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Grand Rounds - Jan. 22, 2021
"Attention Deficit / Hyperactivity Disorder Across the Lifespan"

Speaker: Timothy Wilens, MD. Chief, Division of Child and Adolescent Psychiatry Co-Director, Center for Addiction Medicine Director, Substance Abuse Services in Pediatric Psychopharmacology

Objectives

  1. Define indicators of ADHD in adults and children and their prevalence
  2. Differentiate patients with ADHD from other disorders
  3. Demonstrate an awareness of the pharmacotherapy: indications, efficacy, dosing, side effects, benefits and outcomes
  4. Demonstrate an awareness of the role of pharmacotherapy: therapeutic options, benefits and outcomes
  5. Acquire an awareness of the prevalence rates and outcome in different populations (IMQ's CLC requirement)

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].

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St. Charles identifies source of COVID-19 outbreak at Redmond hospital  

BEND, Ore. – St. Charles Health System’s investigation of a COVID-19 outbreak at its Redmond hospital revealed that the source was a COVID-positive patient. 

The patient—who had underlying health conditions that at times made it difficult to wear a mask—was admitted to St. Charles Redmond on Dec. 31 and was initially tested twice for COVID-19. Because both tests resulted negative, St. Charles caregivers continued to wear droplet precaution personal protective equipment (PPE).  

On Jan. 6, the patient was tested a third time for COVID-19, and that test resulted positive.  

After performing an investigation with the assistance of Deschutes County Health Services and the Oregon Health Authority, St. Charles’ Infection Prevention team determined the Redmond caregivers’ droplet precaution PPE was overwhelmed by prolonged exposure to the highly symptomatic COVID-positive patient.  

“The important learning from this outbreak is that negative COVID-19 test results are not foolproof,” said Dr. Jeff Absalon, St. Charles’ chief physician executive. “In spite of negative test results, if a patient is highly symptomatic, we will need to treat them as if they are COVID-19 positive and aerosolizing, in which case the higher level of PPE is required.” 

Evidence suggests that COVID-19 tests are most accurate five to seven days after exposure. The virus incubates up to 14 days, taking time to build up in a person’s system. 

To date, one patient and 33 St. Charles caregivers at the Redmond hospital have tested positive for COVID-19. Because the health system began its vaccination campaign Dec. 21, none of the 33 caregivers at the Redmond hospital were fully vaccinated. 

Today, the St. Charles Infection Prevention team expects to complete its outreach to patients who may have been at risk of exposure due to the timing of their stay at the Redmond hospital. All current inpatients at the Redmond hospital have been informed that none of them were exposed. 

“We have a strong contact tracing system in place for caregivers that is working to mitigate the spread of COVID-19,” Absalon said. “In the meantime, it’s important to stress that we feel confident our Redmond hospital is a safe place to receive care.” 

The health system has also instituted some changes at the Redmond hospital, including: 

·         Offering COVID-19 testing to all St. Charles Redmond hospital-based caregivers  

·         Asking caregivers to stay home and get tested if they have any symptoms of COVID-19, no matter how mild 

·         Increasing air exchanges to six times per hour 

·         Increasing air filtration to more than the CDC recommendation (+90% filtration at .3 microns) 

·         Instructing caregivers in direct patient care roles to use N95 respirators and eye protection throughout their shift while the outbreak is ongoing 

·         Adding hand sanitizer and cleaning supplies to more locations throughout the facility 

·         Asking caregivers to eat in the cafeteria or on the outside patio rather than in break rooms 

·         Adding maximum capacity signage to all break rooms and conference rooms to ensure physical distancing can be maintained 

·         Temporarily limiting visitors to a higher degree than before  

“This sort of situation isn’t any one person’s fault,” Absalon said. “Everyone is working hard to maintain a safe environment, and as an organization we continue to learn and adjust to improve safety for all.” 

An FAQ about the outbreak is also available on St. Charles’ website. 

About St. Charles Health System 

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, La Pine, Madras, Prineville, Redmond and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,500 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities. 

 

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St. Charles Redmond reports workplace COVID-19 outbreak

BEND, Ore. – St. Charles Health System has reported an outbreak of COVID-19 cases at the St. Charles Redmond hospital campus to Deschutes County and the state of Oregon. An outbreak is defined as a cluster of cases that are related.

As of Wednesday, 31 caregivers had tested positive for COVID-19, and their cases are being investigated in collaboration with Deschutes County Health Services and the Oregon Health Authority.

“We are taking every possible measure to stop the spread of the virus, to protect our patients and our caregivers,” said Aaron Adams, chief executive officer for the Redmond hospital. 

In addition to existing COVID-19 precautions, the Redmond hospital has put in place new safety measures including:

  • Offering COVID-19 testing to all St. Charles Redmond hospital-based caregivers
  • Asking caregivers to stay home and get tested if they have any symptoms of COVID-19, no matter how mild
  • Increasing air exchange to six times per hour
  • Increasing air filtration to more than the CDC recommendation (+90% filtration at .3 microns)
  • Instructing caregivers in direct patient care roles to use N95 respirators and eye protection throughout their shift while the outbreak is ongoing
  • Adding hand sanitizer and cleaning supplies to more locations throughout the facility
  • Asking caregivers to eat in the cafeteria or on the outside patio rather than in break rooms
  • Adding maximum capacity signage to all break rooms and conference rooms to ensure physical distancing can be maintained

The hospital is also currently limiting visitors to the following groups only:

  • A caregiver or attendant of a patient who needs assistance due to a language barrier or the patient’s disability, whether that disability is physical, developmental, intellectual, cognitive, behavioral or is related to altered mental status or communication, whose presence will assist the person with the disability in receiving treatment, ensure the safety of the patient or facility staff, or who must assist with activities of daily living 
  • A close family member of a patient undergoing end-of-life care as determined by the medical provider in charge of the patient’s care 
  • A parent or legal guardian of a hospitalized child. If one parent or legal guardian meets screening criteria but the other does not, only the parent or legal guardian who meets screening criteria must be guaranteed access

“We hope our community understands and will help us by following all COVID-19 restrictions, both inside and outside of our facilities,” Adams said. “The number of positive COVID-19 cases continues to be high throughout the region and we need your help to ensure we have a healthy workforce to care for you and your loved ones.”

It continues to be critically important for individuals to wear masks as well as practice physical distancing and good hand hygiene.

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, La Pine, Madras, Prineville, Redmond and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,500 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

 

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Register for your vaccination

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Our phones have been ringing off the hook this week as so many of you have questions about when and how you will be able to get the COVID-19 vaccine.

I'm inspired that Central Oregonians are ready and willing to be vaccinated in the hopes of ending this terrible pandemic. My ask of you today is to stay calm and patient. We are actively working on a plan to ensure every Central Oregonian who wants the vaccine will have the opportunity to be fully vaccinated. 

Information related to the supply of vaccine has shifted considerably throughout the week. The situation continues to be dynamic and evolving, but I want to share what we know as of today.

Before I do that, though, I want to reiterate to you that the best way to keep yourself and your loved ones safe is to continue diligently doing the things we've been asking you to do for almost a year:

  • Wash your hands frequently
  • Stay home as much as possible, especially if you are not feeling well 
  • If you must go out, wear a mask that covers your nose and mouth
  • Stay at least 6 feet away from people who aren't in your household bubble

With record COVID-19 case numbers, new strains of the virus spreading, cold weather that encourages indoor gatherings and uncertainty around the vaccines, it remains vitally important that you do everything you can to protect yourself.

Vaccinations in Central Oregon

Our team is working tirelessly alongside our local public health partners to stand up large-scale vaccination events in the coming weeks. But these events will be dependent on the availability of vaccine that we receive from the state.

As of today, St. Charles has vaccinated more than 5,000 people who fall into the Phase 1a group under the state’s current guidance. This includes frontline health care workers, EMS providers, law enforcement officers, long-term care facility residents and staff and some educators who work directly with children with special needs. We are making good progress, but we know we have a long way to go.

Our goal is to get the COVID-19 vaccine into as many arms as we can – as quickly and safely as possible. Quite honestly, our hospitals continue to be full. Our caregivers are exhausted from fighting this fight every day. Widespread vaccinations are critical to setting us on a path to a more normal future.

Starting next week, we will move our remaining Phase 1a vaccinations to the Deschutes County Fair and Expo Center in Redmond, which will help prepare us for future large-scale vaccination events. We will provide an update on our large-scale vaccination effort – including who is eligible and how to schedule an appointment – as soon as we know we have the available vaccine. 

Here is the latest on vaccine eligibility from the state of Oregon: 

  • Vaccination of the 1a group—including health care providers, first responders, long-term care facility residents and staff and those with intellectual disabilities—continues. It is the only group eligible for vaccination at this time. If you fall into this group, please visit our registration page and, if you meet the criteria, we will contact you to schedule an appointment.
  • Starting the week of Jan. 25 (and in some counties, sooner), childcare providers, early learning and K-12 educators and staff will be eligible for vaccination
  • Starting the week of Feb. 8, vaccinations will open to individuals 80 years and older
  • Following the 80 and older group, seniors in three age bands will also become eligible in the following order (the dates to be announced):
    • Seniors 75 and older
    • Seniors 70 and older
    • Seniors 65 and older

Our partners in Jefferson and Crook counties are also working hard to vaccinate their Phase 1a group members. They too hope to offer large-scale vaccination events once they have a reliable supply of vaccine. For more information we encourage you to visit their websites at www.JeffCo.net/PublicHealth or www.co.crook.or.us/health

For those of you who may be feeling hesitant to receive the vaccine, I encourage you to watch this informative Doc Talks presentation by Dr. Cynthia Maree, our infectious disease medical director. The evidence shows overwhelmingly that the vaccines are safe and effective.

Please be patient with us as we continue to work on our vaccination roll-out and know that we will proactively share information when it is available. We encourage those of you with questions to call the COVID-19 hotline at 541-699-5109, which is staffed Monday through Friday from 9 a.m. to 5 p.m. and 9 a.m. to 1 p.m. on Saturdays. Please do not call our clinics and hospitals with vaccine questions. Allow our staff to focus on the important work of taking care of our current patients. 

You can be confident that we will be successful in vaccinating every resident in Central Oregon who wants to be vaccinated. We got this!

Sincerely,
Joe

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Grand Rounds - Jan. 15, 2021
"Dermatology Update"

Speaker: Oliver J. Wisco, DO. FAAD, FACMS

Objectives

  1. Understand the primary morphologic descriptors in Dermatology
  2. Understand the importance of the differential diagnosis of cutaneous disease
  3. Understand the initial treatment approach to common inflammatory dermatoses

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].

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FASE 1A GRUPO ÚNICAMENTE:

Existe cierta confusión sobre quién es elegible para una vacuna COVID-19 en este momento, por lo que tuvimos que cerrar temporalmente nuestro módulo de programación.

Planeamos abrir la programación nuevamente el lunes 18 de enero. Mientras tanto, si usted es parte del grupo de la Fase 1a de Oregon, complete el formulario a continuación y le enviaremos un enlace para programar su cita cuando se abra el módulo de programación. nuevamente el lunes.

Ya no accederá al programador a través de esta página, así que asegúrese de leer su correo electrónico para obtener el nuevo enlace.

PARA ACLARAR: En este momento, solo podemos vacunar a personas en el grupo de Fase 1a del estado de Oregon, que incluye proveedores de atención médica, proveedores de servicios médicos de emergencia, fuerzas del orden, niños médicamente frágiles y sus cuidadores y personas con discapacidades intelectuales.

La disponibilidad de vacunas es limitada en todo el estado. Necesitamos que las personas que están programando sus vacunas ahora formen parte del grupo de la Fase 1a como lo describe el estado.

IMPORTANTE: Si es miembro de la Asociación de Práctica Independiente de Oregon Central (COIPA), comuníquese con ellos para vacunarse. St. Charles vacunará a todos los que no sean miembros de COIPA.


Clínica de vacunación COVID-19 - Certificación de fase 1a

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PRD script - SBC South

 

 TST script

 

POC script

 
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Four St. Charles nurses receive the DAISY Award to recognize their extraordinary, compassionate nursing care

BEND, Ore. – The following St. Charles Health System nurses have been honored with The DAISY Award for Extraordinary Nurses®, recognizing the outstanding, compassionate nursing care they provide patients and families every day:

Top-left: Candy Peplin, RN/neonatal transport, Neonatal Intensive Care Unit, Bend
Top-right: Karen Sagner, RN, float, Madras
Bottom-right: Ryan La, RN, Emergency Department, Prineville
Bottom-left: Elena Myers, RN, Medical Services, Redmond

Nominated by patients, families and colleagues, the award recipients were chosen by a committee at St. Charles.

The nurses—which represent all four St. Charles hospitals in Bend, Redmond, Madras and Prineville—were recognized with a ceremony on their respective units and presented with a certificate, a pin and a "healer's touch" sculpture by their hospital’s chief nursing officer. The DAISY honorees will also receive ongoing benefits, such as special rates for tuition and ANCC certification. 

"Our nurses are exceptional and deserve to be formally recognized for their dedication, spirit and the quality of care they provide in the community," said Iman Simmons, St. Charles Health System’s chief operating officer. "We are excited to celebrate all the stories of compassionate care we hear every day."

The DAISY Foundation is a not-for-profit organization that was established in memory of J. Patrick Barnes by members of his family. Patrick died at the age of 33 in late 1999 from complications of Idiopathic Thrombocytopenic Purpura (ITP), a little known but not uncommon auto-immune disease. (DAISY is an acronym for Diseases Attacking the Immune System.) The care Patrick and his family received from nurses while he was ill inspired this unique means of thanking nurses for making a profound difference in the lives of their patients and patient families.

"When Patrick was critically ill, our family experienced first-hand the remarkable skill and care nurses provide patients every day and night,” said Bonnie Barnes, FAAN, president and co-founder of The DAISY Foundation. “Yet these unsung heroes are seldom recognized for the super-human, extraordinary, compassionate work they do. The kind of work the nurses at St. Charles are called on to do every day epitomizes the purpose of The DAISY Award.”

This is one initiative of The DAISY Foundation to express gratitude to the nursing profession. Additionally, DAISY offers J. Patrick Barnes Grants for Nursing Research and Evidence-Based Practice Projects, The DAISY Faculty Award to honor inspiring faculty members in schools and colleges of nursing and The DAISY in Training Award for nursing students. More information is available at http://DAISYfoundation.org.

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, Madras, Prineville, Redmond and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,200 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

 

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