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: https://app.relayhealth.com/Registration.aspx?Status=new

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:

MANAGING A FEVER AT HOME WITHOUT MEDICINE:

-         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 www.RelayHealth.com. Be advised: allow up to 72 hours for the staff to respond with an email message. 

REASONS TO CALL YOUR PRIMARY CARE PHYSICIAN

-         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.

REASONS TO SEEK EMERGENCY 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.

References:

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 http://kidshealth.org/parent/firstaid_safe/sheets/fever_sheet.html

Patient Safety Week Observed at NHTP

Naval Hospital Twentynine Palms Takes Part in Nationwide Effort to Raise Awareness of Patient Safety

Patient Safety Awareness Week, March 3-9, 2013

Twentynine Palms, CA – February 19, 2013 – In an effort to raise awareness and encourage the engagement of patients, families, health care providers, and the public, Naval Hospital Twentynine Palms has announced its participation in the 2013 Patient Safety Awareness Week campaign, Patient Safety 7/365.

Patient Safety Awareness Week is an annual education and awareness campaign for health care safety led by the National Patient Safety Foundation (NPSF). Each year, health care organizations around the world take part in the event by prominently displaying the campaign logo and promotional materials within their organizations, creating awareness in the community, and utilizing NPSF educational resources with hospital staff.

Patient Safety Awareness Week, which NPSF created in 2002, will be recognized March 3-9, 2013. This year’s theme, Patient Safety 7/365, highlights the need for everyone to understand the importance of focusing on patient safety all year round. The 7 days of the campaign also serve as time to recognize the range of work being done to improve health care safety worldwide.

Naval Hospital Twentynine Palms will engage staff, patients, and the community through educational and awareness-building activities specific to patient safety.

“Patient Safety 7/365 reminds us that providing safe patient care requires a constant and valiant effort, 365 days a year. This week encourages a sustainable and conscientious collaboration between health care organizations, providers, and consumers, regardless of their current state of health. The week is intended to imprint an indelible statement that efforts toward patient safety must be collaborative and that we must never be satisfied with the status quo,” said Patricia A. McGaffigan, RN, MS, interim president, National patient Safety Foundation.

NPSF encourages creative collaboration among provider groups, patient advocates, and other community organizations to help patients and consumers understand how they can participate to be part of the solution.

For additional information on Patient Safety Awareness Week, please visit www.npsf.org.

About Naval Hospital Twentynine Palms:

Our mission is to deliver patient-centered healthcare in a safe environment and be ready to deploy. 

About the National Patient Safety Foundation

The National Patient Safety Foundation has been pursuing one mission since its founding in 1997 – to improve the safety of care provided to patients. As a central voice for patient safety, NPSF is committed to a collaborative, multi-stakeholder approach in all that it does. NPSF is an independent, not-for-profit 501(c)(3) organization.

Branch Health Care Clinic China Lake Leads the Way in Patient Care

By Dan Barber, Robert E. Bush Naval Hospital

In December the Branch Health Clinic China Lake (BHCCL) received recognition by the National Committee for Quality Assurance (NCQA) achieving Level III recognition by demonstrating compliance and scoring high in all “must pass” elements of the nine respective NCQA standards.

Those standards are:

·         Access and Communication;

·         Patient Tracking and Registry Functions;

·         Care Management;

·         Patient Self-Management and Support;

·         Electronic Prescribing;

·         Test Tracking;

·         Referral Tracking;

·         Performance Reporting and Improvement; and

·         Advanced Electronic Communication

Included in these standards are 6 “must-pass” elements.  To get the achievement Level II recognition, practices must be validated in at least five of the elements.  Achieving Level II or III depends on overall scoring and compliance with all 6 “must-pass” elements.

Lt. Cmdr. Richard Stacey, Officer in Charge of the Clinic located at the Naval Air Weapons Station, China Lake, Calif., credits Lt. Cmdr. Christina Lumba, NC and staff for this achievement.  “Lieutenant Commander Lumba and many staff here worked many long hours including a lot of overtime to put together our successful presentation for the NCQA evaluation.”

In 2011, the Robert E. Bush Naval Hospital started offering “Medical Home Port” … Navy speak for “Medical Home”…to enroll patients in to Primary Care at the Branch Health Clinic China Lake.

This model of health care delivery was mandated by the Bureau of Medicine and Surgery (BUMED) so the very best possible health care could continue to be given to eligible beneficiaries in an efficient and cost effective way.

This health care delivery method was relatively new to some Navy health care providers at the time and to make sure that clinics were operating their Medical Home Port, according to standards set by BUMED, a tool was selected to measure those standards.  The tool selected was the National Committee for Quality Assurance (NCQA) for Patient Centered Medical Home.

The Medical Home Port model allows patients to see the same team of providers each time they come in for medical appointments which allows the patients and the assigned team of providers and support staff to develop a patient-centered relationship which replaced a system where patients could be directed to any available health care provider.

The ultimate goal of the Medical Home Port is to allow continuity between patients and the assigned Primary Care Manager (PCM) as often as possible.  However, if the main provider is not available, another provider on the same team will deliver the care.    

In addition to medical providers, the team of healthcare professionals is also be made up of nurses, clerks, and Hospital Corpsman.  Patients are given the opportunity to know everyone on the team as well as they know their provider.  Many staff  at the hospital and at the BHCCL, believe this method of patient care provided by the Medical Home Port teams has established a patient-centered health care environment, which provides patients with more access to primary care and allows for longer appointments and better management of the patients medical issues.

 Medical Home Ports add continuity of care for patients even when the active duty providers deploy or transfer.  The combination of both civilian and military team members cultivates stability for the teams and patients when military members are transferred or deployed.

In addition to assigning patients to one of three teams at the hospital and at Branch Health Clinic China Lake, Naval Hospital Twentynine Palms offers Relay Health™ to all patients for an additional secure communications tool they can use to communicate directly with their health care team.

 Relay Health contributes to the success of meeting NCQA standards because it allows patients to request their lab results; request a medication refill; access health care information and allows them to create their own health care record to help manage their own care, all from the comfort of home.  Patients can also use Relay Health to request appointments with their Medical Home Port team.  

Congratulations to the Branch Health Clinic staff for this well deserved recognition in their efforts to provide patients with the highest standards in patient care.

Naval Hospital Twentynine Palms Receives Baby Friendly Certification

By Lt.j.g. Ashley Robertson, NC

Robert E. Bush Naval Hospital

            Naval Hospital Twentynine Palms joins Naval Hospital Jacksonville as the only two Baby Friendly Certified hospitals in the Navy.  At present, 150 U.S. hospitals and birthing centers in the United States hold the Baby-Friendly designation, which represents 5.8 percent of all hospitals in the US.

Currently, scientific evidence overwhelmingly indicates that breastfeeding is the optimal method of infant feeding and should be promoted and supported to ensure the best health for American women and their children.  Breastfeeding is the single most powerful and well documented preventive modality available to health care providers to reduce the risk of common causes of infant morbidity.  Breastfeeding can significantly lower rates of diarrhea, otitis media, lower respiratory tract infections, diabetes, childhood leukemia, and Sudden Infant Death Syndrome (SIDS).  Women who breastfeed have a lower risk of Type 2 diabetes, breast, and ovarian cancer.  Recent evidence suggests that reduction in the risk for cardiovascular and other related diseases may be added to the benefits of breastfeeding for women.

The diverse benefits of breastfeeding translate into hundreds of dollars of savings at the family level, and millions of dollars at the national level through decreased hospitalizations and pediatric visits.  

In 1991 the United Nations Child the World Health Organization (WHO) established the Baby-Friendly Hospital Initiative (BFHI).  The BFHI is a global program to encourage and recognize hospitals and birthing centers that offer an optimal level of care for breastfeeding. The

core components of the BFHI are the WHO Ten Steps to Successful Breastfeeding, which are designed to facilitate the role of the hospital/birthing center in providing women the choice and opportunity to breastfeed, regardless of the method of birth.

The Ten Steps to Successful Breastfeeding are:

1.      Have a written breastfeeding policy that is routinely communicated to all health care staff.

2.      Train all health care staff in skills necessary to implement this policy.

3.      Inform all pregnant women about the benefits and management of breastfeeding.

4.      Help mothers initiate breastfeeding within one hour of birth.

5.      Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.

6.      Give newborn infants no food or drink other than breast-milk, unless medically indicated.

7.      Practice “rooming in” to allow mothers and infants to remain together 24 hours a day.

8.      Encourage breastfeeding on demand.

9.      Give no pacifiers or artificial nipples to breastfeeding infants.

Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital.  HE GUIDELINES AND EVALUATION CR

Family History & Your Health: National Family History Day

By Martha Hunt, MA CAMF

Robert E. Bush Naval Hospital

Each year since 2004, the US Surgeon General has declared Thanksgiving to be National Family History Day. Over the holiday or whenever families gather together, the Surgeon General encourages Americans to talk about and write down the health problems that seem to run in their family. Learning about your family's health history may help ensure a longer, healthier future for you and your loved ones.

Why create your own family health portrait? Knowing your family’s health history can save your life and the lives of those you love. By knowing what illnesses blood relatives suffered can help your doctor predict some of the health problems that may face you or your family.

To help you organize your family’s health information, the U.S. Surgeon General has developed an online tool called “My Family Health Portrait”, which is available at https://familyhistory.hhs.gov/. You may use this tool online or it can be printed and used as a paper record of your family’s health. If you chose to use the online tool to record your family medical history, the information you place there is private. Before you start using this tool, however, you will need to talk with your family members to gather more details about their health histories. Here are some suggestions on how talk to your family about their health.

Make a list of relatives. Write down the names of the blood relatives that you need to include in your family health history. Talking to people who are related to you by marriage and not by blood doesn’t help you plan your health history. The most important relatives to talk to are your parents, brothers and sisters, and your children. Next should be your grandparents, uncles and aunts, nieces and nephews, and any half-brothers or half-sisters. It is also helpful to talk to great uncles and great aunts, as well as cousins if they are available.

Prepare your questions ahead of time. Writing out your questions ahead of time will help you to remember what you need to ask and will keep you on track during the conversation. Among the questions to ask are - Do you have any chronic illnesses, such as heart disease, high blood pressure or diabetes? Have you had any other serious illnesses, such as cancer or stroke? How old were you when you developed these illnesses? Have you or your partner had any difficulties with pregnancies, such as miscarriages? What medications are you currently taking?

Also ask questions about other relatives, both living and deceased, such as - What is our family’s ancestry? What country did we come from? Has anyone in the family had learning or developmental disabilities? What illnesses did our late grandparents have? How old were they when they died? What caused their deaths?

Find a good time to talk. Consider talking with your family when you are together in a relaxed setting such as family reunions, cookouts or holidays such as Thanksgiving. If it’s not possible to talk to your family in person, you talk with them over the telephone or send them questions by mail or e-mail.

Explain to your family what you are doing. Begin your conversation by explaining that learning more about your family health history can help save lives. When you are aware of what diseases or conditions run in your family you may be able to avoid the health problem by taking preventive measures. Let your family know that the information they share about their individual health histories will help you create a Family Health Portrait that will benefit the entire family.

Keep a record. Remember to bring along a pencil and paper, voice recorder or a laptop so you can take down the information that your family members tell you. That way you will have their health information handy when you sit down to create My Family Health Portrait online or to fill out the paper version.

Ask one question at a time. It will be easier for your family members to provide you with useful information if you keep your questions short and to the point. If you need more details, ask follow-up questions such as “why,”“how” or “when.” Try to get as much specific information as possible. This will be especially important for your elderly family members who may have memory issues.

Respect your family’s feelings. Some family members may not want to share their health information. Be sensitive to their feelings and let them know that whatever information they wish to provide will be helpful. Your family member has the right to privacy and may choose not to participate.

Take one step at a time. If during your talks, you find out about a serious health problem that you didn’t know existed in your family don’t panic. Create your Family Health Portrait, print it off if you created it online and then take it to your health care provider who can help you understand what the information means for you and your family.

Filling in the gaps. For family members who are deceased or for whom you have incomplete health information, try asking other family members for information. If it is possible, get copies of medical records, birth records or death certificates as added documentation. Different states have different regulations as to who has access to birth and death records.

Keep your family’s health history up-to-date. As children are born and family members develop illnesses, remember to add that information to your Family Health Portrait. Your family will thank you!

The #1 Way to Survive Breast Cancer

By Shari Lopatin

TriWest Healthcare Alliance

One woman is diagnosed with breast cancer every three minutes.*

And every 13 minutes, a woman will die from this disease. Yet, more than 2 million survivors of breast cancer are living in the U.S. today.* Do you know what that means?

Even if you’ve been diagnosed, there is still hope.

Mammograms Save Lives; TRICARE Covers Them

The sooner you detect breast cancer, the better your chance of survival. And a mammogram is one of the best ways to detect it early enough for successful treatment. The Centers for Disease Control and Prevention say having regular mammograms can lower your risk of dying from breast cancer, in general.

Just remember to also follow up with your doctor for a clinical breast exam and continue your monthly self-exams.

TRICARE covers mammograms for women starting at age 40. For those considered at high risk for breast cancer, TRICARE begins covering mammograms at 35 years old. Best of all, these screening mammograms are at no cost to you.

Early Warning Signs of Breast Cancer

Breast cancer is the most common type of cancer in American women, other than skin cancer, according to the CDC. So, what are some of the earliest warning signs?

·         A new lump in the breast or armpit

·         Thickening or swelling of the breast

·         Nipple discharge, other than breast milk, including blood

·         Change in size or shape of the breast

·         Pain in any area of the breast

If you are concerned about any of these symptoms, visit your doctor immediately.

Where Can You Get Your Mammogram?

Your doctor can give you some options where you can conveniently get a mammogram. Your closest option might be at a military clinic or a local imaging center—sometimes these are called radiology centers. To have your mammogram at no cost, make sure that:

·         Your mammography center is TRICARE-authorized.

·         If you’re on TRICARE Prime, your mammography center is in the TRICARE network. If not, you will need a referral from your primary doctor.

For more information on breast cancer prevention, visit TriWest.com/Prevention.

* Information pulled from Susan G. Komen Race for the Cure.