The BMC Brief

November 14, 2012 Volume 1, Issue 34

• BMC Offers Asthma Concierge Service to Pediatric Patients
• Specialty Pharmacy Opens in Moakley; Future Retail Pharmacy Planned
• Leadership Corner: Ravin Davidoff, MB, BCh, Senior Vice President, Medical Affairs and Chief Medical Officer
• What Do You Do, Ricky Kue, MD, MPH?
• In Their Words
• News of Note
• Awards and Accolades

BMC Offers Asthma Concierge Service to Pediatric Patients

In the ongoing effort to provide the right care to every patient, Pediatrics has partnered with Pharmacy to offer a concierge medication service to asthma patients.

More than 250 young patients are admitted to BMC each year for asthma. Of those, 40-50 percent leave the hospital without filling prescriptions for their vital medications, which can lead to hospital readmission.

“Patients often don’t fill their prescriptions because they are too costly, they have transportation issues getting to and from the pharmacy, and the additional time it takes to go and get the prescriptions is an added burden to families whose child was just admitted for their asthma,” says James Moses, MD, MPH, Director, Pediatric Patient Safety and Quality. “We knew these were barriers to good follow-up care and we needed to improve it."

Working with Pharmacy, the teams devised a program where a pharmacist and nurse meet with the patient and family at the bedside prior to discharge to review the asthma medication and how to take it. In the month since the program rolled out, the number of families leaving BMC with their medications has doubled, from 40 to 80 percent, and the group expects to reach its goal of 90 percent in the coming months.

“The ‘teachable’ moment at the bedside gives parents the opportunity to see a demonstration on how to administer medications, ask questions about them and clarify any insurance or pharmacy issues before their child leaves the hospital,” says Moses. “It’s been an incredibly successfully inter-departmental team effort that delivers excellent patient care.”

Future enhancements to the program include extending the concierge service’s hours to the weekends to accommodate the schedules of parental guardians.

“Pharmacy is pleased to partner with Pediatrics to ensure BMC’s young patients have access to care they need to be well and stay well,” says David Twitchell, PharmD, MBA, Director, Pharmacy. “This is a great example of the multidisciplinary collaboration that happens here every day to provide patients with the highest level of care possible.”

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Specialty Pharmacy Opens in Moakley; Future Retail Pharmacy Planned

This month BMC will open a new pharmacy on Moakley 3. The specialty pharmacy, located in the infusion center, will provide a highly customized medication service to oncology and rheumatology patients.

“The specialty pharmacy is a way for patients to easily and conveniently get the medications they need with counseling from pharmacists on how to take them and a review of their overall medication regimen,” says David Twitchell, PharmD, MBA, Director, Pharmacy.

A new retail pharmacy will open in Shapiro in 2013

The pharmacy expects to serve 200 patients a year, and through its 340b status, which allows BMC to purchase outpatient drugs at 40-60 percent off retail prices, expects to save the hospital $2 million.

Phase two of a pharmacy expansion plan is to open a full-service retail pharmacy on Shapiro 1, in the current location of Patient Financial Services. The 2,500 square-foot pharmacy will be comparable to a CVS or Walgreens, providing prescriptions to patients and non-BMC patients, such as families, visitors, staff, and members of the community. Patient Financial Services will move to the third floor of Shapiro, in the space that was previously occupied by the conference center.

“More than half of prescriptions at BMC come from the Shapiro building,” says Twitchell. “We saw this as a great opportunity to enhance our patients’ experiences by allowing easy access to a pharmacy that can fill not only their medications prescribed at BMC, but all of their, and their families, medications.”

The Shapiro pharmacy is slated to open in spring 2013 and will be staffed by more than 30 new Pharmacy employees.

"Effective medication management is critical to patient outcomes," says Lisa O’Connor, RN, BSN, MS, NEAA-BC, Senior Vice President for Clinical Operations and Chief Nursing Officer. "We are fortunate to have a talented and committed Pharmacy team at BMC, who, with this infrastructure, will deliver the highest quality medication management system in Boston."

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Leadership Corner: Ravin Davidoff, MB, BCh, Senior Vice President, Medical Affairs and Chief Medical Officer

BMC plans to require universal staff flu vaccination for the 2012-2013 flu season. BMC Brief staff recently spoke with Davidoff about the employee influenza vaccination program.

Ravin Davidoff, MB, BCh

BMC has joined many other Boston hospitals in requiring universal staff flu vaccination. Why is it important for staff to get vaccinated?
What is not always recognized, but extremely important, is the illness burden associated with flu. During the flu season between 300 and 1,200 of BMC’s 6,000 employees may become infected with influenza. This has the potential to dramatically affect our work force and directly impact patient care.

We have a commitment and responsibility to our patients, fellow employees and our families to help keep them well and not expose them to infection. The flu vaccination is one of the easiest ways to ensure that our patients and staff are protected from an infectious disease that we can prevent.

The Centers for Disease Control (CDC) previously recommended vaccination for high-risk people, but now recommends everyone above six months of age get the influenza vaccination every year. We are committed to doing this for our patients' safety, and for the health of our employees and their families.

Where can staff get flu shots?
We are making it as easy as possible for staff to get the flu shot by the Nov. 30 deadline.

The flu vaccination is available at Occupational and Environmental Medicine (OEM) locations in Yawkey Ambulatory Care Center 1 or the Doctors Office Building 2 on a daily basis from 7:30 a.m. to 4 p.m.

Flu shot clinics are being held for BMC employees, licensed independent practitioners (LIP) and BUMC personnel working for shared services located in BMC building lobbies on the following days: Wednesday, Nov. 14 – Menino Pavilion: 7 a.m.-8 pm.; Thursday, Nov. 15 – Moakley Building: 7 a.m.-noon; Thursday, Nov. 15 – Shapiro Center: 1-6 p.m. There are also mobile carts that can be brought to certain areas to make it as easy for staff to get vaccinated.

What do employees need to do if they got their flu shot somewhere else?
It is fine for staff to choose to get the flu vaccination elsewhere; we just need documentation that they received it. Those staff must provide documentation of the vaccination to OEM.

What are some common myths about the flu vaccine?
The first myth is that people believe they will get the flu from the influenza vaccination. It is important to know that the flu vaccine being administered is a killed vaccine. It is not a live vaccine. Although some discomfort may be felt afterward, people do not get flu from the vaccination. Occasionally people may have a low grade fever and some minor aches but this is not the flu and these side effects usually last 1-2 days at most. It does take about two weeks after the vaccination for antibodies to develop in the body and provide full protection, so during that time you are at risk for getting the flu or another virus.

The second myth is that you should not get the vaccination if you have an egg allergy. While there are those who have a true chicken egg allergy, the estimated number of employees who have this allergy and should not get the vaccine is about 10 people. There is also concern about a rare syndrome called Guillain-Barre,’ which affects a very small number of people, whether or not they receive the flu vaccination. If someone has had Guillain-Barre’ in the past, they would not be asked to get the vaccine.

Staff who are unable to get the vaccine will need to wear a mask during flu season. What does this mean and how will it work?
Studies have shown that wearing the mask provides protection and reduces the likelihood of individuals getting influenza. Added to other hygiene measures such as washing hands and covering a cough, wearing the mask has been demonstrated to reduce the likelihood of getting influenza by two-thirds in some studies. While the mask is protective, it is not as effective as the vaccination.

Our goal is to get as many people vaccinated as possible and close to 100 percent compliance, but when it is not medically appropriate for some employees to get the vaccination, it is our expectation that staff will wear the mask everywhere on BMC’s campus. We do this because you can’t know who has been exposed to the virus or has gotten it. For 24 hours, a person may be transmitting the virus and feeling entirely well before symptoms begin to appear. For this reason, we feel that having staff wear a mask during the flu season anywhere on the BMC campus is the most appropriate way for us to optimize our protection.

What would you say to a staff member who has concerns about getting the flu vaccine and feels they may want to decline the immunization?
Getting vaccinated is the right thing to do for our patients. We all need to understand that more people die from flu each year in the U.S. than from TB. We understand and accept that TB testing is part of what we should be doing to protect our patients, and the same goes for the flu. Also, if we can reduce the incidence of flu, we’ll dramatically improve our productivity by having staff at work, doing what they do best, and not sick at home.

The flu vaccine is widely endorsed by the CDC and from a public health point of view, receiving the vaccine is universally supported. We all need to be informed about the vaccine, and those with concerns should go to OEM to meet with clinicians to learn and better understand the true facts about it.

Last year BMC had a 74 percent compliance rate for the flu vaccination. Other hospitals in Boston were close to 100 percent and many above 90 percent. Hospitals that have successfully achieved this goal have used similar approaches to what we are employing. I look forward to working with all staff to achieve this very appropriate goal so that we can keep our patients, employees and families safe from a preventable illness.

Employee Flu Shot Clinics will be held in the lobbies:

• Wednesday, Nov. 14 – Menino Pavilion: 7 a.m.-8 p.m.
  
• Thursday, Nov. 15 – Moakley Building: 7 a.m.-noon
  
• Thursday, Nov. 15 – Shapiro Center: 1-6 p.m.

Drop-in flu shots will remain available at both OEM locations (Yawkey Ambulatory Care Center-1 and Doctors Office Building 2) daily from 7:30 a.m.-4 p.m.

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What Do You Do, Ricky Kue, MD, MPH?

Name: Ricky Kue, MD, MPH
Title: Attending Physician
Department: Emergency Medicine
Years at BMC: 3

Ricky Kue, MD, MPH

What brought you to BMC?
I wanted to work at a safety net hospital, which has as strong focus on serving the underprivileged community. I work at both BMC and at Boston Emergency Medical Services (EMS) as associate medical director.

What do you do here?
My day-to-day responsibilities can be quite interesting and variable. For about half of the week I’m working clinical shifts in the Menino Pavilion Emergency Department, treating patients or teaching residents and medical students. For the remainder of the week I am at Boston EMS, training paramedics or working with public safety agencies like the Boston Police Department and, on occasions, the Boston Fire Department on multidisciplinary EMS training.

You recently were deployed as part of Massachusetts Task Force 1 (MA-TF1) to help with Hurricane Sandy relief efforts. Can you tell us about your experience?
As the medical team manager, my main responsibility was to tend to the health care needs of team members, which included police, fire, EMS and civilian volunteers. During that week, I helped with search operations, monitored team members for illness and injury, and provided medical screenings to support the rescue missions. The goal was for our team to be self-sufficient so we wouldn’t need to use local resources, which was very busy dealing with disaster relief on a massive scale.

You’re originally from Queens, New York. What was it like to see your hometown in the aftermath the storm?
I was on the phone with my parents to see if they were okay as our convoy drove past my neighborhood. I lived in New York for 18 years and I’ve seen hurricanes growing up, but I never thought I’d see such devastation to my own borough. This was New York City’s Hurricane Katrina. Luckily, my family and childhood home were unharmed, but it was surreal to see an urban area so destroyed.

In addition to volunteering with MA-TF1, you’re also a Major in the US Army Reserve. Thank you for your service! Has that influenced your career in emergency medicine?
I joined because of the service aspect, but also knowing that I’d be adding to the pool of emergency medicine specialists that the military was trying to improve. When you’re overseas, civilians of foreign countries see hope when they see a military uniform and the American flag. There are so many facets of the service that help in a humanitarian way; it’s a mission in addition to taking care of soldiers doing the hard work. With 10 years of service behind me and 10 years to go, I don’t want to retire until they tell me I have to do it.

Do you know a staff member who should be profiled? Send your suggestions to communications@bmc.org.

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In Their Words

Patients share their BMC experience

Dear Dr. Lazar,

I recently came across your business card and wanted to update you on my mother, who was a patient of yours in 2001. She was 88 in the spring of 2001 when you performed her bypass surgery. At the time you deemed her a good candidate for the procedure despite her age. My mother went on to have a very good quality of life, living relatively independently until January 2011, when she became very frail and my sister and I moved her to a nursing home. She passed away this past May at the age of 99, when her health declined rather rapidly over a period of just a few days.

We believe that the surgery was the right choice adding many enjoyable years to her life. She was able to see her grandchildren marry and she became a great grandmother. Your recommendation to do the procedure and its successful outcome was a wonderful gift of life to her and to our family. Thank you.

Sharon, Mass.

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News of Note

Patients perform in musical concert
Six patients successfully treated by BMC’s Department of Neurology presented a musical concert recently on the Boston University Medical Campus. The concert, called “When Patients Heal You,” showcased selections ranging from classical to rock, and from jazz to Caribbean music. Each performer has overcome some type of neurological challenge. The concert was a unique collaboration among the Department of Neurology, the BU School of Medicine Office of Diversity and Multicultural Affairs, and the BU Medical Campus Arts Outreach Initiative.

Maryellen Schwartz, right, with Jane Liebschutz, MD, manager of the site

Employee wins Wellness Program website scavenger hunt
Maryellen Schwartz, Patient Access Services, recently won the Wellness Program website’s scavenger hunt. Schwartz correctly answered all questions and received an iPad2. In September BMC launched the website as a resource for staff. The site provides information on existing BMC programs and health and wellness resources, such as dealing with stress and burnout in the workplace, nutrition, sleep and spirituality. The site was developed in response to employees’ feedback on the 2011 staff survey.

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Awards and Accolades

Officer Buchanan received the William J. Flaherty Award from Officer Flaherty’s widow, Darlene

Public Safety Officer Peter Buchanan, a member of the BUMC Department of Public Safety since 2006, was selected as the recipient of the William J. Flaherty Distinguished Service Award. The department’s highest honor, the award was named in honor of the former officer who served the department for more than 13 years. “The award exemplifies Billy’s work ethic and honors and recognizes a staff member who exemplifies Bill’s commitment to public safety and public service,” said Connie Packard, BUMC Director of Public Safety.

BMC has been named to the 2012 Harvard Pilgrim Hospital Honor Roll. The Honor Roll recognizes hospitals whose performance was among the top 25 percent of those measured nationally on a set of composite clinical quality, patient experience and patient safety measures, as reported by CMS and the Leapfrog Group.