Lifeline is not just for the wearer, it provides great peace of mind for the caregiver(s). An accident can happen in a split second, a medic-alert system gets help instantly. The buttons are simple, small and easy to use. They are meant to wear in bed and in the shower.
Lifeline is one of the many products and services available through Saint Francis Home Care Services, Inc. These are designed to keep patients at home and enjoying their regular activities. Often, people will shy away from the idea of a medic alert system. Many caregivers achieve success by giving it as a gift. Explaining they will take comfort in knowing the patient has the security. It isn’t just for falls, one patient woke up, didn’t feel quite right and pushed his Lifeline without getting out of bed. Another patient heard someone at the door and she felt uneasy. She pushed the Lifeline button and was connected with help.

Home Care has so much to offer both patients and caregivers. The message is to not only ask for help, but to accept the levels of support that meet the needs of your situation!

Thursday, August 7, 2008

Food Allergy FAQ

By Sarah Daubman, RD
Staff Dietician

What exactly is a food allergy?

A true food allergy involves an immune system response from the body. The body identifies an offending food as harmful and releases antibodies to attack it. This triggers the release of histamine, thus precipitating the outward symptoms of an allergic reaction. These may include itching in or around the mouth, hives, nausea, stomach pain, difficulty breathing and/or anaphylaxis. Most often, people need to ingest the food for the allergic reaction to occur, but certain sensitive individuals may develop symptoms from touching the food or inhaling steam from which the food is being prepared (as in cooking shellfish).

How is that different from food intolerance?

Like a food allergy, a food intolerance is also an adverse reaction to food, but the body’s immune system is not involved. Lactose intolerance, for example, is when the body lacks the enzyme lactase needed to digest lactose, the sugar found in milk. Without the enzyme present, lactose remains undigested and ferments in the gut, resulting in gastrointestinal (GI) symptoms such as diarrhea, bloating or constipation. Lactose intolerance is therefore not the same as a milk allergy, which would involve the type of allergic reaction described above. The cause of other food intolerances may not be as easily identified but may trigger similar GI symptoms.

What are typical food allergies?

Unfortunately, any food can be a food allergy but eight foods account for more than 90 percent of them: egg, milk, wheat, soy, fish, shellfish, peanuts and tree nuts. Certain food allergies that appear in childhood may disappear as the child grows (milk, eggs, soy and wheat), but others (peanuts, fish and shellfish) typically never go away.

How are food allergies diagnosed?

Clinical testing for diagnosing a food allergy may include a skin prick test or blood testing. An elimination diet may also be recommended to assess whether removing the suspected food from the diet results in an alleviation of symptoms.

How are food allergies treated?

The only treatment for food allergies is to eliminate the food from the diet. In a case of multiple food allergies, a visit to a Registered Dietitian may be recommended to avoid any dietary deficiencies.

Where can I get more information?

About food allergies:
The Asthma and Allergy Foundation of America

The Food Allergy and Anaphylaxis Network

The American Pediatric Association

To find a Registered Dietitian in your area: and click on “Find a Nutrition Professional” on the right hand side.

Wednesday, July 23, 2008

Sports Related Concussions, Part 2

By Jean M. Walsh, RN
Trauma Coordinator

As I wrote last time, a concussion, also known as a mild traumatic brain injury (MTBI), is caused by a bump, blow, or jolt to the head or body that causes the brain to move rapidly inside the skull. Quite simply, a concussion alters how the brain normally functions. Concussions can have serious long term health effects and even a subtle “ding” or “bump” can be serious.

According to the Center for Disease Control, it is estimated that nearly 1.6 to 3.8 million sports and recreation concussions occur in the United States each year. Youth 5-18 years of age account for over 2 million sports related emergency room visits per year. Of these visits, nearly 6% or 135,000 involve concussions. Football accounts for nearly 60% of these concussions while bicycling, basketball, soccer and other playground activities round out the top five causes.
If you are a parent or a coach and you believe one of your children or players has suffered a concussion you should:

· Remove the player from the competition immediately.
· Never leave the player alone.
· Get a professional medical evaluation.
· Avoid contact or collision sports for at least 3 weeks.
The 911 system should be activated in the following situations:
· Severe head trauma
· A fall from a height greater than the height of the person
· Prolonged loss of consciousness (greater than 2 minutes)
· Unequal pupils
· Severe Nausea/Vomiting
· Confusion/Perseverating that does not go right away/Restlessness/Agitation
· Extreme drowsiness, weakness or inability to walk
· Severe headache/Slurred speech

A child with a grade III concussion will need to be evaluated by a physician in an emergency setting. A full neurologic exam will be performed to check reflexes, vision, hearing, pupil response, balance, memory, concentration, and coordination. A brain CT scan will be performed to check for any bleeding or bruising in the brain tissue. Admission to the hospital for neurologic observation may also be necessary.

Returning a child to sports after a concussion should be a well defined 4 step process:

1. This should be a gradual process and should be done under the supervision of qualified people. When the player does not have any symptoms, they may be able to do light exercise, stationary cycling or walking.
2. The next step is to do sports specific activity without contact for example running. If there are any symptoms returning then take a step back.
3. Next step is on field practice without contact. Again, any symptoms indicate a return to the previous stage.
4. When a medical doctor has given the go ahead on field practice with contact can begin. The time taken to get to this stage will depend on the severity of the concussion.
Long term consequences of repeated concussions are functional changes that affect thinking, language, emotions, behavior, and sensations. There may be an increased risk of seizure disorders, Alzheimer’s and Parkinson’s disease. Premature return to play can cause permanent neurologic disability from cumulative trauma, death from secondary impact and post concussion syndrome.

Some ways to prevent concussions and their severity are to, wear appropriate headgear at ALL times. Learn proper techniques for tackling opposing players and heading a soccer ball. Understand and recognize the symptoms of a concussion. Never allow an athlete to play if you suspect a concussion. The effects both short and long term are simply not worth it.

Tuesday, July 15, 2008

The 5 Rights of Dispensing Medication

By Laura Dillon
Service Coordinator
Saint Francis Home
Care Services, Inc.

Caregivers assume many responsibilities in order to keep their loved ones safe at home. And if you are a caregiver for a loved one at home, chances are that at some time you have had to tackle the task of dealing with your loved one’s medications. This includes calling a prescription into the pharmacy, picking up medications, dispensing medications or helping organize and fill your loved one’s pill box.
If your loved one takes multiple medications, you know that filling a pill box can take extreme concentration and organization. And although it is often a daunting task as several bottles of medication lie before you week after week, let’s remember that medication compliance is extremely important for your loved one’s health and well being.
With that in mind, before giving a loved one any medication, remember to read each medication label to check for the “5 Rights” - Right Person, Right Medication, Right Dose, Right Time, and Right Route. Here is why checking the labels can be so important:

1. Right Person: Make sure that the name on the bottle matches who will be receiving the medication. This step seems self-explanatory and obvious however, if more than one person living in the home takes medications it is easy to mix them up. Often people have a tendency to store all medication in the kitchen as a visual reminder to take the medication either at a meal time or with food. Instead, each resident of the home should have a separate place to store their medications. If pill boxes are used, make sure to clearly label each box with the proper patient name. Do not trust that you will remember a color-coded system.

2. Right Medication: If you are a caregiver to someone who takes more than two medications you know how confusing labels can be. A patient may be taking one medication and suddenly their physician switches them to the generic version. Make sure to ask the physician if you are unsure what the medication is for or if a generic medication was prescribed as a “substitute.” (Hint: To make life easier for yourself as well as medical professionals in case of an emergency, keep an updated list of medications handy and make sure to update it after each doctor’s appointment.) If the physician no longer prescribes a medication to your loved one, discard the old medication and bottle immediately. If it is not discarded, it may accidentally find its way back into your box of medications. Also, do not reuse old, expired medication bottles to store new medication. A healthcare professional would not be able to administer these medications and it may also confuse the patient and caregivers. Additionally, remember that the manufacturers of the medications may change without notice, thus changing its size, shape and/or color. Do not assume what the medication is just by the way it looks! To be safe, keep all medications in their respective bottles unless putting it directly from the bottle into a pill box.

3. Right Dose: Know the correct dose of each medication. A physician may change the dosages of medication at any time, especially medication that has been prescribed for only a short time period or one whose dose depends on how a patient is reacting to it. Stay current on the dosages so as to not over or under medicate your loved one. Do not adjust dose amount without consulting your physician! Although medications can often be costly, “cutting back” on how many pills you take in order to save money can be very dangerous.

4.Right Time: Be sure to know when your loved one should take their medication. Many times there is a reason the medication should be taken at the time specified. The medication may not interact well with food or may cause drowsiness or alertness. If you have concerns about how a medication is affecting your loved one, consult your physician. Do not change medication times prior to a physician consultation.

5. Right Route: Always know how the medication should be taken (orally, inject able, etc.) and follow the instructions properly.
Hopefully the “5 Rights” will help caregivers remember the importance of carefully and correctly reading their loved one’s medication labels. Next time we’ll take a look at alternatives available through Saint Francis Home Care Services, Inc. if a caregiver is no longer able to assist with their loved one’s medications.