Same Personalized Patient Care, Now with Added Ease, Efficiency and Collaboration

Patients at Yavapai Regional Medical Center (YRMC) will notice something a little different about the personalized care they receive during their next hospital visits. That’s because YRMC has implemented a new state-of-the-art Electronic Medical Record (EMR) system – called Project CARE. High tech meets high touch with this secure high speed medical record network that gives YRMC caregivers quick access to patient medical information from anywhere within YRMC’s hospital locations in Prescott and Prescott Valley.

Paper charts are now a thing of the past at YRMC as caregivers use a variety of sophisticated tools that range from mobile computing carts and wall mount systems to digital scanners to support the personalized care they provide to patients. These computing devices link YRMC caregivers with patient medical records via a highly secure data center that uses encryption and other sophisticated safeguards to protect patient information.

“Project CARE is consistent with our Vision of a Total Healing Environment,” says YRMC President and CEO Tim Barnett. “Patients will always receive the personalized, one-to-one care they depend on, but now with the added assurance that their medical records are always up-to-date and right where our caregivers need them, when they need them,” states Barnett.

Project CARE supports great patient care.

Providing patients with advanced healthcare will always be the primary motivation at YRMC. Project CARE is a great example of this commitment. “Everything we do at YRMC is guided by our Vision and Values,” states Barnett. “We carefully evaluate every opportunity and we always ask ourselves if it’s the very best thing we can do for our patients. In the case of an EMR, we are positive that it’s the right thing to do.”

YRMC’s new EMR – when combined with the personal touch of caregivers at the bedside – creates a new level of communication, safety and sharing.

• With the new EMR, patient medical records are more complete so patients won’t have to answer the same questions again and again.
• As caregivers spend less time charting, they will have more time to do what they do best – provide great patient care.
• Because the medical records are digital, it won’t be necessary to decipher handwriting.
• Test results are available in real-time.
• Caregivers can immediately check for drug-to-drug and drug allergy interactions.
• Accuracy is increased on all levels. From prescriptions that are sent to the pharmacy, to orders for tests and other procedures, to special dietary restrictions– information will be transmitted faster and more clearly than ever before.

Big project. Big rewards.

The launch of Project CARE is the result of over two years of careful planning and research that involved hundreds of dedicated YRMC staff members. Considerable improvements were made to YRMC’s information systems, workflows were enhanced, and extensive training programs were designed to prepare YRMC staff to use the new tools.

“Our caregivers will now utilize the latest information technology rather than a paper chart when providing care to their patients,” says YRMC Chief Nursing Officer Diane Drexler, RN, BSN, MBA, FACHE. “An EMR won’t replace critical thinking skills however – it’s an adjunct to our training and education that provides real-time access to patient information right at our fingertips.” With paper charting, only one caregiver at a time can look at a patient’s medical record.

With the new EMR, multiple YRMC caregivers can view a patient’s medical chart—from physician orders to vital signs, x-rays and test results—at the same time, from different locations. This is particularly important in emergency situations when seconds count.

Yavapai Regional Medical Center’s (YRMC’s) Emergency Department (ED) implemented new guidelines for prescribing controlled substances on October 1. The new guidelines—developed to address prescription medication abuse—mirror the efforts of other Arizona hospital EDs and are part of a broader partnership with MATFORCE, a coalition dedicated to reducing substance abuse in Yavapai County.

“As caregivers, we’re extremely concerned about prescription drug abuse in our county, state and nation,” said Diane Drexler, RN, Chief Nursing Officer, YRMC. “These guidelines allow YRMC to provide the best care possible to all of our Emergency Department patients.”

The guidelines—developed by a team of YRMC ED physicians, nurses, social workers and administrative leaders in partnership with MATFORCE representatives demonstrate great concern for the health of the community, according to Sheila Polk, Yavapai County Attorney.

“It takes an entire community to address substance abuse issues. I admire, support and am so proud that YRMC stepped forward to be part of a solution that is truly going to make a huge difference,” Polk said.

YRMC’s new guidelines incorporate the following standards of care:

• Prescriptions for opioids (narcotics) to treat patients with chronic pain should come from a single provider. This means that YRMC’s ED will not prescribe narcotic pain medication after a patient’s initial ED visit or if the patient has received narcotic medications from another physician or ED.
• YRMC’s ED discourages giving opioids in intravenous (IV) form or as shots for acute pain. Shots to alleviate chronic pain are not given through the ED. YRMC’s ED does not prescribe Schedule 2 Controlled Substances for chronic pain as these medications are linked most frequently to abuse and addiction.
• Long-acting or controlled-release opioids, such as OxyContin, fentanyl patches or methadone, are not prescribed by YRMC’s ED. Methadone doses for people in methadone treatment programs are not administered by YRMC’s ED.
• Patients given prescriptions for controlled substances from YRMC’s ED may be asked to show a government-issued photo ID, like a driver’s license, at the hospital’s pharmacy. In order to track prescriptions for controlled substances, people who don’t have an official photo ID may be photographed for their medical record.
• YRMC does not refill stolen or lost prescriptions for narcotics or controlled substances.
• In keeping with the law and best medical practices, YRMC’s ED requests a patient’s medical records when providing treatment and also shares information about treatment administered in the ED with the patient’s physician or physicians.
• YRMC’s ED will establish care plans for frequent ED patients, which may include recommended strategies for avoiding medications associated with abuse or addiction.

According to Drexler, these new guidelines allow YRMC’s ED to maintain its unique and essential role in the community.

“Emergency departments are available 24 hours a day, seven days a week,” Drexler said. “They care for people facing the unexpected: the passengers injured in a car crash…the person who suffers a heart attack while jogging…the child who fractures his arm while playing at the park. We believe these guidelines for prescribing controlled substances allow us to continue fulfilling that important role and encourage people with chronic pain to work with the appropriate medical professionals to address their long-term health challenges.”

The Arizona Substance Abuse Partnership (ASAP) reported that more than 11 percent of Arizona adults surveyed said they had used prescription drugs without a doctor’s consent in 2010. Almost half of those had misused prescription drugs in the previous 12 months and 13 percent reported misuse in the past 30 days.

A recent expansion of the Emergency Department (ED) at YRMC East in Prescott Valley increases space, enhances efficiency and improves privacy.

“These are excellent improvements,” said Irene Connor, RN, Director, Emergency Department at YRMC East. “They’re good for our patients and their families.”

When it’s completed, the expansion project—launched in early 2012—will increase the ED from 17 to a total of 24 beds and will feature:

• six fully equipped fast-track rooms for patients with less serious illnesses and injuries (e.g., sore throats, ankle sprains and eye infections);
• five critical care rooms, one of which functions as a trauma room and may be used for emergency procedures and surgeries;
• an X-ray viewing station in the trauma room that allows the physician to view images without leaving the trauma room;
• beds that help prevent pressure sores as well as allow patients to be weighed in bed rather than moving to a scale;
• a second triage area that will decrease waits during busy ED times; and a new point-of-care testing area for rapid exam results, such as throat swabs, that are ready when the patient is examined.

Other changes to the ED focus on patient convenience and comfort. A new entrance will allow visitors to access the ED from inside the hospital. A garden area near the current ED main entrance will give visitors a pleasant retreat. Additionally, a children’s waiting area is planned for families with youngsters.

“We know that the surrounding environment is very important to helping relax patients,” said Connor.

The expanded YRMC East ED will feature warm Arizona colors and soothing music to create a calm, comfortable environment for patients and other visitors.

High Risk Newborns and their Families Stay in the Community

“This is a milestone for our community,” said Diane Drexler, RN, YRMC’s Chief Nursing Officer. “It means many babies born early will no longer be transported to other Arizona communities. They will stay with their moms and receive high-level care right here.”

YRMC’s Family Birthing Center—licensed as a Level II Continuing Care Nursery by the Arizona Department of Health Services—is now delivering and caring for babies born at 34 weeks or greater. By January 2014, babies born 32 weeks or greater will be delivered and cared for at the YRMC Family Birthing Center.

Normal gestation is 38 to 40 weeks. According to the March of Dimes, approximately 12,000 babies a year are born prematurely in Arizona.

“Receiving and maintaining certification for the Family Birthing Center through the APT demonstrates that YRMC is committed to providing safe, efficient and effective patient care,” said Connie Buckner, RN, Director, The Family Birthing Center at YRMC.

APT certification brings together Level II Continuing Care Nurseries like YRMC’s to:

• maintain certain standards of care for mothers and babies;
• participate in statewide efforts to benchmark perinatal units; and
• work collaboratively with Arizona’s regionalized perinatal healthcare system.

The Family Birthing Center at YRMC East in Prescott Valley was designed and constructed from the beginning to care for premature infants. The Center, which opened May 26, 2010, followed Arizona Department of Health Services requirements that specify, for example, the amount of space between each baby in the nursery.

After its opening, YRMC’s Family Birthing Center nurses, obstetricians and pediatricians immediately began working together to achieve Level II Perinatal certification. The Center’s registered nurses were cross trained on all aspects of neonatal care, including, for example, how to provide supplemental oxygen, prevent infections, administer medications and manage feeding tubes.

Additionally, the nurses participated in a rigorous series of classroom courses conducted by YRMC’s neonatal nurse practitioner. The Center’s nurses and YRMC respiratory therapists also pursued on-site training in the neonatal unit of another hospital.

“The Family Birthing Center’s staff has been working toward this for a long time. Our first high-risk delivery since the new certification went very well,” Drexler said. “Our team was ecstatic. The newborn did great and so did the baby’s mother. Our entire hospital is proud of this achievement. It’s so important to families in our community.”

State of Arizona Grant Supports Stroke Education at YRMC

Early recognition and rapid response to stroke are the goals of a clinician training program sponsored by Yavapai Regional Medical Center (YRMC). Nearly 270 YRMC registered nurses as well as occupational, physical, respiratory and speech therapists participated in the SimSuite Stroke Simulation Training Program January 7-18. The program featured a wireless patient simulator called the Laerdal SimMan® that replicated possible scenarios associated with stroke in a lab setting as well as classroom-setting workshops.

“Stroke symptoms can be very subtle,” said Diane Drexler, RN, YRMC Chief Nursing Officer. “Because of the SimSuite training, YRMC’s clinicians are more acutely aware of the signs and symptoms of stroke. With this training, they can intervene earlier, which will save lives and help limit disability due to stroke.”

In the simulation laboratory, YRMC clinicians worked in teams of approximately six on a series of scenarios. This experience allowed caregivers to practice identifying and treating stroke patients as well as patients with signs and symptoms that mimic stroke. In addition to the simulation laboratory, the SimSuite training included a learning module with a pre-and post-test. The program’s curriculum is based on the American Heart Association/American Stroke Association “Get With the Guidelines Program: Target Stroke.”

“This is a very effective way of learning in healthcare,” said Drexler. “Every patient is different and the classroom learning combined with the hands-on experience in the lab builds the critical thinking skills necessary to care effectively for patients.”

YRMC occupational, physical, speech and respiratory therapists also learned advanced stroke rehabilitation techniques as part of the training. The therapists participated in two-day, hands-on seminars, which took place in December 2012 and January 2013.

Ellen Benson, YRMC’s Director of Education and Organizational Development, said the training allowed YRMC to increase the skills of its caregivers and improve healthcare for the community. “By training so many clinicians at the same time, we ensure continuity of care,” she said.

The SimSuite Stroke Simulation Training Program was funded in part by an Arizona Job Training Program Grant from the Arizona Commerce Authority. The grant supports Arizona employers seeking to increase the skills of their employees.

According to the Centers for Disease Control and Prevention, one American dies from stroke every four minutes. Each year, more than 795,000 people in the U.S. suffer strokes.

On April 8, The BreastCare Center at YRMC introduces Arizona’s only breast Magnetic Resonance Imaging (MRI) system designed specifically for breast imaging.

“For a community to have this technology within 100 miles is very fortunate,” said Michael D’Angelo, MD, Medical Director, Imaging Services at YRMC. “For a community to have this technology within five or even 25 miles is phenomenal.”

Currently, there are fewer than 50 breast MRI systems in the U.S., all of which are designed by Aurora Imaging Technology, Inc. Most hospitals and imaging centers conduct breast MRI studies by modifying conventional, full-body MRIs. The new system at YRMC’s BreastCare Center was designed solely to study the breast. Every aspect of the Aurora® Breast MRI System—from its outstanding imaging capabilities to the design of the patient table—was conceived exclusively for breast imaging.

Physicians often request an MRI in order to further evaluate areas of concern detected during a woman’s screening mammogram, ultrasound or physical exam. Compared to the more widely available conventional breast MRI, the system at YRMC’s BreastCare Center will offer:

• dramatically superior and precise images;
• speedier results;
• reduced individual imaging times; and
• greater patient comfort.

“This breast MRI is the only commercially available, Food and Drug Administration cleared MRI system that is designed just for three-dimensional, bi-lateral breast imaging,” said Mary Sterling, YRMC’s Director of Imaging Services. “The BreastCare Center at YRMC is so pleased to offer this important service to the women of our community.” Perhaps most significant to women and their families will be the daily availability of this powerful breast MRI system. To accommodate this important equipment and service, a new space specially designed for the breast MRI system was constructed at The BreastCare Center at YRMC.

“Because the exam suite is built exclusively for breast MRI, the experience also will be quieter and more relaxed for patients,” Sterling said.

The breast MRI system joins a comprehensive menu of diagnostic and clinical services available through The BreastCare Center at YRMC, including:

• Digital Mammography;
• Breast Ultrasound;
• Ultrasound Guided Breast Biopsy;
• Stereotactic Breast Biopsy;
• Pre-Surgical Needle Localization; and
• MRI-Guided Biopsies.

“The breast MRI technology is consistent with YRMC’s community-focused Mission of caring and healing,” said Dr. D’Angelo. “Thanks to a local, anonymous donor, women throughout our community soon will be able to access this incredible service without leaving the area.”