Grand Rounds - April 12, 2024  
"Hyper/Hypoglycemia in the Hospital Setting and Post Discharge Management"

Speaker: John A. Tayek, MD. Professor of Medicine‐In Residence, Metabolism, Clinical Nutrition, Lipidology and Diabetes Mellitus, David Geffen School of Medicine at UCLA Harbor‐UCLA Medical Center.

Objectives

1. Recognize when insulin therapy should be initiated for treatment of persistent hyperglycemia.
2. Describe a target glucose range recommended for the majority of critically ill and non-critically ill patients.
3. Apply to practice the use of basal insulin or a basal plus bolus correction insulin regimen as the preferred treatment for non-critically ill hospitalized patients with poor oral intake or those who are taking nothing by mouth.
4. Review the treatment regimen and make changes as necessary to prevent hypoglycemia when blood glucose values are less than 70.
5. Employ a structured discharge plan tailored to the individual patient with diabetes.
6. Identify health disparities among outpatient population and how to identify and mitigate biases that contribute to the disparities.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

The trauma team at St. Charles Redmond recently received a visit from a former patient that they had never forgotten. Arlo was just 15 months old when his mother carried him into the Emergency Department more than a year ago. The little boy was in need of life-saving intervention after an auto accident. The team activated quickly and worked for more than three hours, doing all they could to stabilize Arlo so he could be brought to a hospital in Portland.

Many that helped care for him didn’t think they would ever see Arlo again. But more than a year later, the little boy – now 3 – visited the team with his parents Emma and Jarib. The couple wanted to say thank you to the team who they credit with saving their child’s life.

In a card, Emma wrote: “Words cannot describe how truly grateful we are. I know Arlo is still here today because of the team that was on the day of the accident. We are blessed to have Arlo here with us today. Thank you for everything.”

Arlo spent 599 days in and out of the hospital in Portland, but is now back home in Central Oregon surrounded by family and friends. Emma says that he loves dinosaurs, animals and playing with his cousins – just like any 3-year-old. 

The visit from the family was tremendously meaningful to caregivers from Redmond who had helped care for Arlo that day.

“This means so much to us. We often don’t get the full story and we’ve definitely thought about you guys a lot,” said Danielle Taylor, a nurse who cared for Arlo, told the family. “I’m just so glad he’s OK and to see you guys smiling.”

The pilot who flew Arlo to Portland, Wesley Wilburn, and the Deschutes County Sheriff’s Deputy who helped comfort the family also came to visit.

“The hospital staff here knocked it out of the park. It was impressive to watch everyone circle the wagons. I believe part of the reason he’s here is the fast-acting staff,” said Deputy Kevin Riding.

Emma said that this visit to the team in Redmond “felt like a really important step to take in our healing.”

And no doubt, getting to see Arlo doing well with his family, was healing for the caregivers as well.

Grand Rounds - April 5, 2024  
"Primary Care Treatment for Depression"

Speaker: Matthew Macaluso, DO. Clinical Director, Depression and Suicide Center, Department of Psychiatry and Behavioral Neurobiology, UAB School of Medicine.

Objectives

1. Apply guidelines for screening and diagnosing depression in primary care.
2. Apply practice guidelines for the treatment of patients with depression.
3. Identify new and alternate therapeutic options for depression.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

BEND, Oregon – Central Oregon will have a new option for people wanting to become nurses starting this summer, thanks to close collaboration among Oregon Health & Science University, St. Charles Health System and Central Oregon Community College.

The OHSU School of Nursing’s Accelerated Bachelor of Science Program has opened a new location in Bend, and the program will begin teaching its first group of eight Central Oregon-based students in July. Previously only available to Portland- and Ashland-based students, the 15-month-long program is geared toward people who want to change careers and become a nurse. It helps individuals who have already earned a bachelor’s degree in another field to quickly earn a second bachelor’s degree in nursing.

“OHSU is honored to bring our well-established accelerated curriculum option to Bend in partnership with St. Charles, Central Oregon Community College and many other local leaders,” said OHSU School of Nursing Dean Susan Bakewell Sachs, Ph.D., RN, FAAN. “The OHSU School of Nursing is proud to both help students from Central Oregon become nurses without having to leave home, and also to help the Bend area grow more of its own nurse leaders.”

“This is a huge win for our community, as we provide local access to this high-quality, in-demand accelerated program,” said St. Charles Chief Nursing Executive Joan Ching, D.N.P., RN, CPHQ. “I am excited that, through collaboration with our partners, we are increasing the pool of highly trained nurses who will live and work in Central Oregon.”

“Central Oregon Community College is pleased to be able to lease our nursing lab and simulation space to OHSU’s accelerated BSN program,” said Julie Downing, Ph.D., an instructional dean at COCC. “We’ve been working collaboratively with St. Charles and OHSU to increase the number of bachelor’s degree-prepared nurses in Central Oregon. And with COCC soon starting an RN-to-BSN program, OHSU’s efforts perfectly complement our own, as each institution is reaching different students with different prior education credentials.”

The program’s arrival in Bend is the result of conversations among OHSU Provost Marie Chisholm-Burns, Pharm.D., Ph.D., M.P.H., M.B.A., FCCP, FASHP, FAST, FACHE, Oregon State University Provost Edward Feser, Ph.D., and Ching. Chisholm-Burns and Feser organized a series of meetings with leaders from the OHSU School of Nursing, St. Charles, COCC, OSU-Cascades and other community organizations. The group collectively determined that bringing an accelerated bachelor’s degree in nursing program to Bend would be an effective way to meet Central Oregon’s pressing nursing workforce needs, and would also complement COCC’s planned new RN-to-BSN program. Chisholm-Burns said she is appreciative of the support received from the community, including St. Charles, COCC and OSU.

While OHSU nursing students occasionally have community-based learning opportunities in the Bend area and the OHSU School of Nursing has five regional campuses throughout the state, the school hasn’t had an official presence in Central Oregon until now.

The Bend location for the OHSU School of Nursing’s Accelerated Bachelor of Science Program will be based out of COCC’s campus. Following classroom instruction and practicing techniques in a simulation lab, OHSU students will have hands-on learning opportunities at St. Charles and other community clinics. Bridgette Bochner, Ph.D., RN, who has worked locally as a nurse for 24 years, has been hired to serve as the OHSU program’s Bend-based leader.

Applications for the OHSU program’s first group of Bend-based students are being accepted through April 15. More information is available on the OHSU School of Nursing website.

In addition to tuition, the program’s Bend location is supported by funding from the OHSU Provost’s Office, which is leading efforts to grow and diversify OHSU’s health profession student body. Scholarship opportunities are available for eligible students based at all OHSU School of Nursing locations, including Bend.

COCC’s registered nurse program has long offered associate degrees in nursing. Now, COCC is also developing a bachelor’s degree in nursing program that could welcome its first students as soon as 2025. Their new program is being designed for students who haven’t previously earned a bachelor’s degree, which will make it distinct from and complementary to OHSU’s accelerated bachelor of science program.

Theresa Drulard, MBA
Vice President, Performance Optimization

Theresa Drulard holds a bachelor’s degree in sociology with an emphasis in research methods and a master’s in business administration with a supply chain focus from Westminster College in Salt Lake City. Prior to joining St. Charles, she supported the continuous improvement office for PeaceHealth Oregon Network. Before she worked in health care, Drulard held senior leadership positions in the medical device and equipment industries, managing global regulatory, quality and operations. Deeply committed to continuous improvement practice, Theresa co-founded Lean Pop-Up, a no-fee, cross-industry lean learning and sharing organization in Salt Lake City.

Hospice and Bereavement team guide new walking groups starting April 8 in Prineville, aimed at those who have lost a loved one

New walking groups in Prineville aim to provide innovative support to individuals who have experienced the loss of a loved one. Healing Hearts walking events, which begin April 8, invite individuals experiencing grief to participate in a series of guided walks led by caregivers from St. Charles’ Hospice and Bereavement team in partnership with Crook County on the Move.

Every other week, the group will gather at St. Charles Prineville for a guided walk that will focus on a different topic including understanding grief, six needs of mourning, support networks, leveraging self-care and more.

Aaron Contreras, the bereavement coordinator for St. Charles Hospice, said the idea for the walks came from someone who had experienced a loss. “She wanted to have a group that let her work through her loss, while also having a community to do something active with. Our hope that a walking group like this might be helpful to those who are managing a loss in their life while also engaging in a great self-care activity in the community.”

Contreras will lead the walking groups alongside Mindy Laidlaw, supervisor of home-based care support services for St. Charles.

The walking groups are in partnership with Crook County on the Move, a local group that aims to keep residents healthy and active. The group has numerous events planned this spring, including general walking groups, community garden party, a community-wide Cancer Awareness Walk June 1 (which will feature a walk-through colon from St. Charles), and Heart Health 101 classes taught by a St. Charles provider.

Learn more about all the of upcoming activities at Crook County on the Move’s website. The Healing Hearts walking groups do not require registration. Interested individuals can meet at 1p.m. in the healing gardens at the north end of St. Charles Prineville.

Dozens of traveling nurses opt to make St. Charles their permanent workplace, citing strong culture and competitive pay

In the past year, St. Charles Health System has seen a major turnaround in the strength of its workforce, according to a variety of metrics: Vacancy rates have decreased from near 20% to approximately 6-7% for acute nursing; in 11 of the past 12 months, the number of hires has been more than the number of caregivers leaving the system; and St. Charles has significantly decreased its reliance on high-cost temporary traveling nurses to fill needed positions. In the first two month of 2024, St. Charles hired just 5 temporary traveling nurses, compared with 196 in Jan/Feb of 2022.

Additionally, many traveling nurses are opting to make St. Charles their permanent home by securing positions with the health system.

“These are highly skilled nurses who could find a home anywhere. They are choosing St. Charles – that speaks to our strong culture and competitive rates of pay,” said Rebecca Berry, Chief Human Resources Officer for St. Charles. 

Chris Collins, a Client Relations Manager for FocusOne, which provides traveling nurse staffing for hospitals across the country, says that the percentage of travelers converting to be permanent nurses at St. Charles is notable. “With many of our clients typically experiencing conversion rates of less than 5%, St. Charles definitely stood out with their impressive 12% conversion rate in 2023. There are several likely factors that helped contribute to that success. Notably, St. Charles offers attractive pay packages and is situated in a location known for its picturesque scenery. However, it's the culture St. Charles has created that sets them apart and makes them attractive to those looking for a permanent position.” 

Michael Teeters spent more than six years as a traveling nurse before becoming a permanent staff member at St. Charles last month. He’s one of 14 traveling nurses to be hired as a permanent caregiver in 2024.

“St. Charles feels like home, like where I’m meant to be. The people that work here are incredible,” said Teeters.

Learn more about Teeters and additional stats.

If you followed conversations during the recently concluded Oregon legislative session like I did, you might have noticed a common thread: People have wildly varied ideas about hospitals and clinics as organizations, what we do, how we function, and even why we exist.

Like many of you, those of us who work in health care organizations are deeply concerned about the stability, affordability and quality of health care and the wellbeing of caregivers. These concerns are not new, and big solutions seem as out of reach as ever. But two fresh concerns seeped into the state-wide discourse lately. First, what role should private equity investors play when it comes to essential services? And second, are out-of-state interests taking over Oregon health care and what should be done about it? These are complex questions, and the legislative session closed without much in the way of answers. But that doesn’t mean these questions are going away.

The interests of private equity investors and out-of-state corporations vary widely. Time will tell whether their increasing activity in Oregon leaves us better or worse off. Meanwhile, I want you to know where we stand.

St. Charles is a nonprofit, locally operated, community-oriented organization. We aspire to behave in such a way that society is happy we exist, and not unhappy. We strive to prosper for and along with Central Oregon, not to its detriment. We are not beholden to out-of-state interests or private equity investors. Money spent at any of our facilities goes back into the community through wages, benefits and educational opportunities for our more than 4,800 employees; through investments in equipment and facilities; and through direct dollars that we donate to support other community nonprofit organizations.

St. Charles is many things. As the largest employer in Central Oregon, we are a crucial economic driver for the region. We are an essential provider of “safety net” health care services. We are a place where many people experience some of the most joyful and most harrowing days of their lives. We are a collection of people – your friends, your family members, your neighbors – who have taken on the responsibility of caring for the communities we serve. And you’d better believe we take that responsibility seriously.

The decisions we make today about the care we provide are tied directly to our ability to ensure that you have access to safe, quality health care services for the long term. Because we serve a vast, rural, geographically isolated region, we also find ourselves increasingly partnering with other local organizations to lift each other up and help each other maintain services. These partnerships are exciting as they show that our community is willing to come together for the greater good.

Health care is a complicated business, but at the end of the day my hope is that you know St. Charles is made up of local people who care about doing what’s right for the beautiful and unique communities we are all lucky enough to call home.

Sincerely,
Steve

After being closed for almost a year, the St. Charles Madras gift store has reopened thanks to wonderful volunteers from the community. Two of those volunteers, Julia and Sunny, come from Opportunity Foundation of Central Oregon, a local nonprofit that provides job training and placement for adults with disabilities.

Julia and Sunny love volunteering at the St. Charles Madras gift store. The pair, pictured here with their volunteer mentor Melissa, volunteer at the store every Wednesday morning as part of the job training program. In addition to stocking the shelves, conducting inventory and ringing up sales, the pair also like getting to interact with caregivers.

“I love working here. I’m happy to be with my friends. It makes me happy being here because the people are my friends. It brings me a good mood to see my friends,” said Julia, 53, who has lived in Madras for 40 years.

Vicki Woods, manager of support services for St. Charles Madras, says Julia has gotten to know so many of the caregivers, who love stopping by to say hi during her shifts. She says Sunny is a great worker who loves giving back to the community by volunteering.

“It’s so much fun to have Julia and Sunny here,” said Woods.

Caregivers in Madras are especially appreciative because for many months the gift shop had been closed. Having this support from the Opportunity Foundation helped to reopen the gift store.

Lew England, business relations director for Opportunity Foundation, also praised the partnership between the two organizations and hopes to use the same model in other communities. “It's been outstanding. Staff there are great and it’s a wonderful partnership for us."

The winning design will be turned into a T-shirt and made available in the St. Charles Sparks store, just in time for the summer short-sleeves season.

Vote Today!

Official Rules

This contest is open only to St. Charles caregivers. We want to see your original design, not one created by artificial intelligence or your graphic artist friend. Also: Please don’t infringe on existing copyrights!

• Submissions are limited to one per caregiver.
• Visual submissions are required – no written descriptions of an idea – preferably uploaded as a digital file (JPG, PNG, TIFF, PSD, EPS, PDF) below. If you want to create something on paper, you can upload a photo of it. To drop off a physical submission, email [email protected].
• The design should not include references to any specific department(s). It should be proudly wearable by anyone and everyone at St. Charles.
• Submissions are due by March 18. Entries will be narrowed down by Communications and Marketing and finalists will be opened to a system-wide vote to determine the winner.
• Communications and Marketing will manipulate the winning entry as needed to create a print-ready file. Every effort will be made to retain the design and spirit of the caregiver’s original submission.
• The winning caregiver will not receive compensation other than a free T-shirt with their design and the satisfaction of seeing their design on their fellow St. Charles caregivers this summer and beyond.
• The winning design will be printed on a short-sleeved T-shirt, which will be made available in the St. Charles Sparks store in May.
• Winner will be announced during Health Care Week in May.
• Contest may not be won by the same caregiver in consecutive years.

Questions? Email [email protected].