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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF September 7, 2018 | Archived Issues

Flu Shots for Staff Coming to Cedars-Sinai

Staff members are asked to help Cedars-Sinai protect patients, visitors and colleagues by getting an annual flu vaccination by Friday, Oct. 12. All employees, medical staff, vendors, contracted personnel, volunteers, faculty and students must get their annual flu vaccinations. Flu vaccinations are free of charge.

» Read more

President’s Perspective: Community Support

By Thomas M. Priselac, President and CEO

Before the first patient came through the doors in 1902, it was already part of Cedars-Sinai. It is stronger than ever in 2018 and has never been more crucial to our mission. Community support—especially in the form of philanthropic donations—provided the means to build Kaspare Cohn Hospital (as well as Cedars-Sinai Medical Center decades later) and has become even more important as our clinical and academic programs have grown while payment rates for patient care continue to decline.

» Read more

High Holidays Services Set for September

Senior Rabbi Jason Weiner, director of the Spiritual Care Department, will conduct services for the High Holidays at Cedars-Sinai. The services also will feature cantor Jordan Gorfinkel. Services for Rosh Hashanah will be held Monday, Sept. 10, from 10 a.m.-noon in Harvey Morse Auditorium.

» Read more

Frontline Staff Play Vital Role in Promoting Safety

Frontline staff play a critical role in promoting a culture of safety at Cedars-Sinai. The medical center relies on these bedside professionals to identify flaws in clinical processes that can lead to mistakes and may result in patient harm.

» Read more

Learn About Medical Mission to Guatemala

Employees interested in participating in Cedars-Sinai's annual medical mission to Guatemala next year are invited to attend a recruitment meeting on Sunday, Sept. 9, from 10-11 a.m. in ECC-C. The 2019 mission will take place March 30-April 8.

» Read more

CDI Course Helps Physicians Reflect Quality of Care

The Health Information Department's Clinical Document Integrity Program is offering deep-dive education to help keep physicians up-to-date on new documentation requirements that can impact how the quality of their work is represented.

» Read more

Paquette Named Director for BMT Program

Ronald Paquette, MD, has been appointed clinical director of the Blood and Marrow Transplant program at the Oshin Cancer Institute. Paquette assumed the role on Aug. 29, after his predecessor, Michael Lill, MD, died from appendix cancer in June. Paquette had been serving as interim director for the past two years. 

» Read more

Core Labs Updating eGFR Calculation on Sept. 27

On Thursday, Sept. 27, the Core laboratories in the Department of Pathology and Laboratory Medicine will update the estimated glomerular filtration rate calculation, reported in mL/min/1.73m², from the abbreviated MDRD formula to CKD-EPI, which KDIGO recommends (2013).

» Read more

FDA Issues Warnings and Labeling Change

The U.S. Food and Drug Administration (FDA) is warning that the antibiotic Zithromax, Zmax (azithromycin) should not be given long-term to prevent a certain inflammatory lung condition in patients with cancers of the blood or lymph nodes who undergo a donor stem cell transplant. The FDA is also changing safety labels in a class of antibiotics called fluoroquinolones and warning that cases of a rare, but serious, infection are possible with the use of SGLT2 inhibitors.

» Read more

Are You a Veteran? Let Us Know

Were you in the military, or do you know a co-worker who was? For Veterans Day, The Bridge wants to honor Cedars-Sinai's military veterans. Please email thebridge@cshs.org to let us know when and in which branch you served, and any notable details about your service. Also, please include your current position at Cedars-Sinai.

» Read more

CS-Link Tip: CURES Mandate Begins Oct. 2

The California Department of Justice mandate to consult CURES (Controlled Substance Utilization Review and Evaluation) prior to prescribing, ordering, administering or furnishing a Schedule II, II or IV controlled substance becomes effective on Tuesday, Oct. 2. The law states that CURES must be consulted the first time a patient is prescribed, ordered or administered a Schedule II, III or IV controlled substance. 

» Read more

Flu Shots for Staff Coming to Cedars-Sinai

Anndre-Lee Deacon, MSN, RN, receives a flu shot from Loralyn Soria, RN, BSN.

Staff members are asked to help Cedars-Sinai protect patients, visitors and colleagues by getting an annual flu vaccination by Friday, Oct. 12.

Flu Shot Schedule

The schedule for vaccination clinics is as follows:

  • Monday, Sept. 10
    8 a.m.-10 p.m., ECC-A
  • Tuesday, Sept. 11
    8 a.m.-10 p.m., ECC-A
  • Wednesday, Sept. 12
    8 a.m.-10 p.m., Harvey Morse Conference Room 4 & 5
  • Thursday, Sept. 13
    8 a.m.-10 p.m., ECC-A
  • Friday, Sept. 14
    8 a.m.-10 p.m., ECC-A

All medical staff, employees, vendors, contracted personnel, volunteers, faculty and students must get their annual flu vaccinations. Exceptions may be given for those with approved medical exemptions per guidelines from the Centers for Disease Control and Prevention (CDC). Those who decline the vaccine without an approved medical exemption or religious accommodation will not be able to work and are subject to termination of employment.

Flu vaccinations are free of charge and will be available to all employees, medical staff and volunteers. Vaccines have been ordered, and a schedule of flu clinics will be emailed soon and will be available in issues of The Bridge and on the intranet homepage.

All vendors and contracted personnel must provide proof of vaccination and wear badge buddies while they are in any Cedars-Sinai-licensed area. If they wish to get their flu vaccination at Cedars-Sinai, they will have to show their ID badge and pay a $25 fee; however, the fee will be waived if the vaccine is received during the flu clinics Sept. 10-Oct. 12.

"Thank you to all staff for continuing to provide for the health and safety of our patients and their families," said Jonathan Grein, MD, medical director, Department of Hospital Epidemiology, and infection control officer. "Getting vaccinated is the most important step towards protecting ourselves, our families and our more vulnerable patients—such as those without a strong immune system—from the complications of influenza."

Staff with a confirmed egg allergy that has been documented with Employee Health Services (EHS) may schedule a vaccination appointment with EHS in My CS-Link™.

Green badge buddies will be issued at the time of vaccination, and people with an approved medical exemption or religious accommodation will receive a gray badge buddy. All badge buddies must be visibly worn by Nov. 1. These HIPAA-compliant badge buddies are the easiest method to ensure all employees are in compliance with Cedars-Sinai policy and the County of Los Angeles Public Health Order.

For those staff with an approved religious accommodation or medical exemption, masks are not required to be worn in nonpatient care areas such as administrative offices, cafeterias, break rooms and parking lots. Per the County of Los Angeles Public Health Order, masks must be worn in all patient care areas, even by those with an approved vaccine exemption.

To request a medical exemption, a staff member must have a medical provider complete the Physician's Verification of Request for Medical Exemption From Influenza Vaccination form available from EHS. The request for exemption will be reviewed by a physician panel, who will determine if it meets criteria for an exemption based on CDC guidelines. Please return the completed form to EHS on the second floor of Spielberg by Friday, Oct. 12.

Staff members requesting a religious accommodation should contact their HR Business Partner or call 310-423-5459 to receive the Request for Religious Accommodation form. Completed forms are given to your HR Business Partner. Your request will be evaluated, and an approval or denial letter will be issued to you. The deadline to request a religious accommodation is Friday, Oct. 12.

Family members of staff members are invited to get their vaccines on Sunday, Oct. 28, 10 a.m.-noon, on the second floor of Spielberg. During this time, vaccines also will be available for community members over the age of 18. Vaccinations for children 6 months or older will be available for children of employees only.

For more information, please call Employee Health Services at 310-423-3322 or Hospital Epidemiology at 310-423-5574 or read the FAQs below.

Flu Immunization Policy FAQs 2018-19 (PDF)  

President’s Perspective: Community Support

By Thomas M. Priselac, President and CEO

Before the first patient came through the doors in 1902, it was already part of Cedars-Sinai. It is stronger than ever in 2018 and has never been more crucial to our mission.

Community support—especially in the form of philanthropic donations—provided the means to build Kaspare Cohn Hospital (as well as Cedars-Sinai Medical Center decades later) and has become even more important as our clinical and academic programs have grown while payment rates for patient care continue to decline.

Unlike most academic medical centers, which were established by a university or the government, Cedars-Sinai was started by the community in response to disparities and discrimination about who could receive healthcare and who could practice medicine. More than a century later, the community’s connection to the outstanding care they receive here—and the research and education conducted—continues to motivate donations that sustain our mission. In fact, about 75 percent of donors to Cedars-Sinai are grateful patients.

Community support is one of the two key factors that have enabled Cedars-Sinai to be a leader in healthcare for so long. The first factor, of course, is all of you—the people of Cedars-Sinai—whose incredible abilities, commitment and innovation make a difference in the lives of thousands of people every single day. As a result of the impact of your work supporting our patients and the community, many of them become motivated to give back to Cedars-Sinai in the form of donations, the second factor. And this benevolent cycle continues, as their philanthropy then enables us to remain a leader by providing the additional resources—technology, advanced facilities, new programs and research support—that attract and support our world-class staff, making the difference between an average institution and a great one.

Because of your extraordinary work, our community support has never been stronger. Our recently completed eight-year fundraising campaign raised $615 million, exceeding the goal by $15 million. And while large donations tend to be the most visible at any institution, many people are not aware that most of the donations to Cedars-Sinai are between $1 and $500. In fact, more than 70,000 people contributed to the just-completed campaign, demonstrating the breadth of the impact of your work, and the strength of the community’s commitment to our institution. Equally impressive is the fact that so many of you are now participating as donors; about 18 percent of our employees made donations to the campaign.

The deep, two-way connection between Cedars-Sinai and the people and communities we serve is not only a cornerstone of the institution, but a testament to the dedication and commitment all of you demonstrate every day.

High Holidays Services Set for September

Senior Rabbi Jason Weiner, director of the Spiritual Care Department, will conduct services for the High Holidays at Cedars-Sinai. The services also will feature cantor Jordan Gorfinkel.

  • Rosh Hashanah—Monday, Sept. 10, from 10 a.m.-noon in Harvey Morse Auditorium
  • Kol Nidre—Tuesday, Sept. 18, from 6:30-8 p.m. in Harvey Morse Auditorium
  • Yom Kippur—Wednesday, Sept. 19, from 10 a.m.-12:30 p.m. in Harvey Morse Auditorium

The services will be available for viewing on Channel 50 of the inpatient TV system. On Tuesday, Sept. 11, Rosh Hashanah services will be available again on Channel 50.

If you have questions, please contact Spiritual Care at ext. 3-5550.

Frontline Staff Play Vital Role in Promoting Safety

When new oxygen tanks appeared on 8 Saperstein earlier this year, clinical partner Jennifer Valdez thought something about them looked odd. Valdez helps attach the portable tanks to the gurneys of patients from her unit who must stay hooked up to oxygen while getting an MRI scan.

Because these imaging machines use strong magnetic force, nothing magnetic can be brought into the MRI room. Patients must enter the space on special gurneys with equipment that won’t be attracted to the machine’s magnetic field. The wrong equipment could harm a patient or even collide with the machine.

When Valdez noticed that the new portable oxygen tanks on her unit might have magnetic handles, she immediately warned her supervisor, and hospital staff removed the tanks.

"If you don’t report problems, that could affect somebody’s life," said Valdez, who’s worked at Cedars-Sinai for nine years. "I understand why people sometimes feel nervous about speaking up, but I know my team won’t judge my decisions. I am my patient’s voice."

Frontline staff like Valdez play a critical role in promoting a culture of safety at Cedars-Sinai. The medical center relies on these bedside professionals to identify flaws in clinical processes that can lead to mistakes and may result in patient harm.

"I’m happy and encouraged that Jennifer felt emboldened to speak up," said Bryan Croft, senior vice president of Operations at Cedars-Sinai. "We aspire to have all of our staff members feel comfortable enough to do that. Ultimately, we all want what’s best for the patient."

Croft and other members of hospital leadership have worked to reinforce a transparent and constructive environment for reporting patient safety issues, and it appears to be yielding positive results.

A recent tally of last year’s Culture of Safety survey results showed an increase in positive perceptions about Cedars-Sinai’s safety efforts. The hospital also saw a 20 percent jump in incident reports this past year. That’s a good thing because those reports included useful information from incidents like near-miss events, which can uncover potential system issues and improvement opportunities. The medical center also saw an uptick in Safety Star submissions—recognizing employees who go above and beyond to keep patients safe—from areas including Environmental Services, Security, Food and Nutrition services,  and Central Transport.

"Hospital staff from any area can make a big impact when they identify issues that can potentially compromise safety," said Edward G. Seferian, MD, chief patient safety officer. "It takes a team, including physicians, nurses and other staff, to work together to continuously improve patient safety. Issues identified through incident reporting are taken seriously at the highest level."

To further encourage reporting, a new patient safety training course launched in March and has rolled out to frontline leaders in 19 different units. The course includes a new checklist meant to guide leaders through a standardized set of immediate actions after an adverse event. The checklist helps pinpoint where a breakdown occurred and whether the affected service is safe for the next patient.

The course also aims to overcome one of the biggest barriers around patient safety engagement—the misperception that the process is intended to be punitive, said Rekha Murthy, MD, vice president of Medical Affairs and acting chief medical officer at Cedars-Sinai.

"Our staff are the most knowledgeable sources about potential flaws in our processes of care and ideas to further improve safety," Murthy said. "It’s essential that they feel empowered to report safety issues or near misses to help identify opportunities to improve systems that otherwise could lead to patient harm."

In the year ahead, Cedars-Sinai will focus on many of the same Patient Safety priorities: encouraging incident reporting, expanding the patient safety curriculum rollout and eliminating repeat events.

Learn About Medical Mission to Guatemala

For many residents, a visit from Cedars-Sinai medical professionals marks their only access to healthcare all year.

Employees interested in participating in Cedars-Sinai's annual medical mission to Guatemala next year are invited to attend a recruitment meeting on Sunday, Sept. 9, from 10-11 a.m. in ECC-C. The 2019 mission will take place March 30-April 8.

Information on how to volunteer as well as what the mission entails will be available. People from all positions are encouraged to attend.

"We are looking for volunteers from a variety of work experiences and backgrounds to attend," said Jim Laur, vice president of Technology and Business Affairs. "We need doctors and nurses, but just as important are people who can speak Spanish, can cook, are willing to clean or provide a variety of other support to the team's activities."

The mission is in partnership with HELPS International, a nonprofit group that organizes a wide range of volunteer activities in Guatemala. Volunteers have to use vacation time for the 10-day trip, and they pay for their own transportation.

"It is a meaningful and impactful trip for everyone who volunteers," Laur said. "You witness the direct impact you have on these people's lives."

The Cedars-Sinai team, which consists of roughly 80 people, travels to a rural village with equipment and supplies where they set-up a clinic and an operating room. The team sees hundreds of patients, most of whom have no access to healthcare.

For more information, contact Olivia Marroquin at oliviamr531@gmail.com.

CDI Course Helps Physicians Reflect Quality of Care

The Health Information Department's Clinical Document Integrity (CDI) Program is offering deep-dive education to help keep physicians up-to-date on new documentation requirements that can impact how the quality of their work is represented.

The 90-minute CDI Physician Power Course and Refresher sessions cover how accurate and specific clinical documentation guides ICD-10 code assignments, as well as documentation's impact on quality outcomes, data integrity, value-based purchasing and research.

"As clinicians, we are well-versed in the medical care of our patients, but when it comes to the task of accurately capturing a patient’s clinical condition to conform with current documentation standards, it’s important to stay current with the latest rules and guidelines," said course attendee Nattapaun Thepyasuwan, DO, a hospitalist with Genesis Hospitalist Medical Group and a physician advocate at Cedars-Sinai.

As a physician advocate, Thepyasuwan works with CDI to help resolve queries around the specificity of submitted clinical documentation. She said many of the queries she assists with are common and easily resolved with better understanding of current documentation trends.

"For example, the term 'urosepsis' used to have a specific code several years ago. Based on changes to coding guidelines, per ICD-10, urosepsis no longer has a code. A provider must be queried for clarification if he or she documents this term," Thepyasuwan said. "Without attending this course and learning about these ongoing changes, I would not have known that. To stay up-to-date, I try to attend once a year."

The course also examines how the public reporting of healthcare provider statistics plays a significant role in the decisionmaking of insurance companies and the public when considering which healthcare providers and organizations are preferred or to be avoided.

The sessions, which can be tailored to departmental needs, underline how documentation practices affect severity of illness (SOI) and risk of mortality (ROM) scoring, in turn driving the expected length of stay (LOS) and the case mix index (CMI).

The course also provides access to CDI Program resources that can assist physicians with their documentation needs.

General sessions will be held on the following dates:

  • 10/02/18 3:30-5 p.m. Pavilion, PEC 5
  • 11/06/18 3:30-5 p.m. Pavilion, PEC 5
  • 12/04/18 3:30-5 p.m. Pavilion, PEC 5

Employees wishing to attend a general session or request a built-to-need presentation for their department can contact Health Information Department Supervisor Mark Dale Tajon at 310-423-3052 or MarkDale.Tajon@cshs.org.

Paquette Named Director for BMT Program

Ronald Paquette, MD

Ronald Paquette, MD, has been appointed clinical director of the Blood and Marrow Transplant (BMT) program at the Oshin Cancer Institute.

Paquette assumed the role on Aug. 29, after his predecessor, Michael Lill, MD, died from appendix cancer in June. Paquette had been serving as interim director for the past two years.

"Dr. Lill was a charismatic leader who was the champion of his patients, particularly those who were not served by other programs," said Paquette, who joined Cedars-Sinai in 2016. "Before he died, I promised I would do my best to continue his legacy of caring, excellence and service to those in need of bone marrow transplantation."

The BMT program is known for quality care and being one of only two programs in the country offering bloodless bone marrow transplants to patients with lymphoma, multiple myeloma and other blood cancers. Its staff members have completed nearly 2,200 stem cell and bone marrow transplant procedures and perform about 120 transplants a year.

"Our program is growing and we are recruiting new physicians," said Paquette. "And while it expands, I will ensure patients and their families continue to receive first-rate care."

In addition to growing the team and program, Paquette is eager to continue working with his colleagues: "I am most excited about continuing to work with these extraordinary people to continue to grow and improve our program."

And while colleagues continue to honor the legacy of Lill, who established the program and served as its director for more than 20 years, they are eager to support Paquette.

"Ron’s natural leadership and drive for excellence will greatly benefit our patient community," said Paul Noble, MD, director of the Women's Guild Lung Institute and professor and chair of the Department of Medicine. "I am confident the program will grow and exceed expectations with Ron’s expertise and professionalism."

Core Labs Updating eGFR Calculation on Sept. 27

On Thursday, Sept. 27, the Core laboratories in the Department of Pathology and Laboratory Medicine will update the estimated glomerular filtration rate (eGFR) calculation, reported in mL/min/1.73m², from the abbreviated MDRD formula to CKD-EPI, which KDIGO recommends (2013).

This change is being made because the CKD-EPI formula is more accurate than the MDRD study equation, particularly in people with higher GFR.

Based on guidelines, values >60 mL/min/1.73m² will be reported as such (i.e., only values below 60 will be reported quantitatively). eGFR is automatically calculated as part of BMP, CMP renal function panel (RFPG), and serum creatinine (CREG) orders.

If you have questions, please contact Kimia Sobhani, PhD, at kimia.sobhani@cshs.org or Anders Berg, PhD, at anders.berg@cshs.org.

FDA Issues Warnings and Labeling Change

The U.S. Food and Drug Administration(FDA)  is warning that the antibiotic Zithromax, Zmax (azithromycin) should not be given long-term to prevent a certain inflammatory lung condition in patients with cancers of the blood or lymph nodes who undergo a donor stem cell transplant. Results of a clinical trial found an increased rate of relapse in cancers affecting the blood and lymph nodes, including death, in these patients.

The FDA website has more information.

FDA: Safety Label Changes for Fluoroquinolones

The FDA is requiring safety labeling changes for a class of antibiotics called fluoroquinolones to strengthen the warnings about the risks of mental health side effects and serious blood sugar disturbances—and make these warnings more consistent across the labeling for all fluoroquinolones taken by mouth or given by injection.

The FDA website has more information.

FDA: Serious Rare Infection Possible With SGLT2 Inhibitors

The FDA is warning that cases of a rare, but serious, infection of the genitals and surrounding area have been reported with the class of Type 2 diabetes medicine called sodium-glucose cotransporter-2 (SGLT2) inhibitors. This serious rare infection, called necrotizing fasciitis of the perineum, is also referred to as Fournier’s gangrene.

The FDA website has more information.

Are You a Veteran? Let Us Know

Were you in the military, or do you know a co-worker who was? For Veterans Day, The Bridge wants to honor Cedars-Sinai's military veterans. Please email thebridge@cshs.org to let us know when and in which branch you served, and any notable details about your service. Also, please include your current position at Cedars-Sinai.

CS-Link Tip: CURES Mandate Begins Oct. 2

The California Department of Justice mandate to consult CURES (Controlled Substance Utilization Review and Evaluation) prior to prescribing, ordering, administering or furnishing a Schedule II, II or IV controlled substance becomes effective on Tuesday, Oct. 2.

The law states that CURES must be consulted the first time a patient is prescribed, ordered or administered a Schedule II, III or IV controlled substance. CURES must be consulted every four months thereafter if the medication remains part of the patient’s treatment plan.

It is recommended that you document any reason that you do not consult CURES. You do not have to consult CURES if:

  • The patient is admitted.
  • The patient is seen in the Emergency Department and the substance does not exceed a seven-day supply.
  • The substance is part of a surgical treatment plan and does not exceed a five-day supply.
  • The patient is receiving hospice care.
  • CURES cannot be accessed in a timely manner and the prescription does not exceed a five-day supply.
  • CURES cannot be accessed because of technology limitations.
  • Trying to access CURES would result in an inability for the patient to receive the prescription in a timely manner and does not exceed a five-day supply.

CS-Link™ is implementing tools to assist with this California Department of Justice mandate. Before the Oct. 2 deadline, you will find a CURES Review section in encounters including office visits, orders only, telephone calls, refills, patient email, as well as in the ED and Inpatient settings, including the navigators for discharge, surgical post-op discharge, manage orders and discharge order reconciliation. You will also find the CURES under the MORE activity.

The CURES review activity will contain a hyperlink that will take you to the CURES website. To use the CURES website, you must have registered, and you must remember your login and password. This is a state of California website (not CS-Link). Here you will review the patient’s dispense history and close the window. CS-Link will recognize that you have consulted CURES after clicking a "Mark as Reviewed" button.

The SmartPhrase dotCURES (.CURES) will remain in place in order to assist in documenting an exemption for not checking CURES.

There will also be a Best-Practice Advisory, a pop-up, to remind you if you haven’t consulted CURES in the last four months when ordering a scheduled medication. If you have clicked "Mark as Reviewed," this alert will not appear.

If you need assistance with your CURES User ID, password or questions related to the CURES database, reach out to the California Department of Justice at 916-210-3187 or cures@doj.ca.gov.