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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 April 2015 - Download entire PDF by clicking here. 

Vol 3, No. 4, April 2015
April2015SafetyCounts Page 1

Hospice tuck-in program ensures meds, supplies and support for hospice patients at homeAprilSCpic1

An innovative program developed by Hallmark Health VNA and Hospice volunteers helps their patients stay on track and avoid weekend emergencies.

“Our tuck-in program is very simple,” said Jennifer McGlynn, RN, clinical team manager, hospice and palliative care program. “It involves a phone call, usually on a Thursday, to check in with patients and their caregivers before the weekend to make sure they have what they need.”

The call is scripted to ensure that patients are prepared for the weekend at home:

  • - Medication supplies are adequate.
  • - A nurse has visited or is scheduled.
  • - Pain levels are comfortable.
  • - Any additional needs that hospice can address are identified.
  • - The 24-hour support number (781-338-7866) is handy.

The mainstay of the program since its inception in early 2013 has been volunteer Roy Gray, who “works the phones,” as he says, every week to keep in touch with patients and caregivers. He has a script – to ensure that he covers all the bases – but he engages with them informally, too. “I serve as a touch point for patients and caregivers and a channel for feedback to the hospice team for any issues that might be raised during the call.” He makes 20-50 calls each week.

“At this point, patients and caregivers expect and look forward to Roy’s calls,” said McGlynn. “Some have even called to ask about him if he’s been out for a week or two.”

She added “the tuck-in program provides an opportunity for contact with the patient and family when a clinician isn’t visiting. By calling and confirming that the patient has enough medication to carry through the weekend, we are able to avoid a crisis for the patient and an emergency prescription delivery by our contracted pharmacy. The calls also decrease anxiety levels for patients and caregivers, since they know someone is watching out for them.”


Taking aim at opioid use

State-funded program targets back pain emergency room visitsAprilSCpic2


Back pain is a challenge to diagnose and treat and many people with back pain end up in hospital emergency departments seeking relief. Unfortunately, some pain medications can become addictive and must be prescribed with extra caution.

“For many clinicians, writing a prescription is the easiest way to handle these cases in what is often a hectic ED environment,” said Hallmark Health System Vice President of Medical Affairs and Chief Medical Officer Steven Sbardella, MD, who is also an emergency medicine physician. “But we want to ensure that when we prescribe a potentially addictive narcotic medication, we do so mindfully.”

Hallmark Health received a grant from the Massachusetts Health Policy Commission to develop a sustainable program that would reduce the rate of narcotic prescriptions for patients
with back pain in hospital EDs and urgent care clinics.

The program had three parts: analysis of practice variation, standardization of approach and documentation through development of a clinical practice guideline, and education focusing on pain management and alternative approaches.

The guideline requires prescribers to justify their decisions and document the name and dose of any medication, with a three-day maximum prescription. In addition, prescribers must check the patient’s medical record and the state’s prescription monitoring database. Finally, patients are referred back to their primary care physicians or to physical therapy for follow up and further treatment.

At the end of the six-month trial (January-June 2014) using the new guideline, the rate of narcotics prescribed for back pain in Hallmark Health EDs dropped substantially (see graph).

“This program more than accomplished its goal while also contributing to patient safety,”said Dr. Sbardella. “We are increasingly mindful of the risks and benefits of prescribing potentially addictive medications and we urge patients to cycle back with their physicians to discuss alternatives.”

Anonymous helpline encourages callers

Hallmark Health System’s compliance hotline is getting a makeover. Previously used for employees to register traditional compliance concerns (billing, coding, documentation or privacy), the revitalized Hallmark Health hotline is now poised to handle reporting on a much more expansive set of issues.AprilSCpic3

“The notion of ‘compliance’ really should include anything that has to do with a law, regulation, statute, policy and procedure, or ethical decision making – anything that we as an
organization are supposed to adhere to,” said Tessa Lucey, MHA, CHC, CHPC, corporate compliance officer and chief privacy officer. “The newly rebranded hotline gives people an additional tool for expressing their concerns, bringing potential problems to our attention or just asking a question. This could be about anything – from the availability of parking to a safety concern.”

Many employees are comfortable with raising issues through their manager or supervisor or by contacting Lucey directly.

But for those who are not, the hotline and web tool are good options. They offer anonymous reporting and are managed by an outside company. Whether the issue is raised by phone or web, it is forwarded to Lucey’s office for handling and response but without any employee identifiers unless the individual wishes it. Identified individuals receive updates directly from Lucey or another member of the leadership team. Anonymous individuals receive updates through the outside company.

“The fact that an employee will hear back from us is very important, so he or she will have a sense of what happened,”said Lucey. “We hope this encourages more reporting so that any issue, small or large, can be addressed without employees being singled out if they choose not to.”

If it concerns you, it concerns us!

Let us know if you have a question or concern about anything
relating to Hallmark Health. Both the hotline number and web
reporting URL are anonymous and confidential.
Call 1-888-517-8777
24 hours a day, seven days a week.
Or go to


Less is more: Lowering radiation doses for diagnosis

Imaging technologies such as CT scans and X-rays are essential tools for diagnosing everything from arthritis and lung infections to vascular diseases, some cancers and accidental injuries. Throughout Hallmark Health System, more than 25,000 CT scans are performed and nearly 65,000 X-rays are taken each year.AprilSCpic4

To minimize patients’ exposure to radiation, Hallmark Health has installed radiation reduction software, called ASiR, on its CT scanners. The software adjusts the dose based on data points such as the patient’s weight. “These changes have allowed us to reduce the radiation dose to patients on all CT scans performed while still producing high-quality images,” said John Seccareccio, RT, project director of imaging services. Hallmark Health also has upgraded all X-ray systems to digital radiography. “This has resulted in an approximate 40 percent reduction in radiation dosage to the patient,” he added.

Getting an occasional CT scan or X-ray is not cause for concern in general. “The amount of radiation in a chest X-ray, for example, is about the same amount that one would be exposed to while flying cross country,” said Seccareccio.

Lifetime radiation doses are becoming an increasing concern, however; the federal Food and Drug Administration promotes tracking of radiation safety metrics (such as dose data and adverse events) through the development of national registries and databases. The ultimate goal would be to include cumulative exposure information into patients’ medical records.

“Reducing the dose of radiation each patient receives is an important part of patient safety,” said Seccareccio. “We’re doing everything we can to prevent overexposure and minimize the amount of radiation used in every exam.”


The Insider, April 2015



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