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Behind the Scenes: Medical Staff Services

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We recently sat down with KVH Medical Staff Coordinator Kyle West to learn more about the work of his department. Also present was Kyle’s predecessor, Mandy Weed, now Executive Assistant for KVH Administration.

What is your role at KVH?

I’m the Medical Staff Coordinator, which reports to Dr. Martin, the Chief Medical Officer. I serve the providers who provide care at KVH.

A lot of what I do involves helping providers apply for privileges to work here. Honestly, the more interesting angle is not what I do – which is a lot of gathering paperwork and data – but why I do it. You want to have providers who are well qualified, who’ve been checked out and are going to provide good care for the patients and the community.

We go through a thorough screening before providers come here, and a rescreening every other year when they come up for reappointment, making sure they’re still a solid provider, well-trained and doing a good job.

Are you part of the provider hiring process?

For KVH positions, candidates talk first with provider recruiter Mitch Engel. They interview, he makes an offer, and they sign a contract before he refers them to Medical Staff. Then I help with the privileging process. HR does the standard HR drug and background check, and I do an additional check of references, past employment, claims history and other hospital affiliations.

You previously worked at Community Health of Central Washington.

I was the Residency Program Coordinator for the rural training site of the Central Washington Family Medicine Residency Program. I would work with Mandy to coordinate orientation for the residents, when they would come in, and make sure that they weren’t doing rotations with the same KVH provider at the same time. I did a lot of other things, too. It was a multifaceted job, just like this one.

What are some of the other things that you do as the MSC?

I help coordinate medical staff department meetings.

Mandy: Which also involves 14 different committees.

(Gasp!) Do you sit through all of those meetings?

I do. And take minutes, and help the meeting leader put together the agenda.

Anything else?

Mandy: Kyle coordinates the medical students that come into the facility, working with the school, with Pam Lutz for current contracts, and with another person who does our insurance credentialing. He funnels all that stuff and sends it off for processing. And he’s the point of contact, as well.

Kyle: Say you’re a patient who goes to a KVH clinic, and you have Premera insurance. KVH wants the provider who sees you to be able to bill Premera. Each insurance company has their own process, so I facilitate getting the information to the companies’ credentialers.

Mandy: Kyle also coordinates provider liability insurance.  He also gets the pleasure of the on-call schedule.

Sounds busy. Do you ever get time off?

(Laughs) I’ve only been here 90 days, so, no. Not yet.

What are the major challenges of medical staff coordination?

There are a lot of demands. It requires being good at prioritizing, and a lot of attention to detail. So far, prioritizing has been the most challenging, when several people are all saying, “this is urgent, I need this now,” and there’s only one of me. I can’t do it all.

How do you keep track of your work?

I’ve got a program to manage provider privileging, and a tracking whiteboard in my office. Mandy has been super helpful in training and helping me prioritize, and gives me feedback when I miss something.

Mandy: So in Washington, providers use a WPA, Washington Practitioner Application, to apply for privileges. It’s 16 pages, sometimes more. All of that information, Kyle then takes and enters into this program, so that he can then send out peer references, hospital affiliations, insurance verifications…

Any other challenges that come to mind?

There’s a lot to learn.

What are the rewards?

It’s a nice team of folks to work with. Everybody’s easy to get along with. It’s a rewarding job, because I feel like I’m making a difference for the community and KVH.

What would you put in a go-to bag to succeed in a typical day on the job?

Mandy: Lots of patience. You’re always going in different directions. You have to be able to shift gears quickly and then get back to what you were doing. It’s very fast-paced. There’s a lot going on.

Kyle: Have a sense of adventure, and don’t be afraid to ask questions!

Behind the Scenes: Information Systems

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Jeffrey Yamada

We recently sat down with KVH Chief Information Officer Jeffrey Yamada to learn more about the function of IT in a healthcare system.

While technology is a part of everyday life, it’s not usually the first thing one thinks of when talking about healthcare. What role does IT play in an organization like ours?

It’s always about the patient, and IT provides the technology and the tools to help patient care.

Just imagine yourself or a family member as a patient in an exam room, where the physician can’t access your records because the computer’s down, or your complete electronic record isn’t available. Our team works to minimize the impact on patients, and guides providers in their use of the systems.

It seems like there’s a wide range of responsibilities covered by KVH Information Systems. 

We have major systems, such as our Cerner Community Works system, that have multiple people working on them. These systems have ongoing changes and maintenance, and with new functionalities comes the question of access, training, and education, which we call change control or change management.

When users let us know their systems aren’t working properly, we manage those incidents through SR (service request) tickets, which feed into the Cerner helpdesk.

There are some 30 additional systems unrelated to Cerner, like HR, payroll, dietary – a mishmash of miscellaneous systems; two of our team members take care of them.

We have maintenance and infrastructure, which covers network and connections across the board, wireless, all the servers in our data centers – which includes the issue of backing up everything in one place in case something happens.

Then there’s IT security, breaches of systems, prevention and protection, and some user education, as well.

How do you stay on top of changes in technology?

Yeah, it goes by pretty fast! Actually, as an industry, healthcare is slow to take on new technology; you can imagine why, when regulatory agencies need to get involved, or there’s a concern that it could impact patients.

What about changes in relation to security?

It’s kind of a catch 22, the way things are currently, because everybody wants their information, and everybody wants it accessible, so how do you do that and still protect everything? Or do you get to the point where you’re so secure that you’re hindering your own people from trying to access information? There has to be a balance.

What are some of the challenges faced by IT?

Number one is user education. Everyone has their own way of using the systems, so guiding people through a standardized workflow is key for avoiding problems that could occur by not following a common process. Not all systems were built from a user standpoint, a lot of them are older systems that have just built upon themselves, so one of the challenges is obviously training and how to train providers and others to use it in the context of their patient care workflow.

There are a number of detailed IT systems – known in the industry as “best of breed” – which take into account the workflow of an individual area, like the emergency department. But what everybody’s going to these days are integrated systems, which connect to the entire enterprise.

The ‘detailed’ systems are more tailored and user-friendly, but the integrated systems allow information sharing, so that patients’ information can be accessed by all of their care providers across the KVH system. It’s definitely a challenge.

What are the rewards of being involved in IT?

We have a great team here, and if you’re focused on the patients, trying to help provide the best patient care you can, knowing that IT plays a big hand, whether the patient is here or even at some other hospital in Seattle, all of their information is available, and it helps the patient through their experience. That’s why we’re all in healthcare at some point.

What’s your background and how did you get here?

I’ve worked in hospitals for 36 years. As a student, I worked at both hospitals in Yakima. After getting my undergrad in Idaho, I went through the medical technology program at Central. It included a year internship in a hospital setting. I worked in the hospital during the day, in addition to classes. Just like other clinical areas, training and education led up to passing the board exams.

I’m originally from Hawaii, so I always said, “Nope, when I’m done, I’m going back, not even a question.” I said that for almost the entire year of my internship, until the lab director at one of the hospitals offered me a job after graduation. I thought, “OK, I’ll grab some experience, I’ll work a year – and then I’ll go back to Hawaii.”

One thing led to another, and I stayed for 36 years in that same hospital.

The lab was highly technical, a lot of electronics, a lot of robotic instruments. I got into that side of it as a systems manager, and implemented two LIS systems (Lab Information Systems). Then there was an opening for an IT director. I thought, “Well, I’m doing it for the lab, I can probably do it for the hospital,” and that was a big leap out of my comfort zone.

Several years later I became the VP CIO at Virginia Mason Memorial. We started with 18 employees, and by the time I left we had around 50 in IT, and some 29 locations. We were considered high tech for a smaller hospital system, and applied to be part of the Top 100 most wired hospitals. So it was a pretty big deal.

Coming here to KVH is kind of fun, because it reminds me of the older days. It’s the family feeling you get with a smaller environment. It’s a different vibe. I like it. So now we’re getting things rolling —

And at some point, it’s back to Hawaii?

(Laughs) Yeah, maybe when I retire.

What would you put in an IT “go bag” for a successful day at work?

Calmness. We have so much equipment, things just happen randomly, and just to be able to be calm and think through things is a great tool. You can go from ‘one thing affecting one patient’ all the way to ‘the entire hospital is down,’ and it’s just like a flick of a switch. You can come in thinking you’re gonna have a great day, and – you just never know. So the goal is to reduce those situations. They’ll still happen, just not as often.

Pack a good sense of humor, keep things light, be able to work as a team, and just be a great communicator.

It’s nothing like you think of a technology person, “I have to have a laptop and my smartphone.” I’m more the opposite. When people who sit next near each other start emailing back and forth, something’s lost by not having face-to-face conversation. In those cases, I say, “Forget the email and talk. Just talk to each other.”

Behind the Scenes: House Supervisors

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Vicky Machorro

We recently sat down with CNO Vicky Machorro to learn more about House Supervisors at KVH Hospital. 

What exactly is a house supervisor?
The main role of a house supervisor is to ensure patients have adequate care coverage by coordinating staffing, while monitoring the flow of patients in and out of the hospital. That also includes managing employee injuries and sick calls, and even managing visitors at times.

During the day shift, the house supervisor works in collaboration with department directors. At night and off-shift/holidays, house supervisors also take on an administrator role.

When we hear a “Code Blue” or “Rapid Response” call overhead, what does that mean for the house supervisor?
The house supervisor is expected to responds to every code called at the hospital. They ensure we’ve got adequate people that can handle the situation. Sometimes they delegate tasks, depending on the code. They also set up staffing for code response, which means at the end of each shift, house supervisors assign staff to respond to codes for the next shift.

What kind of qualifications are needed to be a house supervisor?
You have to be a registered nurse, and stay up to date on certifications including Advanced Cardiovascular Life Support, Pediatric Advanced Life Support, and Basic Life Support. You also have trauma education, and neonatal resuscitation certification. Bottom line, house supervisors are expected to be able to perform to some extent in any clinical area.

What’s challenging about being a house supervisor?
It’s a multifaceted role. Boss, customer, supervisor, mediator – so you have to be able to adjust to all the different hats you may wear. And in that position they take on a large amount of responsibility, which means having broad shoulders when something doesn’t go as expected or people are discontented.

You have to be very diplomatic, you have to listen, you have to allow people to vent – and sometimes that’s all you do is listen, because you don’t have a solution. There are times when you just roll up your sleeves and get to work in uncomfortable situations. It’s part of the job.

What’s rewarding about the position?
Every day is a new day. Nothing is the same two days in a row. There are always new challenges.

What would you pack in a House Supervisor “go bag” to get through the day?
Food. A lot of times house supervisors don’t get lunch if things get busy at mealtime. Keep snacks handy to eat when you’re hungry. And I’m sorry, but sometimes it’s challenging to get to the bathroom during busy times. Or you have your phone on you but you miss calls.

You learn to be prepared and aware to take care of your daily needs as best you can. Because you’re also in a counseling type role, you need good coping skills to manage your own emotions while being there for patients and colleagues throughout the day.

We support each other, like when someone needs time to recover after a tough situation. It’s a little more challenging after hours or on weekends, but there are resources and we do back each other up.

Is it true that one of your crew also enjoys decking out the office for holidays?
Yes – and that’s great for our morale! Valentine’s Day is coming, so I’m sure we’ll see those decorations in the next week or so.

What’s it like, being the house supervisors’ supervisor?
Oh, wow. They’re a great bunch. This group has been consistent for quite some time. We haven’t had a lot of new people, so that’s good. They love what they do, they enjoy it, they’re professional, they’re very competent. And they know when to call to me about something – that’s so reassuring to me.

Did you ever do work as a house supervisor?
Yes, I did it for four years! It was my most favorite job, because you had your finger in everything. You got to know the staff. And every day is a new day.

Behind the Scenes: CEO

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Julie Petersen

We recently sat down with CEO Julie Petersen to learn more about her leadership role at KVH.

You’re the CEO. What does that mean?
My title is Chief Executive Officer, but I think of myself as an administrator. Because we’re a public hospital district, I’m also the superintendent, which implies responsibility for public resources. I administer operations and strategy for the district.

What was your career trajectory?
I consider myself an “accidental” CEO. I’m a certified public accountant. I came up through Finance. I was a controller for 15 years, and then a CFO. My skill set is in reimbursement and understanding the financials of the healthcare delivery system, so the transition to CEO came with a lot of surprises. 
What I learned in that transition is how to listen, how to be present.

And now that you’re in the CEO role?
I consider it my job to have a 360-degree perspective. I’m a community member. I’m also directly responsible to the Board. I have relationships with the Board, the senior leadership team, the physicians. I learn about their concerns, their pressure points. I learn why people come to work, and what keeps them awake nights. Whether it’s department directors talking about how to motivate their teams or share patient satisfaction information, or it’s physicians trying to balance their responsibilities to the patients and their responsibilities to their own families – I am privileged to be a part of those conversations.

When the organization comes to a decision point, I can put the people together that have like interests or are going to impact one another. People want to do what’s best for their patients and their department. And so I ask, “How does that decision fit into what the rest of the organization is doing?”, or “Who else needs to hear about this?”

What was your best real-world preparation for this role?
My mother was one of the most positive people in the world. It had an impact on me. One of the disciplines that I strive to bring every day, is to go into every conversation, every situation, assuming that people are coming from a good place, that they’re trying to do the right thing. It’s about listening to learn. People have a true and valid perspective they’re sharing. And I learned that from my mother.

What’s the hardest part of being CEO?
Being candid can be tough. We put a lot of stock in transparency, and that means that even when people would prefer the platitude, you still have to say, “No, this really is a hard job. It really is hard to make a margin in rural healthcare. I am talking about finance a lot. We do talk about patient safety all the time. We do have to follow policies and procedures.”

Sometimes it’s easier to be agreeable, but in reality, we’ll never be able to choose between high-quality care and cost efficiency. You don’t get to choose. You get to do both. People want to be told, “It will be okay.” And it will be – because we’re going to work really hard to make it okay.

What’s the funnest part of being CEO?
That’s easy. I get to buzz around the organization and talk to anybody I want to. I get to go into the lab and talk to the lab about what’s going on. I get to go down to the emergency department. I always feel welcome where I go.

Most people don’t get that experience of being able to say “What’s going on back here? What are your priorities? What happens when you’re busy? What happens when you’re not busy? What do you need most?” Being able to do that, and having people share what’s going on, or when I’m the person that gets to say to a patient, “Can I help you find what you’re looking for?” – that to me is a great day.

What’s most meaningful to you about being CEO?
I truly believe in community healthcare. When you look at a strong, local community, you can feel energy around the schools, the arts, the neighborhoods, and downtown. The community with a community hospital has an extra element that makes them whole.

The great thing about community healthcare is that you become whatever your community needs. For some community delivery systems, it’s more long term care and primary care. For us, it’s a pretty broad spectrum. That’s the glorious thing about community healthcare: it’s not just about healthcare, it’s also very much about the community.

What do you hope to accomplish as KVH CEO?
Every person who’s had this job has built on the work of the person that came before them. And all of them have built towards the future, so you have to thank everyone who’s ever held this job. When I came to KVH, I looked around and realized that I was seeing problems that the industry is delivering to all hospitals right now. This was familiar territory. I was ready to start fixing the problems.

I’d like to see KVH advance down the path of our strategic plan. That means providing more access, and more engagement with the community. I want this community to be aware of the relationships we have with larger systems. We remain independent, but we get bench strength and get clinical strength from our deliberate relationships with other organizations.

What would you pack into a CEO “go bag” to get through the day? 
I would take a name tag so people knew who I was. I’d also pack a coat so I’d be sure to hit the clinics and go outside the building to touch base with other people, rather than waiting in my office for them to come to me to talk, which can take a lot of courage for some people.

I’m not someone who carries my phone with me everywhere. I don’t even carry a pad and pencil. Being single-mindedly present with whoever you’re talking with is something we’re not very good at, and it’s really rewarding.

Anything else you’d like to add?
Every community hospital is unique, but when I look at the elements in Ellensburg, it’s all there: the hospital, a strong school system, a state university, the flow of I-90, and the presence of county and city government. We are an incredibly dynamic healthcare delivery system. It’s a dynamic community. And it’s a pretty darn special place to work as a CEO. 

Tips to beat the winter blues

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KVH Contributor*
Auren O'Connell 
Auren O’Connell, DNP, PMHNP
KVH Family Medicine – Cle Elum

Beat the winter blues
Snow Covered Tree — Image by © Royalty-Free/Corbis

Winter solstice is fast approaching, and it already feels like winter across Kittitas County. December 22 will mark winter and the darkest day of 2018, as we are at the farthest point from the sun in the northern hemisphere. In the new year, we will slowly regain our light until the longest day of light during summer solstice on June 21, 2019.  

The seasons are marked by cycles of cold and heat, darkness and light. Some of us are more susceptible to these cycles, especially during the winter, when there is less light. Symptoms of seasonal affective disorder (SAD) are most common during the winter months, but can occur with any season change. “Winter blues” often refers to the symptoms of SAD, which can be decreased energy, difficulty with focus and concentration, social withdrawal, sleeping problems, and changes in appetite. Many of us will commonly experience some elements of SAD during the winter months.

All of us can benefit from a wellness plan and interventions designed to alleviate symptoms of “Winter blues.” Here are some tips to keep your mood, energy, and motivation steady during the winter:

Stay active: Exercise is vital to our brain power and mood. It is preferable to dedicate 30-minute time blocks to exercise at least three times per week, but even a 10-minute walk during lunch in the daylight can be helpful.

Get outside: There is no substitute for natural sunlight and fresh air. If you are able, try to get outside daily.

Light therapy: Light boxes can be helpful on overcast winter days, and dawn simulators can be the missing link in getting out of bed on time during dark mornings. (There are numerous consumer light therapy products on the market that may or may not be helpful, but it is vital to consult a healthcare professional if you are seeking such products for treatment of SAD or depression .)

Stay social: Try to maintain regular social engagements at least a few times each week. This may be going for a walk with a friend, attending a community event, or simply eating a meal with someone with no distractions. Whatever it is, try to keep it regular.

If you feel stuck, or when symptoms interfere with daily activities and relationships, it is vital to get help from a qualified health professional; seeking help and advice from your primary care provider is a good first step.

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

A history of GNP care

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GNP Care

Familiar ground: GNP Jean Yoder, in the main conference room at KVH’s Radio Hill Facility. The room was once a dining area for assisted living residents at Royal Vista, where Yoder made weekly rounds. (Thumbnail photo: Radio Hill exterior.)

Jean Yoder has been a local fixture in senior patient care for the past 23 years.

“I’ve always liked working with elderly people,” says Yoder, who first ventured into the world of healthcare as a young candy striper, bringing meals and other items to patients in their hospital rooms. Years later, Yoder found her calling as a Geriatric Nurse Provider (GNP), bringing medical care to patients in their homes.

Yoder’s was the first class of GNPs at the University of Washington. “We learned from them and they learned on us,” she laughs. Then, after working with geriatricians in the Seattle area, Yoder learned about a program in Ellensburg led by then-director of Home Care and Hospice Carol Detweiler.

A fellow UW GNP graduate, Detweiler’s vision was to bring medical care delivery out of the traditional patient care setting and into the community, particularly for the frail elderly. It was a vision Yoder shared. “We wanted to make care available for those who couldn’t access it,” she recalls, “whether they were physically frail, struggled with dementia, or had other issues that made it difficult to get in and out of the home for medical visits.”

Soon, the program was underway with Yoder as the sole practitioner.

Yoder’s territory included Royal Vista (a skilled nursing facility) and Kittitas Valley Health and Rehabilitation. Every week, she spent two days at each location, and was on daytime call for both. Nights and weekends were covered by patients’ primary care physicians.

From the outset, the program included a collaborative practice with physicians in the community, starting with Drs. Wise, Schmitt and Anderson in Cle Elum, later expanding to Ellensburg and physicians such as Dr. Solberg, who was struck by the increased level of care his patients were receiving under the GNP program. “He and I made monthly rounds together in the skilled nursing facilities for years,” says Yoder.

The steady presence of a GNP helped fill the care gap for patients and their physicians, whose schedules didn’t often allow for regular visits to these facilities. “We could be on-site, evaluate an individual, see where their code status was, talk to family, talk to staff, and get a plan in place to set up and provide care.”

“We were very busy,” she recalls. “With up to 65 patients in each facility, there’s a lot that goes on from one day to the next.”

Covering the community.

Soon, a second GNP was hired, and Yoder began spending a day each week seeing assisted living patients at Mountain View Meadows (now Meadows Place), and eventually Hearthstone.

“It’s not quite as intense as a skilled nursing facility,” says Yoder. “We focus on treating patients in their environment, keeping them healthy and hopefully away from the E.R.”

The GNP team worked with staff to prevent or treat conditions like urinary tract infections, pneumonias, skin tears, cellulitis, etc. With so many variables, says Yoder, “you never knew what your day would be like.”

Another major shift occurred when GNP Anna Collins entered the picture, joining forces with Yoder to divide up days and locations, increasing overall coverage. Collins took on Meadows Place, while Yoder continued at Hearthstone. “We added on Dry Creek (now Pacifica). And in the middle of all that, we started doing home visits.”

According to Yoder, GNP home visits serve those “who fall through the cracks, in the sense that they have many medical problems, but don’t qualify for the Medicare A Home Program” which covers services from KVH Home Health.

Thankfully, Medicare does allow nurse practitioners to do home visits. “It used to be called a doctor’s home visit,” explains Yoder. “We go through the physician to get a home visit, evaluate the patient and, with the patient’s permission, set up a care plan.”

Once they’ve established care with a patient in their home, GNPs make monthly visits unless a change in health brings them by sooner. “If there’s a spell of illness, or an issue like a wound needing frequent dressing changes, or someone is really fragile and needs more attention and services, we work with a physician to bring in Home Health.”

Taking on the trends.

One big change Yoder’s seen during her time as a GNP is the amount of medications taken by seniors. “It used to be that five medications was remarkable. Now, we have people on 15 or 20,” she says. “We look at the whole picture to see how it’s all working, and focus on comfort while getting rid of unnecessary medications and testing.”

Another trend Yoder sees is a faster discharge from hospitals. “Even if a patient rehabs in a skilled nursing facility, what happens once they get home?” The GNP program will soon begin making home visits after patients are discharged. “You can see when you walk into the environment, what’s working, or isn’t, and what we need to do. It involves quite a bit of detective work.”

The next chapter.

Last month, the GNP office relocated to KVH’s newly remodeled Radio Hill facility – formerly known as Royal Vista, the place where Jean first began her GNP rounds in Kittitas County.

Now that things have come full circle, Yoder is set to retire. “I’ve let go of a lot of things already,” she says, as the GNP team has grown to include practitioners Nenna Nzeocha, Marquetta Washington, and Mary Nouwens. “It’s great to have them here. They want to do this work, and they’re not frightened by the scope and intensity of it.” And while she’s ready to focus on family and home remodeling, there are things Yoder will deeply miss – especially her working relationship with Anna Collins. “We’ve enjoyed each other and we communicate well together. We worked hard!,” she laughs.

Yoder is confident that the GNP program, under the visionary direction of KVH Chief Medical Officer Dr. Kevin Martin, is positioned to continue a pattern of growth in caring for patients throughout the county. Yoder’s optimism rests on a legacy shaped by years of faithful service.

“Nurse practitioners make a difference for patients, family, and staff,” she says. “I really believe that.”

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

When wounds need help to heal

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Mary Nouwens

Long before she helped launch KVH Wound Care, Mary Nouwens grew up on a ranch. Among her favorite things to do was to help her father treat injured or sick cattle.

“I like science,” she grins, “and I believe people have a God-given bent to what they like.”

As an adult, she moved from cows to sheep when her children were small. She enjoyed treating the sheep when they needed medical attention. But once her kids were grown, Nouwens’ dreams of becoming a veterinarian shifted. “I wanted to serve people,” she says.

And off to nursing school she went.

Nouwens went on to earn a Master’s of Science in Nursing from Washington State University. She joined the provider team at Community Health of Central Washington. “It was a wonderful experience,” says Nouwens, who had no intention of leaving the clinic – until KVH moved forward with plans for a wound care service at KVH Hospital.

In August 2018, KVH Wound Care launched with Nouwens on board. She wasn’t surprised when things took off quickly and didn’t slow down: “Before this service started, the closest one was in Yakima.”

What is Wound Care?

While people treat their own superficial wounds with a bandaid and some antibacterial ointment, the treatment of chronic wounds (which take more than two weeks to heal) requires a skilled team with a focused treatment program.

“We see such a variety,” says Nouwens, including post-surgical wounds and diabetic foot ulcers. Patients visit Wound Care over a period of several weeks to months depending on outpatient treatment.

“When a wound becomes chronic, the makeup of the wound changes,” says Nouwens. “There’s an increase in white blood cells call neutrophils which try to clean up the wound and fight any bacteria that would want to colonize there. That keeps the wound in an inflammatory state.”

Often, the work of the wound care team is to take an inflamed wound back to its original condition through a clearing and cleaning process. The team then uses a variety of tools to accelerate healing. “We have so many specialized tools,” says Nouwens. “Alginates and collagens, special hydrofiber foams, wound vacs, and more.”

Each patient visit lasts about 30 minutes, giving staff time to talk with patients about managing their conditions as (for example) the patient’s dressing is changed. Wound Care stocks a variety of materials on wound care and prevention. “We try to provide education every time.”

Jim Gallagher

Beyond the bandages.

Nutrition is a frequent topic of wound care education, especially for patients dealing with complications from diseases like diabetes. “Nutrition is critical,” agrees Jim Gallagher, Director of Food & Nutrition Services at KVH Hospital. “It can reduce inflammation and also provide the necessary elements to produce new tissue for wound healing.”

Wound Care refers patients to Gallagher for nutritional services. Recently, “a patient got her dressings changed while we hung out for about half an hour and talked nutrition,” recalls Gallagher. “I want people to leave with a plan, so they know what they’re going to eat, and what they’re going to do. We pencil out a menu they can use.”

Based on individual patient needs, Gallagher often assigns more targeted therapies including certain vitamins, minerals, and amino acid supplements that can aid in healing. But for some patients there is also an underlying behavioral issue to address.

When it comes to diabetes, “some people just need to get ‘lean and mean,’” says Gallagher. “Others need to make sure they protect their feet, and take precautions to avoid wounds because they can they can be difficult to heal.”

“I’ve seen patients with Type 2 diabetes lose 40, 60, 80 pounds, and their diabetes disappeared completely,” says Gallagher. “Others had the symptoms disappear, but still needed to maintain preventative practices. Even elderly patients with Type 1 diabetes, if they eat right, stay active, and take their insulin when they should, may show very little ill effects from the disease.”

Positive changes start with attitude, believes Gallagher. “If you’re thinking about it, realizing you have a problem and you want to do something about it, that’s something we can definitely work with.”

The making of two M.A.s

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“I’d been working at Starbucks for 8 years and 3 months, and it was about 8 years and 3 months too long.”

No disrespect intended to the international coffee giant. Life just had other plans for Alisha Liedtke.

After a stint selling bamboo sheets for Costco across the continental U.S., Liedtke found herself wanting something that kept her closer to home, and to husband Drew, who at the time was getting his Master of Fine Arts from CWU.

“We’d lived in Ellensburg for three years,” Liedtke recalls, “but I’d never been part of the town.”

She was ready for a change.

Photo: Flores and Liedtke take a moment to confer in a clinic exam room.

Liedtke found a local job opening for a scribe in a clinical environment at Kittitas Valley Healthcare. She applied, and was chosen out of more than forty applicants for the position. “I thought it was an established program,” she laughs. “Turns out I was the first one.”

Soon, Liedtke found herself working alongside teammates José Diaz, April Grant, Laurie Rost, and Carrie Barr, laying the groundwork for the program now in place at KVH, where scribes serve in exam rooms alongside patients and providers, handling the computer charting during the visit.

Rightfully proud of what the team accomplished, Liedtke sees the scribe’s role as “helping the provider to focus on patients.” Now, much of the documentation work that added hours to a provider’s already long day rests in the capable hands of scribes.

Six months before Liedtke began her journey at KVH Family Medicine – Ellensburg, Flores became the newest dietary aide in Food and Nutrition Services at KVH Hospital. Unlike Liedtke, the healthcare setting was familiar to Flores. The daughter of an RN, “I’ve always worked in the medical field,” she explains. “I got my CNA (Certified Nurse Assistant) when I was 16.”

She put that degree to good use for the next 16 years, working as a residential trainer for people with disabilities, then at a nursing home.

About a year into her time in the KVH kitchen, Flores underwent surgery. While convalescing, she received a call from Chief Clinic Officer Carrie Barr, asking Flores if she’d be interested in becoming a medical assistant (MA).

It was a tough decision for Flores to make.

“I’ve always wanted to work in a doctor’s office,” she admits, “but I was thinking about my family in the hospital kitchen. I loved working with everyone there. It was comfortable, and I didn’t want to leave them hanging.”

Around the same time, Liedtke got a call of her own. She was summoned to the manager’s office for a private meeting. “I was terrified! What did I do?” she’d wondered. She then learned that KVH was about to launch another program in the clinics, this time an apprenticeship for medical assistants.

They asked me, “Are you interested?”

That one question led to some sleepless nights for Liedtke, who would be facing yet another major transition. Being an MA “is a whole different ballgame,” she says. “And I’d also be leaving a job that really nurtured me into becoming the person I was supposed to be.”

Despite their initial hesitancy, both women ultimately made the courageous decision to move forward into the exciting world of medical assistants.

Things took off quickly once the apprenticeship began. After a one-day orientation, they shadowed with their coaches (certified MAs), who roomed patients, gave immunizations and EKGs, and did documentation and data entry. “By Day 3, we felt comfortable,” recalls Liedtke. “The coaches were still there, but we were ‘driving.’”

Now that the one-year apprenticeship is drawing to a close, Flores and Liedtke both agree they made the right decision.

“I can’t believe how much I love it,” beams Liedtke. “I’m doing things now that in the past I’d only hoped for. I’m living this life I never could have imagined for myself. I get to wake up and put on PJs (scrubs) and go to work and help patients all day. It’s like the greatest job in the world!”

Flores agrees. “It’s never boring.” As a mother of two, Flores is a hit with the clinic’s pediatric patients. Other than her son Colton and daughter Dakotah, “I’ve never worked with children before,” says Flores. She quickly got past that barrier, finding ways to encourage youngsters who often aren’t thrilled about being at the clinic. “No matter how they do, with their parents’ permission, I give them a popsicle and tell them ‘Thanks for being a good kid. You’re a super hero!’”

The two women’s families are also thrilled, with both mothers aspiring even more for their girls. “My mom thinks I should become an RN,” says Flores, who loves her work as an MA and is content to continue in that role. Young Dakotah feels the same way: “‘It’s more of a mom job you’re doing now,’” she recently told Flores. “’I can say I’m proud of you.’” That, along with the clinic’s family-friendly schedule, is as much of a reward as Flores could ever want.

In the same selfless way that they care for their patients, Flores and Liedtke encourage others to join them in considering an apprenticeship. “If you love the idea of patient care, it’s absolutely the way to go,” says Liedtke. And while program graduates agree to stay with KVH for at least one year, both women find the idea of working elsewhere amusing.

Says Liedtke, “I’m never leaving this place.” Flores nods and smiles gently, “I’d say we’re spoiled.”

Surely, these remarkable ladies’ shared passion for patient care somehow makes us all a little better.

The truth about vaping

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Contributor: Dr. Elise Herman, KVH Pediatrics

Vaping

As parents, we are vigilant about so many things- alcohol, drug use, Internet and technology issues. Here’s one more, and one that can fly under the parental radar. Vaping (using an electronic cigarette to inhale a vapor usually containing nicotine) is increasingly common among youth and has become very popular over the last 5 years. 

Currently, more high school students use e-cigarettes then standard cigarettes. Although often touted as helping smokers quit, there is no evidence to support this, and when used by non-smokers, vaping may lead to nicotine addiction. In fact, youth who vape are more likely to use cigarettes or other tobacco products.

E-cigarette liquid typically includes nicotine (although not always), chemicals to vaporize the liquid (like propylene glycol) additives and flavoring. There are also other potentially harmful ingredients, including ultrafine particles that can be inhaled deep into the lungs, formaldehyde, heavy metals (lead, tin, nickel) and flavorants such as diacetyl, a chemical associated with serious lung disease.

Of course nicotine is the biggest concern with vaping because it is clearly a habit-forming drug that has harmful effects on the heart, lungs, kidneys and more.  Immediate effects include increased blood pressure, heart rate and breathing. It is a stimulant so gives the user a surge of adrenaline as well as dopamine, a brain chemical that affects sensations of pleasure and pain. This increased dopamine makes people feel more contented—easy to see how this could become addictive! Additionally, there is a lot of research showing that nicotine causes cancer.

As e-cigarettes do not actually contain tobacco, use of these has been largely unregulated in the US, but this is changing. Some cities have banned their use wherever smoking is prohibited, and other regulations are in the works. States differ in term of who may buy e-cigarettes. In Washington state, the sale of these devices is prohibited to people age 18 and younger.  Online sites, however, may not ask for proof of age. The use of vapor products is prohibited in schools, on playgrounds, on elevators, etc. in our state as well.

Youth frequently favor an e-cigarette is called “JUUL” (pronounced “jewel”). It is popular because it has sleek, small packaging that resembles a flash drive, all the better to easily carry and use.  Easy to hide in a pocket, easy to use even in a school classroom. It is appealing due to its kid-friendly flavors such as mango and mint.  JUUL is very addictive as it contains twice the concentration of nicotine of other ‘e-cigs’. Each  JUUL pod contains the same amount of nicotine as an entire pack of cigarettes. Because of its ease of use, it is increasingly common on high school and college campuses, and users often share with peers, encouraging non-users to try it. Like JUUL, other e-cigarettes may look like household items- an asthma inhaler, a car key fob, a pen.

In terms of having a conversation with your child about vaping, it is good to approach the subject non-judgmentally and not to lecture.  The topic might come up more naturally if it is response to seeing someone vaping or passing an e-cigarette shop. Acknowledge that you realize it is common, often due to the mistaken idea that it is risk free. Remind your child that his/her brain is still developing and that no tobacco product or nicotine is safe. There is a real risk for people who vape to also use tobacco products. If you do use tobacco yourself, being upfront about the health risks to you and the challenge of quitting is important. Emphasize that you do not want your child to face the same problem.

More information including a tip sheet for parents is available at the websites for the U.S Surgeon General and the American Academy of Pediatrics.

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Grilled Fajita Medley

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Fajitas are a staple in our household for an easy week-night dinner. Grilled fajitas take on a whole new twist! Summer is great for throwing things on the grill and having your meal quickly without heating up your house. Try this recipe tonight!

 Grilled Fajita Medley

Grilled Fajita Medley


Ingredients:
•4 steaks of choice (we used porterhouse and bottom round steaks)
•3 green bell peppers
•4 jalapenos
•8-10 large carrots, cut in half
•2 small red onions
•1 lb of mushrooms
•2 tbs chili powder
•2 tsp cumin
•2 tsp smoked paprika
•2 tsp garlic powder
•1 tsp onion powder
•Salt and pepper to taste
•1 lime, juiced
•1 tbs olive or avocado oil


Directions:
In a small mixing bowl, combine together your seasonings, lime juice, and oil. Mix well! In a large mixing bowl or Ziploc bag, combine your veggies and pour your seasoning mixture into the bag and make sure to coat well. Set aside and prepare your steaks. If you like a lot of flavor, use the same seasonings as your veggies! Looking for something a bit more simple? Season with salt and pepper to taste.
Preheat your grill to medium heat. Once ready, place your veggies (it’s best to put the mushrooms on a skewer) and steaks onto the grill. Flip your vegetable after about 5 mins as well as your steaks. If more time is needed, flip again until you have grill marks on both side and your steak is cooked to desired doneness.
Enjoy for the week with burrito bowl lunches or serve this up for a big family dinner!