As we celebrate Patient Safety Awareness Week (March 12-18, 2017), here are some of the many ways we ensure safe care for our patients at Altru Health System.
Addressing concerns. We diligently address every concern brought forth by patients, families and staff. We encourage patients to provide feedback and/or report any and all safety concerns by privately calling a patient representative.
Assessing fall risk daily. We perform a thorough standardized assessment immediately upon hospital admission, followed by daily assessments to determine individual fall risk. Each patient gets a score—low, moderate or high—and actions are taken to ensure patient safety depending on risk level. Actions may include: bed alarm, chair alarm, patient sitter and/or rounder.
Altru’s inpatient fall rate is 3.45 per 1,000 patient days. This is on the low end of the national, publicly reported inpatient range of 3.3-11.5 falls per 1,000 patient days, according to the NDNQI (National Database of Nursing Quality Indicators) database.
Encouraging honest feedback. Altru has a robust reporting culture for any patient safety or quality care issues. Our reporting structure is non-punitive, encouraging open and honest communication about concerns relating to patient care and safety. In addition to reporting falls, we also document any and all near-falls. This is all tracked in real time to accurately reflect reality and consistently hold staff accountable.
Analyzing errors. If a fall does occur, action is taken immediately. This includes notifying the charge nurse and hospital supervisor, provider and other caregivers, including the patient’s family. We include the patient in a group huddle to assess and revise interventions. Then, a root cause analysis (RCA) is completed to analyze what went wrong and make sure the issue never happens again.
Using the best technology. Healthcare technology can assist staff by providing simple reminders and prompts to keep our patients safe. Electronic medical records can improve the ability to diagnose diseases and reduce—even prevent—medical errors, thus improving patient outcomes.
Washing hands—often and well. Hand hygiene is a great way to prevent infections. Providers might need to clean their hands as many as 100 times per 12-hour shift, depending on the number of patients and intensity of care. Healthcare providers can explain how and why they clean their hands before, after and sometimes during patient care, and let patients know it's okay to ask about hand hygiene.
Keeping it clean. Our Environmental Services team uses a number of quality checks to ensure patient rooms are as clean as possible. For example, an “encompass room check” marks 18 touchpoints before and after a room is cleaned to check and score overall cleanliness. This attention to detail doesn’t go unnoticed—we ranked at the 84th percentile (goal was 70th) overall for 2016 in HCAHPS scores for cleanliness. Beyond the basics, we take extra measures keep our environment squeaky clean, from using bleach for C-diff cases to adding new UV light machines to kill 99.9% of bacteria.
Although we are using this week to celebrate our patient safety achievements and increase awareness, safe care is Altru’s focus 24 hours a day, 7 days a week, 365 days a year.
Lynn Huot has been a nurse for 30 plus years with the past 12 years as a Registered Nurse. She obtained her BSN from Mayville State University in 2016 and is currently the Director of Quality and Patient Safety at Altru Health System. Lynn enjoys spending her free time with her family as well as spending time at the family cabin.
Janice Hamscher, MSN, MBA, BSN, RN, is caring, compassionate and smart (did you see all those letters after her name?), and we are proud to introduce her as the incoming Chief Nursing Officer at Altru Health System.
Prior to joining Altru, Janice was the Vice President and Chief Nursing Officer of Penn Highlands DuBois of DuBois, Pennsylvania, since 2012. She also served as Senior Vice President and Chief Nursing Officer of Saint Vincent Health System in Erie, Pennsylvania.
Beyond being a nurse, she’s proud to call herself a wife and a mom. Here are 10 things to know about Janice.
1. Janice’s first job at age 15 was as a waitress. It taught her many skills for her future in nursing, including organizing, prioritizing and giving people the best customer service possible.
2. Her favorite life quote is, “Never, ever give up.”
3. When not at work, Janice can likely be found reading, cooking, gardening, going for a walk or playing the piano (for herself, not an audience).
4. Janice’s two young adult sons are both in the medical field—one as a nurse, the other actively pursuing medical school. She’s proud to watch them follow in her footsteps.
5. Janice and her husband, Bruce, have had many, many family pets throughout the years, and they currently have three cats.
6. Chocolate is Janice’s all-time favorite food. “If I had to think of one thing I wouldn’t be able to give up, that’s probably what it would be!”
7. If Janice had an extra hour every day to do whatever she wanted, she would spend it reading.
8. She credits her mom as being her main role model in life. “I just always wanted to be like her, and I think I’ve achieved that. My sister tells me I have.”
9. Being a nurse has always been Janice’s dream career. “I’m not sure why exactly—I just wanted to care for people.”
10. Janice is so excited to join the Altru team. “You can just feel the energy and passion here.”
As Chief Nursing Officer, Janice will serve as a member of Altru’s Executive Leadership team. She will be responsible for defining the highest possible nursing standards and ensuring quality patient care is delivered safely and effectively. Janice’s official start date is February 6, 2017.
When it comes to farm equipment, Lynn Niemann, of Crystal, N.D., has a general rule of thumb: Take good care of it before it breaks, and if it’s already broken, fix it. Lynn took a similar approach to his health this summer.
The oldest brother of five siblings, Lynn suddenly lost his two younger brothers at the ages of 37 and 48, both to vascular-related disease. After the second family loss this spring, and struggling to get his own blood pressure under control, Lynn scheduled an appointment with Altru cardiologist, Dr. Rabeea Aboufakher. Even though it was May, one of the busiest seasons for farmers, he knew this was his top priority.
Lynn and his wife, Annette, met with Dr. Aboufakher for a full examination, where he detected a slight heart murmur. He reassured the Niemanns that the murmur was faint but, because of family history, ordered an electrocardiogram (EKG) to check Lynn’s heart’s electrical activity. Everything checked out fine, and Dr. Aboufakher referred Lynn to Altru’s Dr. Keith Swanson, vascular medicine.
Next, Lynn underwent lab work and a series of painless vascular screenings and ultrasound, focused on the neck and ankles, to check for blood clots throughout his body. While there were no signs of blood clots, Lynn discovered he has a slight vascular disease, as lab results detected a heterozygous gene that would’ve been passed down from one parent.
As an educator, Lynn’s wife, Annette, was impressed with the time Dr. Swanson spent educating them about the potential risks of blood thinner medication versus living with low-risk vascular disease. “Both doctors were so thorough at explaining the purpose of each test, talking through the risks and promoting prevention with healthy choices,” explains Annette. “They were personable, friendly and understanding of our concerns.”
Prevention for the Future
Because of previous leg swelling, Lynn wasn’t surprised with the diagnosis, and he keeps a positive attitude.
“I wanted to know what was going on,” explains Lynn. “If they did find a problem, I’d rather know and do something about it.”
Dr. Swanson recommended maintaining a healthy lifestyle through weight control, regular activity, eating right and wearing graduated compression garments. Lynn now wears compression stockings every day to prevent swelling and discoloration, and he continues to take his blood pressure medication regularly.
After losing about 20 pounds in the last year, Lynn’s goal is to maintain his weight loss by watching his diet and staying as active as possible. While he used to grab a pop and candy bar for the tractor, he’s now munching on almonds, dried cranberries and unsweetened iced tea during harvest.
“Jumping on and off the tractor keeps me moving throughout the day,” he explains. “I try to get out and walk as much as I can.”
Similar to maintaining his farm equipment, Lynn believes in keeping his one and only body as healthy as possible. He continues, “If you can prevent something bad from happening, why not do it? I want to see my grandchildren grow up for as long as I can.”
With the help of Drs. Aboufakher and Swanson, when the small town family farmer celebrated his 60th birthday this fall, he could rest assured his heart and vascular health was in good shape.
Altru's Vascular Medicine specializes in the diagnosis and comprehensive treatment of vascular diseases of the circulatory system. For more information about Altru’s Vascular Medicine, schedule an appointment through MyHealth, or call 701.780.6400.
Dr. Darin Leetun of Altru Advanced Orthopedics helps patients get back to the life they enjoy through thorough care and advanced procedural offerings. He’s also a doctor for the USA hockey, ski and snowboarding teams. On top of that, he provides regular free presentations to the community on common concerns with joint pain, and even has time to mix in a round of golf or two. We sat down with Dr. Leetun to discover more about his approach to care, and the things he enjoys doing when he’s not focused on joints.
Q: What is your area of specialty? A: I focus on shoulder and knee care. I do everything from basic care and non-surgical treatment to replacements. I enjoy having that focus as I can confidently manage everything for patients related to their shoulder or knee concerns.
Q: What’s your approach to care? A: I approach caring for my patients as a partnership. I like to work with them to achieve the goal that they’re looking for. Whether it’s to return to an activity, sport or just everyday life—my number one priority is to help an individual accomplish what they set out to do when they sought care. My goal isn’t always to do a surgery, it’s to do whatever I can to get them back to activity with the least amount of risk and difficulty for them. I look at every option and try to emphasize partnering with them to make a decision, not making the decision for them.
Q: What motivates you to do what you do? A: My motivation is simply the fact that I believe God has given me a gift that I can use to help others. Although I may not always be perfect, I can be helpful in what I do and take something that I’ve been blessed with and be a blessing to others.
Q: When did you know that you wanted to go into medicine? A: My interest in medicine started when I was very young. I broke my arm when I was six, and to set it, the doctor used the fluoroscopy (or live x-ray), so I could see my bones being moved. That experience really got me interested in dealing with bones.
Q: What do you enjoy most about your work? A: I enjoy the challenge. Every day is different. Every day there’s something new that I need to adapt to and try to overcome. I enjoy learning new things and adding to my practice. Medicine is advancing all the time, and we’re adding new and better ways to care for our patients—like our recent addition of the Mako Robotic-Arm. That’s allowed me to offer more precision in a partial knee replacement, which is a great value for patients.
Q: What do you like to do outside of work? A: I enjoy golfing and working in my yard. I also enjoy spending time catching up with family and friends—I feel that those relationships are very important. I just got done goose hunting with my cousins. I’ve never hunted for geese in my life, but I did it so we could spend time together. Unfortunately we got skunked—we didn’t get any geese. But, we had a good day. We enjoyed hanging out and experiencing the benefits of what North Dakota brings.
Q: Where would you most like to travel to? A: For me, it would be going to Israel, to Jerusalem. Seeing all the places and sites where Jesus walked and talked, helping the Bible to come alive—to gain a better understanding of what was being taught. Hopefully it would be an opportunity where I could to grow in my faith and apply it to my life.
Q: Where did you go to school? A: I graduated from Bismarck Century High School, then I went to the University of North Dakota. I actually spent my junior year at the University of Alabama doing a student exchange program (primarily because I was a huge Alabama Crimson Tide fan). Then, I ended up going back to Alabama for my first two years of medical school before finishing my medical degree at the University of Virginia. From there, I went to Fort Worth, Texas for five years, and then off to Australia for my fellowship training before starting an orthopedic practice. I’ve been in Grand Forks three years this August.
Q: What do you like about being in Grand Forks? A: Grand Forks reminds me of how Bismarck was when I grew up. Not too big, not too small. I like the opportunities here with the Greenway, the outdoor activities, etc. But, I’ve got to be honest—my favorite thing is UND Hockey. I’m a big fan; I’ve always been. Having the opportunity to go to the games on a regular basis and enjoy the quality of hockey we have here, week in and week out, that’s a huge plus.
Dr. Billy Haug’s warm personality and genuine caring spirit makes him a favorite around Altru Health System. His patients say his vested interest in their health and well-being, beyond their time at the clinic, is what sets him apart. We’ve heard from many of Dr. Haug’s patients recently on the care they’ve received, and all gave glowing reviews. So, we sat down with Dr. Haug to get to know him a little more and understand what drives him to treat each patient as though they were family.
Q: What is the focus of your work at Altru Advanced Orthopedics? A. My practice focuses on medical orthopedic care, such as injury management, ultrasound guided injections, concussion management and promoting healthy lifestyle choices. I enjoy caring for those of all ages, from infants with hip dysplasia to folks in their nineties with arthritis.
Q: What have you done outside of the clinic in your field? A. Earlier in my career I was a team physician for the USA Cross-Country Ski Team and Nordic Combined Team (which involves ski-jumping as well as cross-country skiing). I traveled with them to Norway and Finland. I also worked with the United States Anti-Doping Association at the World Junior Hockey Championship. Three years ago I was appointed to the North Dakota State Board of Medicine which meets three times a year in Bismarck.
Q: What is your approach to care? A. I strive to be present for my patients — to really listen to them and understand their concerns. It is imperative to respect their wishes and to include them in the plan of care to reach their goals. My staff and I focus on treating everyone the way we would like our family members to be treated.
Q: What motivates you to do what you do? A. Knowing my patients trust me with their care, and to care for their family, is humbling and rewarding. It motivates me to come to work every day with a smile knowing I can share a part of their lives. That trust is so special, and it is a bond I take seriously.
Q: Why did you choose to become a physician? A. Growing up in Grafton, N.D., I had physicians who made a difference not only in my life, but in the community as a whole. One physician made a house call to see me on a cold winter’s day, and I have always remembered that. I wanted to make a difference in people’s lives the way they did in mine.
Q: What do you do for fun? A. My wife and I enjoy spending a lot of time with our children. We do outdoor activities and take them to live theater and musicals as much as we can. I also enjoy spending time in northeastern Minnesota paddling my kayak, taking part in bicycle endurance races and playing the guitar.
Q: What do you do outside of your role at Altru? A. For the last five years I have volunteered to read weekly at my children’s elementary school in “Book Buddies.” It is a wonderful way to start a day! I am also involved with Special Olympics, volunteering at the annual soccer and bocce ball tournament and at local events. My son has Trisomy 21 (Down Syndrome), and he is excited now that he is old enough to participate in Special Olympics! Additionally, I am the medical director for the Wild Hog Marathon in Grand Forks. It's a historic event this year as it’s the first full distance running marathon in Grand Forks!
Q: Where would you like to travel? A. When I traveled with the USA Ski Team, I befriended a physician and a few coaches from Russia. Hearing their stories gave me some serious perspective. It is a place I've since wanted to visit and hopefully reestablish those friendships. I’d also love to take my children to England and expose them to where the famous British romantic poets lived. My daughter would especially love to see the new "Harry Potter and the Cursed Child" theater production in London.
Q: What would you like to be if you weren’t a physician? A. The scientist in me would have loved to be a university professor, studying the ecology of the rain forests in South America. The humanitarian in me would love to be a writer, using verse to share the human experience. Don’t look for my work in libraries or bookstores anytime soon, but maybe someday I’ll make an attempt!
As the thermometer reaches temperatures that make us swelter in the sun, we need to be extra vigilant about kids and the toll that heat takes on their bodies.
Heatstroke is the medical term used to describe when the body’s temperature becomes excessively hot. Simply put, hyperthermia occurs when a body produces or absorbs more heat than it gives off.
Young children are particularly at risk for heatstroke, as their bodies heat up three to five times faster than an adult’s. When a child’s internal temperature reaches 104 degrees, major organs begin to shut down. When their temperature reaches 107 degrees, the child can die.
Kids in Cars Heatstroke is the leading cause of non-crash, vehicle-related deaths for children under the age of 14. Since 1998, more than 660 children across the United States have died in cars from heatstroke.
How does it happen?
More than half of these deaths occur when a driver forgets that the child is in the car. Experts will tell you this can happen to anybody. Our busy lifestyles create enough stress to trigger “mental lapses” that cause your brain to go on autopilot. The lapses can affect something as simple as misplacing your keys or something as crucial as forgetting a baby. Read about one mother's real story.
Almost 30 percent of the time, children get into a car on their own. They find a way into the car, but sometimes, they can’t find a way out.
The third scenario is when someone intentionally leaves a child alone in a car. A parent might be running an errand and think, “The baby just fell asleep. I’ll just be gone for a second.” But seconds turn into minutes, and before you know it, the temperature inside of the car has reached lethal levels.
The temperature inside a car can rise 20 degrees in 10 minutes and upwards of 40-50 degrees in the span of an hour or two. It can be a relatively mild day outside and yet, there can be life threatening temperatures inside a vehicle. “Cracking the window” makes very little difference on the internal temperature in the vehicle. What can you do?
Remember to ACT.
Avoid heatstroke-related injury and death by never leaving your child alone in a car, not even for a minute. Make sure to keep your car locked when you’re not in it so kids don’t get in on their own. Keep keys out of children’s reach.
Create remindersbyputting something in the back of your car next to your child, such as a briefcase, your purse or your left shoe that is needed at your final destination. This is especially important if you’re not following your normal routine. For a free vinyl cling window reminder, contact Safe Kids Grand Forks.
Take action. If you see a child alone in a car, call 911 immediately if the parent or caregiver cannot be located. Emergency personnel want you to call. They are trained to respond to these situations. One call could save a life.
We want to hear from you! Safe Kids Grand Forks has more information on heat stroke, including window clings to remind you to look inside and outside your car. You can visit us at www.safekidsgf.com and like us on Facebook.
Carma Hanson has been a nurse at Altru Health System for over 25 years and now serves as the Coordinator of Safe Kids Grand Forks. Carma enjoys traveling to warm places with her husband and kids and spending time at their lake place. Taking pictures and engaging in community organizations also holds a special place in her heart.
Safe Kids Grand Forks is an injury prevention coalition who has as their mission to prevent unintentional injuries and death to children under age 19. Safe Kids Grand Forks has Altru Health System as their lead agency, and they serve upper northeast North Dakota and northwest Minnesota. To contact Carma or Safe Kids Grand Forks, send an email to firstname.lastname@example.org.
Dr. Brad Meland, a hand surgeon with Altru Advanced Orthopedics, has worked with Altru for the past seven years. He’s helped many patients get back to the lives they enjoy through his love for surgery and his passion for helping people improve their well-being. We sat down with Dr. Meland to get to know him a little better and understand his approach to medicine.
Q. What is your specific area of interest in your field? Do you have any procedures that you focus on or conditions you treat most often? A. Though I have practiced both hand surgery and plastic surgery, I am currently solely focused on hand surgeries, including surgery for arthritis, hand traumas, tumor removal, nerve surgery and beyond. I see many patients with carpal tunnel and offer treatment with endoscopic surgery.
Q. Outside of the operating room, what are some of your professional achievements? A. I am a member of ten different scientific societies. I am the past president of the American Association of Hand Surgery, and was previously the chief of hand and upper extremity surgery at Mayo Clinic in Scottsdale, Arizona. In my 16 years with Mayo Clinic, I spent quite a bit of time teaching. I gave lectures and taught courses throughout the world. I have also published 75 articles and 11 chapters for medical books.
Q. Did you enjoy your time teaching and lecturing? Is that something that you are passionate about? A. I did enjoy it, and continue to be interested in teaching. In fact, if I was not a surgeon, I would like to be a teacher or a coach.
Q. What is your personal philosophy of medicine? A. I strongly believe that the patient comes first. I make it a priority to be honest with my patients and explain their options and what’s going to happen during surgery. I do all that I can to improve my patients’ well-being and help them to be productive in their lives.
Q. What motivates or inspires you to do what you do? A. Simply put—I love surgery and the practice of medicine.
Q. What do you like to do in your free time? A. I enjoy being at the lake and taking part in water sports like sailing and fishing. I also enjoy golf, traveling and being involved with my church.
Q. If you could travel anywhere, where would you go, and why? A. China. I have always wanted to walk the Great Wall.
Q. Where are you from, and where have you lived? A. I was born nearby in Northwood and went to school at UND, so I am a proud North Dakota native. Medical training brought me to Michigan and Florida, and I lived in Rochester, Minnesota, and Scottsdale, Arizona, during my time with the Mayo Clinic. I was happy to return to North Dakota in 2009 when I started working for Altru.
Hear what one of Dr. Meland's patients, Justin Kiesow, had to say about the care he received:
Dr. Robert Johnson has been an orthopedic surgeon for the past 34+ years. A few months before his 35th anniversary in the field this June, he’ll be hanging up his white coat. Dr. Johnson retires this spring. Before he leaves Altru Advanced Orthopedics and the profession he’s dedicated his life to since 1981, we asked him a few questions about his career, the things he’ll miss and the things he’s looking forward to in retirement.
Q: What is your specific area of focus in your field? A: I am a general orthopedic surgeon, so I’ve done a wide variety of procedures and treatments for patients over the years. I’d say that I’ve enjoyed hip and knee replacements the most.
Q: Have you worked for many health systems over the past 34 years? A: I’ve practiced in Grand Forks for my entire career. I started at the Orthopaedic Clinic in June of 1981 and spent 14 years there. Then, I joined the Grand Forks Clinic, which merged with United Hospital to become Altru Health System and have been here ever since.
Q: In reflecting on your career, what stands out as a highlight?
A: I’d say a personal and professional highlight was when my son, Alan, joined the physician team at Altru. Having him follow in my footsteps to pursue a career in medicine (he is an ENT physician) and join the team at Altru was very special for me.
Q: What will you miss most about your career at Altru after you retire?
A: I’ll miss my patients and my team. It’s somewhat unusual, but I’ve had the same team working with me for most of my career. Liz Brekke, my nurse, has been with me through my entire career. Bill Janzen was with me for 30 years until he retired, then Suzie Benjamin replaced him and has been with me for the past several years. It’s pretty amazing to be able to work with the same great people for so long.
There are many long-time patients that I’ll miss seeing regularly. I have treated them for years as well as their children.
Q: What are you looking forward to in retirement?
A: I have a number of interests. I enjoy working with computers and might take some courses at UND in computer programming. I’d also like to get back into flying, which is something I’ve done before but haven’t had much time for in the past years. And of course, I look forward to more time with family. My grandkids are here in town, and I will be able to spend more time with them.
Q: Flying and computer programming – that’s impressive. Do you have any other hobbies? A: My wife and I will be restoring our cabin, which combines a few of my hobbies. I enjoy woodworking, as well as electrical and plumbing work. I look forward to using those skills to work on our cabin. I also enjoy being active and spend a lot of time at Choice Health & Fitness. I am a strong supporter of Choice and the impact that it has on our community.
Q: If you find time to travel in retirement, where would you like to go? A: It would be fun to travel to Norway. My wife and I are both Norwegian and have family there. I’d also like to see Alaska and possibly tour the National Parks.
Q: What message would you like to send to the patients you’ve cared for over the years?
A: I’d like to thank my patients for their trust and confidence in me. It makes my day when patients do well and can return to doing what they like to do.
You can’t protect your kids from everything, but you can protect them from HPV-related cancers. I've known families that have lost loved ones from cervical cancer and cancers of the mouth and throat. I'm delighted there's a way that we can protect our sons and daughters from these horrible diseases. My son was immunized as soon as he could be, because I know it's safe and effective.
Human papillomavirus (HPV) is a common virus passed from person to person through sexual contact. It can be spread even without intercourse. Here are 6 things you may not realize about HPV vaccine.
1. HPV is so common that nearly all sexually active men and women get it at some point in their lives. More than 40 types of HPV exist that can infect the genital area, mouth and throat. Some cause health problems, including genital warts and cancers. HPV can affect both men and women.
2. Age 11 or 12 is the best time to vaccinate boys and girls against HPV. The HPV vaccine is recommended for boys and girls at age 11 or 12, so they are protected before ever being exposed to the virus. HPV vaccine produces a higher immune response in preteens than in older adolescents.
3. Catch-up vaccines are recommended for males and females through age 26. So, if you did not get vaccinated when you were younger, do it before you turn 27. HPV vaccines are given in three injections over six months, but being late for the second or third dose does not mean starting the series over.
4. In the U.S., one person is diagnosed with HPV-related cancer every 20 minutes. HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils.
5. HPV vaccine is safe and effective. The vaccine has been studied in thousands of men and women around the world. In the four years after the vaccine was first recommended in 2006, the amount of HPV infections in teen girls decreased by 56 percent in the U.S. The HPV vaccine offered through Altru is 99 percent effective. Nearly 86 million doses of HPV vaccine were given in the U.S. from June 2006 through September 2015, and there have been no serious safety concerns.
6. Giving your child the vaccine does not give them permission to have sex. In fact, the opposite is often true: When parents and doctors talk to kids about sex and values, they actually increase the odds that the child will delay sexual relations. Think of the HPV vaccine as an opportunity to start or continue the conversation on this sensitive topic.
Joanne Gaul, MD, a family medicine physician caring for patients of all ages, enjoys encouraging and watching patients make changes in their lives that add up to better health. In Dr. Gaul’s personal quest for a healthy lifestyle, she runs half marathons, triathlons and countless shorter races. She also enjoys reading, knitting, quilting, playing flute and cooking. She serves on the Community Violence Intervention Center board and has performed with the city band and symphony.