Exceptional Experiences at Community Health Network

Community Health Network will be recognized at the 11th Annual Institute for Safe Medication Practices (ISMP) Cheers Awards dinner and reception as a recipient of the ISMP Medication Safety Alert! Subscriber Award.

According to the ISMP Web site, the Cheers Awards honor individuals, organizations, and companies that have set a superlative standard of excellence for others to follow in the prevention of medication errors and adverse drug events.

The Subscriber Award recognizes Community’s sustained initiative to integrate medication safety practices based on the recommendations and action agendas from the ISMP Medication Safety Alert!® newsletter. “This award is national recognition that we are continually trying to improve our safety,” said Dan Degnan, interim vice president of pharmacy and medication safety officer at Community Health Network.

The pharmacy leadership team at Community reviews the recommendations provided in the ISMP Medication Safety Alert!® newsletter on a quarterly basis to identify ways to improve medication safety. “We are often pleased to find that the recommendations are practices we already have in place at Community,” said Degnan. “We have also been able to adopt some of the recommendations as new practices at our organization, or modify them to best meet our needs.”

Community is the only Indiana health care network to be recognized at the 2008 Cheers Awards, and one of two health care organizations selected for the Subscriber Award from a national pool of nominations. The Cheers Awards will be presented on December 9 in Orlando, FL.

The Indiana State Department of Health (ISDH) is investigating increased pertussis activity in District 5.  Letters have been sent home with students in schools in Hamilton and Shelby counties to describe the symptoms of pertussis, when to see a health care provider, and the importance of vaccination.  Health care providers are encouraged to consider a diagnosis of pertussis in patients with cough illness.

Pertussis Clinical Case Definition

A cough illness lasting at least 2 weeks with one of the following: paroxysmal cough, inspiratory whoop, or post-tussive vomiting, without other apparent cause.  Symptoms typically begin 7-10 days following exposure. Pertussis occurs in three stages: First, an individual may experience cold-like symptoms, including a runny nose or sneezing. A mild, occasional cough may develop as well. During the second stage, the cough becomes more severe with bursts of coughing that may cause difficulty catching ones breath (resulting in a whoop sound) or vomiting following coughing. The second stage can last as long as 10 weeks. Finally, the cough begins to resolve and become less persistent during the third stage.

Laboratory Testing

Please order appropriate testing in suspect pertussis cases (i.e. those meeting the clinical case definition for pertussis or those with a coughing illness of any duration with exposure to a pertussis case). Appropriate testing includes culture and/or PCR. Note that the ISDH has DFA/culture kits available for use in testing suspected cases; kits can be obtained by following the contact instructions in the document linked below. PCR testing is also acceptable if available from another laboratory. The ISDH discourages clinicians from using serologic tests for diagnosis of pertussis as commercial tests available have not been validated.

Antibiotic Therapy

If you suspect a pertussis case, do not wait for laboratory confirmation to initiate antibiotic therapy. Prophylactic antibiotic therapy should also be prescribed for all household contacts regardless of whether or not they are symptomatic and regardless of immunization status. For a chart depicting appropriate antibiotic therapy for both cases and contacts, visit http://www.in.gov/isdh/files/RecommendedPertussisControlMeasures2006(1).pdf Note that antibiotics will shorten the infectious period of pertussis, but they will not shorten the duration of symptoms unless provided very early in the course of illness.

Control Measures

Suspect cases should be excluded from work or school through 5 days on an appropriate antibiotic. If a suspect case is not treated, the case should be excluded through 21 days after cough onset.  Symptomatic contacts should be excluded from work or school through 5 days on an appropriate antibiotic. Symptomatic contacts that are not treated should be excluded through 21 days after cough onset. Asymptomatic contacts should be placed on antibiotics, but they may immediately return to work or school. One exception: inadequately immunized household contacts under the age of 7 should be excluded through 5 days on antibiotics per the Indiana Communicable Disease Rule.  Assess the vaccination status of patients. Children under age 7 are eligible for the DTaP vaccine, and persons ages 10 through 64 are eligible for the one-time Tdap pertussis booster vaccine. Vaccination following exposure will not prevent illness; however, it will help to protect against future exposures. Note that individuals who have been fully vaccinated against pertussis can still develop the illness, but it tends to be milder than in unvaccinated individuals.

Our next Pediatric Grand Rounds speaker is David Patterson MD, with Academy Allergy Asthma&Sinus.  David is an allergy and immunology specialist, who sees both children and adults with varied allergic and immunologic problems.  David will be providing a lecture titled “Asthma and Allergy Q&A”.  We have gathered a list of questions from local physicians and presented those to Dr Patterson, and he is preparing answers to those questions.  This should be an informative session.

These sessions are provided monthly and are eligible for CME.  We provide these offerings on the 1st Wednesday of each month at 7:30 a.m., in the multi-service conference rooms on the 3rd floor of the professional building.  Breakfast refreshments will be served.

If you have any questions about this, you can contact Dr. Robert Lindeman at Community North’s pediatric unit at 317-621-5474.

In case you were wondering why my posting had dropped off, I was getting ready for the 12th Annual Healthcare Internet Conference and my vacation I’m taking after it.

The first day of the conference Community Health Network won the Greystone.Net Best In Class Innovator’s Award.  I was very surprised that we won this award.  In the past we have received the redesign and clinical content integration awards which we unfortunately didn’t win this year.  When you’re working on these projects from day to day, it can be hard to step back and see the innovation involved.

Community Health Network won based on our new mobile site, new find a physician application and the myCommunity card program.

Here is the text that was submitted:

We recently created a mobile site for eCommunity.com at http://mobile.ecommunity.com. The mobile site includes content and several applications that were redesigned for usability on a mobile interface, including Find a Doctor, Online Prescription Refill, Pregnancy Text Messaging program sign-up, health library, medication guide and facility contact information. Redesign considerations included the length of content pages to avoid scrolling and constraint of content to a narrow screen size. Small images were used sparingly to assist with page layout and download. Applications were also redesigned to require few date entry fields.

Our most important consideration was (and is) “Does this content make sense in a mobile format?” For example, the mobile site could house the full-featured version of our Find a Doctor application, including the ability to compare physicians and request appointments, but we realized that a patient would likely not be doing that on a mobile phone. Instead, a patient is probably more apt to need to look up a doctor’s phone number, location, office hours, and so on. Moving forward, we will continue to keep users in mind during evaluation of the usefulness and presentation of various content types on our mobile site.

We created a new version of our Find a Doctor application. This application is an excellent marketing tool for physicians and health care organizations. Our application provides a service to patients and physicians by offering various search options, physician comparisons, and search engine optimization along with a Google maps mash-up.

myCommunity cards were issued to all current myCommunity members earlier this year and are issued to all new members from now on.  The card entitles the member to receive discounts at area retailers and will be used to identify myCommunity members who use it for express check-in at select locations within the network. The card also facilitates linking between patient data in the EMR and personal health record data (patient-created) to minimize the repeated completion of forms collected by various network entities.

http://mobile.ecommunity.com

http://www.ecommunity.com/physicians/

http://www.ecommunity.com/card/

What does it mean when someone says they have the “flu”? This usually means they have a “cold” or upper respiratory infection with runny nose, cough, and maybe a low-grade fever. Sometimes people say they have the “stomach flu”, and this usually means that they have an intestinal virus causing nausea and/or diarrhea. However, to healthcare workers, “flu” refers to illness caused by one of two specific viruses – Influenza A or Influenza B.

Influenza A and B viruses cause widespread infections called epidemics each fall and winter in the United States. 5-20% of people will get the flu each year (as many as one in five) – more than 200,000 people each year. Unfortunately, there is as many as 36,000 who die each year, including thousands of children. The elderly, children, and many with chronic health conditions such as asthma, diabetes, and heart disease, are at particular risk of serious complications. The tragedy is that most of these deaths can easily be prevented.

Symptoms of the flu are many and can include high fever, headache, sore throat, extreme tiredness, runny nose, dry cough, muscle aches, and sometimes vomiting and diarrhea. Complications can include pneumonia, sinusitis, ear infections, dehydration and worsening of the chronic conditions mentioned above.

You can get the flu by touching something infected by another’s cough or sneeze, and then touching your nose or mouth. It’s possible to spread the flu up to one day before you even feel sick yourself!

You can easily dramatically reduce your chances of getting this deadly disease by getting a flu shot (or the inhaled version called FluMist). The flu shot is approved for almost anyone over 6 months of age, and is recommended for healthy people as well as those with chronic medical conditions. There are only a few people who should not receive the flu shot – Be sure to ask your primary care provider if it’s OK for you to get a flu shot. (The shot form is even OK during pregnancy!)

Don’t let it be open season on you! Wash your hands frequently, cover your sneeze and cough, and ask your primary care provider about a flu vaccine! Flu vaccinations are available now, but can be very helpful as late as December and January. Don’t wait to protect yourself!

John W. Fleming, PhD, MD, FAAFP
Assistant Director