March 11, 2014

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By Titi Otunla, Certified Nurse Midwife

Becoming a midwife was part calling and part admiration for the midwives I witnessed growing up in England. I knew I wanted to assist women with health decisions and especially be involved in one of life’s most transformative experiences – childbirth.

The midwifery philosophy acknowledges pregnancy and birth as normal physiological events in a woman’s life. When a woman chooses our practice and comes to the hospital for the birth, she will have a midwife with her throughout labor. Midwifery guidance and support ensures that labor and the birth progress is undisturbed. Midwives believe in being with women, assisting them to have the birth they desire. We teach and strongly encourage women to practice the mind-body connection, which helps prepare them for a satisfying birth.

At Texas Children’s Pavilion for Women, our team of six Certified Nurse Midwives practices with The Women’s Specialists of Houston. Our patients choose to birth with a midwife and have comfort in knowing that if their pregnancy becomes high-risk they can be referred to physicians within the group. The hospital has an intimate and soothing environment but in the event emergency care is needed, women are assured that they are in a state-of-the-art facility with world-class expertise readily available.

About Titi Otunla: Titi a Certified Nurse Midwife with the Women’s Specialists of Houston at Texas Women’s Pavilion for Women. She’s been a midwife for 27 years and believes that a positive birth experience is important for all women.

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Texas Children’s Advance Practice Providers hosted their first International Conference recently. It was a huge success with more than 130 attendees from across the world. The conference started with two days of pre-conference seminars focusing on pharmacology, skills labs and palliative care. The main conference included attendees and speakers from across the nation to equip advance practice providers with acute and subspecialty care knowledge, as well as to connect with experts for collaboration.

The mission of the Texas Children’s Hospital Advanced Practice Provider Conference (TCHAPP) was to empower advanced practice registered nurses (APRNs) and physician assistants (PAs) through state of the art education, training, innovation, collaboration and professional development. The conference curriculum was diverse and allowed attendees to tailor their learning experience to their own unique practice needs.

March 4, 2014

3514icd10640Most people receiving care probably assume their medical records include details like whether their condition is acute or chronic, how their illness is progressing or, at a minimum, which side of the body an injury may have occurred.

Believe it or not, there has not been a standard way to document basic information like this in patients’ medical records across the U.S. The new coding system – ICD-10 – will change that.

On October 1, Texas Children’s and healthcare organizations nationwide will transition to ICD-10, the coding system used to report and code diagnoses, injuries, impairments and other health problems and their manifestations. It will replace ICD-9, the current coding system used at Texas Children’s.

Why make the change?

In 2009 the U.S. Dept. of Health and Human Services formally adopted ICD-10 as America’s new national coding system and set October 1, 2014 as the deadline for facilities and providers to implement the new system.

ICD-10 is important because a patient’s record is a legal document. It notes exactly what care a patient has received, when they received it, why they received it and treatment plans going forward.

Before, a record could show that a patient had uncontrolled diabetes but had no additional documentation. Now, with the increased specificity of ICD-10, the record will show whether the diabetes was caused by an underlying medical condition or whether it was triggered by an external factor, like medication or chemicals. The new codes specifically ask for the type, any complications and the manifestations of a certain diagnosis.

“It’s all about improving the documentation of the care a patient receives,” said Texas Children’s Chief Safety Officer Dr. Joan Shook. “It’s critical because it can improve the quality of care. It ensures our compliance with CMS (the office responsible for Medicare and Medicaid) regulations, and it affects the hospital’s revenue.”

Know the two parts of ICD-10

There are two types of ICD-10 coding: ICD-10-CM, which means “clinical modification” and refers to diagnosis coding. The other is ICD-10-PCS, which stands for procedure coding system and refers to coding for inpatient hospital procedures. Both will be implemented at Texas Children’s on October 1.

How Texas Children’s physicians are preparing

Because ICD-10 will change the hospital’s Epic system, which is our electronic medical record (EMR), members of the hospital’s Epic support team have been meeting with physicians since November to determine the best way to refine it. Physicians will participate in “clinical documentation assessments” to determine what tools need to be refined or added to Epic to make it ICD-10-ready.

The hospital has partnered with Baylor College of Medicine to provide e-learning videos for the doctors about ICD-10. Each specialist will take three to four e-learning courses this summer, along with an e-learning course on Epic.

Throughout the process, a team of ICD-10 physician champions will serve as liaisons to the medical staff. Each specialty also has its own Epic physician liaison should they have any questions or comments.

How others at Texas Children’s are preparing

The coding staff is attending “boot camps” to learn the ins and outs of the new system.

Additionally, the hospital has been educating providers’ offices through the Texas Children’s Health Plan newsletter since last year.

How the rest of us can prepare

Even if you do not work in a role where you have to document or understand documentation codes, you should understand, in general, what’s happening and how it may impact your own medical record documentation. The best thing you can do in the months ahead is learn as much as you can about ICD-10. Below are links to a quick fact sheet and helpful sites with basic information.

For more information

ICD-10 Fact Sheet
ICD-10 Industry Updates
ICD-10 Myths and Facts

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Since 2008 more than 500 Texas Children’s Hospital patients with cancer and other life-limiting disorders have been photographed by Flashes of Hope. The non-profit organization hopes to change the way children with cancer see themselves and it’s doing just that here at Texas Children’s. Now those photographs will be displayed for hundreds of people who visit this year’s Fotofest at The Health Museum.

“We want to document this time together as a family,” said co-founder of the Houston chapter, Amy Spelman.

Professional photographers come to the hospital for the photo shoots and capture smiles to preserve the courage, beauty and dignity of the difficult time in each family’s life. The photographs take focus off of the sickness and bring light to the strength and beauty of a child filled with hope. It’s a chance for the kids to see themselves through a different lens.

In 2001 the parents of a child with cancer started the organization which has now grown to 55 cities across the country including Houston. The photographs are given completely free to the families. The mission, “Flashes of Hope raises funds to accelerate a cure for children’s cancer while honoring the unique life and memories of every child fighting cancer.”

The Fotofest reception on Thursday, March 6, is free and open to everyone. It’s a chance for families and caregivers of patients to come see the photographs. Spelman said there have been instances when the family of a deceased child comes to honor their memory as they view the photos on display.

“I hope they get to see something in their child’s face that maybe they’ve never seen before,” said Spelman.

Perhaps a rare smile captured in a photograph which had been hiding during treatments; a moment in time that will stay with the families and caregivers forever through photos.

The photos will remain on display at The Health Museum until Tuesday, May 6.

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There are always people who stand out. Who go the extra mile even without being asked. Who stay late to comfort a patient family. Who have a passion for the mission and give their all to ever part of their job. Texas Children’s is full of these employees. That’s what makes us such a special place to work and the best place to receive care.

West Campus leadership is looking for those people amongst us. They’re developing a plan to recognize and honor those individuals who excel in exhibiting the characteristics outlined in the Texas Children’s Hospital Guiding Principles, demonstrate excellent customer service attributes, and deliver the finest possible work to our patients and their families.

As West Campus continues to grow, it is very important to recognize employees who work diligently each day to provide that WOW! customer service experience, treats everyone they meet with courtesy and respect, and always exhibits trustworthiness in all aspects of their job.

This new award will be named “Best of the West” and will be presented quarterly to a deserving West Campus employee, contractor or provider.

Read the criteria and fill out the nomination form now!

You may fill out the electronic form online and submit it, or you may place paper nominations in one of five (5) ballot boxes located around the campus. Ballot boxes are located in the Human Resources suite, within the third-floor Chapel lobby area, outside the entrance to DOTS Kitchen, within the Main Lobby, and in the second-floor corridor nearest the Emergency Center entry area.

Recipients of the “Best of the West” award will receive:

1. Use of specialized parking spot for the quarter
2. A paver stone with their name inscribed on it installed on the West Campus grounds
3. Their picture and biography on the monitor mounted outside of the Conference Center leading to DOTS Kitchen, and
4. Coupons for a free meal at DOTS Kitchen and a free drink from The Coffee Spot.

This is an opportunity to recognize the dedication of the entire team that is making Texas Children’s Hospital West Campus the very “Best of the West!”

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An article in the March 3 edition of Time magazine titled “Young Kids, Old Bodies,” raises the issue of obese children aging too quickly, and the dramatic health decline some are seeing as a result.

Dr. Siripoom McKay, a professor of pediatric endocrinology at Texas Children’s, and Dr. Sanjiv Harpavat, a pediatric gastroenterologist at Texas Children’s, were both quoted in the article, after noting the many health issues plaguing (and aging) this generation’s obese children.

“I am thinking that we will have people in their 30s, 40s and 50s who should be at their most productive,” said McKay, “who will be on dialysis or have had several heart attacks.”

Researchers are starting to see signs of accelerated cellular aging at the molecular level in obese children. The extra pounds on children can affect the body in multiple ways, including early signs of puberty, high cholesterol, diabetes, hypertension, fatty liver and cirrhosis.

In order to combat the problems, many doctors are prescribing medications that were originally only intended for adults (typically over the age of 40). Unfortunately, these drugs can present side effects in children such as stomach pains, muscle weakness and fatigue. But without the medication, some children may face worse alternatives such as heart attacks or liver transplants.

Hoping to stop (or at least slow down) one obese patient’s liver decline, Dr. Harpavat has plans to put the boy on a drug trial that’s testing whether cystamine can improve the symptoms of fatty liver. If it works, the patient may be saved from an early downward spiral in his health.

Top gastroenterologists, endocrinologists and other specialists at Texas Children’s are constantly researching improved ways to treat symptoms of child obesity and fight the signs of premature aging in this generation’s obese boys and girls. But for now, beyond medications, lifestyle strategies like a healthier diet and more exercise are still among the best ways to improve health in obese children.

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When my husband Matt and I found out we were pregnant with our daughter Finnley, we both knew we wanted to use a midwife instead of an OB. A midwife is different than an OB in the sense that they usually have a more natural/holistic approach to care. While they are trained to deliver babies, they usually care for women with a normal, non high risk pregnancy. For example, instead of going to drugs to help progress labor, they are more likely to suggest things like walking, using a yoga ball, and changing position. An OB may start with Pitocin, or have a more technical approach to care. Midwives are just as capable to assess a pregnant woman, diagnose problems, and remedy them as needed, but will transfer care to an OB if the patient becomes high risk. We chose a midwife because I knew that I wanted to have a natural delivery without any medications and I wanted our baby to come when she wanted to, without anything speeding her along. My husband and I believed that with a midwife, the birth that we wanted was more likely to happen.

After doing tons of research we decided to use the midwife group from the Women’s Specialists of Houston. Luckily for us, they are housed here at the Pavilion! The group consists of six Certified Nurse Midwives, meaning they are Advanced Practice Nurses that are certified by the American Midwifery Certification Board. Not only has the group been around since 1994, they work in collaboration with the physicians in the practice, just in case you need a higher level of care. The midwives are on-call 24/7, just like the doctors, and do all prenatal visits themselves (they also provide well-woman, family planning and post-partum care).

One of my favorite things about the midwife group was that at each visit you see a different midwife. This was especially important to me and my husband because there was no way to know who would be on-call when we went into labor. I couldn’t fathom getting to the hospital and finding out the doctor on-call was someone I had never met. Because of this practice, I knew each midwife personally, formed a relationship with and trusted each one. I knew that whoever was on-call would be someone that had been a part of my care from the very beginning and I trusted my life and most importantly, my child’s life in their hands.

There are a few questions I get asked all the time by people that aren’t familiar, or even know you have a choice, when using a midwife.

  • Don’t all midwives do home births?

No, some midwives work in hospitals and birthing centers, there are some that only do home births though, if that’s what you’re interested in!

  • What if you had to have a C-Section?

Thankfully I didn’t, but if there was an emergency that could only be handled by an OB, there is always an on-call physician present in the Pavilion in the event a problem arises that isn’t under the scope of practice of the midwife.

  • Does having a midwife mean you can’t get any pain medication?

No! I chose to go the drug-free route and was so proud of myself for having a pain medication free childbirth. But, having a midwife doesn’t mean you have to do that. You can still get an epidural, or the pain medication of choice. Having a midwife doesn’t prevent you from having the birth you have planned. They are there to help, support and give you what you need on one of the most exciting days of your life!

If you are considering using a midwife in the future, I would suggest sitting down with your partner and discussing what sort of childbirth you imagine and ask yourself some questions. Do you want to attempt a drug free birth? Do you imagine yourself trying alternative methods for pain management such as being in the bath or shower, massage, aromatherapy oils and changing position? Do you want to have some freedom in your labor by having the option of moving around? Or, would not having an OB cause you anxiety? Feeling comfortable and confident in your decision is extremely important, so take your time, do your research and follow your gut!

Using the Midwife Group at the Women’s Specialists of Houston was one of the best decisions I made during my pregnancy (besides having a Doula, but that is another story for another time).

Now that Matt and I are expecting baby Curie #2 (SURPRISE!), I am so excited to be using the midwives again. I know we will get the time and care that we need to grow and thrive. I am so thankful for what they do every day and thankful that Texas Children’s Pavilion for Women gives those like me the opportunity to have the pregnancy and birth that we want, even if it is a little unconventional.

Read Bump Watch next week to see one mother’s experience through a videotaped midwife delivery.