institutions in the nation will be great-ly beneficial to finding cures and treat-ment options for many cancers,” saidChristiana Care president and CEORobert J. Laskowski, M.D., MBA.

“This collaboration is exciting newsfor Christiana Care and our cancerprogram, but most importantly, forour patients and neighbors in the com-munity.”

“While Wistar scientists have madegreat progress in understanding thebiological basis of cancer, we are onlypart of the continuum of translationalresearch that yields new therapies forcancer patients,” said Russel E.Kaufman, M.D., president and CEO ofThe Wistar Institute. “By joining withsuch an outstanding clinical partner asthe Helen F. Graham Cancer Center,our hope is that, together, we canbring our laboratory discoveries to

Inside

Engineering tissue for futureartificial salivary glands 3

Value Improvement Teamsstudy cost and consequence 4

Flu shots: Let’s get it done! 5

Seamless patient trackingby Soarian software 6

Project SEARCH interns 9

Better dressing throughnanotechnology 10

Community benefit:Dental implant services 13

Caring for Yourself:Substance abuse 20

VOLUME 22, NUMBER 12

A publication from

Christiana Care Health System

External Affairs

P.O. Box 1668

Wilmington, DE 19899-1668

www.christianacare.org

F O C U SFocusing on the people and initiatives that distinguish Christiana Care Health System

Christiana Care Health System’sHelen F. Graham Cancer Center

and The Wistar Institute, an interna-tional leader in biomedical research,have entered into an historic partnershipto collaborate on translational cancerresearch with the aim of bringing thelatest discoveries in cancer research tocancer patients in the community.

The partnership combines Wistar’sstrengths in basic biomedical researchwith the Helen F. Graham CancerCenter’s exceptional cancer treatmentand patient care. The goal of the trans-lational cancer research collaborationis to “translate” or advance researchdiscoveries made in Wistar’s labs intoearly phase (phase I and II) clinicaltrials with patients at the Helen F.Graham Cancer Center.

“Forming this partnership with one ofthe foremost cancer research

Collaboration with Wistar Institute willspeed bench discoveries to patient bedside

C O N T I N U E D , P. 2

The Wistar Institute, an international leader in biomedical research, joins strengths withthe Helen F. Graham Cancer Center’s exceptional cancer treatment and patient care.

(the most common and aggressiveform of brain cancer) cells. The HelenF. Graham Cancer Center may providehuman glioblastoma cells to Wistar forfurther preclinical study through itsTissue Procurement Collection, one ofonly a few non-university-based pro-grams in the country to collect humantissue samples to help scientists learnmore about the growth and develop-ment of cancer through the NIHCancer Genome Atlas Project. Afterfurther preclinical development, thedrug combination based on Wistar sci-ence may be offered to Helen F.Graham Cancer Center patients in aphase I clinical trial.

“Eighty-five percent of oncology careis given in the community at placessuch as the Helen F. Graham CancerCenter,” said Dario C. Altieri, M.D.,director of The Wistar Institute CancerCenter and Robert and Penny FoxDistinguished Professor. “This part-nership will bring cutting-edge cancerresearch to these patients, while alsoproviding outstanding opportunitiesfor collaboration with our clinical col-leagues that will inform our laborato-ry work and hopefully, ultimately,lead to better cancer therapies.”

“Collaborative initiatives between thetwo Institutions will focus on specifictranslational oncology research proj-ects, with the goal of enhancingopportunities for joint funding andjoint publications between scientists atWistar, the Graham Cancer Center andother institutions,” said Nicholas J.Petrelli, M.D., Bank of AmericaEndowed medical director of theGraham Cancer Center. “The NationalCancer Institute-supported facilities ofboth organizations will interact andshare resources and expertise asappropriate to advance collaborativeresearch projects.”

T R A N S L A T I O N A L C A N C E R R E S E A R C H

and mortality. Using this approach toresearch and treatment, scientists andclinicians bring the latest findingsfrom laboratory bench to bedside and,when necessary, back into the labora-tory very quickly. It is vital to findingcures and treatments for cancer.

Many of today’s standard treatmentsfor cancer began in clinical trials.Patients who volunteer to participatein clinical trials often have the firstchance to benefit from effective newtherapies. Early phase trials evaluatehow a new drug should be given (bymouth, injected into a vein, or injectedinto the muscle), how often, and atwhat doses. They also evaluate howwell the new drug works against aparticular kind of cancer.

Focused ResearchAreas of initial research in the Wistar-Christiana Care partnership will focuson colon cancer stem cells, targetedtreatments for melanoma and novelapproaches for molecular profiling,and treatment of advanced andmetastatic disease.

For example, Wistar scientists recentlydemonstrated in mice that low dosesof an anti-cancer drug currently indevelopment, called Gamitrinib, sensi-tize tumor cells to a second drugcalled TRAIL, also in development.The drug combination kills tumor cellsin mice and in human glioblastoma

Collaboration will speed discoveries from lab to patient

patients more quickly andimprove public health, overall.”

At 24 percent, the Graham CancerCenter has one of the nation’shighest patient accrual rates intocancer clinical trials, far above thenational average of 4 percent.Designated since 2007 as one ofthe original National CancerInstitute’s Community CancerCenters, the Helen F. GrahamCancer Center is also one of the mosttechnologically advanced and largestcancer programs on the East Coast,recording more than 170,000 patientvisits last year.

Established in 1894, The WistarInstitute has been a National CancerInstitute Cancer Center since 1972 andhas focused its basic biomedicalresearch on understanding the causesand treatment of cancer. The Institute’sCancer Center has a history of signifi-cant advances in cancer genetics, can-cer biology, tumor immunology andvirology.

Pioneering gene researchWistar’s accomplishments includeidentifying genes associated withbreast, lung and prostate cancer,developing monoclonal antibodiesused to study the pathways and pro-teins involved in tumor developmentand contributing to improved cancertreatments and diagnostic tests. TheInstitute works actively to transfer itsinventions to the commercial sector toensure that research advances with thepotential to benefit public health movefrom the laboratory to the clinic asexpeditiously as possible.

Translational cancer research trans-forms scientific discoveries arisingfrom laboratory, clinical, or populationstudies into clinical applications toreduce cancer incidence, morbidity

W I S T A R I N S T I T U T E , C O N T I N U E D

2 ● F O C U S S e p t . 1 6 , 2 0 1 1

“The patients carry a water bottle,” Dr.Witt says. “That’s the treatment.”

What researchers learn in developingsalivary glands also could benefitwork on other glands, such as theprostate, mammary and thyroid.

“Tissue engineering/regenerativemedicine is an exciting, emergingapproach in modern medicine as itinvolves the delivery of living tissue,”Dr. Bhatt says. “The scope is so wideand this project has much promise.”

Researchers at the Center forTranslational Cancer Research

(CTCR) at the Helen F. GrahamCancer Center are making importantstrides toward the creation of artificialsalivary glands, a breakthrough thatwill ultimately provide relief for thou-sands of patients who can no longerproduce saliva as a result of radiationtreatment for upper respiratory cancer.

Robert Witt, M.D., chief of theMultidisciplinary Head and NeckOncology Center at the GrahamCancer Center, and Swati PradhanBhatt, Ph.D., a post-doctoral fellow atUniversity of Delaware, are workingon ways to grow cells taken frompatients before radiation on a 3D bio-material-based scaffold that willmimic salivary gland functions.

“The scaffold allows cells to growmore the way they do in a real humanenvironment,” Dr. Witt says.

Significant progress engineering tissueIn recent years, researchers have madesignificant progress in engineering car-tilage, bone and bladder tissue. In2008, doctors in Sweden implanted alaboratory-made windpipe that con-tained the patient’s own cells into aman with late-stage trachael cancer.

“Those structures are less complicatedthan glands,” Dr. Witt says. “We havefurther to go to get to the place wherethe cells can perform their function.”

CTCR is a vibrant partnershipbetween Christiana Care’s Helen F.Graham Cancer Center, the Universityof Delaware, A.I. duPont Hospital forChildren/Nemours, and the DelawareBiotechnology Institute, who share acommon vision to improve cancerresearch and delivery.

“Dr. Witt’s project in collaboration

Growing hope for cancer patients’ dry mouth condition

with Dr. Bhatt is an example of thetype of cutting-edge translational can-cer research that is ongoing at theCTCR,” says Nicholas Petrelli, M.D.,medical director of the Helen F.Graham Cancer Center. “Bringing cli-nicians together with scientists is thekey to new cancer treatments and pre-vention. The CTCR is also an environ-ment which allows students and resi-dents to learn the techniques of cancerresearch with a better understandingof cancer biology.”

The salivary spheres engineered in theproject at CTCR can form lumens,essentially the inside spaces of a tubu-lar structure, such as the ducts thatwater passes through in salivary glands.

“Lumen formation is importantbecause we need a place for the salivato be secreted,” Dr. Bhatt says.

The next step is to deliver growth fac-tors that will enable the cells to branchout and cover the entire scaffold sothat they will be able to secrete abun-dant protein and fluid.

Implants could be 10 years outDr. Witt says it could be 10 years ormore before artificial salivary glandsare implanted in patients. The proce-dure will offer a sweeping improve-ment in quality of life for the 40,000patients each year in the United Stateswho develop xerostomia, an abnormaldryness of the mouth, after radiationtreatment.

Without saliva, patients have difficultyswallowing. They are vulnerable totooth decay. They often lose weightand are undernourished.

“They don’t eat well because fooddoesn’t taste good,” Dr. Witt says.

Currently, medications provide littlerelief.

T R A N S L A T I O N A L C A N C E R R E S E A R C H

S e p t . 1 6 , 2 0 11 F O C U S ● 3

Researchers at Christiana Care aim to grow cells that secrete both protein and fluid

At the Center for Translational CancerResearch, a promising 3D culture systemfor growing salivary gland cells.

Robert Witt, M.D. Swati Pradhan Bhatt, Ph.D.

system, as well as the impact onpatients and society as a whole.

“Unfortunately, given the unprece-dented levels of spending in healthcare, we do not regularly evaluatethe benefits of the care we deliver interms of both quality and cost,” saysSharon Anderson, senior vice presi-dent for Quality and Patient Safety.

Adds Gretchen Makai, M.D., directorof Minimally Invasive Surgery, “Thisis a clinician-led project. It’s not tocut corners; it’s to make certain thatpatients get the best care.”

Sometimes, using a more expensiveinstrument makes sense. Dr. Makaipoints to the harmonic scalpel, a $400disposable tool used in laparoscopichysterectomy that simultaneouslycuts and efficiently coagulates tissue.

“The patient has less pain, can leavethe hospital earlier and get back toher life with her family and her job inmuch less time,” she says. “Whenyou look at the benefits to thepatient, the health care system andthe community, it is money wellspent.”

Simple changes for cost consciousnessDr. Makai and Dr. McCullough say

their heightened cost consciousnesshas resulted in a simple change inprocedure in the operating room thateliminates the waste caused by dis-carding unused disposableinstruments.

V A L U E I M P R O V E M E N T

4 ● F O C U S S e p t . 1 6 , 2 0 1 1

Like most consumers, HelenMcCullough, D.O., compares prices

and product performance when shop-ping for things like groceries or cars.

But it wasn’t until recently that Dr.McCullough, Christiana Care medicaldirector for Gynecologic Surgery,learned the price tags on variousinstruments and procedures in theoperating room, as part of her workwith the Gynecologic Surgery ValueImprovement Team. The team has adynamic initiative focused on estab-lishing the optimum balance betweentop-notch care and cost-efficient treat-ment for hysterectomy patients.

“Our charge was to look at our servic-es and pick them apart,” says LindaDaniel, director of performanceimprovement/care management forWomen’s and Children Service Line.“Are they cost effective? Are they evi-dence-based, will they improvepatient outcomes?”

In a presentation at a recent meeting

How much is that suture in the window?

of Christiana Care CEO Robert J.Laskowski, M.D.’s President’s Cabinet,Dr. McCullough illustrated how thechoices doctors make impact the costof health care.

In one hand, she held a reusableMasterson clamp and suture. The cost:$10-$15.

In the other hand, she held a

disposable stapler that allows the doc-tor to place absorbable sutures. Thecost: $600 for a single use.

“We found that there was no signifi-cant difference in outcome,” Dr.McCullough says. “If that disposablestapler doesn’t need to be opened,Christiana Care just saved $600.”

Surgeons are highlytrained in proceduresand techniques. Butmost are not educatedon costs of specificinstruments and mate-rials.

Department Chair,Richard Derman,M.D., notes that all ofhealth care will bechallenged to utilizeresources wisely with-out compromising thesafety or quality carefor our patients.

Determining value is a complex dancethat balances costs to the health care

Value Improvement Teams study cost and consequence

“The first thing we say to our scrub techs is ‘don’tunwrap anything unless we need it.’”

Helen McCullough, D.O.Medical director, Gynecologic Surgery

Helen McCullough,D.O.

“The first thingwe say to ourscrub techs is‘don’t unwrapanything unlesswe need it,” Dr.McCulloughsays. “We wantto raise aware-ness among sur-geons that thereare costs involved in everything we do.”

Dr. McCullough and Dr. Makaiwill share what they have

learned in a presentation, “Report of18 Month Assessment of ValueComparisons in Christiana CareGynecologic Surgery,” Dec. 14 at theValue Symposium at the John H.Ammon Medical Education Center.

The Symposium, scheduled from 7 a.m. to 1:30 p.m., will focus on valuein the OR for all surgeons, as well asissues associated with uterine arteryembolization, use of robotics, potentialpitfalls on the use of surgical meshand the rise of ambulatory hysterectomy.

Dr. Makai and Dr. McCullough arehopeful the Value Symposium inDecember, focusing on surgery, will bea springboard for raising awarenessthroughout the surgical community.

“We would like all divisions of sur-geons to be aware of what we will bediscussing and to recognize the oppor-tunity to see how their behaviors andchoices impact the bottom line,” Dr.McCullough says. “The surgeons,nurses and scrub techs will take awaya new level of consciousness aboutvalue and product costs.”

S e p t . 1 6 , 2 0 11 F O C U S ● 5

Value Symposiumto help connectthe dots

Gretchen Makai, M.D.

Let’s get it done this flu season!

As a staff member of ChristianaCare Health System, we know

you take your responsibility for thecare of our patients very seriously. It isbecause of you that Christiana Carehas earned an outstanding reputationfor offering superlative, patient-cen-tered care to the 600,000 patients weserve yearly.

Influenza and related complicationshospitalize approximately 226,000Americans and more than 36,000 diefrom the flu every year. In fact,influenza, which vaccination can pre-vent, is the sixth leading cause ofdeath in the United States.

As a health care professional, youknow all too well that influenza cancause serious health complications forour patients, especially those withcompromised immune systems. It canalso create major staffing shortageswhen health care workers become illthemselves, compromising our abilityto provide optimal care.

Christiana Care tries to make this asconvenient as possible by offeringemployees, Medical-Dental Staff andvolunteers free flu shots at EmployeeHealth and other locations. This year,we will also set up on-site flu shot sta-tions to allow you to receive the shot

as you arrive to or leave work.

Let’s give our community its best shotat staying healthy. This year, let’s allget the flu vaccine.

Watch the portals for a complete sched-ule of times and locations for the flu shotstations.

Join Christiana Care and the womenin your community as we laugh,

play and learn at our second annualGirls Night Out event.

Come for the free food and music, plusgifts for all attendees and rafflesthroughout the evening. Stay for mini-lectures on cancer prevention andheart health. Bring a friend or lovedone and get screened for breast cancer,

heart and bone disease.

Schedule your mammogram for on-site at this event! Call 302-623-4200.

Don’t miss this free health event –call 800-693-2273 to register today.

Thursday, Oct. 13, 5 to 8 p.m. at theChristiana Care Breast Center, HelenF. Graham Cancer Center, 4701Ogletown-Stanton Rd., Newark, Del.

affected, as well.Those users will con-tinue to access thesame tool and viewthe same screens, buttheir data may lookdifferent than it doestoday.

“Even if you don’t usethe HIS system, youlikely receive informa-tion from the DataWarehouse,”Brentlinger says.

The implementationwill impact electronicmedical recordsbecause they aredependent on HIS fordata today. While we

are not changing systems, users ofthose systems may see some changesbecause of the Soarian implementa-tion.

Ultimately, Soarian will broadenChristiana Care’s foundation forfuture patient care, while increasingaccess to data for both internal andexternal users. The system will signifi-cantly reduce the need to re-enterdata, saving time.

I N F O R M A T I O N T E C H N O L O G Y

To help meet the dual demands ofproviding exceptional patient care

and complying with future govern-ment regulations, Christiana Care willlaunch a new system that trackspatients seamlessly, and enhances billing.

Phase 1, the Acute Implementation ofSoarian Financials, slated for imple-mentation Sept. 15, 2012, will replacethe HIS system. Patient registrationwill go live that day in all inpatientareas, the Emergency Department, andall ancillary departments. Billing alsowill go online.

“Soarian will provide us with a singlemaster patient index, which we don’thave today,” says Nichol Brentlinger,Soarian program manager. “We willknow which services our patientshave, whether they visit one of ourdoctors or come into the hospital.”

Soarian users will not be the only onesfeeling the impact of the new system.Anyone who retrieves informationfrom the Data Warehouse will be

A look ahead at Soarian, the next step in registration, billing“The commitment from our leaders,from our community, from ourpatients and all those folks who workday-to-day inside Christiana Care whowill use the system; the investment oftheir time and their acceptance of thechange will allow us to implementSoarian as the platform for the future,”says Randy Gaboriault, chief informa-tion officer and vice president ofInformation Technology.

Phase 2 of the project involves theupgrade to the Soarian software toensure compliance with regulationsregarding ICD-10 codes.

Phase 3, the Physician PracticeImplementation, will begin with ourfirst Physician Practices being broughtlive. This phase is designed to enhancebilling.

“I really do believe Soarian will betransformative for our patientsbecause it will make access toChristiana Care easier and more clearto our patients,” says Tom Corrigan,chief financial officer and senior vicepresident of Finance.Employeesthroughout the system will be updat-ed regularly as the Soarian launchapproaches.

6 ● F O C U S S e p t . 1 6 , 2 0 1 1Frederick Giberson, M.D.

Dr. Giberson earns masters degree in Academic Medicine

Acute care surgeon Frederick Giberson,program Director for Christiana Care’s

Surgical Residency Program, received amaster's degree in Academic Medicine fromthe Keck School of Medicine at the Universityof Southern California.

“This is a real accomplishment for a busytrauma surgeon,” commented MichaelRhodes, M.D., chair of the Department ofSurgery.

ing an impact assessment and layingthe groundwork for the new system.

“ICD-10 will be a transformativechange in health care that will enableus to better measure the quality, safetyand efficacy of the care we deliver,”says Sharon Anderson, senior vicepresident for Quality and PatientSafety.

Formally known as the TheInternational Statistical Classificationof Diseases and Related HealthProblems, 10th Revision, ICD-10 willenable health care systems to trackmany new diagnoses, allowing morethan 155,000 different codes.Improving quality and quantity ofdata will help improve quality meas-urement and outcomes, public health,research, monitoring and reimburse-ment.

Health care providers will not be ableto submit ICD-9 codes for servicesprovided on or after Oct. 1, 2013,according to the Centers for Medicareand Medicaid Services. Conversely,providers cannot implement ICD-10before that date, even if their systemsare in place.

Lynahan believes it is highly unlikelythat deadline will be extended.

“CMS is giving clear indications thatthey are not moving this date back,”she says. “When it is time to make thechange, we will be ready.”

I N F O R M A T I O N T E C H N O L O G Y

ICD-10 reinvents classificationof diseases in the U.S.

The next revision of the internation-al classification of diseases codes

from the World Health Organization istwo years and two weeks away fromimplementation, but already it loomslarge in the minds of our nation’sproviders from coast to coast.

“It is a huge, transformative initiative,and the whole country is going live onthe sameday,” saysPeggyLynahan,manager ofthe ICD-10program. “It’slike healthcare’s ownY2K.”

Starting Oct. 1, 2013, the next (10th)revision of the codes, ICD-10, will berequired for claims by everyone cov-ered by the Health InsurancePortability and Accountability Act(HIPAA), not just for Medicarepatients. That means codes for medicaldiagnosis, both inpatient and ambula-tory, and inpatient procedures must beaccording to ICD-10.

ICD-10 is already the coding system inplace for claims and transactions in 25other developed countries, includingmost of Europe, Canada, Australia andThailand.

“This will enable the United States tobe in a position to share informationrelating to disease and morbidity sta-tistics with other countries in morespecific ways,” Lynahan says. In othercountries, codes refer only to diagno-sis. In the U.S., in addition to diagnosis,there will be codes for inpatient proce-dures.

Christiana Care has been preparing forthe transition for two years, complet-

S e p t . 1 6 , 2 0 11 F O C U S ● 7

“It is a huge, transformative initiative,and the whole country is going liveon the same day .... It’s like healthcare’s own Y2K.”

Peggy LynahanICD-10 program manager

InformationWeekmagazine says ‘Steal this idea!’

Christiana Care’s use of large com-puter monitors to better manage

Emergency Department trauma roomshas been selected as one of “20 IT inno-vative ideas to steal” byInformationWeek 500 magazine.

The magazine also ranked ChristianaCare in the top 500 (number 232) ofNorth American enterprise IT. The pub-lication annually shines a spotlight onIT innovation by identifying and recog-nizing business technology teams thathave made a notable difference in howtheir companies do business.

It is difficult to make the list. Accordingto the magazine, qualifying companiesmust complete a rigorous applicationabout their business technology strate-gies. The process is both quantitativeand qualitative, whereby applicants areranked based on their responses to aquestionnaire and are also evaluatedbased on the innovation they outline inan essay submission.

Christiana Care’s Compliance Hotlinecan be used to report a violation of anyregulation, law or legal requirement as it

relates to billing or documentation, 24 hours a day, 7 days a week.

All reports go directly to ComplianceOfficer Ronald B. Sherman.

Callers may remain anonymous.

The toll-free number is:877-REPORT-0 (877-737-6780).

at 302-623-2873.

“Nurses educatepatients andcoach them sothey understandtheir treatmentplans.”

Nurses work withpatients to estab-lish personalgoals, such asbeing able to walkto a neighborhoodcoffee shop tomeet friends.

“One of our nurses persuaded apatient to serve turkey on Easterinstead of ham, which is much higherin sodium,” she says.

Christiana Care VNA rolled out tele-monitoring in 2005. The telemonitor isa device that patients use in theirhomes to transmit their vital signs andother information to a health careprovider. In addition, the telemonitorasks patients “yes/no” questionsabout their symptoms. A nurse at thecentral monitoring station evaluatesthe information and may call thepatient to talk about any symptoms,diet or medications.

The nurse also can use the data forclinical decisions, including contactingthe doctor to discuss a change in theplan of care.

Adding equipment that does notrequire a telephone land line hasenabled VNA to reach more heart fail-ure patients who can benefit from tele-monitoring.

“But it isn’t just the equipment,”Bucher says. “How the equipment isused and placing the equipment withthe right patients plays a big part inour success.”

T R A N S F O R M A T I O N

Patients with heart failure enrolledin the Christiana Care Visiting

Nurse Association telemonitoring pro-gram are much less likely to be rehos-pitalized than the national average,according to statistics by StrategicHealthcare Programs (SHP).

In the program, nurses from the VNAwork closely with patients to electroni-cally monitor such vital signs asweight, blood pressure and the oxygenlevels in the blood so patients canmake adjustments as soon as theirnumbers indicate a problem. Nursesalso help patients to set goals andmaintain heart-healthy diets.

In New Castle County, 22.8 percent ofheart failure patients were readmittedto the hospital within 30 days of dis-charge. That is significantly lower thanthe 32.7 percent of patients readmittednationwide, says SHP, a developer ofmonitoring technology.

Technology enables nursing relationships“The program provides much morethan technology,”says Gale Bucher,RN, MSN, director of Quality & RiskManagement, Christiana Care VNA.

VNA telemonitoring helps prevent heart failure readmissions

8 ● F O C U S S e p t . 1 6 , 2 0 1 1

VNA reduceshospitalizationsand falls

Christiana Care Visiting NurseAssociation is reducing the num-

ber of hospitalizations and falls ofhome health care patients. Last yearthe VNA achieved a 18.8 percent hos-pitalization rate for Medicare patients,compared to a national rate of 25 per-cent. Also, patients requiring emer-gency care because of falls dropped to0.8 percent, a 10 percent improvementfrom 2010 and better than the nationalrate of 1.4 percent. That translates intosaving approximately 50 VNApatients from serious injury becauseof falls.

Heart failure readmissions

in 1996 at Cincinnati Children’sHospital Medical Center. There arenow more than 140 sites in 40 states,Australia and the United Kingdom.

several months at each worksite,depending on the complexity of thejob, tasks they need to learn and howthey perform. Project SEARCH began

G R E A T P L A C E T O W O R K

Focus on:Project SEARCH internship program for students with disabilities

Akick-off open house in Augustlaunched Christiana Care Project

SEARCH, a nine-month school-to-work program for students with dis-abilities.

Christiana Care is the first employer inDelaware to join the national program.Nine students started internships inseveral departments starting Aug. 30.

“Christiana Care Project SEARCH pro-vides real-life work experience to stu-dents with intellectual and develop-mental disabilities, helping them makesuccessful transitions from school toproductive adult life,” says CarvellaJackson, professional recruiter inRecruitment Services.

At the open house, students and theirparents received an introduction toChristiana Care, mingled with depart-mental managers and asked questions.

Participation in Project SEARCH offersChristiana Care access to a trainedlabor pool, reduced recruitment costs,improved retention rates in high-turnover positions, workforce diversity,and local, state and national recogni-tion.

Students spend the first two weeks ofthe program completing orientation inChristiana Care’s culture and facilities.Worksite rotations begin immediatelyfollowing the orientation phase of theprogram and typically include three tofour sites per student by the end of theprogram.

Job coaches, teachers, managers andstudents work together to identifyworksites based on the student’s pre-vious work experience, interests andskills assessment. For each worksiterotation, students prepare a resume,interview with the department manag-er and arrange scheduling.

Students can spend several weeks to

S e p t . 1 6 , 2 0 11 F O C U S ● 9

Christiana Care welcomed students and parents at the Project SEARCH open house.The nine-month school-to-work program provides internship opportunities for studentswith disabilities. Leading a tour for the group, at right in green jacket, is Sr. HumanRelations Representative Carole L. Hines.

Since its inception in December2007, the Crisis Leave Bank contin-

ues to receive very generous supportfrom the employees of ChristianaCare. These funds have providedfinancial assistance of over $115,000 to56 employees during catastrophicemergenies or life crises.

Contributions are received throughoutthe year; however this year, for thethird year in a row, employees havealso had the opportunity to contributeduring the open enrollment process.We have continued to receive over-whelming support through this initia-

tive and are very pleased to announcethis year nearly 300 employees donat-ed over 1,700 paid leave hours for atotal of over $74,000!.

Thank you for your continued supportin making Christiana Care a greatplace to work and making the CrisisLeave program a huge success.

We would like to extend a sincerethank you to everyone who has sup-ported the Crisis Leave program overthe last year through their donations.For a list of donors, check the portals.

Employee generosity drives Crisis Leave Bank

ease who have wounds that havestalled the healing process.

“We have seen how this productcan jump-start the healing process,as well as decrease wound painwithin a matter of minutes,” Abnersays.

The dressing also can be usedunder a cast or a compressionwrap. According to the manufac-turer, it can last for up to 30 days,although the wound center current-ly leaves the dressings in place forno longer than two weeks, and,only in selected cases.

Upfront, the product costs morethan a traditional gauze dressing. But,because the dressing lasts longer andrequires less maintenance, it savesmoney in the long run.

Better, longer lasting dressing“A dressing that can stay on for awhole week is cost effective because avisiting nurse doesn’t have to go outand change it and the patient doesn’thave to buy supplies to maintain thedressing on their own,” Abner says.

Because the seal covers exposed nerveendings, the dressing also sparespatients the physical and emotionaltoll of pain, as well as the cost of painmedication.

“Within minutes, we have seenpatients’ pain level drop from 10 to2,” she says.

After a year in use, Abner says thedressings have been effective inenhancing both healing and patientsatisfaction.

“Patients see a world of difference inquality of life,” she says.

To refer patients to the ChristianaCare Wound Care Center, call 302-765-4132.

The barrier between the wound andthe environment is created by crystalsdeveloped through nanotechnology,the science of engineering materials onan atomic or molecular scale to makemicroscopic devices. The crystals areapplied to the wound, where theycombine with the body’s natural mois-ture and a bit of added saline solution.

“That produces a flexible mold thatfeels almost like a very thin, pliable

plastic,” Abner says. “Theonly thing that can get inor out is vapors.”

In the past year, morethan 40 patients at theoutpatient wound centerat Christiana Care haveused the dressings forsuch conditions asinflammatory wounds,burns, and open, drain-ing wounds. The dress-ing also has benefitedpatients with diabetes orvenous and arterial dis-

V A L U E

Imagine a dressingthat molds itself to

every crevice in awound, relieves thepatient’s pain anddoesn’t have to bechanged for up to 30days.

Thanks to advances intechnology, the dress-ing is a reality forpatients at ChristianaCare’s Wound Careand HyperbaricMedicine Center.

Adrienne Abner, RN,NE-BC, CWS, directorof the center, got anin-depth look at theway the transformingpowder dressing works at theSymposium on Advanced WoundCare, sponsored by the Association forthe Advancement of Wound Care andthe Wound Healing Society

“This dressing is especially helpful forpatients who have limited dexterity ora living situation that makes it difficultto practice proper hygiene because thepatient never needs to touch thewound,” she says.

New hi-tech dressing speeds healing, decreases pain, lasts longer

1 0 ● F O C U S S e p t . 1 6 , 2 0 1 1

Wound Care and Hyperbaric Medicine Center MedicalDirector Nicholas O. Biasotto, D.O., and Director AdrienneAbner, RN, NE-BC, CWS, found a better bandage and lost notime before using it to improve patient care.

tion of specialized knowledge in heartfailure care in the increasingly compet-itive field of heart failure care.

The Center for Heart & VascularHealth announced that four

Christiana Care Nurses received certi-fication from the AmericanAssociation of Heart Failure Nurses(AAHFN) after passing the first-everexam offered by American NursesCredentialing Center (ANCC).

Congratulations to Carolyn M. Moffa,MSN, RN, FNP-C, CHFN; SusanFelicia, MSN, RN-BC, PCCN, CHFN; Patricia Wessell, MSN, RN, CCRN,CHFN; and Heather Hastings, RN II,BSN, PCCN, CHFN.

"The Heart Failure Program is veryfortunate to have the most HeartFailure Certified nurses in the State,”says Mitchell Saltzberg, M.D., medicaldirector of the Heart Failure Program.“The achievement of this milestoneexemplifies the dedication of the staffand the expertise of the Heart Failurenursing staff in general. Great job!"

The Surgical Critical Care Complex(SCCC) at Christiana Hospital is

one of just 22 intensive care units(ICUs) nationwide chosen to partici-pate in only the second multicenter,randomized trial in infection control.

The Agency for Healthcare Researchand Quality (AHRQ), the Centers forDisease Control, The JointCommission and a research teamincluding Yale and the University ofMaryland lead and fund the studynationwide. Hospital epidemiologistMarci Drees, M.D., and SCCCMedical Director Gerard Fulda, M.D.,

L E A R N I N G

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Surgical Critical Care Complex joins ICU infection studylead the study at Christiana Care.

The Benefits of Universal Gown andGloving (BUGG) study aims to deter-mine whether using gowns and glovesfor all patient contacts (instead of onlyfor patients in contact isolation forknown resistant bacteria) decreasesacquisition of the resistant bacteriaand health care-associated infections.

The SCCC began a two-month base-line collection in August. During thistime, nursing staff will obtain admis-sion and discharge surveillance cul-tures for methicillin-resistant

Staphylococcus aureus (MRSA) andvancomycin-resistant enterococci(VRE) for all patients admitted to theunit.

After the baseline period, the SCCCwill be randomized to either continueusual care (gloves and gowns forpatients in contact isolation only) or touniversal gloves and gowning (for allpatients) for 12 months.

For more information, contact Dr.Drees via pager 9575, or Patty McGraw,RN, MS, CCRC, at 733-4166, or hospitalpager 8849.

From left, Susan Felicia, Carolyn M. Moffa, Heather Hastings, and Patricia Wessell.

With certification, nurses prove specialized heart-failure skills Certification assures that a nurse iswell qualified to provide specializedcare, and provides formal recogni-

municate openly and clearly.

“Patients and their families havealways been at the center of ourcare,” said Penny Seiple, vicepresident, Patient Care Services.“But it’s exciting to see the dif-ference that these specificbehaviors can make once staffbegin to understand why aPatient and Family Centeredapproach is successful. Whenthe transformation begins andyou see happier patients andhappier staff.”

Established an Advisory CouncilWilmington has also established aPatient & Family Advisory Council, inwhich former patients and family areenlisted to provide feedback and helpstaff develop and test new initiatives.

“Patient and family centered care isproviding us with tools and new waysof thinking that will increase patientsatisfaction and lead to better out-comes for our patients,” said JanetCunningham, vice president,Professional Excellence, and associateCNO.

Patient and family centered care is notjust for nurses and physicians.Everyone at Christiana Care can usethis approach to improve service toour patients and each other.

Watch for events and informationthroughout the month of October to learnmore, and visit http://depts/PFCC on theportal.

The core concepts of patient andfamily centered care are: respect anddignity; information sharing; partici-pation; and collaboration. These prin-ciples are behind initiatives in bothhospitals, including:

n AIDET (acknowledge, introduce,duration, explanation and thank you):This communication tool ensures thatpatients and visitors feel welcome andat ease, and promotes open communi-cation among families and hospitalstaff.

n Bedside shift reporting: A standard-ized approach to hand-off communica-tion that can ease patient anxiety andengage the patient and family in deci-sion making.

n Hourly rounding: A practice thathelps nurses and support staff to bet-ter anticipate and meet patient needs.

n Patient whiteboards: Shared com-munication tools that invite everyoneinvolved in the patient’s care to com-

F O C U S O N E X C E L L E N C E

October is Patient and FamilyCentered Care Awareness Month,

and at the Christiana and Wilmingtoncampuses, efforts are under way toexpand initiatives that are transform-ing the patient experience.

“Patient and family centered care is anapproach to the planning, deliveryand evaluation of health care that isgrounded in mutually beneficial part-nerships among health care providers,patients and families,” says JaniceNevin, M.D., chief medical officer. Dr.Nevin championed patient- and fami-ly-centered care as senior vice presi-dent, Christiana Care Wilmington,when it formally launched in anOctober 2010 ceremony.

Putting it into practice“It recognizes the vital role that fami-lies play in the health care process,and it does this by restoring dignityand control to the patient and thepatient’s family,” Dr. Nevin says.

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Centering on our patients, for all the right reasonsThe Pledge stands. Last Octoberat Wilmington Hospital hun-dreds of Christiana Care col-leagues, led by President & CEOBob Laskowski, M.D. (left),signed a giant pledge promisingto partner with patients andfamilies.

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C O M M U N I T Y B E N E F I T

Dental implant service changes patients’ lives

Years after breaking fourbottom teeth in a motorcy-

cle accident, ChristopherGrzybowski couldn’t enjoysteak or corn on the cob, histwo favorite dishes at familycookouts.

With help from dentists andoral surgeons from ChristianaCare, Grzybowski receivedimplants at the WilmingtonHospital Health Center.Implants are an expensive pro-cedure, and the center providesthe service to patients at sub-stantially reduced rates.

“They feel like my natural teeth,” saysChris, 46. “I am eating steak and cornon the cob again. That is wonderful.”

Beyond his dental problems, Chrissuffers from disabilities as a result ofhis injuries. He is legally blind and hasdifficulty with short-term memory.

Dentures not a good option“Something removable, like a partialdenture would have been very diffi-cult for Chris to manage and wouldnot have felt like his own naturalteeth,” says Howard W. Zucker,D.D.S., section chief. “With theimplants, Chris eats well and smileswell.” Chris learned about the pro-gram through his mother, CatherineGrzybowski of Wilmington, a retiredregistered nurse who worked atChristiana Care for 42 years. Chrisreturns to the health center for regularcheckups, where he always receives awarm greeting from the staff.

“This program is a tremendousresource, and the people here are verypatient in working with Chris,” hismother says. “These dentists are notonly skilled, they are dedicated andcaring.”

Since the 1950s, as part of Christiana

Care’s mission to provide charity careto the community, the Department ofOral & Maxillofacial Surgery andHospital Dentistry has offered unin-sured and underinsured patients likeChris a wide variety of needed dentalservices at cost. Services range fromroutine dental care to complex recon-structive maxillofacial surgery andrestorative dentistry.

On site and in the communityUnder the direction of Edwin L.Granite, D.M.D., the departmentworks closely with community-baseddentists and Christiana Care dentalresidents to provide many of theseservices on a volunteer basis. Thedepartment also provides care foruninsured and underinsured patientsat clinics in the community, includingWestside Family Healthcare andHenrietta Johnson Medical Center,both in Wilmington.

Since the implant program was estab-lished 20 years ago, it has providedmore than 1,500 implants, Dr. Zuckersays. These restorations range fromsingle crowns to complete oral rehabil-itations. Between July 1 2009 and June

30, 2011, more than 50 patientsreceived a total of 111 implants.

Dr. Zucker and restorative den-tists James C. Baker, D.D.S.,David Isaacs, D.M.D., andSohaib Usmani, D.M.D., super-vise residents and work withpatients to restore their smiles.Department staff, Dr. Edwin L.Granite, Dr. Daniel J. Mearaand community oral and max-illofacial surgeons performsuch procedures as bone graftsto build up bone before animplant is placed, when need-

ed. Community oral surgeons RayPetrunich, D.D.S, Louis Rafetto,D.M.D., and Peter Subach, D.M.D.,also participate in the implant surgeryprogram and serve as attending den-tists that supervise the oral surgeryresidents during the necessary surgicalprocedures.

Patients need implants for many rea-sons; the most common being decayand periodontal disease. Patients mayalso require advanced restorative den-tistry involving implants placementbecause of trauma or congenitallymissing teeth.

Laura Lemon, a 21-year-old womanwith Down Syndrome, had two con-genitally missing incisors and theremaining two front teeth requiredextractions after a long period of ther-apy. Her beautiful smile was restoredwith an implant supported bridge.

“They took excellent care of her,” saysMark Lemon of North Wilmington,Laura’s dad. “Laura liked her doctorsbecause they were so kind and reas-suring, and she came through it like atrooper.”

For more information, call theWilmington Hospital Health Center at302-428-4410.

Laura Lemon’s more beautiful smile wasrestored at Christiana Care’s WilmingtonHospital Health Center

Poignant reminders of patients line memorial walkways

Nov. 4, 2011 ... Nov. 4, 2011 ... Nov. 4, 2011 ... Nov. 4, 2011 ... Nov.

n

n

n

n

n

n Involving patients in future goals,such as involvement in protocol devel-opment, enhance accruals, provide thepatient perspective to researchersdesigning clinical trials.

n Hosting celebrations for clinical trialparticipants.

For more information on the ClinicalTrials Advisory and Advocacy Group, call302-623-4450.

ing feelings in the decision makingprocess.

n Connecting prospective clinical trialparticipants with survivors who havebeen through clinical trials so patientscan make better-informed decisions.

n Coordinating seminars and otheroutreach projects to help educatepatients and the community.

H E L E N F . G R A H A M C A N C E R C E N T E R

Patient advisory group helps build a bridge of understanding

Enrolling in a cancer clinical trialcan raise a myriad of questions for

patients and families.

Our patients can also provide impor-tant feedback based on their experi-ence in a research study.

Now, a special group of people haveformed a committee to help build abridge of understanding betweenpatients and the multidisciplinaryteams of physicians, nurses, socialworkers and others providing care forpatients participating in ongoing clini-cal studies at the Helen F. GrahamCancer Center.

This is the first committee of its kindin Delaware, led by cancer survivorswho participated in clinical trialsoffered by Christiana Care.

Having a patient’s perspective on clin-ical trials provides many importantbenefits to both patients, families andcare providers, such as:

n Increasing awareness.

n ways to educate patients and thecommunity and dispel myths.

n Helping the community understandwhat a clinical trial is and the impor-tance of a clinical trial.

n Limiting/reducing the overwhelm-

Clinical Trials Advisory and Advocacy Group members, from left, include JohnMantakounis, Robert Pietschmanin, Joan Lockett, Cathy Holloway, Viola Smith, LeliaHamroun, Lisa Cerullo-Gilroy, Stephen Grubbs, M.D., Angela Tilton MSN, RN, and Gladwyn Downes, BSHS/M, CRA.

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Christiana Care’s Employee MailOrder Pharmacy now has a web

page available you can access on theportals to help with all of your mailorder prescription needs. To getthere, go to HR Online, click on theHealth & Wellness link at the top ofthe page and find the "EmployeeMail Order Pharmacy"link on theleft side under the "Your Wellness"heading.

New mail order pharmacy web page availableHere, you can:

n Refill your prescription via the web.

n Print out the Christiana Care MailOrder Pharmacy Form.

n Set up your prescriptions for theAuto Refill Program.

n Find tips to ensure you receive yourmedication quickly as well as otherinformation that you may find helpful.

may stay in place for up to six weekswhile the lung heals.

Dr. O’Brien says a pivotal U.S. study isunderway that could lead to morewidespread application of the IBV as atreatment for severe emphysema. Useof the valve to treat the patients asdescribed above is currently under theFDA’s limited “humanitarian useguidelines.”

Aless invasive procedure availablenow at Christiana Care is helping

treat patients who experience persist-ent air leaks following lung surgery.

Interventional pulmonologist GeraldO’Brien, M.D., is using a new, umbrel-la-shaped intra-bronchial valve(IBV™) to stop air from entering thesection of the lung that has the airleak. This allows the lung to heal nor-mally without the need for additionalsurgery.

“Temporary air leaks in the lung arenot uncommon after lung surgery orinjury, but until now prolonged leakstypically required much more aggres-sive surgical techniques to blockthem,” says Dr. O’Brien. “Our expert-ise with the IBV system meanspatients need no longer travel out ofstate to receive this minimally invasivetechnology.”

Using a flexible bronchoscope, Dr.O’Brien inserts the IBV valve on theend of a catheter into the bronchialtree to stop the leak. Multiple valvescan be placed at one time while thepatient is under sedation or anesthe-sia. The procedure takes under anhour, and the patient can breathe inde-pendently the same day. The IBVvalve is designed to be removable and

Christiana Care offers lung surgerypatients new valve to improve healing

Gerald O’Brien, M.D.

Revised visitor guidelines pub-lished by Christiana Care in

August are helping to better definesome important words, such as “fami-ly” and “partner” and provide theclearest possible lines of communica-tion among nursing staff, patients, andvisitors.

As used in the guidelines, the patient’s"family" can mean any person whoplays a significant role in the patient’slife, such as a spouses, domestic part-ners, those joined by civil unions or,significant others (of both differentand same sex), and other individualsaccording to each patient's prefer-ences. Such persons are not alwayslegally related to the patient.

"Family" also includes a minorpatient's parents, regardless of thegender of either parent.

Visits from family members, friendsand clergy are an important part of thehealing process,” says Tim Rodden,Christiana Care’s director of PastoralServices. “Our visitation policy pro-vides a safe environment that pro-motes patients' physical and emotionalwell-being, provides time for patientrest and allows time for medical thera-pies and nursing care.”

Christiana Care encourages visitors tocommunicate directly with the nursecaring for the patient to discuss visit-ing arrangements and share informa-tion about the patient,” Kayatta says.“In return the nurse can provide direc-tion and suggestions for coordinatingvisiting times according to eachpatient's care needs, preferences andthe needs of the family.

F O C U S O N E X C E L L E N C E

Revised visitorguidelines betterdefine ‘family’

Doctors: Do you work with a nursewho exhibits great communica-

tion skills, teamwork and collabora-tion with the physician community?

Nurses: Do you work with a physicianwho exhibits great communicationskills, teamwork and collaborationwith nurses?

Why not nominate them for an ambas-sador award?

The Professional Nurse Council (PNC)will e-mail a link soon to nurses andphysicians providing access to nomina-tion forms on the Physician andNursing Portals.

For more information contact the chair,Matt Young, RN, PNC, myoung@chris-tianacare.org, or co-chair Pam Boyd, RN,PNC pboyd@christianacare.org.

I M A G I N A T I O N S

Students at Imaginations take on Great Kindness Challenge

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The children and staff at Imaginations Early ChildhoodDevelopment Center united on Aug. 13 as part of The

Great Kindness Challenge, a day devoted to performing asmany acts of kindness as possible, presented acrossAmerica by Kids for Peace. From a list of 50 suggested kind

acts, the children chose to give cookies to three organiza-tions that serve some of the neediest folks in Wilmington:Connections Homeless Café, The Sunday BreakfastMission and the Ministry of Caring Childcare Center.

For more information about Imaginations, call 733-5437.

Adults shown in the photos are Imaginations teachers Shameka Piper (blue shirt),and Leslie Lewis (green shirt), helping the children bag cookies for The GreatKindness Challenge.

D I V E R S I T Y A N D I N C L U S I O N

Visítenos hoy en www.es.christianacare.org!

¿Sabías que?Christianacare.org está disponible en español!

with, you can register with RideShareof DE, which works with individualsto help them find carpooling partners.What’s more, the program will guar-antee your ride home.

Please register you car pool grouptoday with RideShare of DE.

Call Christiana Care Public Safety at733-3742 for details.

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HUMAN RESOURCES FREQUENTLY CALLEDNUMBERS

There are many good reasons forChristiana Care employees to con-

sider carpooling to work. You can:

n Avoid high gasoline costs.

n Reduce air pollution.

n Lower stress caused by driving.

n Get a preferred parking permit foryour group.

If you don't know anyone to carpool

Got commuters’ blues?Chill out in a carpool

C O M M U N I T Y O U T R E A C H

S e p t . 1 6 , 2 0 11 F O C U S ● 1 9

women are 20 percent more likely todie from breast cancer than non-Hispanic white women diagnosed atthe same age, often because the canceris diagnosed at a later stage, accordingto ACS.

Within the past year, 41.7 percent ofHispanic women had a mammogram,compared to 53 percent of non-Hispanic white women. Throughoutthe year, Christiana Care’s outreachstaff works with Hispanics and peoplein other underserved communities tomake health care more accessible. “Wefrequently get calls from people whodo not have insurance and others whodo not have primary care physicians,asking if they can get help,” saysJoceline Valentin, a bilingual outreachcoordinator at the CommunityOutreach and Education program atthe Helen F. Graham Cancer Center.

“We tell them ‘yes,’ and that we willmeet them at appointments to inter-pret.”

‘Promotoras’ promote breast health to Latinas in community

Through Christiana Care, Latinasare learning about breast health

and cancer screenings, essential infor-mation they can share with others asPromotoras—promoters of health edu-cation—to Delaware’s rapidly growingHispanic community.

“If you teach someone, then ask her togo talk to her family, her community,you raise awareness that cancer is nota death sentence,” says NoraKaturakes, RN, MSN, OCN,Christiana Care’s manager ofCommunity Health Outreach andEducation.

Josefina Hernandez, 51, knows first-hand how important it is to get anannual mammogram. Her regularlyscheduled screening detected Stage 1breast cancer, an early form of the dis-ease that is highly treatable. “I wouldhave never found out that I had cancerif I hadn’t had my mammogram,” shesays. “Now, I tell my kids, my sisters,my family, so that they will know.”

At a recent workshop at the Helen F.Graham Cancer Center and WoodlawnLibrary, Hernandez and otherPromotoras-in-training learned factsabout breast health and the effective-ness of early detection and treatmentin saving lives.

“Culturally, Latinas don’t see a needto go the doctor’s unless we are sick,”says Sharon Gomez, outreach coordi-nator. “Through the Promotoras, weare emphasizing screenings that candetect a problem before someone feelssick.”

Among Hispanic women, breast can-cer is the leading cause of cancerdeath, according to the AmericanCancer Society (ACS). Hispanic

The Community Health Outreach andEducation Department obtained agrant for a lay health educator pro-gram from the American Recoveryand Reinvestment Act through theNational Cancer Institute NationalCommunity Cancer Centers Program.The two-year grant pays for a full-time bilingual community outreachworker.

Susan G. Komen for the CurePhiladelphia affiliate also pays for abilingual outreach coordinator. Inaddition to the Promotoras, the pro-gram includes training medical assis-tants at federally qualified clinics topromote screenings, starting withbreast health and eventually includingtests for cervical and colon cancer.

“Our goal is to have 300 peoplereceive screenings as a result of thisprogram,” Katurakes says. “Each oneof the Promotoras represents a connec-tion in a family network who canreach others we might not otherwisehave an opportunity to help.”

With help and guidance Nora Katurakes, RN, MSN, OCN, Christiana Care’s managerof Community Health Outreach and Education (far left) Christiana Care is trainingLatina women to be "promotoras"—liasons between the health care system and thecommunity—to encourage Hispanic women to get appropriate breast cancer screen-ings and learn about breast health.

n Repeated requests to borrow money.

n Valuable items in the household gomissing.

There also are physical symptoms ofsubstance abuse. These include: red ordilated eyes, slurred or incoherentspeech, slow or abnormal reflexes, andgrinding teeth and other nervousbehaviors.

If you suspect someone you know hasa problem with drugs or alcohol — oryou are concerned about your ownbehavior — you can call a toll-freenumber for help. You can speak confi-dentially with a GuidanceConsultantadviser at the EAP who can provideresources and information, as well asfree counseling for you and your eligi-ble family members.

To learn more, call 877-595-5284 or goto guidanceresources.com.

C A R I N G F O R Y O U R S E L F

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vides free, confidential counseling foremployees, as well as their eligiblefamily members.”

You might have noticed a shift in atti-tude and personality. People who areabusing drugs and/or alcohol oftenstop seeing friends and start hangingout with a different crowd. They loseinterest in hobbies and things theyused to enjoy doing. Eating andsleeping habits may also change.

Here are other common warning signsof alcohol or drug abuse:

n Sudden changes in behavior.

n Irritability or hostility.

n Depression.

n Paranoia.

n Lying and secretive behavior.

n Unpredictability.

It isn’t easy to talk with people closeto us about substance abuse. It can

be even more difficult to see the warn-ing signs in ourselves.

Yet drinking and drug abuse are seri-ous problems that impact performancein the workplace, as well as personalrelationships.

According to the Department of Labor,11 percent of working adults havealcohol problems, costing employers500 million lost work days annually. Inaddition, 8.3 percent of the U.S. popu-lation age 12 or older (21.8 millionpeople) currently use illicit drugs.

“It’s important for people who haveproblems with drugs or alcohol toknow that help is available to them,”says Mark A. LoGiudice, benefitsmanager at Christiana Care. “TheEmployee Assistance Program pro-

Help is available for alcohol and drug abuse

Clinician: Is anyone doing anythingabout this at national level?

Pharmacist: Regulators and cliniciansare working with pharmaceutical com-panies to address the problem.Currently, there is some federal legis-lation (H.B. 2245 and S.B. 296) callingfor an early warning system for drugshortages. In other words, the lawswould require pharmaceutical compa-nies to provide six months lead timebefore a drug is no longer available.

Clinician: What key drugs are inshort-supply now at Christiana Care?

Pharmacist: To list a few: potassiumphosphate injectables, n-acetylcys-teine, multitrace elements, fluo-rouracil, daunorubicin, and cytarabine.

Clinician: What can I do to help withthe shortages?

Pharmacist: Depending on the drug inshort supply, in general, avoid the useof the drug, consider dosage conserva-tion, or use alternative therapy.

Clinician: How long does a typicaldrug shortage last?

Pharmacist: Depending on the drug, itcould range anywhere from one weekto several months. It is not unusual fora drug to be in short supply for atleast 3 to 6 months before it becomesavailable again.

Pharmacist: Yes, whenever possible.We will notify and provide you withan update of our current supply. Wewill also update you on when we willexhaust our current supply.Unfortunately, most manufacturers donot give us much lead time betweenthe announcement of the drug short-age and the last time we could pur-chase the drug. Once announced, it isnot unusual for the pharmacy to becompletely out of the drug.

Clinician: How does Christiana Careaddress critical drug shortages?

Pharmacist: Christiana Care Pharmacyprovides a continual supply of med-ication for patient care, even in theface of drug shortages in the market,with our primary goal being uninter-rupted patient care. Some strategiesinclude:n Monitoring medication supplynews, frequent communication withsuppliers.

n Monitoring usage/inventory andreallocating supplies.

n Repackaging drugs from large vialsinto smaller, single-use doses.

n Employing dosage conservation

n Recommending the use of a differ-ent drug.

n Keeping staff up-to-date with theavailability status.

Therapeutic notesDrug shortages continueto impact patients andcliniciansBy Tep Kang, Pharm.D., BCPS

If you are managing a patient in thehospital, there’s a chance that you

might not have access to the usualdrugs that are used to treat yourpatient because of increasing prescrip-tion drug shortages. Clinicians,patients, regulators and hospitals arefacing significant challenges in manag-ing the unprecedented surge in drugshortages.

The purpose of this article is to pro-vide a dialogue between a pharmacistand a clinician on the issue of drugshortages.

Clinician: Why are we seeing shortages?

Pharmacist: There are many reasonsfor drug shortages. One of the mainreasons is the merging of pharmaceu-tical companies leaving only one ortwo companies making key drugs. Ifone of the companies has difficultyobtaining some raw materials, it canvery quickly produce a drug shortage.Other reasons include manufacturingand quality problems, delays, or thediscontinuation of older drugs in favorof newer and more profitable drugs.

Clinician: Are there notable trends?

Pharmacist: Yes. The problem hasbeen worse for the past few years. In2010, the FDA reported 178 drugshortages compared to 90 three yearsago (Graph 1). Most shortages involveolder, generic drugs administered byinjection or intravenously. The short-ages range from cancer drugs (cytara-bine) to electrolytes (potassium phos-phate) to multitrace elements (MTE-4).

Clinician: Will someone notify meahead of time when there’s a pendingdrug shortage?

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FDA Report of Annual Drug Shortages (2005-2010).

Anthony Graves, center, of New Castle, and Aionna Williams, right, ofWilmington (both 13), survey a woman on Rodney Square about eating habitsand attitudes on access to healthy foods, shopping locations and exercise.

Camp FRESH, a nine-week sum-mer program conducted by

Christiana Care’s Center forCommunity Health has been push-ing healthy food choices since 2007.

Each year, new recruits from fiveurban Wilmington neighborhoodsjoin with teens returning from theprevious year and community part-ners, such as the Delaware Centerfor Horticulture to build on the pro-gram and work in the Camp FRESHgarden and farmers' markets. Theteens also meet at Christiana Care's

Around the horn: A cornucopia of smart food choices

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In its second year atop the Helen F. GrahamCancer Center, the “rooftop garden” added a

bed for vegetables to its thriving herb selections,with support from Leon’s Garden World onElkton Road. This year we have various herbs, aswell as cucumbers, tomatoes, eggplant, Jalapenopeppers and small white pumpkins. “Each year,we have to wait for the goslings from the nestinggeese to hatch and be rescued since they havedeveloped an interest in nesting on the roof,” saysgardening aficionado Elena C. Schumaker, RD.The garden club includes people from severalareas in the Cancer Center, who all take turnswatering.

Eugene du Pont PreventiveMedicine & Rehabilitation Institutefor educational lessons related toimproving their health and thehealth of their communities. Topicsinclude health advocacy, nutrition,weight management, sexual health,drug and alcohol education, com-munity organizing, communicationand planning for the future.

For information about CampFRESH or the Camp FRESHCommunity Garden & Farmer'sMarket, call 302-428-6525.

Occupational Safety Specialist Marcus Suhr, amember of the Environmental StewardshipCommittee, helps First State School studentsHeniah Collier Ellis (left) and Taylor Reillycheck the ripeness of pears at the committee’sgarden, maintained by Christiana Care staffnear the radio towers at Christiana Hospital.

H E A L T H A N D W E L L N E S S

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Are you ready for a disaster?

Christiana Care’s Office ofEmergency Management is has

been offering a slate of educationalsessions throughout September, withclasses remaining on Sept. 20, 23, 27and 30. Representatives from theAmerican Red Cross and Citizen

Corp., offer displays and presentationsat a variety of locations. Learn how toassemble a personal or family emer-gency preparedness kit and knowwhen to shelter in place and when toevacuate in the event of a disaster.

Check the portal or register via the

Education Center, using key words“preparedness” or “family” to find thelocations and times convenient to you.

For more information on disaster pre-paredness, visit the American Red Crossat www.redcross.org.

Upcoming events

Within hours of the Sept. 11, 2001 terrorist attacks,Christiana Care, working with the Delaware Emergency

Management Agency, dispatch 24 ambulances and nearly 100responders to assist teams caring for victims from “groundzero,” the World Trade Centers in New York City.

The task force left at 4:30 p.m., bound for the emergency med-ical services staging area at the Meadowlands stadium complexin East Rutherford, N.J.

“We do drills, but this was the first time we’ve created a taskforce such as this to travel to a distant site to provide aid,” saidtask force leader Robert Rosenbaum, M.D. “We traveled fartherthan any other unit at that location.”

For its prompt response to the tragedy, the Delaware House ofRepresentatives formally commended Christiana Care’sEmergency and Trauma team for their selfless dedication andrapid response by rushing to aid those affected by the tragicattacks of Sept. 11, 2001.

PRSRT STD

U.S. POSTAGE

PAID

WILMINGTON DE

PERMIT NO. 357

External Affairs

P.O. Box 1668

Wilmington, DE 19899-1668

www.christianacare.org

P R I N T E D O N

R E C Y C L E D P A P E R

Remembering 9-11: Christiana Care’s quick response

Christiana Care joined with the state of Delaware and otherhealth care providers in an ambulance caravan to respondto the terrorists attacks on New York City’s World TradeCenters.