January 2014 Examiner

http://issuu.com/davidmarks8/docs/january_2014_examiner

The January 2014 issue of the Examiner is available through the above link.

Naval Hospital Appoints New Ombudsman

By Hospitalman Jeyzon Fernandez Jimenez
Public Affairs Staff/Editor
Robert E. Bush Naval Hospital

Naval Hospital Twentynine Palms proudly welcomes Mr. Bright Opoku as the new Command Ombudsman.
What is an ombudsman?

An ombudsman is a volunteer, chosen by the Commanding Officer (CO), on call 24 hours a day, seven days a week.

An ombudsman is also a spouse of an active duty or selected reserve member assigned to the command who serves as the official liaison between the command and its families. The ombudsman assists the CO in maintaining the morale and welfare of the command’s service members and its families.

According to OPNAVINST 1750.1G, the Ombudsman Program was introduced to the Navy by z-gram 24 on Sept. 14, 1970, by Chief of Naval Operations (CNO), Adm. Elmo Russell Zumwalt, Jr. A z-gram is a list of policy directives issued by Zumwalt while in office as the CNO (from July 1, 1970 to
July 1, 1974).

Zumwalt adapted this program from a 19th century Scandinavian custom originally established by the king to give ordinary private citizens an avenue to express their grievances to high government officials.

To support the command’s mission and improve family readiness, the ombudsman acts as an advocate for families and Sailors. He helps to disseminate accurate information regarding command policies, services available, resource referral and deployments.

He is a confidential point of contact for families and Sailors and refers them to the appropriate agency for questions, concerns, aid, or intervention. The ombudsman is an effective resource for hearing about the welfare of command families.

To clarify, the ombudsman is not a trained counselor or social worker, but can show you the way to solving your problems or getting assistance.

Furthermore, Ombudsman Appreciation Day is on Sept. 14 (or the Friday preceding the 14th, if it falls on a weekend). Since the 14th is of significance to the history of the program, commands are authorized to celebrate the event at any time deemed appropriate during the month of September or as soon as possible thereafter.

As a confidential point of contact for family members of the military staff, Mr. Opoku, the ombudsman, can be used as a reference and referral guide. For situations that need assistance, he is able to provide you with information on various resources around the base that may help.

Resource connections for Sailors and family members such as the Navy-Marine Corps Relief Society (NMCRS), located at the Village Center (Bldg. 1551), provides financial assistance in difficult times; the DStress hotline, (877) 476-7734 / Dstressline.com, available 24 hours a day, seven days a week for emotional support; and the TRICARE Service Center, which provides health care services such as appointment scheduling and Defense Enrollment Eligibility Reporting System (DEERS) registration, are just a few of the many resource links that are listed in the Ombudsman Newsletter, which is generated and published every two months via the command emailing platform.

You may contact Mr. Opoku by phone at (760) 910-2050, or by email at nhtpombudsman@yahoo.com.

Change of Executive Officer at Robert E. Bush Naval Hospital

By Hospitalman Jeyzon Fernandez Jimenez
Public Affairs Staff / Editor
Robert E. Bush Naval Hospital

The Executive Officer, CAPT Cynthia J. Gantt, Nurse Corps, United States Navy was relieved by CAPT Angela S. Nimmo, Nurse Corps, United States Navy.

The command was officially established as Naval Hospital Twentynine Palms in 1988 under the command of then CDR G. Russell Brown. Newly commissioned LT Cynthia J. Gantt became the first Family Nurse Practitioner assigned to the command; it was also her first “job” as a plank owner of the Robert E. Bush Naval Hospital in 1991.

CAPT Cynthia J. Gantt, NC, USN, FNP-BC, Ph.D., a recipient of the American Hospital Associations (AHA), “2010 Federal Health Care Executive Award for Excellence,” was selected by Rear Adm. Elizabeth Niemyer, Director of the Navy Nurse Corps for the Executive Officer position at Naval Hospital Twentynine Palms.

CAPT Gantt comes from Temple City, Calif., a suburb of Los Angeles. There she attended Temple City High School and then went on to earn an Associate Degree from Pasadena City College.

She then earned a Bachelor of Science in Nursing from her alma mater Sonoma State University, graduating cum laude and was the valedictorian speaker at the commencement ceremony. CAPT Gantt also later returned to Sonoma State University and earned a Master’s in Science degree as a Nurse Practitioner.

Furthermore, as a memorable experience, CAPT Gantt met her husband, Robert Gantt, here at Robert E. Bush Naval Hospital. CAPT Gantt is eternally grateful for the inspiration and opportunities that she has received from her family, the United States Navy, military leaders and the mentors that she has learned from over the years.

In a previous interview with Daniel M. Barber, Public Affairs Officer (retired), CAPT Gantt emphasized the importance and value of an education. CAPT Gantt started at a community college and worked her way up to earning a Ph.D.

“‘I’ve told folks more than once, if I can do it, you can do it...Truly the value of an education, no matter how long they are in the Navy, whether they become a Master Chief Petty Officer, or if they are interested in becoming an officer, is...an absolutely valuable thing to have...and is a life-long process,’ said CAPT Gantt.”

CAPT Gantt’s leadership philosophy strongly highlights a few important and fundamental elements: positive leadership, trust and collaboration.

Regarding leadership, CAPT Gantt added, “I trust the folks that I lead and I want to be trusted by them. I firmly believe that leaders should be mentors and particularly that mentors or leaders are generous with their knowledge, and as much as possible, and with their time.”

The newest Naval Hospital Twentynine Palms’s Executive Officer is CAPT Angela S. Nimmo.

Her official biography denotes that she is the daughter of a retired Naval Officer. CAPT Nimmo graduated from a Department of Defense (DoD) High School in Naples, Italy. She received her Bachelor of Science from University of Memphis, College of Nursing in 1986.

She then completed a pediatric internship program at Le Bonheur Children’s Medical Center in Memphis, Tenn. and worked in the Neonatal Intensive Care Unit for two years.

She obtained her commission as an Ensign in 1988, and completed her first tour on the oncology unit at National Naval Medical Center, Bethesda, Md. During this tour she deployed on the United States Naval Ship (USNS) Comfort supporting Operation Desert Storm and Desert Shield.

Her next duty station was at Naval Air Station Sigonella in Sicily, Italy where she worked in a variety of settings including emergency room, in-patient ward, and Labor and Delivery.

Her next tour was at the Naval Health Care New England, Newport, RI. as Division Officer for one of the Family Practice Clinics.

She then became Department Head for Home Health and Health Promotions and established an ambulatory wound care clinic. She was then accepted into the Duty Under Instruction (DUINS) Program, completing her Master of Science degree and Clinical Nurse Specialist degree in Medical Surgical Nursing from University of Maryland, Baltimore graduating in May 2000.

She focused on specialized advanced wound care during her graduate studies. Upon completion of her degree she returned to National Naval Medical Center where she was the Department Head for the Neonatal Intensive Care Unit. During this tour she once again deployed on the USNS Comfort supporting Operation Iraqi Freedom.

The next tour of duty was the Naval Medical Clinic Quantico, Va. as Department Head for Primary Care and the Ambulance Services.

She reported to Naval Hospital Jacksonville in July 2006, as the Department Head for Maternal Infant Unit and Labor and Delivery.

In April 2008, she became the Associate Director for Medical Services, and in Aug. 2009 she became the Director of Medical Services. She was also the Director for Nursing Administration at United States Naval Hospital Yokosuka, Japan.

CAPT Nimmo is a board certified wound care specialist at the fellowship level with the American Board of Wound Management. She is a member of the Wound, Ostomy, Continence Nursing Society and Phi Kappa Phi.

Her personal awards include the Meritorious Service Medal (two awards), Navy and Marine Corps Commendation Medal (two awards) and Navy Achievement Medal (two awards).

CAPT Nimmo is married to her husband Paul, of Charleston, W. Va., and they have two children, Madelynn and Alexander.

Behavioral Health is Moving to New Relocatable

By Hospitalman Jeyzon Fernandez Jimenez
Public Affairs Staff / Editor
Robert E. Bush Naval HospitalNaval Hospital

Twentynine Palms’s Behavioral Health Clinic will be moving into a new temporary “Relocatable.”

The location of the clinic will be Bldg. 1658 R1, Marine Corps Air Ground Combat Center (MCAGCC).

The move is currently planned for early August 2013.

Lt. Cmdr. Jonathan H. Locke, Medical Service Corps, a Clinical Psychologist from New England who arrived onboard in August 2012, currently works in Deployment Health as the Department Head.

Locke received his Bachelor of Arts (B.A.) from Grinnell College in 1990, his Master of Science (M.S.) in counseling psychology from Northeastern University in 1994, and his doctorate in clinical psychology from Massachusetts School of Professional Psychology in 2003. Locke actively oversees the moving process of the Behavioral Health Clinic.

Why is the move important to patients at the hospital? Locke said that the move will make it easier for many behavioral health patients to go to their appointments.

Because mental health services will be offered at a new separate location, patients will gain the benefit of having a little more privacy.

Additionally, due to the increase of space at the new location, patients may have more treatment options. Parking may become easier for the patients as well.

The impact that this move would create on patients is that those having additional appointments at the hospital will need to allow more time in their schedules to travel to their other meetings.

Relocating will impact staff members by gaining much more space to work in and a bit more autonomy, but will also mean that staff members will not have access to the galley or the locker rooms at the hospital.

Furthermore, attending regular meetings at the hospital may become a little more challenging for the staff.

Future plans to again move, this time into a permanent infrastructure, are underway for year 2015.

When asked what services and / or programs do Behavioral Health currently offer to patients, Locke said, “The staff is planning on continuing to offer very similar services to what it has offered in the past.

These services include individual and group treatment, a variety of talk therapies, medications, crisis services, post deployment health re-assessments (PDHRAs), traumatic brain injury (TBI) evaluations, among others.”

Will the clinic expand such services and/or programs in the future? “We are looking into increasing the number of therapy groups we offer, and we will be switching the leadership of some of these groups between Mental Health and Deployment Health,” said Locke.

To avoid confusion and for clarification purposes, “Behavioral Health was divided into two smaller departments, now called Mental Health and Deployment Health. Mental Health is made up of primarily active-duty providers. Deployment Health is mostly compromised of civilians and has three components: The Post Deployment Health Re-assessment Program, the Traumatic Brain Injury Program and Counseling Services. The Deployment Health Department’s main purpose is to assist service members with conditions related to deployments, while Mental Health offers a broad range of services that complement those offered by Deployment Health,” said Locke.

For care during business hours, 7:30 a.m. to 4:30 p.m., call the front desk at (760) 830- 2724/2935. In the event of an after-hours crisis, call 911.

The Behavioral Health Clinic also covers the Naval Hospital Twentynine Palms’s Emergency Medicine Department, which is open 24 hours and can be contacted at (760) 830-2354.

Hospital Corps Celebrates 115 Years

By Hospitalman Jeyzon Fernandez Jimenez

Public Affairs Staff / Editor
Robert E. Bush Naval Hospital

The Hospital Corps 115^th birthday celebration will take place June 17. Many of the Hospital Corps employment opportunities have evolved over the years. Hospital Corpsman work in an extensive number of career fields.

There are approximately 270 Hospital Corpsman on staff at Naval Hospital Twentynine Palms.  

Hospital Corpsman First Class, Fleet Marine Force (FMF) Andrea Nicole Turner from Denver, Colo., is the Director of Medical Services’ (DMS) Leading Petty Officer (LPO) and one of the two Respiratory Therapy Technicians at the hospital. Turner’s stepmother, who was a nurse, influenced and sparked her interest in the medical field. When Turner decided to join the Navy, she told the recruiter of her interest. As a result, the recruiter suggested Hospital Corpsman as a career option for Turner.

When asked what her most memorable experience to date in the Navy, she said, “Honestly, there is not one particular experience that stands out to me. My entire career has been memorable and I take little bits from every experience, and those little bits have made me the person I am today.”

As a medical professional, she believes that to be a Respiratory Therapy Technician, “definitely takes drive and dedication to learn the job, and keep yourself trained up on the constant changes of procedures, techniques, medicine, etc.

Respiratory Therapy is a vastly growing field.” Some of Turner’s aspirations are to complete her bachelor’s degree in Respiratory Therapy, the possibility of applying to a Physician Assistant (PA) school, and advancement in the Navy.

Additionally, one piece of advice that she gives to junior Sailors is, “Set yourself up for success. The Navy has several opportunities available at your disposal. Work towards your degree, study for advancement, get involved in the Command and Community, and keep yourself educated on the ever changing military policies and procedures, instructions, etc.”

Hospital Corpsman Second Class Patrick M. Malone of Waukon, Iowa, is an Optician who checked onboard the hospital in May 2010. He currently works at the Optometry Clinic.

Malone has many memorable experiences. But the one that is the most memorable to him was in 2005 when a tsunami impacted the shores of the island country of Sri Lanka in South Asia. Malone, who was 19-years-old at the time, had recently checked onboard a ship. Malone and other Sailors from his command were actively involved in providing medical humanitarian assistance to the victims of Sri Lanka. “I was there for two months straight...doing just regular sick call, helping them with disposal of waste, etc,” said Malone. The look on the victims’ faces is something that continues to be unforgettable to Malone. 

Another memorable experience was when he reported to Italy in 2008. He used this opportunity to go on a two week backpacking adventure with a friend throughout Southeastern Europe. During his backpacking trip, he enjoyed visiting the legendary Count Dracula’s Bran Castle in Bran, Romania.

Hospital Corpsman Third Class Alison B. Raphael from Montville, N.J., is an X-Ray Technician who arrived onboard in July 2012. Raphael shared that her reasons for becoming a Hospital Corpsman were linked to her medical education background obtained through some years of nursing school. One of her most unforgettable experiences in her naval career was graduating from X-Ray C School.

“I had grown so close with everybody that I went to school with. And we really grew such a gorgeous relationship...When it was time to say goodbye, it was like a bitter-sweet experience for me because these were the closest friends I had built since I've been in the military, especially in such a short period of time. But, obviously, we can’t stay in school forever,” said Raphael. 

Another memorable experience in her career was when she was nominated Blue Jacket of the Year at her previous command in Sicily, Italy. So, what does it take to be a X-Ray Technician? Raphael emphasized that it takes a lot of patience, motivation, being good with patient care, plenty of drive and energy.

Raphael’s future career ambitions are to continue with her x-ray education, plus she plans on opening a private pre-school. Raphael’s advice to Sailors, “Try not to get caught up in an identity crisis. To realize that you don’t have to be two completely separate people inside and outside the uniform. That’s where a lot of people, I feel, get stuck in a rut; they get in trouble because they feel like they have to be perfect in uniform. And then, once they take it off, then they want to kind of revert back to, maybe, old habits. And that’s my biggest advice; just to keep it with you outside of work as well, so that you don’t fall in that identity crisis category,” said Raphael. 

Hospitalman Christopher J. Moran of Las Vegas, Nev. is a Surgical Technologist who arrived on board December 2011. Moran pointed out that his reasons for joining the Hospital Corpsman rate are because he enjoys taking care of people and likes helping them become healthy. Moreover, Moran said a memorable experience throughout his career has been on him noticing that assisting surgeons in the operating room is an opportunity that many people his age do not have in the civilian world. He started assisting surgeons at the age of 19 when most of his friends had just graduated high school or were commencing their college path.  

What does it take to be a Surgical Technologist? Moran believes that it takes dedication, integrity, plenty of studying, and knowing what is right and wrong. One of his future goals is to attend the University of California, Los Angeles (UCLA) to work on his premedical education. His advice to fellow Corpsman highlights the importance of being persistent and not to become discouraged when one has done something wrong. Rather, he emphasizes to use such mistakes as a learning experience.

“I hold the care of the sick and injured to be a privilege and sacred trust...I dedicate my heart, mind, and strength to the work before me. I shall do all within my power to show in myself an example of all that is honorable and good throughout my naval career.” These words, taken from the Corpsman Pledge, constitute what the Hospital Corpsman continuously and traditionally live by. Hospital Corps, thank you for your continuous Honor, Courage, Commitment, Integrity, and Service. Happy 115th Birthday Hospital Corps.

The Navy Nurse Corps

By Ensign Devon Cassidy, NC
Multi-Service Ward
Robert E. Bush Naval Hospital

       The Navy Nurse Corps was established by Congress on May 13, 1908.  At the time, there were only 20 female nurses. These twenty nurses became known as the “Sacred Twenty”.  They were the first females to formally serve in the US Navy.  At the beginning of World War I, the Nurse Corps grew from 20 to 160 members who not only worked in hospitals and clinics on the home-front but were also deployed to overseas military hospitals and with special combat support operating teams.  By November 1918,  there were 1,550 active duty Navy Nurses. 

       In 1920, Navy Nurses received orders for shipboard positions aboard the USS Relief. During World War II, Navy Nurses who served aboard the USS Solace were responsible for treating casualties from the Japanese attack on Pearl Harbor.  By 1945, 11,086 nurses were serving in over 40 Naval Hospitals, 176 Dispensaries and 6 Hospital Corps Schools. The first Navy Flight nurses served in Iwo Jima and Okinawa during medical evacuation flights in 1945. During the Cold War, Navy Nurses continued to serve aboard the Hospital ships providing care to sailors and marines. After the Cold War, the Nurse Corps took on a new mission to aid in humanitarian relief and disaster support. With the Gulf War in the 1990’s, two hospital ships supported the fleet and fleet hospital facilities ashore. Today, Navy Nurses are deployed all around the world supporting humanitarian relief efforts and combat missions with  Fleet Surgical Teams, hospital ships, aircraft carriers and boots on the ground with Marine and Army forces.

       In 1944, Navy Nurses were formally recognized as commissioned officers.  The Navy Nurses were officially distinguished as a permanent staff corps in 1947. The first male nurse officer was commissioned in 1964. Today, there are over 4,000 active and reserve Nurse Corps officers serving from Ensign to Rear Admiral. The primary mission of the Nurse Corps today is to provide quality nursing care and promote the health of uniformed personnel and their family members.  Nurse Officers today serve in  leadership  roles, integrating compassion with discipline and preventative health  promotion with wartime readiness.

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.