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Safety Counts! a newsletter highlighting safety at Hallmark Health System

Do you have a safety story to share? The Safety Counts team wants to hear from you. Email us at This email address is being protected from spambots. You need JavaScript enabled to view it..

Safety Counts Nov-Dec 2014 - Download entire PDF by clicking here. 

Vol 2, No. 10, Nov-Dec 2014
DecSafetyCounts2014 Page 1

Preparing for the 2014-15 flu season

More than 2,000 Hallmark Health System (HHS) employees and staff received flu shots during November and December. The majority were administered at day-long clinics at the HHSFlu hospitals plus separate clinics at nonhospital sites. Night supervisors helped with immunization of off-shift staff. At the Hallmark Health VNA and Hospice, the vacination rate was 94 percent.

“The first doses of our allotment go to inpatients and outpatients, who are at much higher risk of getting the flu,” said Elaine Boerger, RN, infection control nurse. “Next are employees who are at higher risk, such as those who work in the ED and on the inpatient floors plus those who have chronic illnesses.”

For several years, HHS has had a mandatory flu vaccine policy: all employees, contract employees, physicians, students, volunteers or others who work at an HHS site or provide an HHS service are required to get a flu vaccine. Those who cannot comply (e.g., for medical or religious reasons) are required to wear a mask at work if they come into contact with others.

In November, the Massachusetts Department of Public Health issued proposed regulations that are very similar to the HHS policy, including the wearing of masks by those
who decline immunization. The new regs would apply to hospitals, clinics and long-term care facilities.

Flu season has already begun at HHS. “We’ve had our second flu admission, and it’s beginning to show up in the ED now with a number of cases,” said Boerger.
Staff vaccination is extremely important to patient safety for two reasons, said Boerger. “First, when someone gets the flu, that person is contagious before he or she gets sick. Staff could come to work and not know they have the flu. And second, if many staff are out sick during peak flu season, our workforce is diminished. So getting
vaccinated makes all of us better able to take care of patients.”.

Waking up to alarm fatigue

Hospitals turn down volume on audio distractions

Technology is most often a benefit in health care. But sometimes it can be too much of a good thing.Fatigue

Take the proliferation of medical devices that have alarms. Among the alarm-equipped devices that may be at a bedside are electrocardiogram machines, pulse oximetry devices, blood pressure monitors, central station monitors, infusion pumps, ventilators and many more.

These devices are critical to the provision of safe care, and clinicians rely on them for accurate information. Yet sometimes the alarms that are intended to alert staff to a problem instead cause a problem, called alarm fatigue.

The Joint Commission estimates that tens of thousands of alarm signals go off in the average hospital each day, sometimes hundreds for a single patient. “The patient safety ramifications of this proliferation are so important that the Joint Commission has singled out alarm fatigue as a national patient safety goal for 2014,” said Diane Hanley, MSN, RNBC, EJD, associate CNO.

At Hallmark Health System, a multidisciplinary committee has been meeting monthly to manage alarm fatigue and has taken a number of actions:
1.  distribution of an alarm safety survey to all clinical staff where all critical alarms were reviewed
2.  development of an inventory of alarmequipped devices – there are more than 100 such devices throughout HHS
3.  establishment of guidelines for settings on these devices, including determining the proper settings and who has the authority to change a setting
4.  development and implementation of mandatory training for telemetry alarm settings for patients requiring cardiac monitoring
5.  inclusion of queries in RMPro reporting regarding equipment and alarms
6.  establishment of a schedule for regular preventive maintenance for alarm equipped devices.

“Alarm fatigue is a serious problem, since our staff can become desensitized to the constant noise of dozens of alarms,” said Hanley. “We are looking for the ‘sweet spot’ where alarms do their job of protecting patient safety without overwhelming staff.”

Finding balance to reduce stress

Hallmark Health sponsors wellness strategies seriesBalanceArt

Many research studies have demonstrated a link between stress and patient safety. According to one study, the most frequent stress-induced safety events include errors or omissions in documentation, potential medication errors and delays in delivering care.

“Unchecked stress takes a toll on people,” said Carol Plotkin, LICSW, director of Behavioral Health. “Stress contributes to fatigue and distraction and can impede decision making. It may have an impact on the immune system’s ability to fight infection.”

For these reasons, it’s important for health care workers to monitor their stress and recognize stressors. “It’s natural for nurses, for example, to volunteer to pick up an extra shift if a unit is shorthanded because they believe it’s for the good of the unit,” said Plotkin. “But sometimes it’s important to step back and recognize the potential downside of this – the fact that high stress levels actually can compromise productivity.”

The key is balance. Everyone who has flown has heard the flight attendant announce that if the oxygen masks drop adults should put on their own mask first before fitting a
mask on their child. While that is counterintuitive for a parent, it achieves balance – “you can’t help someone else if you are
compromised,” said Plotkin.

The need for balance is particularly acute during the holidays when there are added stressors on top of those that health care workers deal with every day at work. To help staff find the balance they need to cope with stress, Hallmark Health is sponsoring a series of Wellness Strategies for the Holidays sessions in November and December. “The sessions are intended to help staff reduce some of the burdens they put on themselves at this time of year,” she added, “so they can be at their best while on the job.”

Zero tolerance for workplace violence

Raising awareness, offering support to improve employee safety

Even Buckingham Palace is not immune to workplace violence. In mid-November, the Queen’s chef was fired for head-butting another chef Quoteimageduring an argument. Physical violence between employees in health care settings is unusual.

More frequent is violence by patients toward employees. In hospitals, the highest-risk areas are the Emergency Department (ED) and Behavioral Health units. In outpatient settings, violence can occur in home care settings and physician practices. Among the risk factors are patients and families who may be in crisis, open access of health care facilities and the availability of drugs or money.

Workplace violence goes beyond physical assault. “It’s really any event that threatens the safety of an employee or impacts his or her physical, emotional or psychological well-being,” said Debra Wright, RN, MPH, CPHRM, manager of the HHS Risk Management Department. “It also includes verbal abuse, threats and bullying.”

In 2009, HHS formed a Workplace Violence Prevention Committee. Among its initiatives have been the installation of undercounter panic buttons and distribution of personal panic alarms, “particularly for those who work in high-risk or isolated areas,” said Wright. The committee has conducted multiple trainings, both in workplace violence prevention and the management of assaultive behavior. “This includes reinforcing the notion that workplace violence is not acceptable and that staff may refuse to continue a conversation with a verbally abusive patient or family member,” said Wright. The committee also has launched a code violet response team to support employees involved in or witness to workplace violence.

The committee also encourages reporting of workplace violence incidents. “Many staff believe that assaults – verbal and physical – are part of the job, or only report if there is an injury,” said Wright. “A key part of our message is that it is definitely not part of the job and need not be tolerated. Our goal is to make everyone feel and be safe.” 


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