Pathway to Excellence
By Karen Baggerly, RN, Chief Nursing Officer
Formerly known as the “Nurse Friendly Program”, Pathway to Excellence is one way how we recognize the importance of nursing care
and our commitment to a positive working environment. To celebrate our commitment to the care given to patients and families, we
have submitted our notice of intent application for Pathway to Excellence in 2013!
At Covenant, we strive to make this the best place for you to practice medicine and the best place for patients to receive care.
Stat Notes
Non-Profit Org.
U.S. Postage
PAID
Permit No. 642
Lubbock, Texas
P.O. Box 1201
Lubbock, Texas 79408
We are pleased to share our journey of excellence with you and the 12 practice standards we value most as nurses caring for excellence:
1. Our nurses control the practice of nursing.
2. Our work environments are safe and healthy.
3. We have systems to address patient and practice concerns.
4. Our orientation prepares new nurses.
5. Our CNO is qualified and participative.
6. We have professional development.
7. Our wages and salaries are competitive.
8. Our nurses are recognized for achievements.
9. We encourage a balanced lifestyle.
10. We have collaborative interdisciplinary relationships.
11. Our Nurse Managers are competent and accountable.
12. We utilize evidence based quality practices.
A Publication for the Physicians of Covenant Health
www.covenanthealth.org
Thompson Named
Covenant Children’s
CMO
We know that our designation as a Pathway to Excellence ministry will symbolize our commitment to excellence as the hallmark of
recognizing quality nursing care. Over the next several months, you will receive updates on how we are fulfilling our promise through
the practice standards noted above.
We are most excited to recognize our nursing practice and our excellence in caring for our patients. Let’s let our action match our
passion!
Information Sophistication
By Larry Martinelli, M.D., Chief Medical Information Officer
Covenant Health and St. Joseph Health are well on the way to a
massive change in our approach to Information Technology and
our Clinical Information Systems. This is being called Information
Sophistication.
Most of you know that CH will be implementing Computerized
Physician Order Entry (CPOE) and electronic documentation this
fall, the EHR. What you may not know is that this implementation
will also include nursing and ancillary documentation, laboratory and
Radiology reporting and will impact our workflows and processes.
There are a large number of people from all areas of our System
involved in this project, however the time lines are aggressive and in
order to achieve our goals there is a huge amount of work to be done.
The second part of the three-part Information Sophistication
initiative includes centralizing all of CH and SJH storage into a single
data center from the several data centers that are currently being
used. There will also be a backup data center. This data centralization
will allow the third portion of Information Sophistication to occur;
the use of data-mining and advanced analytics to provide clinical and
operational insights to improve our patient care and patient safety.
The portion of Information Sophistication that will be most visible
to and have the most impact on physicians will be the EHR. We
need to be aware that the EHR is only one component of the overall
project. CH relies on a number of third party applications to support
our work. Almost all of them interact with Meditech in some way
and many of them will be upgraded or updated. Most of this will not
be apparent to us, but some of it will. As a result of this, almost all
of the CH staff will be training on and using new and/or upgraded
applications. Although the IT and CIS Departments will be providing
extensive training and support, we cannot expect an implementation
of this scope and magnitude to be without some difficulties. We must
anticipate that there will be some bumps along the road.
Please bear with us when we encounter unanticipated issues and
be assured that the IT and CIS Departments will be addressing any
problems as they arise to resolve them as quickly as possible.
If you have any questions about the Information Sophistication
initiative, please feel free to contact me at 806.725.0265.
Top 5 Hurdles Physicians Face in 2013
Reprinted from Becker’s Hospital Review
Physicians have faced many changes in their profession in 2012,
including the growing trend of employment, increased utilization
of electronic medical records and more responsibility as they take
the lead in care teams as the healthcare community strives to
become more coordinated. These changes, and their effects, will
carry over into the new year.
The Physicians Foundation identified five issues that will likely
have the largest impact on physicians in 2013, based on research
studies and policy papers. "We hope [the research] will help…
healthcare providers formulate smart policy decisions that are
beneficial to America's patients and doctors," said Walker Ray,
M.D., vice president of The Physicians Foundation and chair of
the research committee.
Here are the top five physician issues the foundation identified
and how hospitals and health systems can help.
1. Ongoing uncertainty over the Patient Protection and Affordable
Care Act. Even though the healthcare reform bill was upheld by
the Supreme Court in June, there are still questions about what the
implementation of the Act will look like. According to a Physicians
Foundation survey, uncertainty over the future of health reform
was one of the key factors making physicians pessimistic. Hospitals
and health systems should keep their physicians updated on
any developments they make in the areas of accountable care
organizations and reimbursement restructuring to help maintain
physician morale.
2. Consolidating. Many physicians have become employed
or expressed interest in becoming employed by hospitals or
health systems in 2012. However, according to The Physician
Foundation, physicians are concerned about patient access and
cost of care consequences affiliated with consolidation. Hospitals
and systems that employ physicians should be careful about the
legal ramifications that come along with their alignment strategy
and make sure physician alignment strategies are designed to
deliver the services and care most needed by the hospital's patient
population.
3. Preparing for 30 million new patients. In 2014, the PPACA will
give roughly 30 million Americans health insurance for the first
time, putting pressure on practicing physicians to provide care for
new patients. This addition of patients will also exacerbate the
nationwide physician shortage, which is especially pressing for
primary care. Hospitals and health systems can attempt to lessen
this impact by making sure they have enough care providers, even
non-physician providers, to handle the influx of patients that will
be coming in 12 months.
4. Losing autonomy. The Physician Foundation believes physicians
are losing their ability to make independent medical judgments
without non-clinical interference. To avoid this phenomenon,
hospitals and health systems can attempt to streamline processes,
promote physician leadership and involvement in hospital
committees, and allow physicians to treat patients as independently
as possible.
5. More administrative duties. Physicians have been facing more
"red tape" that cuts into their time treating patients, according to
The Physicians Foundation. In 2013, hospitals and health systems
can work to reduce the administrative duties put on physicians so
they can get back to what they are trained to do — treat patients.
It is with great pleasure that we announce that Dr. Amy
Thompson has graciously accepted the position of Chief
Medical Officer/Chief Quality Officer for Covenant Children’s Hospital. Dr. Thompson has proven to be a sensational leader and has very effectively built the pediatrics
hospitalist program.
Dr. Thompson is a true champion for patient and familycentered care and her passion for excellence is contagious.
We are delighted that Dr. Thompson will begin her new
role in March 2013. Please join us in welcoming Dr.
Thompson to the Covenant Children’s team.
Respiratory Care, Laboratory
Receive CAP Accreditation
Covenant Medical Center Respiratory Care Services Laboratory,
based on results of a recent on-site inspection as part of the CAP's
Accreditation Programs. The facility's director, Rodney A. Wertz,
M.D., was advised of this national recognition and congratulated
for the excellence of the services being provided. Covenant
Medical Center Respiratory Care Services Laboratory is one of
more than 7,000 CAP-accredited facilities worldwide. The U.S.
federal government recognizes the CAP Laboratory Accreditation
Program, begun in the early 1960s, as being equal-to or morestringent-than the government's own inspection program. During
the CAP accreditation process, designed to ensure the highest
standard of care for all laboratory patients, inspectors examine
the laboratory's records and quality control of procedures for the
preceding two years. CAP inspectors also examine laboratory staff
qualifications, equipment, facilities, safety program and record, and
overall management.
February 2013
Responding to Physicians’ Requests
to Improve Lab Service
At the January 2013 Urology Section meeting, physicians asked
Covenant Administration to improve the turnaround time on
microbiology resulting because the 48+ hour delay was impacting
patient care and length of stay. Tina Anderson, Lab Director,
researched the request and is happy to announce the following
change.
• Covenant Lab is changing its current process of only releasing
susceptibilities during the day shift to effective immediately,
susceptibilities on urine cultures will be released on BOTH the
day and night shift Sunday through Thursday.
• A Medical Technologist will be hired on the night shift to process
specimens for all cultures and release all susceptibilities that are
ready at night (hiring process in place)
Special thank you to the Dr. Mahal and the Urology Section for
submitting this request. If you have any suggestions on how we
can provide excellent service to you and your patients, please let
us know. Please contact the following senior leaders for assistance
or suggestions:
Suggestions for LAB, RADIOLOGY, SURGICAL SERVICES:
Walt Cathey, VP Operations wcathey@covhs.org 725.5627
Suggestions for NURSING: Karen Baggerly, Chief Nursing
Officer kbagger@covhs.org 725.0533
Suggestions for PATIENT EXPERIENCE: Chris Shaver, VP of
Patient Experience cshaver@covhs.org 725.4322
Suggestions for Meditech, CPOE: Felicia Gordon, VP of
Performance Improvement fgordon@covhs.org 725.4346
Suggestions for CMO: Craig Rhyne, M.D., Chief Medical Officer
crhyne@covhs.org 725.3118
Suggestions for COO: Troy Thibodeaux, Chief Operations
Officer tthibodeaux@covhs.org 725.0536
Suggestions for Covenant Children’s CEO: Chris Dougherty,
Women’s & Children’s CEO cdoughertyc1@covhs.org
725.7960
Suggestions for CEO: Richard Parks, President/CEO Covenant
Health Richard.parks@covhs.org 725.0447
Covenant Health CME Update
Upcoming CME Opportunities
To learn more or register for these upcoming CME
activities, visit https://cmetracker.net/CHS/, or contact
Covenant Health System Continuing Medical Education
at 806.725.3105, cme@covhs.org.
TeamSTEPPS® – Multiple times offered at Knipling
Saturday, February 9, 2013 @ 7:30am
Friday, February 22, 2013 @ 12:30pm
Thursday, February 28, 2013 @ 7:30am
Thursday, March 7, 2013 @ 12:30pm
Advances in Stem Cell Research
Thursday, January 24 - CANCELLED
Reschedule Date: TBA
Neurology & Epilepsy Grand Rounds
Thursday, February 21, 2013 from 12:00pm to 1:00pm
Thursday, March 21, 2013 from 12:00pm to 1:00pm
Knipling Education Conference Center
Reason for Admisson
Document the patient’s “reason for admission”. If the patient’s
“reason for admission” is a symptom, document the cause, possible
cause or differential diagnosis. Document every condition that
is impacting the patient’s stay, including chronic conditions.
Document the “clinical significance” of every abnormal test result
in the progress notes.
Coders can only take diagnosis from treating physicians.
Radiologists, pathologists and cardiologists who only read the
tests are not treating physicians. The results of CT, MRI, ECHO
or pathology have to be written in the progress notes for it to be
coded. Interventional radiologists and interventional cardiologists
are considered treating physicians.
The physician documents the clinical significance of every abnormal
test in the progress notes, by way of a diagnosis, without using
symbols. For example, the clinical significance of sodium of 128
is documented as: “hyponatremia” if the patient is hyponatremic.
If you have questions on documentation, call Jacque Smith at
725.0676.
Patient Praise
Printed with permission from our patients to celebrate the
excellent care given by our physicians.
“I want to recognize J. Nathan Wilson, M.D., and Hal Green,
M.D., for their care and service.” – submitted by a patient on 1
South Orthopedics
“The anesthesiologist, Robin Minielly, M.D., was very
compassionate & caring. He explained everything very calmly &
helped me to be informed and not be as nervous. He was very
friendly & took wonderful pictures to help us remember this
special event.'' – submitted by a patient on Labor & Delivery
“Dr. Jennifer Owen and Dr. Cindy Brown are absolutely amazing
physicians.” - submitted by a patient on Labor & Delivery
“I absolutely love & appreciate my doctor/surgeon, Michelle
Sahinler, M.D.. She has taken extremely excellent personal care
of me, including the day of surgery & following.” - submitted by a
patient on Labor & Delivery
Friday, March 1, 2013
Lubbock Memorial Civic Center
11:00 a.m. – 1:30 p.m.
$10.00 per ticket
Sponsorships available
River Smith’s Catering
Klemke’s Sausage Links $2.00
“My physicians Dr. James Kirk and Dr. Cynthia Dunn were
wonderful to me and provided excellent care. Dr. Stephen Holmes,
my anesthesiologist, also provided me with excellent care during
my surgery. I appreciate all that Covenant does to ensure, a safe
and caring environment for patients. I commend the hospital and
staff for a job well done!” – submitted by a patient on South 4
cardiac telemetry
“Dr. Robert Ordonez and Dr. Fawwaz Shoukfeh were great!” –
submitted by a patient on South8
Contact 806.725.6020 for additional information
or to get your tickets today!
“Dr. Tapan Nath was a very intelligent, kind and helpful hospital
physician! His coordination of reports, soft voice and touch were
comforting. He reported what was happening; the efforts made
to get pancreatitis under control, get enzymes back to normal &
alleviate my intense pain.” – submitted by a patient on South 9
“I would like to recognize Dr. Muhammed Ali and Dr. Curtis
Carothers for their service and care.” – submitted by a patient on
Short Stay
Listening & Responding
On the 2012 Covenant Physician Survey conducted by PRC (Professional Research Corporation), there was an open-ended question that
asked physicians to submit any comments or questions to Richard Parks. We will be featuring the questions and responses in future issues
of MedStat Notes. The following are the Nursing-related questions and responses from Karen Baggerly, Chief Nursing Officer. If you have
questions or comments, please contact Karen at kbaggerly@covhs.org or 725.0533.
Response to Physician 2012 PRC Questions
Nursing Services improved
considerably over last year.
Nurses are overworked
and understaffed.
Acknowledged positive feedback with article in December STAT
Notes.
Individual nursing unit “nurse to patient ratios” are
monitored closely for appropriateness and patient safety.
New unit benchmarks were established last fall and staffing
grids were revised to assist in maintaining adequate coverage
on all shifts. The Staffing Operations Office (SOO) reviews
staffing needs every four hours, working diligently to obtain
additional staff as needed or requested. A new program,
Lifesavers, was instituted in the med/surg areas in December
to encourage licensed staff to float to units needing assistance.
As of January 2013, only 33 fulltime positions are vacant
for licensed nursing staff, with 42 new nurses beginning
orientation this month.
Work on hiring nurses
who love their jobs.
Each nursing unit has established a unit goal related to reduction
of annual turnover of nursing staff. Tactics associated with these
goals include increased focus and awareness of the impact of
appropriate hiring on retention, as well as the importance of peer
interviewing. Nursing leadership is in the process of performing
high-middle-low assessment of all staff—behavior and attitude are
important attributes in this assessment.
Witnessed ER Head Nurse disrespect
hearing impaired patient and
believes quality of ER care will
decrease in October.
Newly appointed AED Nurse Manager, Vicente Martinez, has been
named since this comment was submitted. Dr. Skelton, Medical
Director, and Tammy Jones, Nursing Director, are working closely
together to address concerns as they arise and monitor quality of
care. No significant decreases in quality have been demonstrated
these past few months and monitoring remains in place.
Need more nursing attention.
In November, Covenant Health submitted an application for
Nursing Pathway to Excellence designation. This program focuses
on providing a supportive and healthy workplace environment
for nursing, with emphasis on a shared governance structure
for decision-making, interdisciplinary relationship building, and
acknowledging the contributions of nursing in quality and patient
satisfaction outcomes.
Nursing care, all they need to do with
government mandates.
Nursing leadership and staff work closely with the Standards
department to address compliance issues while minimizing
additional work for direct care providers. We will continue to do
so, soliciting input from nursing staff as processes change.
Q&As on EMR from Physician Survey
For Meditech or EMR questions, please contact Felicia
Gordon, Vice President, at fgordon@covhs.org or call
725.4346.
Need Integrated Electronic Medical Records; Upgrade the
Electronic Medical Record System
Covenant Health is currently in the process of designing
and implementing an Electronic Health Record. This is
scheduled to "go live" at all of our Texas Region Ministries
this Fall. We have a tremendous amount of work and
training to do in the interim. This will be an integrated EHR,
replacing not only our current paper charts, but also allowing
for Computerized Provider Order Entry (CPOE) . We have
introduced the Meditech Mobile Rounding Application as a
prelude to the full EHR implementation. This App provides
some useful functionality now for those who would like to
take advantage of its capabilities now.
Simplify Use of Electronic Medical Records
During the design of the Meditech EHR, the teams are
working diligently to make our EHR as "user-friendly" as
possible. The version of the EHR that has been implemented
in our Regional Emergency Departments has been wellreceived and we are working to improve on this beginning
as we move toward our full EHR roll out this fall.
Get Rid of Meditech
Prior to finalizing plans for the Fall rollout of the EHR, an
examination was undertaken to consider replacing Meditech
with an alternative. When this process was complete the
decision was made to stay with Meditech for a number
of reasons, including time to implementation, changes to
established workflows and processes, cost and the finding
that the "perfect" EHR does not exist.
2012 PRC Physician Survey— Adult Medical Staff
Open-Ended Comments—Nov. 7, 2012
Q 84. And finally, do you have any comments, suggestions, or is there anything else you would like the CEO, Richard Parks, or
Chief of Staff, Dr. Mike Danchak, to know?
GREEN= Positives;
YELLOW= Neutral
RED= Concern/Something to address
RICHARD PARKS (725.0567)& DR. DANCHAK
Keep up the Good Work-X4
Richard Parks is Doing a Good Job—X3
Overall Hospital has Improved Over Last Couple of Years
The CEO has Been Refreshing and Engaging
Senior Administration is Great Improvement From Past
Maintain Great Level of Communication
Very Happy With Current Administration
Administration is Going in the Right Direction
Positive Change in Admin Over the Last Couple of Years
Transparency and Communication is Markedly Improved
Continue Effort to Include Physicians and Their Input
Current Administration has Been the Best in My Career
You did a Good Job
Thinks new Administration in Making an all out Effort
Covenant Delivers Excellent Care
Administration is Very Good on the way to Excellent
Better Health Care
NICU is First Class, Doing Great Things
Admin Interaction is Much Better Than Previous Admin
Do the Best and Hope for the Best
Continue Openness and Involving Phys in Decision Making
I Would Like to Meet the CEO—X2
Must Include Phys in Decision Making or Hosp Will Fail
Need More Communication With the Physicians—X2
To Succeed Covenant Needs to Partner With Physicians
Continue to get Better so We are the Best
Pleased W/ Cleaning up Hosp, not With Closing Units
Give Opportunity for Staff to Express Concerns
Effort to Include the Staff but it Still Falls Short
Need more socials/networking to know people
Need pediatric surgery
Continue to pursue corporate physicals
New CEO Look Into Past Before Making Changes
Make More Rounds Around the Hospital—X3
Worry More Money Than They do Patient Care—X2
Need to Treat Physicians Equally and Fairly
They Have no Accountability to Problems
Not in Touch With the Medical Staff
Improve Communication With Phys Prior to Policy Changes
Focus More on Adequate Staffing
Community Plastic Surgeons Feel Lied To
Emphasis Appears to be Budget at Cost of Patient Safety
Improve Technology Infrastructure
Rather Than Paying Lip Service to Phys, do Something
Never Communicate Directly, No Access to Talk to Them
Hospital is Falling Behind Compared to Other Hospitals
Be More Involved in Daily Work of the Staff
Complaints get to CEO He Should Handle Them Personally
Don’t Feel Included in Decision Making
The Administration and Management Staff Diversify
CEO be More Available Locally for Physicians Concerns
Administration is Poorly Responsive to Medical Staff
At Times the Admin Think We Compete With Covenant
Covenant Health is at the Worst it has Ever Been
Sorted by Leader based on comment
WALT CATHEY (725.9290)
Dr. T in Pathology is Especially Great for Biopsies
Address Nursing Shortage and Staff Shortage in the OR
Need a Nicer Rehab Unit
Anesthesia Leadership has Integrity Issues
Nighthawk Radiology is Awful
Lack of Communication From Night Hawk
Need to Establish Definite Start Time in OR
Need Better Organization in the OR
After Hours Radiology Needs to Improve on Timeliness
Admin Give Feedback to Surgeons in OR Issues
Delays in Getting Results Back in Radiology
Viewing X-Rays is a Problem Within Medical Records
CRAIG RHYNE, M.D. (725.3118)
ER Physicians Evaluation of Patients Need Improved
Put in Meaningful Quality Assurance
Patient Safety is Excessive
KAREN BAGGERY (725.0533)
Nursing Services Improved Considerably Over Last Year
Work on Hiring Nurses Who Love Their Jobs
Witnessed ER Head Nurse Disrespect Hearing Impaired Pt
Believes Quality of the ER Will Decrease in October
Need More Nursing Attention
Nursing Care, all They Need to do W/Government Mandates
Nurses are Overworked and Understaffed
STEVE MCCAMY—CMG (725.0538)
Need Better Communication Btw Hospitalists/Private Phys—x2
More Hospitalists Needed Late Afternoon/Evening Hours
Soon as Hospitalist go on Salary They Won’t Take Our Pt—
More Hospitalists Needed Late Afternoon/Evening Hours
FELICIA GORDON (725.4346)
Need Integrated Electronic Medical Records—X3
Simplify Use of Electronic Medical Records
They Won’t let Me use the Hospitalists
Medical Records Needs to Assign Charts to Correct Phys
Get Rid of Meditech
Upgrade the Electronic Medical Record System
ROXIE TAYLOR (725.7932)
Integrate Psychiatric Services Into the Main Hospital
Takes a Week to get Back in for a Mammogram