Monday, March 25, 2013

Continuing the Communication Channels

By Dan Barber
Public Affairs Officer
Robert E. Bush Naval Hospital

My career as the Public Affairs Officer at the Robert E. Bush Naval Hospital will end May 31 when I retire, but my relationship with the Hospital will continue… albeit as a health care consumer… hopefully on a very limited basis.

As such I will continue my curiosity to know what is going on at the hospital?  When flu shots and other health services will be given to retirees like myself?  What the hours of operations are for the clinics and ancillary services?  Who replaced my Primary Care Provider? Why can’t I get an appointment when I want one? How do I give praise to a great Corpsman who provided me with a wonderful experience?... You noticed that I included all the important basic communication questions… Who, What, When, Where Why  and How.
To this end, the command has established “Communications” as one of its strategic initiatives. Each directorate here has assigned a Public Affairs Representative who is responsible for ensuring that information is fed to one of the communications channels the hospital uses. These communications links include:
*   “The Examiner” which is published each month and inserted into the base newspaper “The Observation Post” normally on the first Friday of each month. “The Examiner” is also published on the hospital’s Facebook page;
*  Closed Circuit TV programming used to inform and educate patients in health care issues;
*  Social media which includes Facebook, Twitter and a Health Blog. Every day Monday-Friday the day’s available appointments for the Blue, Gold and Pediatric Clinic Medical Home clinics are published on Facebook before the clinic appointment lines open at 7:15 a.m;
*  Information is also fed to the Combat Center’s Joint Public Affairs Office (G5) to be included, as needed, in the Speedcall email message system and on Combat Center radio and television broadcasts; and
* A huge communications channel that cannot be overlooked is the Face-To-Face “2-step communications method.” The hospital has a very active Customer Relations program with representatives in each department and clinic of the hospital. Patients with any issue they would like to discuss from a complaint to praise, should seek one of these representatives out for assistance. If not satisfied with the help received with one of these reps, they can contact the Customer Relations Officer, (CRO) who is HMC Tamara Marks, who can be reached at 760-830-2825. Chief Marks is a special assistant to the Commanding Officer, Captain Jay Sourbeer, MC. The Customer Relations Officer and clinic reps also provide input to the Comunications team so educational information can be developed to help patients or command staff.
The leadership of the Naval Hospital as well as Navy Medicine is constantly searching for a way for patients as well as medical staff to provide feedback to the leaders so they can make informed decisions to help in providing the best possible health care service.
The Naval Hospital’s Communications team is headed up by Lt.j.g. Ashley Robertson, NC. Robertson recently met with his team to discuss other communications strategies that can be used to reach the command’s beneficiaries. One of the Public Affairs Reps, Hospitalman Kylie Guest, Surgical Services Directorate, pointed out that we need to push our social media communications out to our younger beneficaries who are “wired” into instant communications through their smart phones. A plan was to set into motion with that suggestion to create some strategies to get the younger population of the Combat Center to “log on” to learn about services at the hospital.  I recently discovered what a “QR” does, because I finally buckled to peer pressure and purchased a smart phone… so I will be creating some posters where patients can take a photo of our QR with their smart phone to automatically log on to our social media sites. This will be done as soon as I can figure out how to use my smart phone, other than making or receiving phone calls, to create a QR with the QR App… maybe I’ll just get HN Guest to create it.
Feedback is also encouraged. The Facebook, Twitter and Blog sites each have the capability to receive that feedback… instantly. The only thing the hospital would like to see is for users to provide constructive criticisim or even positive feedback about a good experience with the hospital.  Personal attacks should be avoided as the social media sites are constantly monitored and can be viewed by anyone .
Good ideas are always welcomed, and many times incoporated into the health care services provided to patients.
Because of the hospital’s dedication to the protection of patient privacy personal patient information will never be discussed on social media. For private consultation, beneficaries should book an appointment with their health care team by calling 760-830-2752 or by calling the Customer Relations Officer at 760-830-2825. Another option beneficaries of the Robert E. Bush Naval Hospital have is “Relay Health.” Customers can log on to this secure site to communicate directly with their health care team at the Robert E. Bush Naval Hospital… check it out:

Tuesday, March 12, 2013

Pediatric Fever: A hot topic

Lt. Alessandra Ziegler, RN, BSN, CCRN, CEN
Emergency Medicine Department
Robert E. Bush Naval Hospital

            Fever is a common reason many of us seek medical care for either ourselves or our children. A sick loved one is a worrisome sight. Most of the time fevers are manageable from home with patience, vigilance and a little bit of tender love and care. In this article, I wish to talk to you about what a fever is, why it’s important, what to do at home if a fever occurs, when to see your primary care provider, and when it is necessary to come to the Emergency Room for further care.  
            Fever alone is not an illness but rather a symptom or sign of a sickness. A fever is actually a good thing for your body to have and is a positive sign an infection of some sort is being battled. It is the body’s way of creating a warmer environment to essentially have the good guys, white blood cells, “cook” the bad guys, or bacteria. 1 Fever, especially in the pediatric population, is commonly associated with respiratory illness (pneumonia or croup), ear infections, influenza (flu), sore throats, and severe colds. 2 Since a fever is the body’s natural response to invading organisms, it is important to understand why we care so much about it.  
When a fever occurs, the body is placed in a state of stress and makes the child feel uncomfortable. The heart rate and breathing rate increase as the temperature rises to help the body compensate for the internal thermostat changes. Most medical professionals are taught, in a non-urgent setting to treat the patient not the numbers (i.e. vital signs). If the patient, your child, feels normal, is not experiencing pain, etc., no intervention is necessary. Thus, it is important to treat the patient not the “number” of the fever. For instance, if your child has a temperature but is behaving normally – eating and sleeping well, periods of playfulness, adequate urinary output – then it is not a priority to treat the fever. Once your child becomes quite bothered and uncomfortable you may treat it with the following methods. 2
First ensure that you have measured your child’s temperature appropriately. In the Emergency Department we get a rectal, or core, temperature on most children under the age of three. After this age, an oral temperature is acceptable. Again, remember to treat the child not the temperature. A temperature is considered a fever if a rectal is >100.4°F, an oral/pacifier temperature is >100.0°F, or an axillary (under the arm◦) is >99.0°F. 3 It is appropriate to treat your child’s fever with Ibuprofen (if older than 6 months) or Acetaminophen. Never administer aspirin to a child. These medications should be administered per weight based dosing. Most of the labels on these medications, however, are by age. Please do not give any cold/cough medicine to your child under 2 years of age. Call your primary care physician’s office or the Naval Hospital Twentynine Palms (NHTP) Patient Centered Medical Home Pediatrics or  Gold/Blue Team (Family Medicine) clinics if you have any questions regarding appropriate dosing. Discuss fever medications with your doctor during your next well-child exam to be proactive in treating your child. Here are some non-pharmacological, or non-medication, ways of treating a fever:


-         Keep them home from school to rest and rehydrate in a comfortable environment
-         Encourage them to drink extra fluids (water, Jell-O, popsicles, commercially prepared oral electrolyte solutions such as Pedialyte).
-         Keep your child’s room and your home comfortably cool, and dress them lightly.
-         Place a fan nearby to keep cool air moving around the room.
-         Sponging your child with lukewarm water in a bath. 2

Now that you know how to treat your child’s temperature at home, here is when taking them to your primary care physician would be indicated.
            If you are concerned about your child’s fever, call your doctor to book an appointment or physically walk into the clinic to book a same-day appointment.  At the NHTP clinics, the Medical Home initiative allows you to continue to seek care from your primary care physician or primary care team for your non-urgent needs. You may also call the on-call Medical Officer of the Day (760-830-2190) who can give you advice over the phone on how to treat your child’s temperature. Lastly, you may use Relay Health, an online service, allowing you to email your primary care team. Please sign up at Be advised: allow up to 72 hours for the staff to respond with an email message. 

-         Signs of dehydration (dry mouth, urinating less than usual, no tears when crying, less alert and less active than usual)
-         Has a skin rash
-         The child gets worse in any way
-         Persistent diarrhea and/or repeated vomiting
-         The fever lasts more than 3-5 days despite consistent, around-the-clock medication administration (Acetaminophen or Ibuprofen)
-         Has a chronic medical problem like cancer, lupus, heart problems, or sickle cell disease 4
-         Has a febrile convulsion 3, 4

It is also important to know if your child’s vaccinations are up-to-date. Make sure to keep a record of this on hand to provide to medical staff for quicker treatment.
If at any point in time you are gravely concerned for your child’s well being, seeking emergency care is warranted if their primary care physician is unavailable. Ensure that your child is also not suffering from heat stroke – fever due to environmental or external heat. If heat stroke is suspected, rapidly move the child to a cool place, remove all clothing, sponge them with cool water and fan them, then seek medical care immediately.


-         If your child is an infant or younger than 3 months of age and has a temperature of 100.4°F or higher.
-         A febrile convulsion lasting more than fifteen minutes (be sure to turn your child’s head to the side so saliva and vomit can drain from the mouth – do not put anything into your child’s mouth)
-         Suspected heat stroke especially when there is no improvement in condition.

Although sometimes frightening, especially to first time parents, fevers are virtually unavoidable and are a normal body process we all experience at one time or another. The key message is to ensure your child has adequate comfort and hydration until the fever passes and to seek the appropriate medical care when necessary.


1.      Avner, J. R. (2009). Acute Fever. Pediatrics in Review, 30(1), 5-12.
2.      Shelov, S. P., M.D., M.S., F.A.A.P., Editor-in-Chief. (2009). Fever. Caring for Your Baby and Young Child: Birth to Age 5 (Fifth Edition ed., pp. 747-755). New York: Bantam Books.
3.      Hertz, A. R. (2011). Fever. Pediatric Nurse Telephone Triage (pp. 95-97). Elk Grove Village: American Academy of Pediatrics.
4.      Fever Instruction Sheet . (n.d.). KidsHealth - the Web's most visited site about children's health. Retrieved February 10, 2013, from