Tracing the cause of the problem
By Dr. Anthony Policastro
One of the things we learned in the 1990's was that medical errors are usually complex in nature. Seldom does one step of a complicated process go wrong. There are usually several steps that set things up for mistakes. I was recently reminded of this with a non-medical process. I tried to use one of my credit cards for an online purchase and the card was declined. I used another card and a few minutes later I received a call from the credit card issuer. They told me that because I had not used the card "in a long time," it had been declared compromised. The company had programmed their computer to follow purchases and I had not made any recently. However, the computer programmers had clearly made several errors. They had written the program to identify purchases. They did not realize that there are other types of activity that need to be included to show that the card is in use. For example, in May 2011, I cashed in some rewards from the card. In July 2011, I was charged the annual fee which I paid in August 2011. In July 2012, I was again charged the annual fee which I paid in August 2012. In December 2012, they sent me a new card and I called to activate the card on Dec. 19. I was informed that none of that counted as activity on the card. I informed the caller that her superiors and the computer programmers were clearly not thinking logically. They needed to change their methods. Complex medical procedures also have many steps like this. Over the years, we have found that we can impact the way we do things. The approach is to break the complex procedure into its parts so we can make sure that each step is carefully followed. For example, we have used this approach to decrease wrong site surgery, breathing tube caused pneumonias and IV line infections. Other procedures are being addressed with a similar approach. Over the years, I have reviewed many medical complaints. The assumption of the patient is usually that someone has done something wrong. The feeling is that if we punish that individual, it will make all the difference in the world. That is not true. I once had a nurse wash out a patient's eye. She was supposed to use salt water. The salt water was in a bottle that was the same color as a substance that burned the eye. She used the wrong bottle so the patient had an eye burn. We counseled the nurse. Five months later another nurse did the same thing. The problem was not the nurse. It was that the bottles looked too much alike. We put the substance that burned in a dropper instead of a bottle. No nurse could make the same mistake again. When amoxicillin was first released, it was called Laroxin. The name was similar to the Digitalis brand name of Lanoxin. Several children died until they changed the name to Larotid. The physicians who wrote the Laroxin prescription and the pharmacists who filled them with the wrong drug would not have done that if the names were more different. The take home lesson here is that whether you are dealing with credit cards or medicine, there are always steps involved. Any one of those steps can cause a problem. The individual is usually not the main cause of the problem.
Bayhealth saddened by loss of doctor The Bayhealth family is saddened by the death of Orthopaedic Trauma Surgeon Clifford Turen, M.D., the lone occupant of a small plane that crashed recently east of Dover. Dr. Turen came to Bayhealth in 2011 from the Georgia Orthopaedic Trauma Institute where he served as director and chair. Previously, he spent 20 years at the University of Maryland Shock Trauma Center in Baltimore, where he held the positions of chief of Orthopaedic Trauma and fellowship director for the Orthopaedic Traumatology Fellowship. "Dr. Turen was an exceptional orthopaedic surgeon, a passionate teacher, a strong leader and visionary," says Gary Siegelman, M.D., Bayhealth's senior vice president and chief medical officer. "He was also a friend and a colleague. He will be sorely missed." Dr. Turen's patients will be contacted by employees of Bayhealth Orthopaedic Surgery, Dover.
Norovirus Clusters Reported The Delaware Division of Public Health (DPH) is urging the public to take precautions to prevent possible exposure and spread of norovirus, an illness that typically occurs during the winter months. After the first report received on January 3, 2013, DPH has investigated a number of suspected and confirmed norovirus outbreaks. The norovirus is not related to influenza nor linked to the high number of influenza cases so far this flu season. Gastrointestinal illness caused by norovirus is unpleasant and can be severe for those who are elderly or have an underlying health condition. Symptoms include nausea, vomiting, diarrhea, and stomach cramping. Some people may experience fever, chills, headache, muscle aches, or a general sense of tiredness. The symptoms can begin suddenly and an infected person may go from feeling well to very sick in a very short period of time. In most people, the illness lasts for one to two days. People with norovirus illness are contagious from the moment they begin feeling sick until at least three days after they recover; some people may be contagious for even longer. Infection can be more severe in young children and elderly people. Dehydration can occur rapidly and may require medical treatment or hospitalization. Although there are no specific medications to treat norovirus, drinking plenty of liquids to prevent dehydration is important. Noroviruses are easily transmitted by touching a contaminated surface as well as by direct contact with an infected person or by eating food or drinking liquids that have been contaminated with the virus. The best course of action is prevention. DPH recommends the following steps to prevent exposure to and spread of norovirus. 1. Noroviruses can be difficult to kill with normal cleaning and disinfecting procedures. Surfaces that have been contaminated with stool or vomit should be cleaned immediately and disinfected with a freshly prepared diluted bleach solution (1 part bleach:10 parts water) or a bleach-based household cleaner. Never use undiluted bleach). 2. If you are ill with vomiting or diarrhea, you should not go to work, school, or attend daycare. 3. Healthcare facilities, such as nursing homes and hospitals, may restrict visitation of sick family members or friends for the safety of not only the ill persons but also the visitors. 4. Wash your hands frequently and thoroughly with soap and water. This is one of the most effective ways to protect yourself and others against norovirus since hand sanitizers alone are not as effective against the virus as handwashing. For more information about norovirus, see the DPH Web site at http://dhss.delaware.gov/dhss/dph/files/norwalkfaq.pdf.
Nanticoke sees increase in flu Nanticoke Memorial Hospital has seen a 20% increase in Emergency Department patient volumes due to patients with flu/flu-like symptoms. As of Jan. 10, Nanticoke has had three confirmed and four suspected (rapid test positive) admitted patients treated for influenza. Nanticoke Memorial Hospital is making every effort to see patients arriving with flu/flu-like symptoms quickly, especially in their minor care area. "Unless someone is in distress requiring respiratory support/oxygen, we can handle patients in a clinic like setting - minor care," explains Lisa Wile, RN, director of Emergency Services at Nanticoke Memorial Hospital. "They can see the physician assistant, and we can offer appropriate treatment to help decrease the severity of the symptoms." At this time, The Centers For Disease Control and Prevention (CDC) does not recommend testing all patients who come in with flu-like symptoms for confirmation. "We offer and encourage use of a mask for any adult or child who is coughing or sneezing or for anyone who wants to use one. We also have hand sanitizer readily available and encourage people to cover their mouth when coughing or sneezing with a tissue and then wash/sanitize hands. We discourage bringing healthy visitors to areas where they could be exposed," said Wile. As with many hospitals, procedures for the influx of patients, due to a contagious condition such as the flu, is a part of the Nanticoke Emergency Preparedness Plan. For patients admitted to the hospital with flu symptoms, droplet precautions are used for admitted patients diagnosed with influenza. Droplet precautions consist of placing the patient in a private room, cleaning hands when entering and leaving the room, and wearing a mask upon entering the room. The mask is discarded before leaving the room. Nanticoke Memorial Hospital continues to monitor the increased volume.
Beebe prepares to implement plan As the number of cases of flu has swelled throughout Delaware, Beebe Medical Center held an initial meeting to implement its Flu Plan, which is part of the organization's well-established Emergency Management Plan. Telephone operators and greeters at the hospital campus in Lewes have been provided with instructions to screen visitors to the hospital who exhibit cold-like or flu-like symptoms such as a cough, or runny nose. Clinical personnel were reminded of the protocols in the written Flu Plan that include the use of masks in the rooms of patients with flu, as well as the initiation of droplet precautions and cleaning procedures that assure infection control. Beebe Medical Center's Flu Plan, if implemented, provides for designated areas to care for and isolate flu patients. Between Dec. 1, 2012, and Jan. 10, 2013, 863 tests have been performed.
Of those, 154 tested positive to Influenza A, and 8 tested positive to Influenza B. Anyone who feels that they may have flu-like symptoms should contact their primary care physician and use the Centers for Disease Control and Prevention website http://www.cdc.gov/flu/ as a resource. They should only go to the Emergency Department if they need emergency care. Any person planning to visit the hospital patients who has cold or flu-like symptoms should avoid coming to the hospital.
Bayhealth responds to outbreak Bayhealth - Kent General and Milford Memorial - is adapting hospital facilities to meet the local community's increased need for care. The best way to prevent influenza is to get vaccinated. Vaccines are still available and are effective against this year's strain of flu. Over 95% of Bayhealth employees received this year's vaccine. To complicate the upsurge in influenza cases, the community is also experiencing an increase in Norovirus - commonly known as the "stomach bug." Symptoms include diarrhea and vomiting, and the virus is easily transmitted from person to person. Anyone can get the Norovirus. It is not related to influenza, and there is no vaccine to prevent Norovirus. If you wish to visit patients at Kent General or Milford Memorial:
Learn more about influenza symptoms, prevention and treatment by visiting www.cdc.gov/flu/keyfacts.htm. The Centers for Disease Control also have information on norovirus at www.cdc.gov/Features/Norovirus/.
- Visitors should receive approval from nursing before entering a patient room.
- Only immediate family should visit.
- No one under 18 years of age should visit.
- Visitors should disinfect hands using the gel dispenser located inside each patient care unit as they enter and exit.
Flu shots still available Flu shots are still available by appointment. Influenza is a serious disease that affects many people, including the elderly and those with serious, long-term health problems. The U.S. Centers for Disease Control and Prevention (CDC) recommends that everyone get a seasonal flu vaccine every year. Nanticoke Memorial Hospital is offering seasonal flu shots to individuals 18 and older at Nanticoke Memorial Hospital's main campus (801 Middleford Rd., Seaford). There is no charge but a $10 donation per vaccination is requested. Flu shots are available by appointment by calling 629-6611, ext. 2642.
Walk for Autism is April 20 As a statewide agency whose mission is to create better lives for people with autism, Autism Delaware is expanding to provide the range of services needed by all Delawareans living with autism spectrum disorders over their lifespans. To this end, the nonprofit agency relies on volunteers, donations, and fundraising. "Our next big fundraiser in southern Delaware is Walk for Autism on April 20 at Cape Henlopen State Park," says Lisa Albany, the committee chair. "Our goal is to raise as much as possible to provide services through Autism Delaware that benefit individuals with autism spectrum disorders. We need volunteers to help run the event plus business and corporate leaders to sponsor it." "The need for autism services and support is rising rapidly," adds Autism Delaware Executive Director Teresa Avery. "The CDC now says that one in 88 children is identified with an autism spectrum disorder. In 1991, the Delaware Department of Education reported 152 public school students with autism and 982 in 2010. That's a 546 percent increase over 19 years. For more information, visit autismdelaware.org.
CHEER offers support group The Alzheimer's Association Delaware Valley Chapter announces that a support group for the caregivers and families of those suffering from Alzheimer's disease and related disorders will begin meeting at 10 a.m. on Tuesday, Jan. 22, at the CHEER Community Center located at 20520 Sand Hill Rd., Georgetown. This group will meet monthly thereafter on the third Tuesday of each month at 10 a.m. This is an open support group sponsored by the association and all interested parties are invited to attend. In addition to the support groups, the Delaware Valley Chapter offers support to caregivers through a 24-hour Helpline at 800-272-3900, professional and family caregiver education workshops and trainings, care consultation, multicultural outreach, advocacy and a free quarterly informational e-newsletter. For more information, contact Jamie Magee at 854-9788 or 1-800-272-3900.
CPR classes offered Nanticoke Memorial Hospital will offer community CPR classes to anyone interested in learning CPR at the Nanticoke Training Center located on Water Street in Seaford. Participants will learn how to perform the basic skills of CPR on adults, children, and infants and how to help an adult, child, or infant who is choking and use of the AED. This classroom-based, video, and instructor-led CPR course offers families, friends, and community members the opportunity to learn CPR and receive a course completion card. Classes are open to participants ages 12 and up. The target audience is those who have a duty to respond to a cardiac emergency because of job responsibilities or regulatory requirements. Cost is $45. Payment and registration is required by no later than five business days prior to the class. Late registrations may be accepted if seating is available. To register and obtain a listing of class dates/times, contact the Nanticoke Memorial Hospital's Training Center office at 629-6611, ext. 8919. Pre-registration is required.
Diabetes education program Nanticoke Memorial Hospital will offer a free educational program to share diabetes self-management and lifestyle strategies at 5 p.m. on Monday, Jan. 28. Roger Baird, a member of the A1C Champions Program and supported by Sanofi, a patient-led approach to diabetes education, will present the program which is based on his extensive training and his personal experience living with diabetes. If you or someone you know is struggling with diabetes or has an A1C that is 7% or above, the A1C Champions can provide motivation to take those first steps to better blood glucose control. Diabetes patients need to know they are not alone and there are people like Roger who can help them along their journey with diabetes. Call 629-6611, ext. 2446, to reserve space for this free event.
Forum offers free health screenings The Delaware Breast Cancer Coalition (DBCC) is proud to present its ÁVIDA! Latina Breast Health Forum on Saturday, Jan. 19, at St. John's United Methodist Church located at Pine and Poplar Streets in Seaford from 9 a.m. to 2 p.m. This one-day conference is free and open to the public. For the past two years, the ÁVIDA! program has been held in Georgetown and this is the first year that the program is expanding to Seaford. ÁVIDA! will be held again in Georgetown later this year. ÁVIDA! is a bilingual (Spanish/English) educational event that focuses on breast cancer screening, treatment and survivorship. Over 200 community members attended last year's VIDA! event. This year's event will feature free health screenings and information about breast health and healthy living. Lunch will be provided for all attendees, but space is limited so those interested are encouraged to register by calling 1-888-672-9647. The Women's Mobile Health Screening (WMHS) Van will be on-site to provide screening mammograms (with a prescription from a doctor). There will also be free screenings for blood pressure, cholesterol, blood sugar, HIV testing and clinical breast exams. Beebe Medical Center, La Red Health Center, Nanticoke Memorial Hospital, Westside Family Healthcare, Practice Without Pressure, and Maxima 900 AM Radio will attend. There will also be SNAP benefits registration provided by the Food Bank of Delaware. Call 1-888-672-9647 for more information.
Go Red for Women 2013 The Southern Delaware Go Red For Women will be held on Friday, Feb. 8, 2013. Tickets, which are $35 each, include extensive health screenings, $10 gift card from Macy's, guest gift bag and lunch, entertainment that includes fashion show and silent auction. Table sponsorships are $1,000 and exhibitor sponsorships are $1,500. The event begins at 10 a.m. with lunch and the program starting at noon. For more information, visit www.heart.org/southerndegoredluncheon.
Parkinson's support group meeting The Nanticoke Parkinson's Education and Support Group will hold its regularly scheduled monthly meeting on the third Monday of each month, from 10 to 11:30 a.m in the ballroom at the Nanticoke Senior Center. The public is welcome to attend the meeting and stay for lunch and a social time after the meeting.
HIV/AIDS Support Group A new support group for HIV/AIDS will meet every other Wednesday, at 7 p.m., in the Branford Lounge at Epworth UMC at 19285 Holland Glade Rd., Rehoboth Beach. The group is sponsored by Epworth UMC, CAMP Rehoboth, the AIDs Delaware and Delaware HIV Consortium. For more information, contact David at firstname.lastname@example.org.