BEST
1: excelling all others

I’m not exaggerating when I say that PHS truly has the best nurses in the business. Hands down. Just ask any one of our patient families, any of our kiddos, any of the healthcare professionals we partner with day in and out. PHS nurses have skill, compassion, heart, expertise and the list could go on forever, but I think you get the idea. PHS has nurses in our Infusion department, Private Duty Nursing department as well as in our Respiratory Therapy department. In celebration of National Nurses Week we wanted to ask a few of our nurses (well, the ones that didn’t run away as soon as they saw the camera) what is their favorite part about being a nurse. Why are they so passionate, and just why are they the BEST?! We were able to track a few down.

Check out the video below to hear from:

1. Christine Olson, RN, Home Infusion Therapy Nurse
2. Jodi Bancks, BSN, PDNS Case Manager
3. Jill Wall, RN, BSN, CRNI, Home Infusion Therapy Nurse
4. Steven Moehrle, RN, BSN, PDNS Case Manager
5. Joel Skog, RN, Home Infusion Therapy Nurse
6. Doreen Carson, Home Infusion Therapy Nurse
7. Jade Turner, RN, PDNS Case Manager

Do you know a PHS nurse? What do you think makes them the best?

Meet Lalita Jyoti

Winning candidate for the PHS Respiratory Therapy $1,000.00 scholarship.

A few facts about Lalita:

• Currently a student at Sanford Health Medical Center Respiratory Care Program through NDSU-Fargo and will graduate with her bachelor’s degree in respiratory care in December 2012.
• Following graduation Lalita plans to work as a Respiratory Therapist and hopes to move on to become an RT Educator in the future.
• Currently working as a Nurse Aide in the ER at Sanford Health.
• Has worked in the past as a phlebotomist.
• Enjoys being able to work with people as well as the medical equipment and technology.
• Graduated with a degree in Health Communications in 2011.
• She and her family speak Mathali at home, a language from India.
• Lalita is the youngest of five children in her family.

“I knew a career in healthcare was for me after taking science courses along with gaining professional work experiences in the healthcare arena. After exploring healthcare professions, such as pharmacy and nursing, I found a career where I felt comfortable and would have opportunities to educate patients and families regarding their health and at the same time have variety in work and chances of advancement.  I decided to pursue a career in Respiratory Care last fall and declared as a major this past winter.” – Lalita Jyoti

Meet Joshua Oye

Winning candidate for the PHS Respiratory Therapy $500.00 scholarship.

A few facts about Josh:

• Currently a student at Concordia College of Saint Paul, on track to complete a four year bachelor’s degree in respiratory care (July 2012).
• Served as President of his respiratory program at Saint Paul College for just under two years
• He is interested in the many possibilities ahead of him in the respiratory field:
  • Managerial roles
  • Teacher/mentor at a local college
  • Sales representative for new RT technologies, specifically ventilators and electronic equipment
• Currently works at both Minneapolis and Saint Paul Children’s Hospitals as a respiratory therapist
• He loves the pediatric respiratory care field (so do we Josh!)
• Prior to being a therapist at Children’s, he was a respiratory intern on the Minneapolis campus while attending respiratory school at Saint Paul College.
• Before Respiratory school Josh was in the Air Force. He worked as a medic responsible for two different base respiratory protection programs.
• Is trained at Children’s to work in NICU, PICU, Cardiovascular Critical Care (CVCC), general floors and ER.
• Josh has obtained his Neonatal Resuscitation Program (NRP), S.T.A.B.L.E. (sugar & safe care, temperature, airway, blood pressure, lab work, & emotional support) and is currently studying to take the Neonatal/Pediatric Specialist course (NPS).

“My patients would probably say that I am a very thorough and somewhat of a respiratory “nerd”.  My goal is to leave each patient room with no questions unanswered and if there are some questions that I cannot answer then will find someone who is able to answer them for the patient.” -Josh Oye

Meet Xe Yang

Winning candidate for the PHS Respiratory Therapy $500.00 scholarship.

A few facts about Xe:

• Currently a student at Saint Catherine University, graduating May 2013.
• Volunteers at her parents 55+ assisted living company-  Asian American Elderly Assisted Living, LLC with various activities and exercises such as:
  • Aerobics
  • Yoga
  • Walk
• Volunteers with Bridges to Success as a mentor to elementary school students.
• She says the primary reason she wants to become a respiratory therapist is because she finds enjoyment in the care she provides for others.
• Student member of the AARC
• Lives by the quote “To be successful you must be determined”

PHS was thrilled to get applications from such amazing candidates and we hope to be seeing more of Josh and Xe in the future. Congratulations!

PHS's Derek Hustvet (left) with scholarship winner Josh Oye (center) and Nate Bostrom (right) of Concordia University

The scholarship is designed for students or recent graduates enrolled in respiratory therapy programs, through which they learn to care for people with heart and lung disorders. Pediatric Home Service received 16 applications and awarded three students scholarships ranging from $500 to $1,000.

“Education and philanthropy are a large part of the culture at Pediatric Home Service,” said Derek Hustvet, PHS Director of Respiratory Service. “We are always looking to hire the best of the best and we’re happy to support future respiratory therapists who could be caring for our patients following graduation. While we were only able to award three scholarships we are excited to know there is a great group up students about to enter the field.”

PHS's Derek Hustvet (left) with scholarship winner Xe Yang (right)

Josh Oye, a student at Concordia College of St. Paul, and Xe Yang, a student at St. Catherine University, each received $500 scholarships. The grand prize scholarship of $1,000 was awarded to Lalita Jyoti, a student at North Dakota State University in Fargo.

Jyoti is enrolled in the Sanford Health Medical Center Respiratory Care Program through NDSU-Fargo and will graduate with her bachelor’s degree in respiratory care in December 2012. Jyoti plans to specialize in pediatric respiratory care and patient education.

PHS's Derek Hustvet (left) with scholarship winner Lalita Jyoti (center) and Robyn Urlacher (right) of the Sanford Health Medical Center Respiratory Care Program

“I can’t describe how thankful and blessed I feel to receive a scholarship from Pediatric Home Service. The scholarship has given me the opportunity to keep pursuing my dreams,” said Jyoti.

In the coming week we will go into a bit more detail about each of the winning candidates so be sure to check back.

PHS Employee Becki plays basketball with kids in iCAN Hoop program

Through our Sharing Care program, PHS provides its staff with the opportunity to donate time to programs and events in the community that are directly associated with serving medically-fragile and underprivileged children. In 2011, the company’s employees volunteered at 11 events and fundraisers, donating more than 300 hours of service to organizations throughout Minnesota and western Wisconsin.

Staff volunteer for organizations such as HopeKids MN, Ronald McDonald House, West Metro Miracle Athletics, Oley Foundation, Toys for Tots and numerous local children’s hospitals. The company also hosts two annual blood drives and raises money for a variety causes, including sending families to Faith’s Lodge, a retreat for people with medically-fragile children or families who have lost a child.

“Volunteering is a powerful experience in which I’m able to make an impact on kids and families outside of work. Giving back is not an obligation at Pediatric

PHS volunteers at Faith's Lodge planting trees donated by PHS after many were lost in storm

Home Service, it’s simply part of our culture,” said Dana Akerson, Pediatric Home Service Marketing Specialist. “Sharing my time and talents makes me

realize how meaningful it is to be part of something bigger than myself.”

Whether cooking dinner for families whose children are hospitalized, playing basketball with children with cognitive and/or physical challenges, bowling to raise money for a local children’s hospital, or planting trees at a charitable retreat center, Pediatric Home Service staff embrace volunteering as a way of life all year long.

Measuring outcomes helps PHS:

• Establish benchmarks and standards of safe, in-home health care
• Determine if appropriate care is being provided by all caregivers
• Identify areas for improvement
• Document interventions and treatments that are most effective
• Evaluate effectiveness of education and training tools
• Provide patients and other patient caregivers a method to evaluate the quality of PHS’s in-home health care

Like I said before, we have been measuring outcomes data for quite some time, and in the Fall 2011 issue of The Pulse, we reported outcomes on central line blood stream infections (CLABSI) in homecare patients with central venous access serviced by PHS home infusion nurses. PHS reported infection rates significantly lower than hospital infection rates. What makes these low infection rates even more remarkable is the high acuity of these PHS patients.

Recently, we added a page devoted to patient outcomes on our updated PHS website. There, you will find information on the CLABSI results, as well as other outcomes related to respiratory therapy, private duty nursing and shipping accuracy.

On the respiratory side, we recently completed a 12-month observational study of our tracheostomy dependent patients. (You can read more about this study in a blog post here.) Tracheobronchitis is one of the most common medical conditions affecting pediatric patients with artificial airways and there’s a lot to be learned about it in the homecare setting. We are working to compile the results and look forward to sharing the results with you soon.

In the meantime, we encourage you to take a look at the new patient outcomes page on our website. Check back often, because we will continue to populate the page with additional statistics and studies as they become available.

At PHS, we want to know what’s working—and what isn’t—so we can continually improve our services. Your feedback, as a patient caregiver, health care professional, or patient, is one of the best methods we have in making those determinations. “We accept the premise that there are always areas for improvement,” says Pam Clifton, PHS Senior Vice President of Operations. So, with that in mind, we continually ask:

• What is PHS doing that we should continue? Or discontinue?
• Is there something we should be doing that we are not?

We sincerely want to know what you think.

Keep an eye out for this postcard being sent to your home soon as a reminder to hop online and let us know how we're doing.

How it works

PHS clients are surveyed once a year, slightly more often if they are new to the company. Surveys are patient specific, which means that you are only going to get questions that relate to the services you receive or deal with in some capacity.

Next, our operations staff reviews every returned survey, yes you heard right, we read every single survey. We’re not kidding when we tell you we truly care about what you have to say. Our operations staff takes careful note of responses that indicate anything less than the highest mark of satisfaction. Managers then review the surveys and follow-up as needed. Respondents who indicate anything less than the highest levels of satisfaction (and include contact information) will be contacted by PHS so we learn how we can make their experience better.

In the past year, PHS contacted 87 people (out of 230 returned surveys) or 37.8 percent of respondents.

You talk, we listen

There’s always room for improvement. Following are some of the changes that resulted from customer feedback:

• We extended our hours of operation: we now answer the phones from 7 to 7 to be more available to our families, and outside those hours, we use an answering service to distribute calls to our on-call staff members.
• We added private duty nursing service: for years, many people have responded to the question, “What is the one thing we’re not doing that we should be doing” by answering “offer extended hours nursing.”
• We improved the “usability” of our education materials: redesigning the layout, adding more photos to demonstrate techniques, and changing how information was delivered.

5 important things to know about PHS surveys

1. The survey is now available online! No writing or mailing necessary. And the best part? It only takes about 5 minutes. Simply visit www.PHSSurvey.com to fill one out.
2. You might win a prize. We’re serious about wanting your input so we’re offering an incentive: we hold a drawing quarterly for a $100 Visa gift card that is accepted at most retail locations. Anyone who includes contact information on a returned survey is eligible for the drawing.
3. Survey results are compiled quarterly and shared with all staff. This information motivates employees to continually strive to achieve great customer service.
4. If a survey mentions a specific employee, a copy of the survey will be shared with the employee. So if someone has done something extra special for you lately, go ahead and tell us so we can thank them internally for their efforts in taking care of the child.
5. Once we see a trend in responses and are satisfied we are doing something well, we move on to something new so that we are always learning, continually improving.

Private Duty Nursing Service (PDNS) was added to the broad spectrum of services offered by Pediatric Home Service just over a year ago and we have nothing but great news to report.  Adding PDNS to the service offerings allows PHS to do everything possible to help kids live their lives to the fullest at home, with their family, where every child belongs. It also makes it easier for our family caregivers and professional health care partners, who can get all their questions and concerns answered in one place, with a single phone call.

When you bring your child home from the hospital, we come with you. In fact, we’re usually already there, with all the equipment and support you need to ensure your child gets the best possible care and highest level of comfort.

• Our private duty nurses provide round-the-clock care, if necessary, or scheduled visits as required or deemed appropriate by your doctor.
• All PHS extended-care, private duty nurses are licensed trained and experienced in the specialized discipline of caring for young patients.
• Training includes comprehensive pediatric assessments, equipment competency, emergency response and CPR certification.

To learn more about Private Duty Nursing click here. To see outcomes from our first year of service click here.

“We understand that having people in your home who are not family can feel like an intrusion, no matter how necessary the intrusion may be. At PHS, we work with families to do our best to accommodate their schedules and household dynamics, in addition to providing the highest quality home nursing care.”

— PHS Founder/Owner Susan Wingert

He was born eight weeks premature, and although his parents were never given an official diagnosis, he was suffering from severe apnea and couldn’t breathe on his own. He was ventilated, kept in neonatal intensive care, and what should have been a tiny baby’s belly was distended and filled with fluid. Yet, test after test came back negative.

A battle between his liver and his lungs.

Rilee’s enlarged abdomen and failing liver meant less room for his lungs, and although they should have been growing stronger, they shrunk to half their already diminished capacity. But at the age of 3 months, Rilee received a new liver and new hope.

With a PHS team that includes:

• a respiratory therapist
• an infusion nurse
• a dietitian
• 24/7 private duty nurses
• and a host of support staff including an onsite medical director, pharmacists, customer support specialists and more ready to assist around the clock

Today, Rilee is thriving and growing up at home with his family, where he belongs. He no longer needs breathing help from the ventilator and everyone is hopeful for decannulation (removal of the trach) in the future. When that happens, he’ll learn to eat on his own and won’t require g-tube feedings. In other words, his prognosis is great!

Learn more about Rilee on the PHS website here and watch a video of his story as told by his family and PHS care team.

Also be on the look out for Rilee’s TV commercial airing now. We need to let all families know that it’s possible to have safe, quality, all-encompassing care at home. Kids deserve to be at home and Rilee is all the proof we need to show how well they do once they get there! His smile will melt your heart.

Have you seen the commercial airing yet? What do you think? We’d love to hear from you.

This month we will finish up our food pump series by troubleshooting gravity bags.

A gravity bag does not need a pump to deliver formula or breast milk. It is used short term if, after troubleshooting with a PHS clinician, it has been determined that the food pump needs to come in for service. This allows you to feed your child/patient while your replacement pump is being delivered. To make sure you give the right amount of formula or breast milk you must use a simple calculation.

• Enter the rate on your food pump into the ___(blank line)___
• Multiply that number by 20
• Divide that number by 60 to give you the number of drips per minute to set using the gravity bag.
• For example if you have a set rate on the food pump of 35 mL**/hr it would look like this:
• 30 x 20 = 600
• 600 divided by 60 = 10 drips per minute.
• **NOTE: If the number is not a whole number round either up or down to the closest whole number.

Once you have figured out the Calculation for Gravity Drip follow these instructions to deliver the right amount of formula or breast milk:

1. Clean workspace and gather supplies.
2. Wash hands well.
3. If formula is in concentrate or ready to feed form, shake can well.
4. Wipe off top of can with clean cloth.
5. Close roller clamp on feeding bag.
6. Pour formula or breast milk into bag. Close top firmly.
7. Hang feeding bag high enough to allow tube feeding to flow by gravity.
8. Open roller clamp to fill tubing.
9. Close roller clamp. The drip chamber must be half full.
10. Flush feeding tube with warm water.
11. Have your child sit comfortably in upright position during the feeding.
12. Open the roller clamp on the tubing. Use the clamp to adjust the flow rate. Speed up the flow by opening the clamp, or slow down the flow by closing it. If your child has diarrhea or abdominal discomfort, slow down the flow rate.
13. After feeding is complete, close all the clamps.
14. Disconnect tubing from the feeding tube and flush with warm water.

John Sheahan, RRT-NPS, LRT is a Licensed Respiratory Therapist at PHS and would love to hear from you if you have a tip that you’ve found helps when working with your equipment, or have an idea for a Troubleshooting Tip post. Share your tip or idea through a comment here or an email to John at jcsheahan@pediatrichomeservice.com.

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