May 2014 – Texas Children's News

May 27, 2014

Texas Children’s recently received an impressive report card from The Joint Commission with surveyors commending the hospital for demonstrating several best practices.

“Our survey results are a great indication that we are meeting the expectation of quality care for our patients,” said Texas Children’s President and CEO Mark A. Wallace. “This should only propel us to continue our focus on providing safe, quality care every single day for every one of our patients.”

Every three years, Texas Children’s undergoes an accreditation process by The Joint Commission survey team to ensure our delivery of high-quality patient care. Five surveyors arrived at Texas Children’s for a five-day survey on May 12. The survey team included a pediatrician for inpatient areas and the medical staff, and another pediatrician for ambulatory areas, an Ob/Gyn specialized nurse, pediatric nurse and a life safety engineer.

What Joint Commission noted

The survey is intended to assess the organization’s compliance in patient care areas that contribute to positive outcomes and to measure and improve performance. The Joint Commission team was very impressed with our improved outcomes in asthma, diabetes, radiology efficiency and flow, patient flow and surgical complications. The team also identified several best practices observed during the survey, including:

Time out processes across the system
Error prevention technology in the anesthesia ad pharmacy areas
Use of data to improve patient outcomes

“The Joint Commission survey team visited several Texas Children’s facilities to evaluate patient care processes through on-site observations, interviews and tracer methodology,” said Mary Jo Andre, Texas Children’s senior vice president of Quality and Safety. “Surveyors use tracer methodology to retrace the specific care processes that a patient experienced by observing and talking to staff in areas where the child received care.

“The surveyors were very impressed with the knowledge and confidence of the staff and faculty who participated in the tracer interviews. They complimented them also on their ability to navigate Epic and explain the continuum of care. Most importantly they were impressed with their ability to talk about quality projects and outcomes. We are very proud of their performance.”

How we prepared for the survey

Preparing for regulatory surveys is an ongoing process underscored by Texas Children’s daily focus on patient safety and high quality programs. About six months before our anticipated Joint Commission survey, Texas Children’s hires a consultant to review our processes and evaluate our survey readiness. The information provided by the consultant helps the organization fine tune.

“The results we get from area tracers during that preparation process provide information we need to develop and implement an organization-wide readiness education program,” said Trudy Leidich, Texas Children’s director of Quality and Safety and Medical Staff Services. “But we regularly evaluate our internal processes against regulatory guidelines to identify opportunities for improvement. Regulatory surveys are valuable evaluation tools, but we have a deliberate focus on the quality and safety of our patients’ care every day.”

An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 20,500 healthcare organizations and programs in the United States. Approximately 77 percent of the nation’s hospitals are accredited by The Joint Commission. Accreditation surveys are unannounced, so preparation is a crucial, on-going process.

“Accreditation by The Joint Commission means Texas Children’s meets the highest quality and safety standards in patient care,” Wallace said. “It gives patients peace of mind knowing that our facilities are surveyed routinely and that we meet or exceed a comprehensive assessment of the care we provide.”

The Center for Children and Women has been honored by The National Committee for Quality Assurance (NCQA) as the first obstetrics practice in Texas to receive the Patient-Centered Specialty Practice Recognition (PCSP). Practices that become recognized under Patient-Centered Specialty Practice Recognition have demonstrated commitment to patient-centered care and clinical quality through: streamlined referral processes and care coordination with referring clinicians, timely patient and caregiver-focused care management and continuous clinical quality improvement.

“We are proud to be the first obstetrics practice in Texas to receive the PCSP recognition,” said Dr. Lisa Hollier, medical director of obstetrics and gynecology at Texas Children’s Health Plan – The Center for Children and Women. “Our care teams work hard to provide the best, comprehensive care for our patients and to empower our patients to become healthier,” she concluded.

Earning NCQA PCSP Recognition shows consumers, private payers and government agencies that the practice has undergone a rigorous review of its capabilities and is committed to sharing information and coordinating care. Recognition also signals to primary care practices that the specialty practice is ready to be an effective partner in caring for patients.

“The Center for Children and Women is honored that our operations and healthcare team meets and exceeds the qualities worthy of the Patient-Centered Specialty Recognition,” stated Tangula Taylor, director of operations at Texas Children’s Health Plan – The Center for Children and Women. “We continue to pursue excellence as we strive to find new and innovative methods to deliver outstanding care to our patients.”

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performances. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.

New brand book shares power and architecture of Texas Children’s brand

You’ve just made the finishing touches to your department’s monthly newsletter, but you feel like it’s missing something. You’re thinking, “Maybe I should add the Texas Children’s logo.”

Or maybe you’re designing your unit’s Go Texan Day t-shirt, and you’ve cleverly come up with a graphic of a cowboy lassoing the Texas Children’s logo.

Intentions in both scenarios are good – you’re a Texas Children’s employee, and you want to show your pride and passion for the organization. But our red logomark is more than that familiar dot with the three arcs beneath it. The logomark is only part of the full logo. The Texas Children’s logo is the primary representative of our brand, and whether it’s on a billboard, a button or letterhead, it still serves to communicate who Texas Children’s is and what we stand for. That’s why it’s important that all staff and employees know how to treat the logos in our system and when and where they should – or should not – be used.

“A brand is who and what an organization represents to its key audiences,” said Amber Tabora, Texas Children’s vice president of Marketing and Public Relations. “An organization’s name and logo serve as shorthand for its brand – what the organization would like its audiences to think and feel about it. The stronger the brand, the easier it is for an audience to understand the organization and what it stands for.”

Marketing and Public Relations recently debuted the Texas Children’s Brand Book to help staff and employees harness that aforementioned pride and passion and direct it in a way that makes our brand even stronger. The new Brand Book defines the Texas Children’s brand, our audiences, our organizational structure and more to help staff and employees understand how all elements of the Texas Children’s brand – the logo, the images, the experience – reflect our organizational identity.

“The book explains the Texas Children’s ‘promise,’ our positions and pillars of support, our brand voice and language, brand imagery and how to become a brand ambassador,” said Lisa Yelenick, Texas Children’s director of Brand and Service Line Marketing. “As an employee, this is important information to be equipped with because our organization impacts the lives of children, women and their families every day. Each time we are with them, we are representing the Texas Children’s brand.”

Texas Children’s Brand Book is available online, and we encourage every employee to take a few minutes to learn about our brand and how to be a brand ambassador. To support the book’s contents, this summer, a series of videos will further demonstrate the power of the Texas Children’s brand and the responsibilities we all play as ambassadors.

“Our goal is to strengthen the Texas Children’s brand locally and globally,” Yelenick said. “By delivering strategic, consistent messages and exceptional experiences, we as an organization will support a brand that is increasingly powerful, meaningful and valuable.”

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Peter Hotez, president of the Sabin Vaccine Institute and Texas Children’s Hospital Endowed Chair in Tropical Pediatrics, put the spotlight on neglected tropical diseases (NTDs) in the Central African Republic (CAR) through a recent op-ed piece in the Huffington Post. With just more than five million people, CAR is considered one of the most remote and economically devastated countries in Africa – and according to Hotez, its brewing brutal civil war could mean an overwhelming increase in disability and death caused by NTDs if action isn’t taken quickly.

“NTDs and poverty reinforce each other through mechanisms that involve reductions in workforce, food insecurity and the health of girls and women. Less well known, but equally important social forces, in promoting NTDs, are war and conflict,” said Hotez. “CAR has a fragile health system to begin with. If we now superimpose conflict and war, it could result in near or complete collapse and inability to provide treatments.”

CAR is one of Africa’s largest sources of endemic and hyperendemic NTDs, and the numbers are staggering. Approximately 1.5 million children require periodic deworming for their intestinal helminth infections, of whom more than 500,000 also need regular treatment for schistosomiasis. Hotez explains that while all of the most common NTDs, such as intestinal worms and schistosomiasis, are of concern in CAR, there also is reason to be especially worried about NTDs transmitted by insect vectors such as kala azar and African sleeping sickness. According to the World Health Organization (WHO), CAR is one of four African countries annually reporting more than 100 cases of the Gambian form of sleeping sickness, which usually leads to death in two to three years.

Currently, neither the United States nor the United Kingdom governments support NTD control and elimination programs in CAR, and there is very little private philanthropic money focused on NTDs going to support such measures. The END Fund, a private philanthropic fund dedicated to combatting NTDs, was one exception and supported NTD control efforts in CAR in 2012. But due to the impact that violence and instability had on the ability for program partners to move forward with mapping and mass drug administration (MDA) activities, the END Fund had to place support to CAR on hold.

“NTD control often falls off the priority list when conflict arises as agencies and governments focus on providing food, shelter and security to affected populations,” said Hotez. “As MDA often mobilizes thousands of health workers to treat millions of people at risk of NTDs in a short period of time, the activities can be dangerous in times of conflict.”

While the majority of health organizations in the U.S. don’t seem focused on NTDs in CAR yet, Texas Children’s is highly aware of the situation there, stressing how important it is that the people of CAR receive access to essential NTD medicines.

“Texas Children’s Hospital is emerging as the first truly global children’s hospital – we take care of the world’s children,” said Hotez. “This is an absolutely unique vision pioneered by Dr. Mark Kline and Mark Wallace, but also extends to Drs. Michael Belfort and Chuck Fraser who are committed to women’s health and surgical issues in resource-poor settings.”

To ensure that NTDs are not further neglected during times of crisis in CAR, Hotez calls for engagement from health agencies with expertise in complex emergencies and a willingness to ensure NTD control efforts remain a priority.

He also is working tirelessly to develop vaccines that can be administered in places like CAR to help eliminate the spread of NTDs. The Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development are pioneering the development of a human hookworm vaccine and schistosomiasis vaccine. They also have a new vaccine for leishmaniasis under development.

“At Texas Children’s, we are very concerned about the suffering of children everywhere,” said Hotez. “We’re making vaccines for the world’s poor.”

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By Dr. Tiffany McKee-Garrett

When a baby is born, parents want nothing more than to love and protect their child. Part of that protection starts right after birth with the administration of a vitamin K injection. Babies are not born with sufficient vitamin K levels and cannot get adequate amounts of vitamin K from breast milk, so this injection, given within the first hour after birth, is crucial because it helps a baby’s blood to clot normally, which prevents vitamin K deficiency bleeding (VKDB) in newborns.\

A dangerous trend
A recent CDC report confirmed that there has been a nationwide increase in parents refusing the vitamin K shot for their newborns – and this dangerous trend, often based on inaccurate information found online and faulty science, is causing more babies to experience hemorrhaging that is preventable and may cause brain damage or even death in some cases.

In the United States, administration of intramuscular vitamin K at birth to prevent all forms of VKDB has been standard practice since first recommended by the American Academy of Pediatrics in 1961. Without the shot, the incidence of early and classical VKDB ranges from 0.25 percent to 1.7 percent of births and the incidence of late VKDB ranges from 4.4 to 7.2 per 100,000 infants. The relative risk for developing late VKDB has been estimated at 81 times greater among infants who do not receive intramuscular vitamin K than in infants who do receive it.

Early VKBD usually presents in previously healthy appearing infants as unexpected bleeding during the first two weeks of age, usually between the second and fifth day after birth. The bleeding can present as oozing from the umbilical cord area, bleeding from the circumcision site, persistent oozing from puncture sites, gastrointestinal hemorrhage, and/or bleeding into the brain, which can result in significant neurological complications that have a lifelong impact on a child.

Late VKDB is an indication of severe vitamin K deficiency and presents as unexpected bleeding, including brain bleeds in infants 2-12 weeks of age. Complications of late VKDB may be severe, including death. It classically presents in exclusively breastfed infants who received either no or inadequate neonatal vitamin K. It can also present in infants with intestinal malabosorption defects.

The myths
One myth about vitamin-k injections is that they are linked to leukemia, but studies show absolutely no relationship between getting vitamin K as a baby and an increased risk of leukemia. Another myth is that the vitamin K injection increases the risk of jaundice – which is inaccurate. Jaundice associated with vitamin K has been observed only in high risk babies (such as premature babies) in doses 30-60 times higher than the dose we give.

Some parents also argue that injections cause babies pain, but this pain is very brief and the benefits of the injection are very much worth a short period of discomfort. Parents are encouraged to mitigate this brief uncomfortable experience by holding baby skin to skin before and after the injection or allowing the baby to breastfeed before, during and/or after getting the injection.

In the not so distant past, infants and children had high rates of dying early in life. During the 20th century alone, the infant mortality rate declined greater than 90 percent and the maternal mortality rate declined 99 percent! Much of this is due to advancements in modern medicine. While it might seem nice to do things completely naturally, modern medicine has saved the lives of countless mothers and babies.

Our beloved friend and colleague, Katy Wilkinson, passed away peacefully on May 13 at the age of 52 after a valiant struggle with ALS. She will be deeply missed by her husband, Wade, her daughter, Amanda, and her son, Clayton, as well as the many colleagues, friends, and patients in her Texas Children’s Hospital family.

Katy earned her Master’s Degree in Physical Therapy at Texas Women’s University in Denton, Texas. This degree, together with her joy in working with children, landed her at Texas Children’s Hospital. She loved her work and her large second family of coworkers and patients. This love was reciprocated, and Katy was recently honored for 30 years of continued service at Texas Children’s. During her years at Texas Children’s, Katy was involved in many facets of leadership and patient care. She was highly involved with the Lung Transplant Team as well as working in a variety of areas including International Adoption and the Pediatric Intensive Care Unit. Katy’s unending support and positive attitude earned the love and respect of the many therapists and students that she mentored over the years.

In her love for her family, Katy always found a way to make things happen. She served on the volunteer board for Amanda and Clayton’s school. She arranged her time off from work to allow her to be involved in school activities. Katy was an avid runner who loved reading and all of nature. Family time away from Houston took them snorkeling in Cozumel, hiking and skiing in Colorado, visiting all of nature’s wonders in Yellowstone or Rocky Mountain National Parks, and exploring Costa Rica. She had a special love of all animals. So much so, that they humorously called their home The Zoo.

Katy will be deeply missed and always remembered. In her honor, a memorial service will be held on at 3:30 p.m. Wednesday, May 28, in the third-floor conference room of the Clinical Care Center. In lieu of traditional remembrances, Katy requested with gratitude that contributions in memory of her be directed to ALS at http://www.alsa.org/ and click on Donate.

Dr. Huda Zoghbi, professor of neuroscience, pediatrics, molecular and human genetics and neurology at Baylor College of Medicine and founding director of the Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, was the recipient of an honorary Doctor of Medical Sciences degree at Yale University’s 2014 commencement ceremony this week. She was one of 12 individuals who was awarded an honorary degree for achieving distinction in her field.

Zoghbi, who also is a Howard Hughes Medical Institute investigator, is best known for her pioneering work on Rett syndrome, a genetic neurological disease that affects young girls (males with the condition usually die in infancy). Girls born with the disease develop normally for one or two years, but then begin to show progressive loss of motor skills, speech and other cognitive abilities.

“As a pediatric neurologist, your compassion for your patients led you to the laboratory and a career as a neuroscientist and geneticist, seeking answers to the mysteries of neurological disease,” said Yale University president Peter Salovey as Zoghbi received her degree. “You have discovered the cause of Rett syndrome, a rare and severe form of autism, and of a neurologic disorder that results in degeneration of the cerebellum. Your work has helped explain brain development and function and offers hope of finding cures for debilitating conditions. You are a role model for conducting translational research – always looking for ways to apply science to understanding disease. You are a leader in the scientific community, and we are pleased to name you Doctor of Medical Sciences.”

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