Cedars-Sinai Medical Center

medical staff pulse newsletter

Text size: A A A
A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Aug. 16, 2013 | Archived Issues

Chris Ng Nominated for Chief of Staff; MEC Approves Form for Patients Refusing Treatment

Christopher Ng, MD, has been nominated to be the 2014 chief of staff, and Peggy Miles, MD, has been nominated for vice chief of staff, the nominating committee reported at the Medical Executive Committee's meeting Aug. 5.

» Read more

New Guidelines Aim to Increase Quality of Inpatient Progress Notes

A task force commissioned last year by Cedars-Sinai's Health Information Committee to improve the inpatient progress notes physicians enter into CS-Link™ has created evidence-based guidelines defining best practices. "Today we're seeing (progress notes) not only as a way of communication, but as a legal document and paperwork for billing and coding," said Joe Kim, MD, chair of the task force.

» Read more

CS-Link Tip: Routing Charts to Colleagues

This week's CS-Link™ tip comes from Neil Goldberg, MD. The InBasket has many folders, and it can be difficult to know which folder has top priority. When routing charts to colleagues for review, it is best to do so by using the Level of Service and Follow-Up section.

» Read more

Acetaminophen Associated With Risk of Serious Skin Reactions

Pharmacy Focus

The U.S. Food and Drug Administration has notified healthcare professionals and patients that the pain reliever acetaminophen has been associated with a risk of rare but serious skin reactions. The skin reactions — known as Stevens-Johnson syndrome, toxic epidermal necrolysis and acute generalized exanthematous pustulosis — can be fatal. These reactions can occur with first-time use of acetaminophen or at any time while it is being taken.

» Read more

Circle of Friends Honorees for July

The Circle of Friends program honored 105 people in July. Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

» Read more

Center Strutters Gives Participants a Safe Place to Walk

Need a safe place for your patients to walk and exercise? Consider referring them to the Center Strutters "Walk for Fitness" Program.

 

» Read more

Comforting Connection

iPads® Help New Moms Connect With Their Infants in the Neonatal Intensive Care Unit

For newborns in Cedars-Sinai's Neonatal Intensive Care Unit, nurses Yvonne Kidder and Julius Caceres' innovative plan for using a familiar technology has brought the babies the most comforting sound they can hear: their mothers' voices.

» Read more

Chris Ng Nominated for Chief of Staff; MEC Approves Form for Patients Refusing Treatment

Christopher Ng, MD, has been nominated to be the 2014 chief of staff, and Peggy Miles, MD, has been nominated for vice chief of staff, the nominating committee reported at the Medical Executive Committee's meeting Aug. 5.

The MEC approved the nominating committee's recommendations.

Ng is currently vice chief of staff, and Miles is medical staff secretary.

Also at the MEC meeting, a new form was approved to help patients understand the risk they are taking if they refuse nursing measures, safety measures or medical treatment ordered by their physician. These include:

  • Measures to prevent skin breakdown, such as turning side to side every two hours, and padding heels, knees and elbows
  • Measures to prevent fall injury (bed alarm, positioning belt)
  • Measures to prevent blood clots in the leg
  • Patient identification safety measures (color-coded wristbands)
  • Anticoagulants (blood thinners)
  • Blood and blood products (This is separate from the forms signed by patients who are Jehovah’s Witnesses.)

The new form will not be used until after the patient has been provided education by nursing staff on the measures, the physician is notified that the patient is refusing, and the physician has discussed the measures with the patient and the patient or family continues to refuse.

In addition, 36 new members of the medical staff were noted at the MEC meeting. Click the PDF link below to see their names and specialties.

Morning After Report - August 2013 (PDF)

New Guidelines Aim to Increase Quality of Inpatient Progress Notes

A task force commissioned last year by Cedars-Sinai's Health Information Committee to improve the inpatient progress notes physicians enter into CS-Link™ has created evidence-based guidelines defining best practices.

The guidelines, approved by the HIC — a medical staff committee — and the Medical Executive Committee in April, address what constitutes a quality progress note at Cedars-Sinai, said Joe Kim, MD, associate medical director of Quality Improvement.

"It used to be a progress note was communication from one doctor to another, but today we're seeing it not only as a way of communication but as a legal document and paperwork for billing and coding," said Kim, who serves as chair of the task force.

The evolving functions of the progress note means the note must efficiently convey information that is clinically accurate, legally protective and billing compliant. This wide usage, which also encompasses social services, makes appropriate entry into CS-Link a vital part of the process, Kim said.

The subcommittee created a scoring system, or tool, based on physician input to identify quality progress notes and any challenges clinicians face while creating the document for patients' electronic medical records, he said.

The guidelines and scoring tools were initially rolled out in the Department of Medicine, the Division of General Internal Medicine and the Neonatal Intensive Care Unit. A template for a progress note based on the new guidelines is available from the Department of Medicine.

Generally speaking, progress notes provide a brief daily account of patients and their illnesses, and of developments in their diagnosis, problem list and treatment, for all of those who share in their care. While the information is straightforward, the document can become complicated.

For example, the task force found that some physicians were copying and pasting too much information, which was weighing down the progress note.

"In this world of the EMR (electronic medical record), we now have SmartTools that make it easy to pull in or copy forward information from other parts of the medical record, which can clutter the progress note or make it longer than necessary and as a result degrade the quality," said Peggy Miles, MD, associate director of the Division of General Internal Medicine and a member of the task force on progress notes. "The development of these guidelines should help physicians take advantage of the information within EMRs in an efficient and meaningful way."

"The electronic medical record presents extraordinary opportunities to improve physician documentation and efficiency," Kim said. "However, indiscriminate use of EMR functions may unnecessarily clutter notes, lengthen documents and degrade the quality of the EMR.

"The ideal progress note serves as a concise interpretation of clinical information and conveys the analytical decision making of the clinician."

In addition, the task force recommends that guidelines for progress notes be included in the resident orientation booklet. Medical students are taught the SOAP (Subject Objective Assessment Plan) format for medical evaluation entries in patient records, Kim said. These entries can become "top heavy" with redundant information within the EMR, he said.

To address that, Cedars-Sinai's guidelines for progress notes recommend a variation of the SOAP format. In the APSO format, the most pertinent and current information is placed at the beginning of the note. The new format has been well received by the residents.

Kim said the next step is wider rollout of the guidelines, with HIC physicians supporting adoption by more clinicians.

"Doctors are very busy and prefer to spend more time with patients and providing medical care," Kim said. "These guidelines can assist doctors in using this technology to their advantage."

CS-Link Tip: Routing Charts to Colleagues

This week's CS-Link™ tip comes from Neil Goldberg, MD. The InBasket has many folders, and it can be difficult to know which folder has top priority.

When routing charts to colleagues for review, it is best to do so by using the Level of Service and Follow-Up section. When forwarded in this way, the chart is sent upon closing the section and placed it in the CC'd Chart folder of the receiving party's InBasket.

When a chart is routed from the Chart Review section, it is sent to the "Review Reports" folder, which is not widely accessed by physicians. We thank Dr. Goldberg for this tip.

To view screen shots of this tip, please click this CS-Link Central link, scroll to the section titled Tip of the Week, and click on the tip for Aug. 16, "Routing Charts to Others."

Acetaminophen Associated With Risk of Serious Skin Reactions

Pharmacy Focus

The U.S. Food and Drug Administration has notified healthcare professionals and patients that the pain reliever acetaminophen has been associated with a risk of rare but serious skin reactions.

The skin reactions — known as Stevens-Johnson syndrome, toxic epidermal necrolysis and acute generalized exanthematous pustulosis — can be fatal. These reactions can occur with first-time use of acetaminophen or at any time while it is being taken.

Other drugs used to treat fever, pain and body aches (e.g., non-steroidal anti-inflammatory drugs, or NSAIDS, such as ibuprofen and naproxen) also carry the risk of causing serious skin reactions, which is already described in the warnings section of their drug labels.

This new information resulted from the agency’s review of the FDA Adverse Event Reporting System database and the medical literature to evaluate cases of serious skin reactions associated with acetaminophen. It is difficult to determine how frequently serious skin reactions occur with acetaminophen, due to the widespread use of the drug, differences in usage among individuals and the long time that the drug has been on the market. It is likely that the events are rare, the FDA said.

The FDA recommends that healthcare professionals consider these risks with acetaminophen, along with other drugs already known to have such an association, when assessing patients with potentially drug-induced skin reactions. Any patient who develops a skin rash or reaction while using acetaminophen or any other pain reliever/fever reducer should stop the drug and seek medical attention right away. Anyone who has experienced a serious skin reaction with acetaminophen should not take the drug again and should contact a healthcare professional to discuss alternative pain relievers/fever reducers.

FDA will require that a warning be added to the labels of prescription drug products containing acetaminophen to address the risk of serious skin reactions. FDA also will request that manufacturers add a warning about serious skin reactions to the product labels of over-the-counter acetaminophen drug products marketed under a new drug application and will encourage manufacturers of drug products marketed under the OTC monograph do the same.

Click here for more information.

Circle of Friends Honorees for July

The Circle of Friends program honored 105 people in July.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

Click here for more information about the program and for a list of past honorees.

  • Daniel C. Allison, MD
  • Farin Amersi, MD
  • Parvaneh Bahmani, MD
  • Jason A. Berkley, DO
  • Selvyn B. Bleifer, MD
  • Mathew H. Bui, MD
  • Miguel A. Burch, MD
  • Ilana Cass, MD
  • Michael L. Chaikin, MD
  • Christopher Chang, MD, PhD
  • Alice P. Chung, MD
  • J. Louis Cohen, MD
  • Stephen R. Corday, MD
  • Bryan Croft
  • Catherine M. Dang, MD
  • Mark M. Davidson, MD
  • Arnelyn D. De Las Armas, RN
  • Lorna R. Dean
  • Doniel Drazin, MD
  • Noam Z. Drazin, MD
  • J. Kevin Drury, MD
  • Marla C. Dubinsky, MD
  • Brian G. Durie, MD
  • Joshua D. Ellenhorn, MD
  • Karen Fabac, RN, MSN/ED, ONC
  • Charles A. Forscher, MD
  • Stuart Friedman, MD
  • Philip K. Frykman, MD, PhD
  • Gerhard J. Fuchs, MD
  • Ivor L. Geft, MD
  • Ilya Gelman, MD
  • Armando E. Giuliano, MD
  • Judy R. Glover, RN
  • Theodore B. Goldstein, MD
  • Martin N. Gordon, MD
  • Richard E. Gould, MD
  • Paul J. Grodan, MD
  • Scout Hebinck, RN, MSN
  • Andrew E. Hendifar, MD
  • Kristie A. Hier, RN
  • Antoinette Hubenette, MD
  • Robin R. Hudson, RN, CPAN
  • Leonel A. Hunt, MD
  • Griselda Islas, RN
  • William T. Jacobs
  • J. Patrick Johnson, MD
  • Stanley C. Jordan, MD
  • Peter Julien, MD
  • Saibal Kar, MD
  • Sousan Karimi, MD
  • Beth Y. Karlan, MD
  • David Kattan, MD
  • David Kawashiri, MD
  • Ali Khoynezhad, MD, PhD
  • Angela Khurdajian
  • Keith J. Kimble, MD
  • Michelle M. Kittleson, MD, PhD
  • Ellen B. Klapper, MD
  • Dee Dee L. Klute-Evans, RN, MSN, CIC
  • Jon A. Kobashigawa, MD
  • Jodi Ladge, PA-C
  • Mykel V. LeCheminant, RN, BSN
  • Madeline S. Lerman, RN, BSN
  • Ronald S. Leuchter, MD
  • Michael S. Levine, MD
  • Andrew J. Li, MD
  • Yong-Jian Lin, MD
  • Jessi L. Lopez
  • Rajendra Makkar, MD
  • Adam N. Mamelak, MD
  • Roxanne A. Masserat, RN, BSN, PHN
  • Jaci M. Mastrandrea, RN, BSN
  • David N. Matsumura, MD
  • Robert J. McKenna, Jr., MD
  • Gil Y. Melmed, MD, MS
  • Ronald B. Natale, MD
  • Nicholas N. Nissen, MD
  • Guy D. Paiement, MD
  • Sunny L. Peltier, RN
  • Edwin M. Posadas, MD
  • Alexandre Rasouli, MD
  • Kenneth E. Robison
  • Barry E. Rosenbloom, MD
  • Regina Rozenblat, RN
  • Tracy Salseth, ACNP-BC
  • Ashley M. Samaniego, RN
  • Howard M. Sandler, MD, MS
  • Prediman K. Shah, MD
  • Allan W. Silberman, MD, PhD
  • Steven M. Simons, MD
  • Shirley Sinclair
  • Melinda Sobel
  • Daniel J. Stone, MD, MPH, MBA
  • Alfredo Trento, MD
  • Richard Tuli, MD, PhD
  • Rafael Villicana, MD
  • Anna Volkov, RN
  • Daniel J. Wallace, MD
  • Elizabeth Whiting, RN, MSN
  • Logan M. Williams
  • Janet H. Wulf
  • Payam R. Yashar, MD
  • Amara Yob, RN, BSN, OCN
  • Rachel Zabner, MD
  • Christopher Zarembinski, MD

Center Strutters Gives Participants a Safe Place to Walk

Need a safe place for your patients to walk and exercise? Consider referring them to the Center Strutters "Walk for Fitness" Program.

Hundreds of people have taken part in the free program, which is located in the Beverly Center and runs from 8 to 10 a.m. on Mondays, Wednesdays and Fridays. Parking is validated.

The program is sponsored by Cedars-Sinai Community Health and Education. For information, please call 310-423-9581.

Comforting Connection

Julius Caceres, RN, (left) and Yvonne Kidder, RN, helped create the BabyTime program, which allows new mom Florentina Trujillo to see her newborn baby in the Neonatal Intensive Care Unit.

iPads® Help New Moms Connect With Their Infants in the Neonatal Intensive Care Unit

For newborns in Cedars-Sinai's Neonatal Intensive Care Unit, nurses Yvonne Kidder and Julius Caceres' innovative plan for using a familiar technology has brought the babies the most comforting sound they can hear: their mothers' voices.

And it's helped lessen the anxieties of the mothers who can't be with their infants at such a critical time.

"After delivery, mothers can become quite anxious not being able to see or hold their newborns and there is added stress when their babies are admitted to the Neonatal Intensive Care Unit," said Kidder, RN, a clinical nurse IV, who works closely with the caregivers in the NICU, Postpartum, and Labor and Delivery to coordinate using Apple's FaceTime application so recovering mothers can view their infants in the intensive-care environment and also meet the caregivers.

BabyTime, as the project's been dubbed, went live in February in the NICU at Cedars-Sinai's Maxine Dunitz Children's Health Center, connecting three mothers and their babies the first day.

Florentina Trujillo checks in on her baby using an iPad while she recovers in her hospital bed.

For Rachel Little, one of the first mothers to use BabyTime after her cesarean section in February, the program meant feeling just a little closer to her baby girl and the comfort of being able to hear the physician explain her infant's condition.

"While it's not the same as being able to hold your baby, it was almost as good," Little said.

BabyTime's inception was an organic one, growing from Kidder's desire in August to help a patient who had just given birth and wasn't able to be with her newborn. The new mom, who had no family in town, was being treated in the Intensive Care Unit while her baby received care in NICU.

The mother was understandably anxious to see her baby, and Kidder had an idea – what if she used her iPhone's FaceTime application to connect the two?

And that's how BabyTime was born.

Kidder, in conjunction with nursing leadership, moved forward with using iPads® to allow new mothers who are not ambulatory to see their infants. Julius Caceres, RN, provided the technical expertise needed to launch the project.

"We needed to connect mothers to their babies' care when they couldn't physically be there. This technology proved the best solution," Caceres said. "When doctors and nurses are treating a newborn in the NICU, mom now can be right there asking questions and getting updates, even if she's on a different floor."

Charles F. Simmons Jr., MD, chair of the Cedars-Sinai Department of Pediatrics and Ruth and Harry Roman Chair in Neonatology, estimates that 20 to 30 percent of mothers who undergo a cesarean section do not feel well enough to travel from their bed in the Labor and Delivery Unit to the NICU for the first 24 to 48 hours.

Now, as soon as a baby is admitted to the Neonatal Intensive Care Unit, an iPad can be set up next to the infant's incubator. A second iPad is delivered to the mother, allowing her to visit with her newborn and speak with the medical team over a secure Internet connection.

For new mom Tana Navarro, there was an added bonus to using BabyTime to see her newborn, Stephanie. Her 8-year-old daughter, who is too young to visit the NICU, was able to see her baby sister in real time.

"We saw her respond when we were talking to her," Navarro said. "It was so great."

Kidder said she is thrilled with the feedback she and the other nurses are getting.

"They absolutely love it. It's been so rewarding seeing mothers' faces light up when they see their babies for the first time," Kidder said.

Cedars-Sinai is looking to expand the program and the hospital is already adding another set of iPads to bridge communication for more mothers who are not able to move around or cannot visit their babies.

And for mothers like Little, that contact allows them to make a difference for their babies, in spite of their separation.

"Even though I couldn't hold her," Little said, "she stopped crying when she heard my voice."