Caring November 17, 2005 - Massachusetts General …November 17, 2005 HEADLINES Working together to...

Inside:Celebrating Physical Therapy

Month .................................. 11111

Jeanette Ives Erickson ............ 22222Strategic Planning Retreat

Fielding the Issues .................. 33333Universal Protocol

Ballantine Award ..................... 77777

Clinical Narrative .................... 88888Denise Montalto, PT

Another Perspective ............ 1010101010Linda Bracey, RN

Clinical Nurse Specialists .... 1212121212Kathryn Beauchamp, RN

and Lois Parkier, RPh

Hand Hygiene ...................... 1313131313

Food & Nutrition Services .... 1414141414

Educational Offerings ........... 1515151515

Reading Disabilities ............. 1616161616

CaringCaringNovember 17, 2005

H E A D L I N E S

Working toMGH P

PT Month 2005“Your health, our hands”

(see page 4)

Senior physical therapist, Paula Downes Vogel, PT,works with patient, Barbara Lee, on the stationary bike

in the Physical Therapy gym

gether to shape the futureatient Care Services

November 17, 2005November 17, 2005Jeanette Ives EricksonJeanette Ives Erickson

Jeanette Ives Erickson, RN, MSsenior vice president for Patient

Care and chief nurse

Patient Care ServicesStrategic Planning Retreat

(Part I)ver the years,the Patient CareServices Lead-

ership Team hasheld many valuable

strategic planning ses-sions. I think I speak forthe entire team when Isay that the strategicplanning retreat we heldlast month was one of themost comprehensive,productive, and inform-ing planning sessionswe’ve ever had.

Preparations for theretreat began monthsbeforehand when I gavemembers of my leader-ship team a series of as-signments and pre-retreatexercises to help lay thefoundation for our work.I wanted us to be able to‘hit the ground running’when we finally cametogether at the retreat.

The first exercisecame in the form of abook report. Drawingfrom my own library, Iassigned each member ofthe team a book to readand summarize, and thenshare with the group. Iwanted us to have a com-mon understanding ofsome of the themes andideas discussed in thesebooks. Some of the titlesincluded:

Managing the Unex-pected, by Weick andSutcliffeLeadership withoutEasy Answers, byHeifetz

O The Genius of SittingBull, by Murphy andSnellFYI: For Your Im-provement, by Lom-bardo and EichingerCreativity, Inc., Build-ing an Inventive Or-ganization, by Mauzyand HarrimanEach book generated

discussion and debate.Each book gave us a lit-tle more grist for the ideamill. And each book help-ed us ask provocativequestions about our ownorganization, our ownleadership, our own fu-ture vision.

The next pre-retreatexercise was a survey Iconstructed to help set atone and direction. I ask-ed each member of theteam to answer thesequestions honestly:

What is the one thingyou are most proud of?What’s the one thingyou wish you had done?What one thing do youworry about?What one thing do youwant to learn moreabout?What one thing do youplan to accomplish inthe future?When they write thehistory of the last nineyears of Patient CareServices, how will webe remembered?If you could changeone thing within Pa-tient Care Services in

the next ten years,what would it be?If you could make sureone thing in PatientCare Services didn’tchange in the next tenyears, what would itbe?This was a valuable

exercise and really help-ed us hone in on what’simportant to us as anorganization.

Another exercise tohelp prepare for the re-treat was a solicitation oforiginal thoughts andideas related to specifictopics. For instance, Iasked each team memberto identify ‘worthy aims’and enumerate specificaction steps to help ac-complish those aims. Iasked them to identifyworthy aims in the fol-lowing categories:

Evidence-based clini-cal practice and profes-sional developmentEvidence-based ad-ministrative practiceand support of admini-strative practicePerformance-improve-mentCustomer service andpatient satisfactionHealthy work environ-ments; creating a cul-ture of quality andsafetyCommunity outreachCultural competenceCommunicationReward and recogni-tion

Many excellent ideassurfaced from this exer-cise. And it became clearearly on that a lack ofcreativity and innovativethinking was not going tobe a problem.

It also became clearthat with so much goingon, with so many com-peting priorities, this wasnot going to be a retreatthat would easily yield aset of clear-cut strategicgoals. This was going tobe the beginning of aprocess where membersof the PCS leadershipteam could share ideas,inform one another aboutissues and concerns af-fecting their disciplines,and brainstorm abouthow to prioritize the im-portant work ahead.

As you can see, a lotof time and energy wasspent before the retreateven began. When wedid come together for theintensive, two-day, plan-ning retreat, I invitedselect members of theteam to provide over-views of some key areas,to further inform ourwork.

George Reardon, dir-ector of Systems Im-provement, gave us anupdate on the status ofour physical environ-ment, building logistics,and the challenges creat-ed by limited space avail-ability, judicious use ofcapital spending, acces-sibility, and the need toremain technologicallycompetitive.

Joan Fitzmaurice,director of the Office ofQuality & Safety, re-viewed a number of safe-ty campaigns and initia-tives currently under way,and shared informationabout some national qua-lity indicators includingthe national voluntaryConsensus Standards forNurse-Sensitive Care.

Associate chief nursefor The Knight NursingCenter for Clinical &Professional Develop-ment, Trish Gibbons, re-visited the Staff Percep-tions of the ProfessionalPractice EnvironmentSurvey, noting that therewas an excellent response

continued on next page

Call For AbstractsNursing Research Day

May 10, 2006

Submit your abstract to display a poster onNursing Research Day 2006

Categories:Encore Posters (posters presented atconferences since May, 2005)Original ResearchResearch UtilizationPerformance Improvement*

* Two new conditions for acceptance ofPerformance Improvement abstracts:

Key personnel have been certified in theProtection of Human Subjects.(http://www.citiprogram.org/default.asp)Project has been reviewed and approvedor excluded by the Partners HumanResearch Committee (HRC). For moreinformation about the HRC review, con-tact your clinical nurse specialist; Cath-erine Griffith, RN, co-chair of the Nurs-ing Research Committee; Virginia Ca-passo, RN, coach; or Kathleen Walsh,RN, (pager: 3-1792)

For more information, or to submit anabstract, visit the Nursing Research

Committee website at:www.mghnursingresearchcommittee.org

Abstract deadline is March 1, 2006

Jeanette Ives Ericksoncontinued from previous page

rate with the majority ofstaff reporting a highlevel of satisfaction withthe work environment.Three areas identified asrequiring more attentionwere: conflict manage-ment; cultural sensitivity;and the ‘non-stop’ paceand demand of the day-to-day work load.

Sally Millar, directorof the Office of PatientAdvocacy and Joan Fitz-maurice shared data andfeedback related to pa-tient- and staff-satisfac-tion. Feedback receivedby the Office of PatientAdvocacy grouped con-cerns into four broadcategories: clinical care,interpersonal relation-ships or communication,operations, and finances.

Sally noted that opera-tional concerns usuallyrevolved around commu-nication issues or havingto wait longer than ex-pected for procedures orappointments. Joan shar-ed data from our patient-satisfaction survey andcompared MGH resultswith national averages.

Steve Taranto, mana-ger, for PCS Human Re-sources, and Chris Graf,director of PCS Manage-ment Systems, gave anoverview of vacancyrates throughout PatientCare Services and spokeabout staff participationin the PCS Clinical Re-cognition Program.

Armed with all thisinformation and chargedwith sorting out prioritiesfor the future of Patient

Care Services, our workwas just beginning.

I will continue thisaccount of our most re-cent strategic planningretreat in the next issueof Caring Headlines. Butknow that your mana-gers, associate chiefs,and directors are workinghard and diligently onbehalf of our patients andstaff. There will be manyopportunities for staff tobe involved in these ef-forts, and I look forwardto working with you asour strategic plan un-folds. Once again, I’mfilled with pride by thespirit of unity and team-work that permeates thisorganization.

UpdateI’m pleased to announcethat Janet Mulligan, RN,has accepted the nursemanager position for theIV Nursing Team.

November 17, 2005November 17, 2005Fielding the IssuesFielding the IssuesUniversal Protocol: a JCAHONational Patient Safety Goal

Question:What is theUniversal Protocol Pol-icy:

Jeanette: The UniversalProtocol is a NationalPatient Safety Standardissued by the Joint Com-mission on Accreditationof Healthcare Organiza-tions (JCAHO) that statesthat prior to any invasiveprocedure or surgery, allpatients will have a ‘timeout’ during which clini-cians verify that the cor-rect patient is undergoingthe correct procedure on

the correct proceduralsite.

Question: What proced-ures fall under the Uni-versal Protocol?

Jeanette: All proceduresthat expose patients tomore than minimal risk(including proceduresperformed in settingsother than the operatingroom). Some examplesinclude: peritoneal taps,lumbar punctures, chest-tube insertions, and arter-ial-line placement.

Procedures not in-cluded under the Univer-sal Protocol would beprocedures such as: veni-puncture, peripheral lineplacements, PICC lines,and the insertion of NGtubes and Foley catheters.

Question:Where is theUniversal Protocol appli-cable and who shouldconduct the ‘time out?’

Jeanette: The UniversalProtocol is used in opera-ting rooms, proceduralsuites, the Emergency

Department, ambulatoryclinics and some inpa-tient units. The physicianor nurse performing theprocedure should con-duct the time-out.

Question: What happensin the case of a patient-care emergency?

Jeanette: In the eventthat a patient is in anemergent cardiac/respira-tory-arrest situation, theintent of this protocol isfor caregivers to meet theminimum expected re-quirements for patientidentification and verifi-cation of the procedure tobe performed (the pa-tient’s name is John

Smith and a central-lineplacement is going to beperformed).

Question: Is there a spe-cific form to be used forthe Universal Protocoland is there a writtenpolicy?

Jeanette: Yes, the Uni-versal Protocol form canbe ordered from StandardRegister (order #84530).The policy can be foundin the Clinical Policy &Procedure Manual underUniversal Protocol.

For more informationabout the Universal Pro-tocol, please contact theOffice of Quality & Safe-ty at 6-9282.

November 17, 2005November 17, 2005

uring the monthof October everyyear, the physi-

cal therapy profes-sion is celebrated in hos-pitals and communitiesacross the country. As

part of the PT Monthcelebration, the MGHPhysical Therapy Depart-ment highlighted its com-mitment to patients andthe profession with anumber of educational

presentations, the annualMarjorie K. Ionta Lec-ture, a special communi-ty-service project, and itsannual recognition lunch-eon. The theme of thisyear’s national celebra-

tion was, “Your

health, our hands.”On October 19, 2005,

the department offered apresentation focusing ondeveloping, implement-ing, and ‘staying with’ asafe exercise program.The presentation high-lighted the unique con-tributions of physicaltherapists through thecomprehensive evalua-tion of a patient’s physi-

Physical TherapyPhysical TherapyMGH celebrates Physical

Therapy Month—by Tracy Daigle, PT, physical therapist

Dcal condition and devel-oping an individualizedexercise program.

Physical therapistsgave presentations at theMGH health centers andat MGH West. On Octo-ber 20th at the ChelseaHealthCare Center, pos-ture screenings were pro-vided to health centerstaff. On October 24th, a

continued on page 6

Above left:Above left:Above left:Above left:Above left: physical therapy clinical

specialist, Diane Plante, PT, is one of

several featured speakers at this year’s

Marjorie K. Ionta Lecture.

Above:Above:Above:Above:Above: senior physical therapist,

Morgan Cole, PT, updates the progress of

the PT-OT community-service, fund-raising

competition on the Hopkinton-to-Boston

marathon board, created to monitor

pledges acrued by sponsors.

At left:At left:At left:At left:At left: physical therapist, Kate Adeletti, PT,

and colleagues, staff educational booth in

the Main Corridor to help raise awareness

about exercise-related injuries and

physical therapy treatments.


Physical therapist, Badia Eskandar, PT,works with patient, William Anastas, at the bedside

on the Ellison 6 Orthopaedic Unit


demonstration of work-station ergonomics washeld in Revere. And onOctober 31st, physicaltherapists in Walthamhosted a forum for staffto discuss exercise andergonomics.

The 23rd annual Mar-jorie K. Ionta Lecturewas held on September27th. The Ionta Lectureis jointly sponsored bythe MGH Physical Ther-apy Department and thePhysical Therapy Pro-gram at the MGH Insti-tute for Health Profes-sions. It honors the visionand contributions of for-mer MGH Physical Ther-apy director, MarjorieIonta. More than 165staff members, IHP fac-ulty, students, and alum-nae attended.

A number of speakersshared their thoughtsabout their professionaljourneys in various areas

of clinicalpractice.Presentersincluded:Lucy Buck-ley, PT, pri-vate prac-titioner andowner ofBetter Bonesin Chatham,Massachu-setts; JimGleason,PT, associate director, The Eunice Ken-nedy Shriver Center for DevelopmentalDisabilities; and Diane Plante, PT, MGHphysical therapy clinical specialist.

Now a Physical Therapy Month tra-dition, PT and OT staff challenged eachother in a high-spirited, community-ser-vice, fund-raising project. The competi-tion was expanded this year to includefaculty, staff, and students of all disci-plines at the IHP. In keeping with thetheme of exercise and a healthy life style,12-member teams competed in a ‘mar-athon challenge’ to raise money for theMGH Social Services Discretionary Fundand relief efforts for Hurricane Katrina.

Physical Therapy Monthcontinued from page 4

Team members foundsponsors to support theirexercise activities over athree-week period. Theirprogress was monitoredon a rendering of theHopkinton-to-Bostonmarathon route. Teamscrossed the finish linewith a grand total of209 miles, which trans-lated into $3,395 for twovery worthy causes.

Physical TherapyMonth activities con-cluded with the annualrecognition luncheon onOctober 27th. Speakers,Ned Cassem, MD, de-partment of Psychiatry;

Leslie Portney, PT, dir-ector of Physical TherapyPrograms at the IHP; andMary Knab, PT, directorof Clinical Education atthe IHP, described thecontributions of MGHphysical therapists to thecare of patients, the edu-cation of students, andthe Physical Therapyprofession at large. Jac-queline Mulgrew, PT,clinical specialist, sharedsome of her thoughtsabout the evolution ofher professional practiceover the course of hercareer.

At the luncheon, the

Physical Therapy AnnualReport was shared withstaff. The report spotlightsthe many contributions ofindividuals and groupswithin the department.

Physical TherapyMonth is an opportunityto celebrate the uniquecontributions of physicaltherapists to the care ofpatients and the commu-nities we serve. PhysicalTherapy Month was richwith activities and eventsthat represent the colla-borative work of so manywho share a vision andcommitment to their pro-fessional journeys.

1

2

3

Photos on this page Photos on this page Photos on this page Photos on this page Photos on this page show

physical therapist, Janet Callahan,

PT, performing the Hallpike-Dix test

with patient, Vincent Giordano.

The test is a diagnostic tool for

detecting benign paroxysmal

positional vertigo (BPPV).

Callahan is assisted in the exercise

by physical therapy co-op student,

Molly Krumpelbeck.

November 17, 2005November 17, 2005RecognitionRecognitionPatel receives Janet Ballantine

Oncology Volunteer Award

Burn Safety andSmoking Cessation

(Burns, the other reasonto stop smoking)

The Prevention Committee of SumnerRedstone Burn Center will present an

information booth in conjunction with theMGH Quit Smoking Service.

November 17, 2005Main Corridor

In 2002, tobacco products caused anestimated 14,450 residential fires, 520deaths, 1,330 injuries, and $371 million

in residential property loss.

Training for Managersand Supervisors

This session will help you learn howto use the Employee Assistance Program as

a management and employee resource.Consultation with EAP can help you with

behavioral health, mental health, andsubstance-abuse concerns. Session will

include a didactic presentation, casestudies, and discussion.

Tuesday, January 31, 20069:00–11:00am

Haber Conference Room

To register, call the Employee AssistanceProgram at 726-6976.

n October 24,2005, three yearsto the day after

the passing ofJanet Ballantine,

friends, family members,

and others in the MGHcommunity came togeth-er in the Satter Confer-ence Room to pay tributeto a loved one with thepresentation of the an-

O nual Janet BallantineOncology VolunteerAward. This year’s reci-pient was Raj Patel, avolunteer in the Yawkey8 Infusion Unit.

Senior vice presidentfor Patient Care, JeanetteIves Erickson, RN, re-minded guests of Bal-lantine’s own contribu-tions as a committedMGH volunteer. SaidIves Erickson, “Duringher illness, Janet and afellow breast-cancer pa-

tient co-founded theFriends of Hope organi-zation, which has raisedmore than $100,000 tosupport breast-cancerresearch at MGH andthe Dana Farber CancerInstitute.”

Ballantine’s familycreated the Janet Bal-lantine Oncology Vol-unteer Award in herhonor to recognize vol-unteers who demon-strate a commitment tocompassion, caring, andthe important contribu-tions of the volunteerrole.

Patel, this year’srecipient, was nominat-ed by two nurses in theYawkey 8 Infusion Unit,Laura Ryan, RN, andKate Costello, RN. Inher letter of recommen-dation, Ryan wrote,“Raj has a wonderfulway of interacting withstaff and patients. Heimmediately makes pa-tients feel like dearfriends. He has the un-canny ability to speakon many subjects andtopics, instantly puttingpatients at ease.”

Said Costello, “Rajis a caring and compas-sionate volunteer. Hispersonality is so engag-ing, that often a con-versation with one pa-tient will escalate into agroup discussion withmany patients and fam-ily members.”

Patel thanked theBallantine family andhis co-workers, saying,“It is an honor to receivethis award for some-thing I love to do. I willcontinue to do my bestfor patients at MGH.”

Award recipient, Raj Patel (center), with members of the Ballantine family and Jeanette IvesErickson, RN, senior vice president for Patient Care (left), director of Volunteer Services, Pat

Rowell (right), and professional development coordinator, Julie Goldman, RN (second from right).


Denise Montalto, PTsenior physical therapist

M


Physical therapist relies onvaluable past experiences in treating

spinal-cord injury patientDenise Montalto is an advanced clinician in the PCS Clinical Recognition Program

Clinical NarrativeClinical Narrative

y name is DeniseMontalto, and Iam a senior physi-cal therapist at

MGH. It wasanother tragic story of ateenager’s life alteredforever. I entered thePediatric Intensive CareUnit (PICU) to consulton a young man who hadbeen in a car accident.Most likely, his motherhad told him to wear hisseat belt, but he didn’t.And the law says, “Don’tspeed,” but he did. Andthen there was the ques-tion of substance abuse.Now, he was here with aspinal cord injury, andhis friend had died in theaccident.

Every year there areapproximately 11,000new cases of spinal cordinjury (SCI) in the Unit-ed States; 80% of themare sustained by males,and 50% are due to mo-tor vehicle accidents. At17, Joe was younger thanthe average SCI victim(38). There are stories ofrecovery after spinal cordinjury; recovery can de-pend on the amount ofdamage to the spinal cord,the fracture or amount ofdislocation of the verte-brae, how quickly medi-cal care was initiated,even the size and shapeof the spinal canal.

After reviewing Joe’schart and looking at allthe CT, MRI, and opera-

tive reports, it was clearthat Joe’s spinal cord wasseverely injured. He hadsustained an unstablefracture at the 8th, 9th,and 10th thoracic verte-brae with a burst at T9causing severe narrowingof the spinal canal. Hehad had his spine surgi-cally stabilized with rodsand screws from T6 toT12 and been given sol-umedrol to reduce theswelling in his spinalcord. Joe had associatedinjuries—rib fracturesfrom 2 to 9 and pulmon-ary contusions. At the 9ththoracic level, I wouldexpect him to be able toachieve independencewith bed mobility, trans-fers, and activities ofdaily living. He would beable to propel a manualwheelchair, drive anadapted car, and playsports if he desired. Hemight be able to standwith bracing, but hisprimary mode of trans-portation would be awheelchair.

I have taken greatcare in developing myapproach to patients withtrauma and their families,because I know the initialencounter can be difficultwith the uncertainty ofrecovery and the possibi-lity of permanent disabi-lity. It has taken practiceand a lot of reflection tolearn how to answer ques-tions about possible func-tional outcomes and rec-

ognize both what to sayand when to say it.

Joe was alone, rest-ing. He was using a PCA(a patient-controlled an-algesia or self-controlledpain-medication) andwas a bit drowsy but ableto respond to my ques-tions. I introduced myselfand explained my role inhis care. I asked himabout himself, his family,his activities and school.I knew I’d need to re-address this when he wasmore alert, but it wasimportant to establish arapport and relationshipbefore starting to exam-ine him. As we talkedand I began evaluatinghis movement and sensa-tion, it was apparent thathe was having more dif-ficulty breathing, and hiscough was congested andineffective. I decided itwas more important toaddress his pulmonarysystem and assess hisventilation.

His spinal cord injurywas at the 9th thoracicvertebra, which causedhim to have weakness ofhis lower intercostal andabdominal muscles dueto a lack of innervation.Although he’s only 17years old, Joe smokes.This can cause an in-crease in pulmonary se-cretions and poor mo-bilization due to damageto the mucociliary tree.He also had many ribfractures that can cause

pain with coughing. Allthese factors contributedto the problem he washaving clearing his secre-tions.

Joe’s oxygen satura-tion was adequate at 98%but he required ten litersof supplemental oxygenby face mask. With re-tained secretions, he wasat risk for deteriorationof ventilation. He com-plained of pain as I rolledhim onto his side, likelydue to the rib fracturesand his spine surgery. Iencouraged him to usehis PCA. He reportedsome relief but becamedrowsier and participatedless with deep breathingas I performed manualairway-clearance tech-niques with his respira-tions.

We tried an assistedcough. I supported Joe’supper abdomen while hecoughed, trying to clearthe secretions, but itwasn’t effective enoughand I felt it would makehim tire quickly. Speak-ing with Joe’s nurse andthe medical fellow in theICU, we discussed his

tenuous respiratory statusand the need to clear hissecretions with blindendotracheal suction. Ianticipated that this mightbe necessary for a fewdays until his cough im-proved, his secretionsdecreased, and his painimproved allowing himto breathe more deeply.We all agreed.

I explained the pro-cedure to Joe and he con-sented. We performedmanual airway-clearancetechniques on each sideto mobilize the secretionsso that suctioning wouldbe maximally effective.As I gathered the equip-ment I needed, I review-ed the steps of the pro-cedure in my mind. Eventhough I had done thissuccessfully many times,I knew it was an uncom-fortable treatment and Iwanted it to go smoothly.

Afterward, he feltbetter, but smiled andsaid, “I can’t believe youdo that to people!” I couldsee that he used humor toget through difficult situ-ations. He was tired, so


Clinical Narrativecontinued from previous page

we agree to continue hisexamination the next day.The nurse and I position-ed him comfortably onhis side and discussed aplan for the next fewdays.

That afternoon, I re-turned to check on hisrespiratory status. I in-troduced myself to hisparents and explained myrole in their son’s care. Iasked them to tell meabout Joe. They told mehe was very athletic, heenjoyed wrestling andweight-lifting, and morerecently, he’d becomeinterested in webpagedesign. I asked abouttheir home and they im-mediately began tellingme how they were goingto change the three-stepentrance to a ramp; theyhad a room downstairsfor Joe. He was fortunateto have a supportive,creative family. Joe’smother spoke with tearsin her eyes, and his fatherstood with his hand onJoe’s arm, but they werelooking forward. Wediscussed Joe’s rehabili-tation needs and goalsand briefly touched onhis eventual level of func-tion

Over the next fewdays, Joe’s ventilatoryfunction took priority.We focused treatment onsecretion-clearance andbed-mobility. I complet-ed his motor and sensoryexamination. He had nomovement or sensationbelow the level of hisinjury. In his chart, his

neurologist had notedthat Joe had no anal tone.It was still too early to becertain about his progno-sis for recovery but thesewere not good signs.

Joe’s body jacket (orbrace) arrived three daysafter our initial meetingso we could begin to tryto mobilize. Joe was ner-vous about the pain butstill had access to thePCA. I assured him Iwould wait until he wascomfortable enough tomove, and his nurse wasprepared to give himextra pain medication ifneeded. His nurse assist-ed me in putting on hisbody jacket. We movedJoe onto his side and intoa sitting position for thefirst time in about a week.He reported feeling dizzy,but I monitored his vitalsigns. He showed anappropriate hemodyna-mic response with slight-ly increased heart andrespiratory rates and aslight drop in blood pres-sure. He sat up for tenminutes and was pleased.He was tired but told mehe was looking forwardto tomorrow.

Five days after ourfirst encounter, Joe askedthe question I’d beenanticipating: “Will I beable to walk again?”

The medical staff haddiscussed his injury withhim, and I knew he wasaware of the severity ofhis condition. I told himhis spinal cord was se-verely damaged and itwas unlikely he would

walk again. But he wasgetting the best possibletreatment and we couldnever say, ‘Never.’ Therewas ongoing researchand advances were al-ways being made. I toldhim we needed to startfrom where we wereright now, and that waswith no movement orsensation in his legs. Wediscussed what that meantin terms of his mobilityand independence. Hewould need a wheelchairbut might be able tostand with bracing forexercise and weight-bearing. We discussedthe connection betweenhis physical and occu-pational therapy pro-grams; how his upper-body strength, sittingbalance, and lower-bodyflexibility would helphim with bathing, dress-ing and transfers. Heasked me if I knew any-one with spinal cord in-juries like his. I told himabout my friend from thegym who is paraplegic,who works out, is mar-ried, and has a child. Joelooked more hopeful. Iwanted him to have hopefor the future.

It was just a few daysbefore Joe was transfer-red to an excellent rehab-ilitation facility that spe-cializes in patients withSCI. He e-mailed mesome pictures of himselfwearing a Boston RedSox T-shirt; he was up inhis wheelchair enjoyingthe outdoors. Later, Ireceived an e-mail fromhis physical therapistsaying that Joe was al-ways the one to greetnew patients and show

them around, offeringsupport and encourage-ment.

I have treated manypatients with spinal cordinjuries in my years as aphysical therapist. Earl-ier in my career, I couldperform the skills neces-sary to gather informa-tion, construct a plan fortreatment, provide goodcare, and assess dischargeneeds. But I’m sure Ididn’t consider so care-fully the psychosocialimpact of such a life-altering injury. As a ther-apist, my role was to helppeople learn to compen-sate for their disabilityand I was ardently goingto ‘do my job.’ About 15years ago, a gentleman Iwas treating refused tolet me treat him againafter I brought a wheel-chair for him to use. Thiswas a turning point forme—learning to appre-ciate what a patient isready to hear. But per-haps the most importantmilestone was about fiveyears ago when I receiv-ed a consult for a 13-year-old boy with a cer-vical spinal cord injury. Iexpected that his parentswould want informationabout their son’s future.That was the day I beganpreparing words thatrealistically spoke abouta patient’s chances forrecovery; words that gaveenough information toallow the patient to stayin the moment, but wordsthat could minimize themagnitude of their griefwithout providing falsehope.

The greater skill Ilearned, though, was

listening. Without listen-ing, you don’t know whatpatients and families areready to hear. It won’talways go as smoothly asit did with Joe. Therewill be patients and fam-ilies who are too over-whelmed by the injuryand cling to the hope of amiracle; those who takelonger to grieve for theloss of one future beforethey can embrace a newone.

I’m trying to be moreprepared each time. Iknow I’ll always need tobe flexible and adjust myapproach to meet thepatients’ and families’needs.

Comments by JeanetteIves Erickson, RN, MS,senior vice presidentfor Patient Care andchief nurse

Denise’s compassion andempathy, as well as herexceptional clinical skills,come into play in thisnarrative. Having caredfor many patients withspinal cord injury, Deniseknew what Joe was infor. She knew how diffi-cult it would be for Joeand his family to come toterms with the injury.Understanding where thepatient is and what he’sready to hear is a skillyou can only acquirewith time and experi-ence. Denise’s compre-hensive assessment ofthis patient encompassedfar more than his phy-sical abilities and limita-tions.

There are lessons herefor every clinician: listen,learn, adjust.

Thank-you, Denise.


ursing is a profes-sion that attractscompassionate,caring, selfless indi-

viduals who putthe needs of others aheadof their own. Nurses thriveon improving the lives oftheir patients. Whateverproblem a patient mayencounter, a nurse willexhaust all options toensure the most favorableoutcome. But when itcomes to taking care ofthemselves, nurses oftenput their needs on theback burner. I am a clas-sic example of how nursesput their own problemson hold while caring forothers.

Being an operatingroom nurse for 33 yearshas allowed me to ac-quire many skills. Beyondbeing able to scrub andcirculate on most opera-tive procedures, I haveexpanded my abilities inother areas of the OR.For example, I’m a CPRinstructor, and I helpwith the re-certificationof OR staff. Sometimes, Iwear the hat of nurseliaison, which enablesme to interact with pa-tients and their familiesto alleviate any fearsconnected with their sur-gery. I’m also a resourcenurse in the OR. Theresource nurse, alongwith staff from Anesthe-sia, runs the daily opera-tion surgical schedule.

This can be a very tryingrole, but I get a lot ofhelp from clinical nursespecialists, team leaders,our nurse manager, andthe OR education staff.Together as a team we tryto run a smooth ship. Itwas while working inthis role a little over ayear ago that I suffered astroke.

At the time, the onlysymptom I exhibited wasa slight slurring of myspeech. While interactingwith my peers, I realizedI couldn’t pronouncewords beginning with theletters ‘K’ or ‘L.’ Mytongue felt heavy on theright side, and my slur-ring was intermittent. Mythought processes wereintact. No other symp-toms were evident—noweakness in my extremi-ties, no paralysis, no vis-ual changes. Even thoughthe possibility of a strokewas in the back of mymind, I really thought Iwas having an allergicreaction to something.Thinking back, my speechand voice reminded meof how a deaf personwould sound. But sincethe symptoms were in-consistent, I dismissedthem. I continued to domy work. After givingreport to the in-comingcharge nurse, I stayed fora few hours to help out.The problems with myspeech didn’t subside,

but they didn’t get worse.Later, when my hus-

band picked me up to gohome, I told him whathad happened that after-noon. We went home andhad dinner, and I went tobed early that night. Ithought rest and relaxa-tion would do the trick.In the morning, I wokeup to find my speech thesame, and I noticed aslight drooping of theright side of mymouth. This iswhen the realityof a stroke hitme.

On the wayto work, I talkedwith my hus-band about mak-ing an appoint-ment with mydoctor. Onceagain, even withmy symptoms, Ithought mymind was okayand my thoughtprocesses wereintact. Overall, Ifelt well enoughto go to workand resume myduties as re-source nurse.

While takingreport from thenight chargenurse, I men-tioned what hadhappened theday before andhow I felt thatmorning. As we

were talking, I becamevery emotional. She in-sisted I go straight to theEmergency Department.She spoke with two ofour clinical nurse spe-cialists who contactedthe ED and the neuro-surgical team. We all metin the ED, and I was ad-mitted immediately totrauma bay one. (Sincewe didn’t know how longit would take to find outwhat was wrong withme, the OR called anoth-er nurse to replace me forthe day.)

I was escorted to theCAT scan and MRI area.Within an hour, my fears

were confirmed. I hadhad a lacunar infarct.The CAT scan showedthat a pea-sized clot hadlodged in the lacunararea behind my left eye.The doctor told me theprognosis was good andsaid I should make a fullrecovery. But tests need-ed to be performed inorder to find the cause.

Here I was, a 53-year-old woman with no ap-parent health problems.Why did this happen?Would I be able to re-sume my duties in theOR? What were thechances I’d have another

To thine own self be trueone nurse’s story is cautionary tale

for all clinicians—by Linda Bracey, RN, operating room nurse

N

Another PerspectiveAnother Perspective


OR nurse, Linda Bracey, RN,prepares to leave work for the day.


stroke? So many thoughtswent through my head.My children were grown.This was supposed to bemy time with my hus-band. Why did this hap-pen now?

Lying on the stretch-er, I came face to facewith the realization thatmy health was in jeopar-dy. I tried to convincemyself not to borrowtrouble until all the factswere in. It was also abitter pill to swallow (nopun intended) that I wasnot in control. Someoneelse would be the care-giver, not me. But I feltblessed that I was in theright place at the righttime.

During the 36 hours Ispent as a patient at MGH,I came to realize that thisis a wonderful place tobe ill. I saw first-handhow caring and hard-working the nursing staffis. From the 12 hours inthe ED to my overnightstay on White 12, I wastreated with the utmostrespect and kindness. Myphysical and emotionalneeds were met withcompassion and genuineconcern.

Being a surgical nursewith a medical problem,this gave me a chance tomeet the other half of theMGH family. Staff inCAT Scan, MRI, andUltrasound, neurologyresidents, staff, and med-ical students—everyonewas professional, caring,

and concerned.As I went through the

battery of neurologicaltests, the look on mostdoctors’ faces was amaze-ment. Even though theCAT scan showed a la-cunar infarct, other thanmy speech, everythingelse was fine. It was hardfor my family and friendsto believe I’d had astroke. I looked okay, butif I got nervous or tiredmy speech would start toslur.

Throughout my hos-pitalization I came incontact with caregiversfrom a number of disci-plines: neurologists, he-matologists, speech path-

To Thine Own Self be Truecontinued from previous page

Safety Netthe new Partners patient-

safety newsletterThe first issue of Safety Net, the newPartners patient-safety newsletter wasreleased this month in hard-copy andon-line. The quarterly publication fea-tures tips, stories, and updates on pro-grams and initiatives aimed at keepingour patients safe.

Safety Net is the product of the Part-ners Office of Patient Safety. The edi-torial board is comprised of patient-safety leaders from throughout the Part-ners network including Joan Fitzmaur-ice, RN, and Cy Hopkins, MD, direct-ors of the MGH Office of Quality &Safety.

Safety Net can be found at: http://intranet.partners.org/ClinicalAffairs/content/Newsletter/Current.pdf. Formore information, call 726-5255.

ologists. When all thetests were completed, itwas determined that mystroke had not been caus-ed by stress but by poly-cythemia and thrombocy-tosis. In layperson’s terms:too many red blood cellsand platelets. Doctorssurmised that I had abone-marrow defect thathad caused an increase inthe production of redblood cells and platelets.

When I was discharg-ed, I was told to takesome time off to recoverand get my systems inorder. In the three monthsI took off, I met oftenwith my doctor, speechpathologist, neurologist,and hematologist, whowere all very supportive.Today, I’m taking a fewmedications to help keep

everything on an evenkeel. Occasionally, I haveto have blood drawn tohelp control the produc-tion of red blood cellsand platelets.

It’s been a year sincemy stroke. In my timeoff, I came to an impor-tant realization. If I don’ttake care of myself, howcan I take care of anyoneelse.

Words can never ex-press my gratitude to mycolleagues at work. Theircards, phone calls, andvisits helped me througha very tough time.

I returned to work fulltime last January 2nd,and was able to resumeall my duties. Coincident-ally, on the anniversaryof my stroke, I read apoem at a dear friend’s

memorial service. I wasapprehensive because ofthe problems with myspeech, but I relied onwhat my speech patholo-gist had taught me. Takeyour time, enunciate, andeverything will be fine. Itwent off without a hitch.

And last but not least,my husband and childrenwere given the scare oftheir lives. Even thoughwe all think we’re indi-spensable in some way, Ifelt blessed and extreme-ly lucky to have my fam-ily by my side. They tookwonderful care of mewhile I recuperated, andmade it easy for me toreturn to work.

I just want to say onething to all nurses. Betrue to your patients afteryou’re true to yourself.


he Pediatric Ser-vice, along with

the departments ofPharmacy and Bio-

medical Engineering,has undertaken a collabo-rative approach to medi-cation safety. The effortinvolves eliminating the‘Rule of Six,’ and imple-menting standard con-centrations for vasoactivemedications and contin-uous infusions.

Medication admini-stration for pediatricpatients differs greatlyfrom that of adult pa-tients because of the needfor weight-based dosingthat requires individualdose calculations. Pedi-atric patients are at great-er risk for medicationerrors due to the mathand individual mixingrequired for each infu-sion. Based on a 2001study conducted at MGHand Children’s Hospital,13% of medication errorsoccur in the administra-tion phase.

Because the majorityof medications are deliv-ered via continuous in-fusion in the Newbornand Pediatric IntensiveCare Units (NICU andPICU), the Rule of Sixmethod has been utilizedfor many years. The Ruleof Six was originallydesigned to enable care-givers to easily prepare

and titrate admixtures ofvasoactive medications.The concentrations arebased on the patient’sweight, so that 1mcg/kg/minute always equals1mL per hour. However,utilizing this formula forpatients whose weightsrange from less than 1kgto more than 40kg re-sulted in an unlimitednumber of drug concen-trations. Since Pharmacycould not provide sup-port for such a wide vari-ety of concentrations,nurses were involved inpreparation at the unitlevel.

Prior to 2004, theJoint Commission on Ac-creditation of HealthcareOrganizations (JCAHO)included minimizing thenumber of available con-centrations of a givenmedication in its Nation-al Patient Safety Goals.The JCAHO specificallyincluded eliminating theRule of Six as part of thisgoal, with an implementa-tion deadline of Decem-ber 31, 2008.

As part of a largerfocus on patient safety, amulti-disciplinary taskforce was formed to ad-dress this issue. The taskforce included represen-tation from Nursing,Pharmacy, Smart Infu-sion Pump Learning Lab(sponsored by the Sims

Lab) and BiomedicalEngineering. Goals in-cluded:

eliminating the Rule ofSixestablishing standardconcentrations for con-tinuous infusionsimplementing smartinfusion pumps withMGH-approved druglibraries.

There are many bene-fits to using smart infu-sion pumps.

Drug libraries can betailored to the patientpopulation by weightcategoriesSoft minimums (re-commendation can beoverridden) and maxi-mum dosing for eachdrug provides guidanceto clinicians to preventunder-dosing or over-dosingHard minimums andmaximum dosing (re-commendations are afail safe and cannot beoverridden) to preventover-dosing of electro-lyte solutionsBar-coding capabilities

As a first step, teammembers visited the Al-bany Medical Center toreview their medicationdelivery system, especial-ly the weight-based stand-ard drug concentrationsand administration guide-lines.

Considering the factthat we would be provid-ing standard drug con-centrations to patientsweighing less than 1kg,and children who werefluid-restricted, the grouprecommended that thepatient’s weight no long-er drive mixing calcula-tions. Rather, standard-ized mixes would beused based on safe flowrates. As a result, weightprofiles were identifiedfor the pediatric druglibrary to guide the dos-ing parameters neededfor smart infusion pumps.

Since pump flowrates of at least 0.3mL/hour provide optimaltitration, standard drugconcentrations were de-veloped, using patientweights ranging from0.5kg to more than 40kg.The Pediatric MedicationAdministration ProcessManual for Syringe In-fusion Pumps was devel-oped, which includesmixing guidelines andflow rates. The manualcontains:

the pediatric drug li-brary

mixing guidelines andflow rates for eachdrug and concentrationIV administrationguidelines for eachdrug, starting dose,bolus, or loading dose,and continuous dose bydrugusual and maximumdosing by drugpump flow rates bydrug concentration,dose rate, and patientweight

Color zones, based ontraffic lights (red, yellow,and green) were develop-ed to assist clinicians inchoosing the concentra-tion associated with opti-mal flow rates. This me-thod of pediatric medica-tion administration is soprogressive that the man-ual has been copyrightedand affiliates are express-ing a great deal of inter-est in implementing thisnew program.

Team members com-pleted the initial projectgoals in the summer of2005. Standard drug con-centrations and smartinfusion pumps using the

Clinical Nurse SpecialistsClinical Nurse SpecialistsPediatric Medication

Administration Process—by Kathryn A. Beauchamp, RN, PICU clinical nurse specialist

and Lois F. Parker, RPh, senior attending pharmacist

T


Kathryn Beauchamp, RN (left), and Lois Parker, RPh

Submission of Articles

Next Publication Date:December 1, 2005

Written contributions should besubmitted directly to Susan Sabia

as far in advance as possible.Caring Headlines cannot guarantee the

inclusion of any article.

Articles/ideas should be submittedby e-mail: [email protected]

For more information, call: 617-724-1746.

Please recycle

MGH pediatric drug librarywere introduced in the NICUand PICU in September, 2005,and the Cardiac OR in October,2005.

Future goals include expand-ing the use of smart pumps and

the pediatric drug library to allinpatient areas that care for pe-diatric patients, including theED, operating rooms, and theCardiac Cath Lab and evaluat-ing outcomes.

We would like to thank the

members of our task force fortheir hard work and commitmentduring the past two years: co-chairs, Brenda Miller, RN; andRay Mitrano, MS; project mana-ger, Gayle Fishman, RN; pedi-atric pharmacist, Lisa R. Morlitz;Mary Wyszynski, RN; Ellen Kin-nealey, RN; and Nat Sims, MD.

Pediatric Medication Administration


Published by:Caring Headlines is published twice eachmonth by the department of Patient Care

Services at Massachusetts General Hospital.

PublisherJeanette Ives Erickson RN, MS,

senior vice president for Patient Careand chief nurse

Managing EditorSusan Sabia

Editorial Advisory BoardChaplaincy (interim)

Marianne Ditomassi, RN, MSN, MBA

Development & Public Affairs LiaisonVictoria Brady

Editorial SupportMarianne Ditomassi, RN, MSN, MBAMary Ellin Smith, RN, MS

Materials ManagementEdward Raeke

Nutrition & Food ServicesMartha Lynch, MS, RD, CNSDSusan Doyle, MS, RD, LDN

Office of Patient AdvocacySally Millar, RN, MBA

Orthotics & ProstheticsMark Tlumacki

Patient Care Services, DiversityDeborah Washington, RN, MSN

Physical TherapyOccupational Therapy

Michael G. Sullivan, PT, MBA

Police & SecurityJoe Crowley

Reading Language DisordersCarolyn Horn, MEd

Respiratory CareEd Burns, RRT

Social ServicesEllen Forman, LICSW

Speech-Language PathologyCarmen Vega-Barachowitz, MS, SLP

Volunteer, Medical Interpreter, Ambassadorand LVC Retail Services

Pat Rowell

DistributionPlease contact Ursula Hoehl at 726-9057 for

all issues related to distribution

Hand HygieneHand Hygiene

(L-r): associate chief nurse, Jackie Somerville, RN; and from the InfectionControl Unit, staff nurse, Judy Tarselli, RN; Hazel Audet, RN; and David Hooper

MD, chief, collect signatures for the Hand Hygiene Campaign

Infection Control Weekfocuses on hand hygiene

ational Infection ControlWeek was observed Octo-ber 17–21, 2005, and theMGH Infection Control

Unit sponsored a numberof activities and events to markthe occasion. With an education-al display in the Main Corridor,the Infection Control Unit focus-ed primarily on raising aware-ness about hand hygiene.

N In addition to disseminatinginformation, raffling off prizes,and giving away colorful ‘hand-shaped’ pins, organizers offeredemployees an opportunity tosign a 2x3-foot poster signifyingtheir support for good hand hy-giene. More than 500 employeessigned the poster; others had anopportunity to sign smaller ver-sions of the poster on their units.

During National InfectionControl Week, healthcare organ-izations around the country planactivities designed to heightenpublic awareness and profession-al commitment to preventinginfections in healthcare settings.Healthcare workers, patients,and visitors can help prevent thespread of infection by usinginfection-control measures suchas good hand-washing practices.

For more information abouthand hygiene or infection con-trol, call the Infection ControlUnit at 6-6330.


s our alliance withNursing continues

to develop, Nu-trition & Food Ser-

vices has received anenormous amount ofpositive feedback. Wehave been meeting withstaff on units where pilotprograms have been im-plemented to provideservice-improvement up-dates and explore oppor-tunities for future im-provement. The spirit ofcollaboration and ourmutual commitment topatient-centered care hasbeen so important duringthis journey.

Our goal is to givepatients what they want.We’ve learned that whilespecific menu itemsmight be important tosome patients, other pa-tients are more concernedwith the timeliness ofmeal delivery. Overnight

admissions and diet-advances have becomecommon, and our turn-around-time for breakfastdelivery hasn’t met theneeds of all patients.

In an effort to betterrespond to the variedneeds and requests of ourpatients, we’re pilotingan ‘Express BreakfastMenu.’ We’re research-ing breakfast items thatcan be stocked on unitsand offered to patients ina more timely fashion.

We will continue tooffer alternative break-fast choices with theunderstanding that theymay take a little longer toprepare and deliver. Thisgives patients a choicebased on their own needsand preferences.

We know that storageof used trays continues tobe a problem, particular-ly in the evening. Our

Manager of Patient Food Services, Sara Estabrook, RD (left)and senior manager of Patient Food Services, Susan Doyle, RD

We hear you loudand clear!

—by Susan Doyle, RD, senior manager, Patient Food Services

efforts in this areaare not limited topilot units. Withthe help of Build-ings & Grounds,we’re installingcabinets in patientcare areas. Thesecabinets providean unobtrusiveplace to store usedtrays until theycan be collected and re-turned to Food & Nu-trition Services. We arerestructuring job flow toallow more frequentpick-ups of used trays.And we’re moving to anupgraded paper servicefor all 4-Food deliveriesafter 8:00pm. It is ourhope that these changes

will help alleviate ourproblems with used trays.

If a back-up of usedtrays should occur, call4-Food (4-3663) to ar-range for a pick-up. Anytime you notice an un-usual amount of usedtrays, call 4-Food. Thishelps keep the collectionof used-trays moving

smoothly, and it helps ushelp you.

As winter approaches,we’ll be rolling out service-improvement initiatives tomore areas. As our workcontinues, please let us knowhow we can serve you bet-ter? Call 6-2579, or e-mailcomments or suggestions to:[email protected].

A

Food & NutritionFood & Nutrition

Call for ProposalsThe Yvonne L. Munn, RN,Nursing Research Awards

Staff are invited to submit researchproposals for the annual Yvonne L. Munn,

RN, Nursing Research Awards to bepresented during Nurse Recognition Week,

May 7–12, 2006.

Proposals are due January 15, 2006.Guidelines for developing proposals

are available at:www.mghnursingresearchcommittee.org

under “Funding Sources”

For more information, contactVirginia Capasso, PhD,

at 617-726-3836, or by e-mail [email protected]

The Knight Nursing Center for Clinical & Professional Developmentpresents

Inaugural Visiting Professorin Wound Healing

Courtney H. Lyder, ND, GNP, FAAN, professor of Nursing,professor of Internal Medicine and Geriatrics, University of Virginia

Thursday, December 15, 2005

“Pressure Ulcers: Avoidable or Unavoidable?”A dialogue with critical care nurses

11:00am–12:00pm, Blake 8 Conference RoomAll are welcome, contact hours will be awarded

“Building an Infra-Structure for Wound Care in Acute Care”A dialogue with the CNS Wound Care Task Force

12:00–1:15pm, Blake 8 Conference RoomOpen to members of CNS Wound Care Task Force

“Shifting the Paradigm: Implications of Deep Tissue Injury and F-Tag 314on Care of Pressure Ulcers”

Nursing Grand Rounds1:30–2:30pm, O’Keeffe Auditorium

All are welcome, contact hours will be awarded

“Pitfalls of Pressure Ulcers: Avoiding a Malpractice Suit”2:30–3:30pm, Blake 8 Conference Room

All are welcome, contact hours will be awarded

Educational OfferingsEducational Offerings November 17, 2005November 17, 2005

2005

2005

For detailed information about educational offerings, visit our web calendar at http://pcs.mgh.harvard.edu. To register, call (617)726-3111.For information about Risk Management Foundation programs, check the Internet at http://www.hrm.harvard.edu.

Contact HoursDescriptionWhen/WhereSpecial Procedures/Diagnostic Tests: What You Need to KnowO’Keeffe Auditorium

TBANovember 288:00am–4:30pm

CPR—American Heart Association BLS Re-CertificationVBK401

- - -December 17:30–11:00am/12:00–3:30pm

CVVH Core ProgramYawkey 2220

6.3December 17:00am–12:00pm

Pre-ACLS CourseO’Keeffe Auditorium $100. (to register e-mail: [email protected])

- - -December 28:00am–2:30pm

Coronary SyndromeO’Keeffe Auditorium

TBADecember 58:00am–4:30pm

16.8for completing both days

Oncology Nursing Society Chemotherapy-Biotherapy CourseYawkey 2220

December 6 and 98:00am–4:00pm

Building Relationships in the Diverse Hospital Community:Understanding Our Patients, Ourselves, and Each OtherTraining Department, Charles River Plaza


Intermediate ArrhythmiasHaber Conference Room

3.9December 78:00–11:45am

Pacing ConceptsHaber Conference Room

4.5December 712:15–4:30pm

New Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0(for mentors only)

December 78:00am–2:30pm

Intermediate Respiratory CareRespiratory Care Conference Room, Ellison 401


Nursing Grand Rounds“Pilmonary Hypertension.” Sweet Conference Room GRB 432


Workforce Dynamics: Skills for SuccessTraining Department, Charles River Plaza


BLS Certification for Healthcare ProvidersVBK601

- - -December 158:00am–2:00pm

Nursing Grand Rounds“Deep Tissue Injury.” O’Keeffe Auditorium


Schwartz Center RoundsWalcott Conference Room

- - -December 1612:00–1:00pm

On-Line Clinical Resources for NursesFND626

3.3December 168:00–11:00am

CPR—Age-Specific Mannequin Demonstration of BLS SkillsVBK401 (No BLS card given)

- - -December 198:00am and 12:00pm (Adult)10:00am and 2:00pm (Pediatric)

CPR—American Heart Association BLS Re-CertificationVBK401

- - -December 207:30–11:00am/12:00–3:30pm

New Graduate Nurse Development Seminar IITraining Department, Charles River Plaza

5.4 (for mentors only)December 218:00am–2:30pm

Nursing Grand Rounds“Care of the Stroke Patient.” O’Keeffe Auditorium


16.8for completing both days

Oncology Nursing Society Chemotherapy-Biotherapy CourseYawkey 2220

February 16 and 238:00am–4:00pm


CaringCaringH E A D L I N E S

Send returns only to Bigelow 10Nursing Office, MGH

55 Fruit StreetBoston, MA 02114-2696

First ClassUS Postage PaidPermit #57416

Boston MA

To promote awareness aboutdyslexia and support the theme,“Help Us Bring Reading to Child-ren,” Phyllis Meisel, director ofReading Disabilities and her staffsponsored the first annual,“Opening Doors to Literacy,”gala event and benefit auction,Thursday, October 20, 2005, atLong’s Jewelers in Boston. Music,mingling, and enthusiastic biddingmade for an exciting evening asthe winner of a $1,000 shoppingspree (at Long’s) was revealed ina raffle drawing. The evening wasa great success, raising moneyand awareness for an importantcause.

Many thanks to Eileen Faggi-ano, chair of the planning com-mittee, and her enthusiastic team

for coordinating the event.

Reading DisabilitiesReading Disabilities

Gala benefitto help bring reading

to children

(Photos by Abram Bekker)

Caring November 17, 2005 - Massachusetts General …November 17, 2005 HEADLINES Working together to...

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