All posts by Angelo Antoline

Nutrition Administration and Ventilator Weaning in Long-Term Acute Care

Ernest Health, which includes Northern Idaho Advanced Care Hospital, recently was recognized nationally for its work in nutrition management and administration for patients being weaned from ventilators in its long-term acute care hospitals (LTACHs).

The initiative, which was introduced and led by Cindy Tew, Ernest Health’s Director of Clinical Programs and Resources, and Anne Woodbury, Registered Dietitian Nutritionist at Utah Valley Specialty Hospital, won the 2017 Quality Achievement Award from the National Association of Long Term Hospitals.

“We wanted to see if we could track specific nutritional indicators that could positively influence patients being weaned from ventilators,” Tew says. In particular, the team wanted to find if the level of protein provided to a ventilated patient had any effect on the success of weaning the patient off the ventilator.

“Mechanical ventilation is a life-saving procedure that’s used to support patients who are recovering from critical illnesses or injuries,” Woodbury explains. “Patients who require prolonged mechanical ventilation need specialized medical assistance in healing and weaning from ventilator dependence, and nutrition plays a critical role in this.”

A team of Ernest Health dietitians led by Tew and Woodbury created a nutritional tracking form to collect data from its LTACH hospitals to monitor tube feeding tolerance and nutrition administration. That data was collected from patients who had been on a ventilator longer than 96 hours and were in respiratory failure.

After two years of collecting data from 204 patients, the team found more successful ventilator weaning results when a patient could tolerate 1.6-2.0 grams of protein each day.

“Data of this nature has never been recorded before, so we’re optimistic about the potential impact of our findings,” Tew says. “These are promising results not only for our patients, but for other post-acute hospitals to consider for their patients as well.”

Ernest Health’s LTACH hospitals will continue to collect data and measure protein intake values to substantiate significance with a larger data pool of patients being weaned from ventilators. The intent is to publish the results in the future for other post-acute hospitals to consider.

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Don’t Let Driving Distractions Wreck Your Summer Vacation

Distracted driving is a growing – and dangerous – recurring event in the United States. Distracted driving is any activity that takes your eyes off the road, hands off the wheel, or mind off driving.

A study through the National Institutes of Health found that drivers eat, reach for the phone, text, or otherwise take their eyes off the road about 10 percent of the time. This behavior can endanger the drivers, passengers and bystanders.

Distracted driving can include a myriad of activities, including:

  • Texting
  • Talking on a cell phone
  • Looking at a GPS system
  • Eating or drinking
  • Grooming
  • Talking to passengers
  • Adjusting the radio
  • Reaching for items elsewhere in the car

Probably the most alarming distraction of all is text messaging because it requires visual, manual, and cognitive attention from the driver. Five seconds is the average time someone’s eyes are off the road while texting. When traveling at 55 mph, that’s enough time to cover the length of a football field blindfolded.

With summer vacations in full swing, many of us will be driving to our destinations. Let’s remove our distractions and pay attention to road. The simplest and most effective way to do this is to turn off your cell phone when you turn on the car ignition. It’s simple.

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Communicating with a Family Member in Critical Care

Sometimes it’s hard enough to say what we mean. So what do we do if we have a family member in critical care? Rest assured, communicating is an important part of the healing process for your loved one as well as your family.

Here are 5 tips to help you out:

  1. Even if your loved one is on a ventilator, he or she will most likely be able to hear you. Speak in a calm, clear manner in a normal tone of voice. There’s no need to speak loudly. Read your family member a favorite poem, book, or prayer. If the staff says it’s OK, you could even play some music.
  2. Use short, positive statements. Reassure your loved one that you’re there, and that everyone is taking good care of him or her. Help orient your family member to the surroundings by sharing the date, day of week and time of day. Help describe the noises in the room.
  3. It’s OK to acknowledge that your family member may be experiencing discomfort. You can help by explaining what is going on, “That tube is helping you breath.” Remind your loved one that this is just temporary and helping him or her to get better.
  4. Don’t ask questions that can’t be answered. Make it simple. Suggesting hand gestures to communicate may be helpful. For example, a thumbs up or thumbs could indicate pain level. A small dry erase board may also be helpful in communicating as well. You could write words that your family member could point to, or possibly your loved one can write a few words as well.
  5. Human touch goes a long way. Ask the hospital staff first, but holding a hand or touching your family member gently is a great way to express your love and concern.

If you’re unsure about the best way to communicate, don’t hesitate to ask a member of the hospital staff for help. If one way doesn’t seem to be working, there likely will be another way that can be more effective.

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6 Things to Expect When Your Loved One is in Critical Care

It’s difficult to imagine a loved one being ill or injured enough to require critical care. But being prepared for what to expect can help you manage the situation.
Here are 6 important things to know:

  1. You have an experienced team on your side. The hospital staff that’s caring for your loved one is highly trained and prepared to treat the sickest – and most medically complex – patients. From the physicians and nurses to the respiratory therapists and dietitians – they all are specially trained to care for your loved one.
  2. The tubes and equipment in a critical care unit can be intimidating. But, they all have a role and purpose in providing your loved one with the intensive healthcare that he or she needs. The healthcare team will be able to explain the role of any equipment to help you better understand what it happening.
  3. Information overload can – and most likely will – occur. Everything will be new to you from the equipment and noises to the procedures and health professionals. Take a deep breath. Once you get your bearings, think of how you can best keep track of information. Write in a notebook. Keep notes on your phone. Jot down items like key information, questions you want to ask, purpose of treatments, and names of hospital personnel.
  4. Expect peaks and valleys. Critical care can be a bumpy ride. Some days will be better than others. As much as possible, try to be patient and keep perspective.
  5. Talk to your loved one. Communicating with your loved one is important for not only him or her, but for your entire family. Often patients can hear while in critical care. Speak calmly and clearly, and make short, positive statements. Hold your loved ones hand or touch them gently if a member of the healthcare team says it’s OK.
  6. Take care of yourself. It may be a long road to your loved one’s recovery, so be sure to take time to do things like sleep, eat, and shower. Don’t be afraid to leave the room for a bit. The healthcare team will be there 24/7 to provide care.
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Northern Idaho Advanced Care Hospital celebrates 10 years of helping patients with serious respiratory conditions

(photo) Dr. David York, a pulmonary and critical care physician, and Diane Joralmon, a respiratory manager at Northern Idaho Advanced Care Hospital in Post Falls help patients achieve better breathing outcomes.

The beep worried Linda Sprenger.

As she drove her husband, Mike, to their home in Moscow — *Beep!* — from North Idaho Advanced Care Hospital in Post Falls, thoughts began to weigh on her mind. What if the machine stops working? *Beep!* What if the machine stops working and Mike stops breathing? *Beep!*

Linda got home. The white knuckle drive was over. But a new stress of caring for her husband of 28 years was just emerging. Mike has ALS, or amyotrophic lateral sclerosis, is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. He now relies on a ventilator to keep him alive.

“It’s scary,” said Linda. “I don’t have a huge amount of people to take care of him. You’re alone and you’ve got this machine and you’re looking at it every time it makes a sound.”

Not that it’s much consolation, but Linda isn’t alone. Every day, an average of 15 Americans are newly diagnosed with ALS — more than 5,600 people per year. As many as 30,000 Americans may currently be affected by ALS. Annually, ALS is responsible for two deaths per 100,000 people. The average life expectancy of a person with ALS is two to five years from time of diagnosis.

Mike, 51, has had the disease for five years. He can’t speak or move without the assistance of a wheelchair. Yet he is able to text messages, and they celebrated the birth of their first grandchild on Christmas Eve.

“He’s doing really well,” said Linda. “I am so grateful.”

Last August, the couple experienced a scare when Mike got pneumonia. He was own to Spokane for a tracheotomy. Eventually he was transferred to Northern Idaho Advanced Care Hospital as part of his recovery. He spent 35 days at the Post Falls hospital.

“It was one of the most amazing hospitals I have ever been in,” said Linda. “They were with us 24 hour hours a day and they really cared for us.”

The hospital, which celebrates its 10-year anniversary on Feb. 17, provides long-term acute and critical care services to patients throughout the Inland Northwest who are recovering from serious illnesses or injuries. To date, Northern Idaho Advanced Care Hospital has served more than 4,000 patients. Often these individuals need care for medically complex conditions such as trauma, infectious diseases, wound healing, cardiovascular disease, stroke, and amputations, and respiratory failure.

“They provided all the training I needed,” said Linda. “I know how the machine works, how to clean it and when to call a technician.”

For ALS patients, respiratory issues become a matter of life and death.

“Respiratory failure occurs when there isn’t enough oxygen passing from the lungs into the body’s bloodstream,” explained Dr. Kevin Strait, Medical Director of Northern Idaho Advanced Care Hospital. “Oxygen-rich blood is needed to help the body’s organs – such as the heart and brain – function properly. Respiratory failure also can occur if a patient’s lungs can’t remove carbon dioxide from the blood. Carbon dioxide is a waste gas that also can harm a body’s organs.”

The 40-bed facility, at 600 Cecil in Post Falls, features all private patient rooms, and an 8-bed high- observation critical care unit.

Northern Idaho Advanced Care Hospital is the first hospital in Idaho, and the fifth in the nation to receive the Joint Commission’s disease-specific certification for Respiratory Failure. The Joint Commission, an independent, not-for-profit organization, accredits and certifies nearly 21,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

All patient rooms include cardiac monitoring equipment and mechanical ventilators. The hospital also features a 2,590-square-foot therapy gym with private therapy rooms and a heated aquatic therapy pool.

By MARC STEWART – Coeur d’Alene Press

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Northern Idaho Advanced Care Hospital helps patients recover from serious health issues

(photo) John Bierne nearly died from kidney failure, liver failure and congestive heart failure. He spent several months at Northern Idaho Advanced Care Hospital in Post Falls, recovering and rehabilitating. Photo by Marc Stewart.

John Bierne looks and feels like a new man.

The Twin Lakes Village resident nearly died from kidney failure, liver failure and congestive heart failure — at 39 years of age.

“I was 456 pounds,” said Bierne. “I kept gaining weight and I wasn’t feeling right. My breathing was off. I had sleep apnea. I should have gone to the doctor months earlier and gotten some simple blood work done.”

Instead, Bierne continued to make poor health choices and worked long hours as a project manager for a local construction company to help provide for his wife, Theresa, and their 3-year-old daughter, Kylie.

It all caught up with him March 19, 2015. Bierne collapsed while visiting his mother’s house. When paramedics arrived he wasn’t breathing. They managed to resuscitate him and get him to the hospital — where he hovered near death in the intensive care unit for weeks.

“The doctors told my family that I had about a 1 percent chance of living,” he said. “I’ve been told I coded several times, but I didn’t die. I don’t remember any of it. I don’t remember collapsing or being in the hospital.”

Doctors drained 131 pounds of uid from Bierne’s body, much of it around his lungs. They also discovered he had an enlarged heart and that his kidneys weren’t getting enough oxygen.

“I was prepared to be on dialysis the rest of my life,” he said. “I knew my life was going to be different from that point on.”

Bierne spent a month in the hospital, then was transferred to Northern Idaho Advanced Care Hospital in Post Falls to begin a long and difficult road of recovery.

Northern Idaho Advanced Care Hospital provides long-term acute and critical care services to patients throughout the Inland Northwest who are recovering from serious illnesses or injuries. Bierne had severe problems to contend with, given his weight and organs in severe distress.

“When I first saw John, he looked pretty rough,” said Kate Smead, lead therapist at Northern Advanced Care. “He was a big guy and he was hooked up to a ventilator with all kinds of tubes going in and out of his body. I wasn’t sure what he was going to be able to do.”

Diane Joralmon, respiratory therapy manager at Northern Idaho Advanced Care Hospital, said Bierne’s breathing quickly improved, but he faced long-term health challenges.

“He had trouble sitting up and he was on oxygen,” said Joralmon. “He did well with the lung therapy and responded to it. He’s feisty.”

John was weaned off the ventilator and began breathing on his own. However, one of his most pressing health issues was a nasty bedsore. Despite steadily increasing his mobility and strength once he reached Northern Idaho Advanced Care, months of lying in bed had taken its toll and his skin and muscles had deteriorated into a horrific state.

“John had a stage 4 pressure ulcer,” said Morgan Pitschka, wound management specialist at the hospital. “He was so sick, he couldn’t be moved. This led to a substantial bedsore. He basically had a gaping wound that would eventually require plastic surgery. ”

Treating his wound was delicate and required using negative pressure with a device that vacuums the injured area and treats it with medical foam. In addition, he was given a matrix of protein supplements to help his body build new tissue.

Bierne healed quickly with continuous supervision and care from his medical team. In short order, he was up and out of bed, ready for the next challenge. The medical team picked up on his macho attitude and used it as a motivator.

“I treated him like I was his drill sergeant and his friend,” said Smead, who designed his physical therapy sessions. “I gave him a hard time. I pushed him. Whereas other patients need to be treated with kid gloves, John needed somebody who wouldn’t back down when he got down or didn’t want to do something.”

Bierne spent about three months in Northern Idaho Advanced Care Hospital.

Despite the grim prognosis, he never believed he would die and tackled his rehabilitation with a vengeance. If he was asked to take 60 steps on the first day, he went for 180 steps. If he was told to go 10 minutes on the treadmill, he went 20…

Today, the 6-foot-1 man is 255 pounds and his caregivers at Northern Idaho Advanced Care Hospital describe him as looking “fantastic” and “amazing.” His kidneys are now functioning normally and his liver has bounced back. He exercises regularly and eats nutritiously. He was even able to go elk hunting in the fall — something that surprised his caregivers.

“I’ve been an athlete all of my life,” he said. “Death never entered my mind. I just took it day by day. I wanted to do more every day and keep improving. I am so grateful to everyone at Northern Advanced Care Hospital. They really saved my life.”

By MARC STEWART – Coeur d’Alene Press

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Local hospital 5th in nation to receive Joint Commission Certification; Gold Seal of Approval

Northern Idaho Advanced Care Hospital located in Post Falls Idaho is the 5th hospital in the nation to earn The Joint Commission’s disease-specific certification for Respiratory Failure. The hospital earned The Joint Commission’s Gold Seal of Approval for Respiratory Failure after a rigorous on-site review earlier this month, this reflects the hospital’s commitment to providing safe and effective care to these patients.

“Respiratory failure occurs when there isn’t enough oxygen passing from the lungs into the body’s bloodstream,” explains Dr. Dr. Kevin Strait, Medical Director of Northern Idaho Advanced Care Hospital. “Oxygen-rich blood is needed to help the body’s organs – such as the heart and brain – function properly. Respiratory failure also can occur if a patient’s lungs can’t remove carbon dioxide from the blood. Carbon dioxide is a waste gas that also can harm a body’s organs.”

Strait says different types of diseases can cause respiratory failure. Included among these are lung diseases such as chronic obstructive pulmonary disease (COPD), pneumonia, or cystic fibrosis. Respiratory failure also can be caused by conditions that affect the nerves and muscles that control breathing such as stroke, spinal cord injuries and muscular dystrophy.

“Northern Idaho Advanced Care Hospital has thoroughly demonstrated a high level of care for patients with respiratory failure,” says Wendi Roberts, Executive Director of Certification Programs, The Joint Commission. “We commend Northern Idaho Advanced Care Hospital for becoming a leader in respiratory failure care, potentially providing a higher standard of service for respiratory failure patients in its community.”

Certification through The Joint Commission’s Disease-Specific Care Program is voluntary and addresses three main areas:

  • Compliance with consensus-based national standards
  • Effective use of evidence-based clinical practice guidelines to manage and optimize care
  • An organized approach to performance measurement and improvement activities

“Northern Idaho Advanced Care Hospital is pleased to receive this certification from The Joint Commission,” says Sandra Yule, Chief Executive Officer of Northern Idaho Advanced Care Hospital. “This award recognized how dedicated we are and how well we provide treatment to patients with respiratory failure. Through our services, we want to provide hope and quality of life to our community members who are experiencing this debilitating event. This certification provides us with the framework to create a culture of excellence for those patients in our community.”

In addition to The Joint Commission’s respiratory failure certification, Northern Idaho Advanced Care Hospital also is one of 700 nationwide – or 15 percent – that has earned the National Quality Respiratory Care Recognition from the American Association for Respiratory Care. This designation is given to facilities that meet strict safety and quality standards related to providing respiratory care.

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