Author: Natalie Wong

At RML Specialty Hospital, “Extended Family” Takes on New Meaning

Connection and Communication: Powerful Forces on COVID Unit

Marian Steele, shown above with her husband Robert, remembers vividly the April day she was transferred to RML Specialty Hospital, recovering from COVID-19 and on a ventilator. “I hadn’t seen my family in almost four weeks, I couldn’t talk, and now they were taking me by ambulance to someplace even further away,” she recalled. “I was so anxious. But when I got to the hospital, I was surrounded by people who told me they were going to take care of me. They changed my gown and washed me. They treated me like I was their mom, or their sister or their auntie. They put my mind at ease.” Ms. Steele was one of the earliest patients treated on the dedicated COVID unit at RML Specialty Hospital in Hinsdale. By the time she arrived, she had already been on a ventilator for nearly three weeks and she desperately wanted to see her husband, Robert. Ms. Steele was about to discover two things: her team members were experts at helping patients learn to breathe on their own again and they were also now her new family – at least for the time being.

RML Steps Up When Acute Care Hospitals Call for Help

Clinical Outcomes Impressive

In the early months of 2020, COVID-19 evolved rapidly in the United States from a handful of isolated cases to a full-blown crisis, stressing the fabric of communities and every aspect of daily life. Hospitals were full, and COVID patients who needed ventilator support to breathe were stretching the capacity of intensive care units. As one of the nation’s leading ventilator-weaning hospitals, RML had a unique role to play. In very short order, the hospital opened dedicated COVID units at both the Hinsdale and Chicago locations, developing extensive safety protocols to protect patients and staff. They then asked for volunteers. Despite possible risks to their own health and the health of their families, employees from both hospitals stepped up without hesitation. By mid-April, the units were admitting new patients every day. The clinical results have been impressive. RML teams have been so effective that, to date, they have cared for 105 ventilator-dependent patients. Of these, 95 or 90%, have been successfully weaned from their ventilators and 65, or 62%, have been discharged either to their home or to an acute rehabilitation center. Two research studies about these results are expected to be published in the near future. While the clinical successes of the COVID unit are significant, though, staff members say that something else happened in this unique environment as well. Patients and staff formed bonds that will last a lifetime.

Becoming a Family

Support, Encouragement and Communication Make the Difference

For Marian Steele, there were days when she couldn’t tell the difference between reality and hallucination, but the personal support she received gave her the will to keep trying. For 24-year-old Olivia Vecchiet, the unit’s certified occupational therapy assistant (COTA), the experience was “transformational. I will never forget this time with my patients and with this team. I’m just two years into my career, but this experience will be with me forever.” What made this situation so different from others? “I discovered just how important emotional support is – for everyone,” said Joy Magundayao, a respiratory therapist who has been with RML for 12 years. “We were all scared, but the hospital did everything possible to keep us safe and we felt supported by leadership and people in every department. We’d see people walk by the door to the unit and wave to us through the window for moral support. That was great. “With our patients, we were the only ones at the bedside, day in and day out,” Ms. Magundayao continued. “I became closer to my patients than ever before. I knew the little things they needed, like a nail file or a nail clipper, and I made sure to bring those things in. We touched them, we held their hands. These things had a big impact – on them and on us.” Staff members who worked on the unit said they recognized just how frightening the new COVID environment could be for everyone. “For family members, it was devastating to take a very sick loved one to the emergency department, be told they had to be put on a ventilator, and then be asked to leave because of the no-visitor policy,” said Amy Grissette, RN, BSN, the unit’s nurse manager. “And for our patients, in particular, they were waking up in a different hospital from where they started. It was unfamiliar, and they wanted their families.” The team and the hospital did everything to keep people as connected as possible, Ms. Grissette said. “So that patients could see their loved ones, we conducted virtual visits with families by either using their personal cell phone or laptop, or by using iPads purchased by RML,” she explained. “Our nurses also called family members daily. Some families were having a very hard time, and our nurses became their counselors and support system.” Although this level of responsibility could be draining at times, Ms. Grissette was also inspired by the dedication of the COVID team. “There was a lot of bonding on the unit,” she said. “We truly became a family, working together, with no person left behind. Our mission was to help our patients return back to their families.” Jillian Childs, PT, DPT, a physical therapist, was impressed with the extensive communication the team was able to have “on a constant basis. Everyone was always on the unit, so we could bounce ideas off of everyone together, anytime we needed. It really helped us move our patients forward.”

First Moments of Awareness, First Steps toward Recovery

One of the team’s biggest challenges happened to be RML’s area of expertise: helping patients through the process of waking up in unfamiliar surroundings and learning to breathe again on their own, without the support of the ventilator. “Most people have no idea how terrifying this is,” said Ms. Magundayao. “Patients often cry when they first wake up, and they can be quite agitated. They don’t know where they are. Because they’ve been so sick, they often imagine things and have hallucinations during this period.” Marian Steele was one of those people. “I couldn’t tell what was real and what was a dream,” she recalled. “I was convinced that I’d had a terrible verbal confrontation with a woman at my church. I really wanted to apologize. Turns out, it never happened, but I was absolutely sure that it had.” Marian also had to be slowly weaned from the ventilator, and by the time she was breathing completely on her own, she had been using ventilator support for nearly six weeks. “This is what we do every day for patients across our hospital, but we learned that with our COVID patients, we had to go more slowly,” said Ms. Magundayao. “When the ventilator has been doing the work of breathing for you for so long, you really have to give the lungs and the body time to adjust.” For Marian, staff encouragement helped her turn the corner, and the long-anticipated family ‘visit’ worked like magic. “I had just been trying to stand for the first time, and I was so broken-hearted when I couldn’t do it,” she recalled. “It felt like I was weighed down with cinder blocks. The day arrived when my whole family was coming to see me through my hospital window, but I wasn’t sure I would be able to stand up. Olivia was with me, though, and she shouted out to them, ‘She’s going to stand, she’s going to stand.’ And then I just had to do it. She helped me to the window, and the family was applauding, screaming and crying. They had made ‘Woman of Steele’ posters because that’s my nickname. It was an amazing feeling.” Olivia Vecchiet, the certified occupational therapy assistant, had actually started working on the unit as a patient care technician (PCT) because the hospital wasn’t yet assigning physical or occupational therapists. As a PCT, she provided intimate and supportive care for Ms. Steele, and they became close. She remembers vividly the Steele family visit. “It was so emotional, so happy. All of my fears of COVID left me for a moment and it felt wonderful.”

A Final Plea for Safety

After more than two months in three different hospitals, Ms. Steele was thrilled to return home to her husband, Robert, in early June. Mr. Steele didn’t “deal well” with being separated from his wife of 30 years. “She is my sweetheart. It was really hard when she was so sick.” He has a message for the world: “Whatever you’re told to do to keep people from getting sick, please do it. Wear a mask, stay home if you can. Stay far apart. It’s important. This is serious.”

Nutritional Study Improves Outcomes for Tube-Fed Patients

Patients who transfer to RML Specialty Hospital often come directly from the ICU of a either a neighborhood acute care hospital or a downtown Chicago teaching hospital. Many of these patients receive nutritional support via feeding tubes due to having undergone tracheostomies, which subsequently leads to dysphagia (difficulty swallowing),” said Cindy Rohde, RD, LDN, a Nutrition Support Dietitian at RML. “Patients who are intubated with a breathing tube, have undergone trauma, or cannot use the oral route for nutrition often require a feeding tube.”

After following 500 patients by use of a specifically developed malnutrition protocol and subjective global assessment for RML patients, Rohde discovered that 74% of patients arriving from the ICU of acute care hospitals were moderately malnourished, and 15% were severely malnourished. “We realized a contributing cause was the patient not receiving full prescription of feeding in a day due to being off the feeding for a procedure, surgery, or other treatment.” explained Rohde.

“We switched patients to a volume-based feeding method, so they would receive the prescribed amount of nutrition each day, regardless of when they received it,” said Rohde. “If they were disconnected from their feeding tube during the day, the difference would be made up at night when they were less likely to have feeding interruptions and the formula could be run at a higher rate.”

After the switch, 95% of patients were found to have received their total prescribed nutrition on a regular basis, up from 82%. “This improvement is important, because a patient’s nutritional status is directly related to his or her ability to fight infection, heal wounds, be weaned off a ventilator, and work with physical and occupational therapists,” said Rohde. “Our focus on outcome-based results helps to improve each patient’s nutritional status, which in turn leads to a higher success rate for ventilator weaning, and a better chance of patients being able to perform daily activities after leaving RML.”

Written by Denise Freese Link to original article can be found here.

Specialty Hospital Focuses on Safety For Patients, Families, and Staff

You work hard to keep your home and your family safe.  If you don’t have control over your own safety, or the safety of those you love, you have to rely on others to protect you.  At RML Specialty Hospital, keeping patients, their families, and RML staff safe is a top priority.

Adria Helmich, Director of Ancillary Services at RML Specialty Hospital, is responsible for campus security at RML’s two locations in Chicago and Hinsdale.  “Our patients come to us from hospitals in the Chicago area, and typically stay with us for about a month,” she explained.  “Starting at the time of referral, we evaluate potential safety concerns, for example, if the patient was a victim of violent crime or domestic abuse.  Our goal is to make sure each patient is safe throughout their stay with us.”

Patient and family privacy is of the utmost importance at RML Specialty Hospital.  “We utilize a visitor management system to register patient visitors,” added Helmich.  “Visitors register with their driver’s license or state ID on their initial visit.  Once registered, they just have to check in with the receptionist and obtain a pass on subsequent visits.  This is for the safety and security of our patients, our staff, and our visitors, and it also allows us to know who is in the building in case of an emergency.”

“We assess security topics annually to make sure we’re prepared for any potential issue,” said Helmich.  “We perform drills to teach our staff how to recognize warning signs and escalating behaviors.  We do active shooter drills and Code Black drills to prepare for a tornado.  We focus on safety procedures for the benefit of our patients, their families, and our employees.”

Link to original article can be found here.

Specialty Hospital Maximizes Security of Patient Information

While technology affords us many ways to gather, organize, and distribute information, it can be challenging to keep that information out of the hands of those who shouldn’t have access to it. In a hospital setting, it can be even more challenging due to privacy laws and and regulatory standards. At RML Specialty Hospital, the Information Services Department works hard to ensure safety and privacy of all patient information and medical records.

“Cyber security is of the utmost importance for us,” said Todd Prellberg, Director of Information Services for RML Specialty Hospital. “We use technology in so many areas of the hospital, from patient records and insurance information to computerized ventilators and IV pumps. We can’t ever get comfortable; we continually monitor our systems for possible threats.”

Just like on a home computer, network security is necessary to avoid problems like viruses, malware, and phishing. “We work hard to educate our staff,” added Prellberg. “We have protocols in place so they know how to respond to things like unsolicited emails with embedded links. We’ve built walls around all our devices to prohibit outside access.”

RML’s Information Services staff is responsible for varying levels of security. “We offer support from a “help desk” standpoint, but we also have analysts who support our medical staff,” said Prellberg. “We’re required to meet minimum regulatory standards, and that dictates how information is made available in our systems. For example, nurses can access a patient’s health record, including lab results and vitals, while billing staff can access financial information and billing codes, but not lab results. Our software is structured to offer the highest level of security for patient information. We’re continually auditing and reviewing our systems so they’re as up-to-date as possible.”

Link to original article can be found here.

Specialty Hospital Helps Post-Transplant Patients Through Complicated Recovery

After a difficult transplant surgery, patients need specialized medical care to ensure a full recovery. At RML Specialty Hospital, patients benefit from an entire post-transplant team that offers attention to detail and continuity of care.

“We admit a variety of post-transplant patients, including those with heart, lung, liver, kidney, pancreas, and bone marrow/stem cell transplants,” said Nicole Jones, Clinical Pharmacist for RML Specialty Hospital for 14 years. “Our patients require frequent monitoring of their immunosuppressive medications to ensure they maintain appropriate drug levels to prevent rejection and to limit side effects. We review their medication profiles to watch for drug-to-drug interactions, which is critical since they average about 20 medications each. We also communicate with the post-transplant team to discuss medication levels and medication changes, and to give clinical updates.”

Alison Fudacz, Clinical Pharmacist with RML for 15 years, works closely with Jones to ensure continuity of care for transplant patients. “We act as the bridge between RML and the transplant team,” she explained. “We’ve built relationships with many area hospital transplant teams, and can communicate drug issues before the patient arrives at RML, during their stay with us, and after they leave for home.”

Both agree that one of the best things about working at RML is the relationships they’ve built with the physician and nursing staffs. “We all work as a team to provide the best patient care possible,” said Jones. “If I had a loved one that needed this level of care, I wouldn’t hesitate to bring them to RML.”

Jones and Fudacz often talk with post-transplant coordinators and physicians to give updates and to discuss medication management. “I don’t know of any other LTACH that has dedicated Clinical Pharmacists that bridge the gap between it and the acute care hospital the way RML does,” added Fudacz. “We’re dedicated to ensuring these post-transplant patients achieve the best possible outcomes.”

Link to original article can be found here.

Outstanding Wound Care Facility Treats Fistula Patients

A fistula is an abnormal connection that develops between two separate organs or areas inside the body.  Fistulas can form during the healing phase after an injury or a previous surgery.  They can also develop as a side effect of Inflammatory Bowel Disease, diverticulitis, and radiation.  They can appear in a variety of areas, including between the intestine and the skin or between an artery and a vein.  Some fistulas heal and disappear without intervention, but others require surgical repair and wound care treatment.

External fistulas cause discharge through the skin, and are usually accompanied by abdominal pain, bowel obstruction, and fever.  Internal fistulas may cause diarrhea, rectal bleeding, dehydration, a bloodstream infection, or sepsis, a medical emergency where the body has a severe response to infection.

“Fistulas are classified based on the amount of drainage, or output, they create,” said Cecilia Yanez, RN, BSN, CWOCN, a Wound Care Clinician with 21 years of experience at RML Specialty Hospital.  “The typical treatment for patients with fistulas involves containing the drainage and maintaining skin health, with the use of various pouches and negative pressure therapy.  Managing sepsis, nutrition, and electrolyte balance is very important with these patients.”

Yanez is proud of the exceptional work that RML Specialty Hospital provides to fistula patients.  “We have many experienced CWOCNs (Certified Wound, Ostomy, and Continence Nurses) who have received the proper education and training, and have an excellent understanding of the physiological condition of this type of patient,” she explained.  “RML also has a terrific interdisciplinary group of specialists, including physicians, dietitians, and pharmacy and wound care nurses who collaborate for the best outcomes possible.”

Yanez cares for patients with various types of wounds and fistulas.  “I love helping patients and their families from every walk of life, and assisting them with the various challenging and complex issues they face,” she said.  “I take pride in my work, and love working for RML.”

 

Written by Denise Freese 

Link to original article can be found here.

Specialty Hospital Remodels to Benefit Patients, Staff

As advances in technology improve patient care, more space is required to house specialized medical machinery and equipment.  At RML Specialty Hospital, a plan is set to remodel the aging building, create more sound-proofed private rooms for patients, and add storage space for computers and other medical equipment.

“We’ve begun construction on D Wing, which currently houses administrative offices,” said Ken Pawola, Chief Operating Officer for RML Specialty Hospital.  “We have three patient care units in service now, and D Wing will be the fourth, which will add 26 additional private patient rooms.  We hope to have it up and running in early 2019.”

RML’s current building was constructed in the 1950s, with smaller double-occupancy rooms that aren’t conducive to offering the highest quality patient care.  “After the remodel, rooms will be larger and private, and will offer special perks like computers, lift devices, and dialysis outlets in each,” added Pawola.  “We’ll offer cutting-edge conveniences like you’d expect to see in a modern hospital.”

According to Pawola, the additional rooms will allow RML Specialty Hospital to fill to licensed capacity.  “Currently, we don’t have much storage space,” he added.  “We need additional room for specialty chairs, ventilators, computers, and medication carts.  We plan to build niches into the walls for extra storage space so equipment isn’t sitting out in the hallway.  It will be a better overall environment, much more functional and efficient.”

There are many advantages provided by RML’s remodel.  “More room to spread out is better for patient privacy and infection control,” said Pawola.  “Many patients are with us for a long time, and normal, uninterrupted sleep is important for the healing process.  There will also be more room for family members to visit.  And it’s better for our nursing teams, allowing them to work more closely together for improved teamwork and daily planning.”

 

Written by Denise Freese 

Link to original article can be found here.

Specialty Hospital Offers Life-Changing Experience for Wound Recovery Patient

When Chris Coley speaks, the gratitude pours out of him. After being sidelined by a serious bacterial leg infection last year, Coley spent five weeks rehabilitating at RML Specialty Hospital in Chicago.

“I had swelling, pain, and discoloration. Three days later I was in Metro Hospital’s ER,” said Coley. “I’d never been hospitalized before, so I was scared. I was told I could lose my leg if the infection worsened.” Treatment consisted of antibiotics, painkillers, and surgical skin grafts, and he got through it successfully. Then he faced five weeks of wound recovery care at RML Specialty Hospital.

“I weighed 350 pounds at Metro,” said Coley. “I’d been hiding under excess weight and big clothes. I dreaded mirrors and being photographed. RML told me losing weight would help my leg recover. If I didn’t, I could have major complications down the road.”

Coley felt an instant connection with his RML representative. “I trusted her, and it became the tone for everything,” he explained. “They were very encouraging. RML went from strangers to staff to friends to family. While I cried a little going in, mainly out of fear, I cried openly when I left, because they’d become my family.”

“I’ve met angels, and they work at RML. My nurses, therapists, and other caretakers talked with me about comics and other fun things to distract me from the pain. They put me on the Paleo diet, and I weighed 275 when I left. I hadn’t weighed under 300 pounds since the seventh grade,” he added.

Coley didn’t want to let RML down during his recovery at home, so he continued to lose weight, and now weighs a svelte 175. “I’m more sociable, and I have a new job working with people,” he said. “I enjoy seeing others and being seen. RML saved my life in more ways than one. I have two birthdays: December 25th and the day I left RML.”

 

Written by Denise Freese

Link to original article can be found here.

Ventilator Weaning Patient Undergoes Amazing Recovery, Life Transformation

Her story started with alcohol addiction, which led to dramatic weight gain and a stomach ulcer.  Carol Murillo’s husband found her one night on the bathroom floor, necessitating a trip to the emergency room at a nearby hospital.  Doctors discovered she had sepsis, a dangerous infection resulting from a perforated ulcer.

“I was in a coma for eleven days,” said Murillo.  “I stayed in the ICU for six weeks, then transferred to RML Specialty Hospital in Hinsdale for long-term recovery.  My right lung had collapsed twice, and I needed to be weaned off a ventilator.”

Murillo also underwent a tracheotomy, and was on dialysis for a week.  “RML left no stone unturned,” she explained.  “They treated me, my husband, my family, and my friends very well.  They made concessions for my support system.  My Care Coordinator even drew diagrams to explain each of my procedures to my husband.”

“I can’t say enough about RML,” added Murillo. “My health care team was amazing; from my doctors and nurses to my dietician, psychologist, physical therapist, and RML’s chaplain, they completely changed my life.  They’re so knowledgeable, and they were all very attentive, I never felt alone.  I was there almost three months, and they became family to me.”

Murillo’s Care Coordinatorcontinued to check on her once a month after her release from RML.  “They were tough, and encouraged my family to not let me wallow in sadness, and to make me work hard to improve,” she said.  “My recovery went well, due to RML’s support both in the hospital and at home.  All the hard work was worth it.”

Another positive change in Murillo’s life was that RML’s chaplain services helped her reconnect to her Catholic faith.  “My faith is stronger, I’ve lost 110 pounds, I’m walking again, and I’ve been sober for 21 months,” said Murillo.  “I don’t think I’d be here if it hadn’t been for RML.”

 

Written by Denise Freese 

Original article can be found here.

Holiday Caroling Warms Hearts of Specialty Hospital Patients

For patients needing long-term acute hospital care during the holiday season, it can be difficult to experience holiday joy. The staff at RML Specialty Hospital understands the need to spread holiday cheer, and achieves it with holiday caroling, a lovely, heartwarming tradition.

Chris Bacchi and Ken Pawola (Inventory Manager and Chief Operating Officer, respectively, at RML Specialty Hospital) and other RML staff, volunteer their time to offer a special show to RML patients and families. “This is the 20th anniversary, and my sixteenth year, of this fun holiday tradition,” said Bacchi. “Early on, there weren’t instruments, just vocals. We’ve recently raised the bar; Ken and I play guitar, and we’ve added a ukelele player and a multi-instrumentalist playing the recorder and other percussion instruments.”

Carolers spend several hours performing at each of RML Specialty Hospital’s two locations (Hinsdale and Chicago). The repertoire includes classic Christmas carols, plus some fun Christmas songs by Springsteen and other popular artists. “After caroling at the Hinsdale location, we have an informal jam session in the lobby,” added Bacchi. “We play rock songs, including some favorite Beatles tunes.”

Caroling took place on Tuesday, December 12th at the Chicago location, and will again on Thursday, December 14th (5:00 pm) at the Hinsdale location. “This is one of the best kept secrets at RML,” said Bacchi. “We do our best to help patients and their families, to lift their spirits. Some patients who normally have trouble moving find a way to wave their hands with the music. It’s so heartwarming, sometimes I think it does us more good than it does them.”

Interestingly, last year as carolers sang, a nearby patient on an EEG machine showed normalization of brain waves, reinforcing the belief that music and singing help create a calming effect for listeners. 

 

Written by Denise Freese

Original article can be found here. 

13th Annual Golf Tournament, September 18, 2017

 

 

 

 

On Monday, September 18, RML Specialty Hospital will host its 13th Annual RML Specialty Hospital Golf Tournament, benefiting The Patient and Family Needs Fund, at Ruth Lake Country Club in Hinsdale. Golf will be followed by dinner featuring a silent and live auction. New this year will be a concurrently run Paddle Tennis Clinic and Tournament.

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Climbing for a Cause

RML supported the American Lung Association on Valentine's Day by participating in the Fight for Air Climb in Oakbrook Terrace.

Employees raised over $2,300 while climbing 31, 62, or 93 flights of stairs in support of lung health at the fundraising event.

Congratulations and thank you to all RML employees who stepped up to the challenge and raised funds to support research, education, and programs to help those impacted by asthma, COPD, lung cancer, and other lung disease. Lung health is an important part of who RML is and impacts many of the patients we serve. We are proud to sponsor and support the American Lung Association.

Dry Skin Care in Winter

During winter we like to feel toasty and warm, wrapped up in cozy sweaters or blankets, or settled in front of a fire. However, freezing temperatures, low humidity, and furnace-blasted dry air can leave our skin dry, flaky and itchy.

Here are some useful tips to keep skin from getting too dry during the cold weather months:

  • Add humidity to your home and work by using humidifiers.
  • Use an oil-based moisturizer. Ointments or heavy creams seal water in the skin and preserve moisture better when the humidity is low.
  • Generously apply sunscreen before going outdoors. Apply a moisturizing, broad-spectrum sunscreen with at least SPF 30 to any exposed areas. Sunscreen protects from the sun’s harmful UV rays.
  • Everyday bathing, hot showers, or baths can strip skin’s natural oils. Limit showers or baths to no more than 10 minutes, pat dry, and moisturize while your skin is still damp. Avoid deodorant bars, antibacterial soaps, perfumed soaps, and skin care product containing alcohol. Instead, use warm water and a mild, fragrance-free soap or moisturizing body wash.
  • Hydrate. Drink 8 to 12 glasses of water per day.
  • Don’t wear wet gloves or socks. They irritate the skin and causes cracks, peels, and in some cases, eczema.

These simple tips should help prevent dry skin. If you experience severe, chronic dry skin, consult your physician or dermatologist.

- Nafisa Kha, Pharm.D

Education Simulation Lab Opens

RML's Education Simulation Lab featuring Sage the Sim Man is open at RML Hinsdale. Donors, community members, physicians, former patients, and staff joined us to celebrate this technologically advanced space that will have a lasting impact on the patients and communities we serve.

Simulation training will help RML meet the demands of the rapidly changing healthcare environment. The lab will increase the clinical capabilities and expertise of staff, improving quality and reducing healthcare system costs.

Mannequin simulations use high fidelity simulators – mannequins that breathe, with breath sounds, heart tones, and palpable pulses. The mannequin has a monitor that displays EKG, pulse oximeter, blood pressure, arterial wave forms, pulmonary artery wave forms, and more. Sage the Sim Man simulates vital cues, providing real-time information and allowing for virtual feedback.

By practicing clinical skills in a safe and regulated environment with a simulation mannequin, clinicians learn exceptional evaluation and treatment techniques while increasing team work and communication skills.

This project would not have been possible without the support of Foglia Family Foundation and Sage Products. Thank you to both organizations for their continued support of RML.

If you are interested in touring the Education Simulation Lab, please contact Jennifer at 630.286.4400.

 

RML Chicago Opens High Acuity Unit

In complex environments like long-term acute care hospitals (LTCHs), reducing medical errors while serving increasingly complex patients saves lives and reduces costs. RML continuously identifies opportunities to meet the needs of patients in this ever changing healthcare landscape. As a result, a high acuity unit opened at RML Chicago this week.

This specialized, technologically advanced six-bed unit will allow clinicians to care for patients with acute needs requiring high observation. This is similar to treating patients in an intensive care unit setting in a traditional hospital, within RML’s LTCH scope of limitations.

Much planning and educational training went in to the opening of this unit. Thank you to all of the staff who contributed their time and talents --- it was a true multi-disciplinary team effort.

If you have questions about RML’s high acuity unit, including referring a patient, contact RML’s Intake Department at 773.826.6400.

Alternative Pain Management Therapies

In most hospitals, pharmaceuticals are the first response to pain. RML’s rehab team is currently trialing non-pharmacological alternatives to pain management.

Rehab therapists are testing a wearable device that uses electrical stimulation to trigger pain relief responses in the brain. The stimulator is worn on the upper calf, activating sensory nerves in the leg. This stimulation signals the brain to release endogenous opioids, which block pain signals in the body.

How does electricity alleviate pain? Researchers believe the electrical impulses interrupt messages about pain sent from the nerves to the brain. The electricity blocks the activity of the pain receptors. If the brain doesn't get these messages from the nerves, it doesn't know that there is pain. Researchers also believe that electrical stimulation encourages the body to produce more of its own endorphins, which are natural pain relievers.

This pain controlling alternative is technological rather than pharmaceutical. Rehab services at RML also use other non-pharmacological, complementary techniques to reduce pain including:

  • soft tissue mobilization,
  • massage,
  • hot or cold packs,
  • and empathy and compassion.

Insomnia and Sleep Aids

Sleep is arguably the most important part of a healthy lifestyle. A good night’s sleep can improve health, focus, creativity, memory, and mood. Sleep can help you live longer, lower overall stress, and improve the quality of life. Sleep has been shown to decrease inflammation in the body, which has been linked to heart disease, stroke, diabetes, and arthritis.

Most people do not get a good night’s sleep due to pressures at work and at home. They might suffer from chronic insomnia and stress. People over-medicate with stimulants, such as caffeine, which prevents them from sleeping.

Here are some non-pharmacological aids to help you sleep:
- Light exercise an hour or more before bedtime can help a person fall asleep faster.
- Minimize light, noise, and excessive temperature in the bedroom.
- Resolve stressful issues or problems before going to sleep.
- Listen to soothing music or meditate 15 minutes beforehand.
- Avoid drinking fluids to prevent frequent bathroom visits.
- Stop caffeine intake in the late afternoon.

Developing a nightly sleep ritual with the above aids on a consistent basis can help improve sleep.

Over the counter sleep aids are available when non-pharmacological measures are insufficient. Most sleep aids contain diphenhydramine, mostly used for allergic reactions. It can cause sedation, so is used to help with sleep. Tolerance can develop over time, so the longer it is used, the less likely it will help. Diphenhydramine is known to produce a “hangover” effect of grogginess the next morning. Other medications contain doxylamine (Unisom) which works similar to diphenhydramine. Melatonin can be used to help prevent jet lag and reduce the time to fall asleep, though its effects are mild at best.

Drinking alcohol may seem like a good idea, but persistent use has been shown to create more sleep disorders.

Prescription benzodiazepines such as zolpidem (Ambien), or hypnotics such as eszopiclone (Lunesta) are available from your physician. Side effects are mostly mild to moderate, such as dry mouth, daytime drowsiness, stomach pain, and headache. These medications are considered controlled substances, and dependence and abuse can happen without proper supervision from a physician.

A good night’s sleep is crucial for a healthy life. If experiencing insomnia, first start with non-pharmacological aids. Consult with your doctor before starting any over-the-counter medications or if a prescription is needed for stronger relief.

- Min Ko, PharmD

Reducing Heel Pressure Ulcers

Hospital acquired pressure ulcers are costly to patients and organizations financially, physically, and emotionally. Heels are the second most common site with 43% of pressure ulcers developed in hospitals occurring on the heel.1 ,2

Committed to patient safety and quality outcomes, RML piloted a program aimed at preventing heel pressure ulcers. In partnership with Sage Products, RML Hinsdale’s B-1 unit tested a new methodology and product, Sage’s Prevalon Heel Protector with Integrated Wedge (boot).

Staff became vigilant in assessing the largest organ of the body, skin. Nurses and patient care technicians worked with RML’s wound care team to proactively develop a plan customized to the needs of each patient. This method of heightened skin assessment, awareness, and new product intervention resulted in the heel pressure rate decreasing by almost half in a relatively short amount of time.

The pilot program not only helped with the prevention of heel ulcers, but also with the treatment. In two cases, the prescribed methodology and use of Prevalon boots contributed to the treatment of newly developing wounds.

Thank you to Sage Products and all clinical staff involved in the pilot program. Your commitment to making RML a safer, healthier environment for our patients is greatly appreciated.

Read more: B1 Initiative to Prevent Hospital Acquired Heel Pressure Ulcers
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1. Amlung, S.R., Miller WI, Bosley L.M. Adv. Skin Wound Care Nov/Dec 2001: 14(6); 297-301.
2. Walsh, J., DeOcampo, M., Waggoner, D. Keeping heels intact: evaluation of a protocol for prevention of facility-acquired heel pressure ulcers. Poster presented at the Symposium on Advanced Wound Care, San Antonio, TX, Apr 2006.

Medication Myth Busting: Generic Drugs

Today, nearly eight of ten prescriptions filled in the United States are for generic drugs. The use of generic medications is expected to grow over the next few years as a number of popular drugs come off of patent through 2015.

Here are some facts about generic drugs:

  • FDA requires generic drugs to have the same quality and performance as brand name drugs. When a generic drug product is approved, it has met rigorous standards established by the FDA with respect to identity, strength, quality, purity, and potency.
  • Generic drugs are required to have the same active ingredient, strength, dosage form, and route of administration as the brand name product.
  • Generic drugs do not need to contain the same inactive ingredients as the brand name product.
  • The generic drug manufacturer must prove its drug is the same as (bioequivalent) the brand name drug.
  • Research shows that generics work just as well as brand name drugs.
  • When it comes to price, there is a big difference between generic and brand name drugs. On average, the cost of a generic drug is 80 - 85%lower than the brand name product.
  • Generic manufacturers are able to sell their products for lower prices because they are not required to repeat the costly clinical trials of new drugs and generally do not pay for costly advertising, marketing, and promotion.
  • FDA monitors adverse events reports for generic drugs. FDA is actively engaged in making all regulated products – including generic drugs – safer.

Please note, this article is for informational purposes only, clarifying myths regarding generic drugs, not endorsing them. Please consult your physician to decide if a generic drug is appropriate for you.

-Smriti Chawla, Pharm.D.