My child is in hospital – what are family-centered rounds and how can I make the most of them?

family centered roundsRounds are the discussions that happen every day between the medical staff and parents of a child at TMC for Children, about the child’s progress and plan of care. The family-centered rounds take place in the patient’s room and include the family and patient as a critical part of the health team.

“Parents know their children and know how they’re going to react to new situations. The physicians and medical staff know what the evidence-based care is appropriate for the child. Working together in family-centered rounds, parents and medical staff can develop a plan of care that is best for the child.” said Jordan Richardson, child life specialist. “When parents take an active role in the family-centered rounds, they feel more involved. It improves communication and outcomes when everyone is on the same page.”

What can parents do to capitalize on family-centered rounds?

Be present on rounds

Try to be at the rounds. We know that it can be difficult to be there, and particularly if you don’t have flexibility in work schedules. At TMC, rounds on the pediatric unit occur from 9 a.m. – noon every day. The order and the time of rounds is dependent upon how sick patients are and varies from day to day as acuity often changes.

Participate!

Listen on rounds. Ask questions about things you don’t understand. Don’t hesitate to speak up on rounds.

Know that longer conversations may have to happen later

Our staff spends time with each patient, but needs to see everybody by the end of the morning. Once the hospitalist sees all of the patients and develop plans to move everyone’s care forward, he or she can return in the afternoon to have more in-depth discussions.

Write your questions down on a piece of paper

If you think of questions after the doctor leaves, or in the middle of the night, write down the question on a piece of paper or on the whiteboard in the room.   “We will be happy to answer them on rounds in the morning.” Richardson says.

medical students

Be part of shaping doctors of the future

The attending physician often is working with physicians in training and medical students. The attending physician will allow the trainees to present your child in a formal format and then may do some quick bedside teaching.   The teaching is for you as well! Please listen in and participate. This is how we all learn.   Don’t be surprised if you find that you have something to teach our trainees; our families often have valuable insight.

Just with every team, everybody brings different strengths. You, as a parent are a key team player on family-centered rounds.   Do not hesitate to ask questions and express your concerns.   Our goal is to provide high-quality, effective care for your child while in the hospital, and the best way we can do that is with your involvement.

 

 

When your child is diagnosed with Type 1 diabetes

type one diabetes diagnosed

“Our biggest goal in properly managing diabetes is to help the patient and family achieve a lifetime of good health.”

Dr. Priti and Chetanbabu M. Patel, TMCOne pediatric endocrinolgists

If your child has received a Type 1 diabetes diagnosis you may be feeling overwhelmed. While the condition develops gradually, the symptoms can seem to appear overnight.

Symptoms of Type 1 diabetes

  • Excessive thirst
  • Hunger or loss of appetite
  • Dry skin
  • Blurry vision
  • Numbness
  • Fruity breath
  • Excessive urination
  • Weight loss
  • Excessive sleeping
  • Irritability
  • Weakness
  • Delays in wound repair or infection control
  • Nausea and vomiting

Not all children will present with the same signs and symptoms. Some children may present with few or none of the above symptoms and some children may present with many.

Is there a cure for Type 1 diabetes?

While there isn’t a cure yet, the past decade and specifically since about 2014, leading-edge technology is helping the diabetes community.

Today some insulin pumps are capable of making micro adjustments to help the patient curb hyperglycemia (low blood sugar) and can turn off the insulin supply if the patient is experiencing hypoglycemia.

Continuous glucose monitors allow patients and families to glance at a screen at any moment to see glucose levels in real time. These advancements are without a doubt life-changing.

However, we still have not discovered the elusive cure. Until that time, it is imperative children with diabetes and their families feel supported and confident in their ability to control blood glucose levels. Please remember people with diabetes do incredible things every day. There are actors, Olympians, scientists and neurosurgeons with diabetes. People with diabetes can live long, productive and healthy lives!

Why is it so important that my child learns to manage Type 1 diabetes?

“We know that if we can help get the glucose (sugar) levels down in the first 5 years, those children will have a smaller number of complications than children who were not able to properly manage their diabetes,” said Dr. Patel. “The three main complications we try to prevent as an adult or older teenager are eye disease, kidney disease and nerve disease.”

Type 1 diabetes is a life-long condition with life-threatening implications if not under control. We know the habits children develop at an early age can stay with them for a lifetime. If children remain supported and encouraged to care for themselves early on, they can develop positive coping skills which can help keep them healthy and happy into adulthood.

What does it mean to ‘manage’ diabetes?

When people with Type 1 diabetes eat carbohydrates–whether whole wheat bread, pasta, fruit or candy–they must inject insulin into their body to help their body move the glucose out of the blood stream and into the cells. You must figure out just how much insulin to inject based upon the amount of carbohydrates consumed. As children’s bodies are constantly growing their insulin needs increase making this adjustment an ever changing target.

Learning how to count carbohydrates at every meal can be demanding for a family. Even families with the best routine can easily forget to cover carbohydrates at a busy family event or on a long road trip. The reality of it is that sometimes life gets in the way. Learning to plan, cope, organize and forgive yourself are some of the best tools for any new Type 1 diabetes family.

The child’s pediatric endocrinology team can be a support system to help the family understand how to safely manage changes in insulin requirements.

What should I do if I think my child may have Type 1 diabetes?

As noted earlier, some children present with few or none of the symptoms listed above, and some children may present with many.

Remember, children go through growth spurts and might ask for more water, might sleep a little more or might be constantly hungry. These symptoms might seem normal, but they could also be clues to a potential diabetes diagnosis.

If you’re concerned, don’t delay. Ask your child’s primary care provider for a glucose test. Depending on the result, the PCP may order additional tests, may start your child on insulin or have your child admitted to the hospital for close monitoring.

Don’t doubt your parental gut feeling! Untreated diabetes can escalate quickly to critical diagnoses like diabetes ketoacidosis or coma. If your child DOES have diabetes, TMC and TMCOne can form a team to help support your child to learn to care for this manageable chronic condition.

You can find the TMCOne pediatric endocrinologist contact information here.

Mission Moments: Inspired by a 6 year old to first assume good intentions

Family of four standing in front of a bay

The call was enough to make a parent’s heart drop: Come to the school now. Your daughter may have to go to the Emergency Department.

Sanjay Timbadia, Tucson Medical Center’s Laboratory manager, rushed to school to find his first-grade daughter’s head bandaged with blood in her hair and on her dress.

A child had been throwing rocks on the playground and one of them had struck his daughter in the head while she played on the monkey bars. There wasn’t any malice: It was just an accident.

It was later, after she had been treated at the TMC Pediatric Emergency Department, that the little girl said something that was a poignant reminder for her father.

“That boy that threw the rock: I think he was just trying to get it out of the playground so that no one would trip on it,” she said.

It was a moment for pride and reflection, Timbadia said, and he shared the story with his team as they entered the holiday season.

“She has reminded us of an amazing lesson: to always assume positive intent first,” Timbadia said.

The lesson can be applied in the lab, which is a busy place that processes more than 2 million tests every year. It can also just as importantly be applied in everyday life as a balm against the divisions that can cause cultural and political divides – and it’s even stronger when peppered with gratitude, he noted.

“If I’m delayed because I’m in traffic or if I get a flat tire, I just try to remember that at least I have a car to take me places because there are many others who are waiting for a bus in the summer heat,” Timbadia said. “And if someone gets in front of me and drives slowly, you never know: Maybe that person just prevented me from getting into an accident.

“I think like anything else, assuming positive intent and being grateful is something we learn, and it’s also something that gets stronger with practice. At TMC, we are committed to being here to make things better for our patients and our community when they need us – and we approach that work with positive intent.”

Tucson Medical Center earlier this year adopted a new mission statement. To celebrate, we will share an ongoing series of “mission moments.”

What are mission moments? They aren’t necessarily dramatic stories of heroism, although our medical staff saves lives every day. These are moments that breathe life into words – moments that are profound or powerful or touching and that remind us why we do the work we do. Hundreds of these reminders happen every day. Thank you for letting us share some with you.

Do you have a TMC mission moment you’d like to share? Send it to Communications@tmcaz.com.

UFC champion Frank Shamrock visits TMC for Children patients

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Frank ‘The Legend’ Shamrock, retired four-time undefeated UFC Middleweight (Light Heavyweight) Champion, met with patients and families at TMC for Children as part of a Southern Arizona visit.

He arrived around noon and went from room-to-room visiting patients and their families who were delighted to see him.

Shamrock will make several appearances in Sierra Vista over the weekend.

TMC One’s new nurse practitioner ready to partner with you and your family

Maria

Maria “Maricruz” Bustamante 
Family Nurse Practitioner
TMC One

Maria “Maricruz” Bustamante is a board-certified family nurse practitioner with TMC One who is ready to provide compassionate health care for you and your entire family during every phase of life. Bustamante partners with her patients of all ages to help them achieve health and well-being with a focus on disease prevention. She blends her expertise and passion about fitness, nutrition and wellness coaching to help her patients achieve their goals, whether they be weight loss, increasing strength, reducing or eliminating medication, managing chronic health concerns, or decreasing pain.

Bustamante is also fluent in Spanish.

▪ What is your background?

I am a registered nurse with more than 12 years of intensive care experience. I have worked at all the local ICUs in town throughout my career. I decided to further my education in hopes of preventing patients from being admitted to the ICU from things like a high blood pressure crisis and diabetes complications.

▪ What inspired you to go into primary care?

I am a firm believer that health care starts in the home. I enjoy empowering parents to lead the way for their children in the hope that good health will be passed from one generation to another. I want to care for the whole family. Knowing and understanding the dynamics of an entire family allows me to better tailor the care plan for the family as a unit.

▪ What made you want to practice in Tucson?

I was raised here, so Tucson is and always will be a special place for me. I understand the culture and I see the need for people to do better for themselves. It is my sincere hope to help them make that happen by focusing on health care as wellness, not disease management.

▪ What do you think is the biggest health risk facing Southern Arizonans?

I believe the biggest health risk facing Southern Arizonans is obesity. In most cases, obesity is preventable. I strongly believe that if we educate our patients and empower them to take control of their well-being, many diseases can be prevented.

▪ Do you have any areas both in your practice and outside of work that are of particular interest to you?

In primary care, I love caring for the entire spectrum from newborns to the elderly. I especially enjoy pediatrics and women’s health, as well as helping patients manage their diabetes. When I’m not working, you’ll likely find me outside hiking and enjoying nature. For indoor activities, I love breaking a sweat with Zumba classes and really experience the health benefits of yoga.

▪ Why is it important for people to get established with a primary care provider before they get sick?

It is so important for people to get established with a primary care provider before they get sick because many specialty care needs can be prevented. I strive to help my patients and their families with disease prevention. I approach every patient holistically and team with them to best meet their health care needs. Being under the supervision of a primary care provider can also help in coordinating care for those times when specialty care is needed.

▪ What has been your most valuable life experience that has impacted your medical career?

My most valuable life experience that has impacted my medical career has been my time as an ICU nurse. It taught me not to take life for granted and showed me how quickly our loved ones can be taken from this earth.

▪ How do you approach your relationship with your patients?

I approach my relationship with my patients as a partnership. I love empowering them to take control of their health and will be there for them along the way, acting like their biggest cheerleader and guide.

Maricruz Bustamante is located at TMC One, 5295 E. Knight Dr., right across from TMC.
She is accepting new patients! Call (520) 324-1010 to make an appointment.

Phoenix Children’s now providing pediatric intensive care, hospitalist coverage for TMC for Children

TMC for Children patient careTucson Arizona, June 8 — Phoenix Children’s Hospital, one of the largest children’s hospitals in the country with a staff of nearly 1,000 pediatric specialists working across more than 75 pediatric subspecialties, has assumed coverage for intensive care and hospitalist services for TMC for Children. The transition, which began on June 3, was a smooth handoff from the long-standing service by University Physicians Healthcare.

“Not only does this relationship ensure stable, predictableTMC for Children 4C coverage, but Phoenix Children’s has a
philosophy that fits very well with our patient-centered approach,” said Brooke Casebolt, a registered nurse and the director of patient care services at TMC for Children. “Phoenix Children’s emphasizes daily rounds and family engagement in its approach, and has a clear understanding of the need to draw from multiple disciplines in providing the best care for the children and families we serve.

PCH_hospital_stk_PMS 2New to Tucson are several members of the Phoenix Children’s staff, who are based in this community and call TMC their hospital home. They include, Dr. Heather Hanley, medical director for the pediatric intensive care unit and Dr. Kevin Carter, medical director for pediatric hospitalists.

“While Phoenix Children’s shares our philosophy that care provided closest to home is preferable whenever possible,  this relationship will allow TMC to explore new opportunities to further build the pediatrics program,” said TMC Chief Medical Officer Rick Anderson, noting Phoenix Children’s will augment specialty services where gaps might exist.

Phoenix Children’s joins a team of other long-standing pediatric providers on campus, with Pediatrix TCPS Logoproviding medical coverage to TMC’s newborn intensive care unit. Pediatric specialty coverage is provided by Tucson Community Pediatric Specialists, a community-based, accessible and a valuable part of the TMC for Children care team. Tucson Community Pediatric Specialists include physicians who specialize in anesthesiology, cardiology, dermatology, emergency medicine, ENT, neonatology, neurology, ophthalmology, oral surgery/dentistry, orthopedics, plastic surgery, pulmonology, radiology, surgery and urology.

Big honors for TMC speech/language pathologist Brenda Abbey

Congratulations to TMC’s pediatric outpatient speech/language pathologist Brenda Abbey! Abbey is one of 17 professionals who have been chosen as Inside Tucson Business’ 2014 Up & Comers. The publication honors professionals who are likely to achieve positions of leadership or high standing in their organizations, industries or communities. Similarly, their accomplishments, leadership and service are likely to have a significant positive effect on their organization, industry or community during the remainder of their career.

Abbey is being honored in the bio tech/medicine/healthcare category.

TMC speech/language pathologist Brenda Abbey with the Debbault triplets: Victoria, Sophia & Cecelia

TMC speech/language pathologist Brenda Abbey with the Debbault triplets:
Victoria, Sophia & Cecelia

Abbey starting working as a speech/language pathologist at TMC in June 2006 after receiving her master’s degree from the University of Arizona Speech and Hearing Sciences program. She is a lead speech/language pathologist for pediatric inpatient care, including diagnosis and treatment for premature infants, children in the newborn and pediatric ICUs, and the regular inpatient pediatric unit. She also provides evaluation and treatment of infants through school-aged children for a variety of feeding and communication disorders. “Brenda’s expertise is in educating families and making them the center of the family interdisciplinary team,” said Mary Lou Fragomeni, TMC manager of outpatient therapies and audiology.

Abbey’s latest accomplishment is the development of a newborn ICU follow-up clinic that is unique to our community. The NICU After Care program is based on her research, and addresses a specific need for Southern Arizona’s most vulnerable newborns. Abbey coordinated with TMC’s developmental specialist Julie Seidl and the TMC Foundation to secure funding from Children’s Miracle Network.

Abbey also mentors new graduates in speech/language pathology during their introductory year, leads training for all new therapists into the NICU, and has chaired Junior League philanthropic projects. In addition, Abbey was selected as a fellow in 2013 for the first class of Arizona Leadership in Neurodevelopmental and Other Related Disorders, for future leaders in pediatric health care.

Abbey, along with the other nominees, will be honored during a ceremony on April 10.

Congratulations, Brenda!

Thanks and a tip of the hat to Tucson’s Lioness Club

6-year-old Lynnea Foy shows off her new, colorful surgical hat

6-year-old Lynnea Foy shows off her new, colorful surgical hat

A supersized thank you to the Lioness Club for the time, effort and money they spent on making our school-age patients colorful surgical hats!  The ladies brought more than two-dozen handmade hats to TMC for Children, and proudly handed them over to TMC Child Life Specialist Amy Rothenberg, who works in ambulatory surgery and the PICU.

“When the ladies came to TMC to deliver the hats, they told us each hat is a work of love, and they do it because it helps make the children happy,” said Rothenberg.  “These hats add to the child-friendly environment at TMC.  Children usually put on blue disposable hats before going into surgery so that their hair is out of their face in a sterile operating room.  The children light up when they learn about the colorful ones, and since they can pick which design they want, it gives them a little control in what can be a frightening situation.”

Inside TMC’s new Orthopaedic and Surgical tower, pediatric patients have a colorful waiting room, child-friendly private pre-op rooms, and even their own post-anesthesia care unit.

TMC Child Life Specialist Amy Rothenberg accepts handmade surgical hats and cloth dolls from members of the Lioness Club

TMC Child Life Specialist Amy Rothenberg accepts handmade surgical hats and cloth dolls from members of the Lioness Club

The Lioness Club also donates cloth dolls which are used by Child Life Specialists to help explain medical procedures to young children.

From all of us here at TMC, thank you for your help in creating a welcoming enviornment for little ones from throughout Southern Arizona!

Block by Block Miracles Happen as TMC zeroes in on raising final $1 million

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By M. Scot Skinner

TMC for Children, fully operational since June, is like a brand-new car in your garage. It’s sleek, clean and jammed with advanced technology and life-saving features. But it’s not really yours until you make the last payment.

The colorful pediatric unit is humming along nicely, tending to the needs of infants, toddlers, teens and their families. But Tucson Medical Center won’t have a clear title until it raises another million bucks.

The capital campaign, which kicked off in November 2009 with a $12.5 million goal, has already raised more than $11 million.

The last million will be somewhat easier to raise than the first million, said Kim Bourn, who chairs the pediatric campaign, dubbed Block by Block, Miracles Happen!

“Now that people can actually see and touch what we’ve established for the community, I think it’s a little more tangible,” she said. “They get it. It’s like when you take out a bank loan. The Foundation has to pay that money back.”

It’s been an intense, all-consuming effort, said Michael J. Duran, chief development officer for the TMC Foundation.

“Raising money for this pediatric expansion has been a singular focus of the foundation since 2009,” said Duran. “We started with new constructions — about 16,000 square feet — and then we went back and renovated the existing unit.”

The result is a cheerful, welcoming place, he said. And TMC for Children is not just for children, of course. Great attention has been paid to the needs of parents and siblings of the young patients, not to mention the needs of all those adults who work in pediatric care.

Although some of us see children as short, adorable versions of adults, pediatric medical care is not akin to grown-up care downsized. Are the needs of a 60-pound child really that much different than a 120-pound adult? Cut the medical recipe in half and you’re good to go, right?

Dr. Moira Richards, TMC’s medical director for children’s services, is too polite to laugh at such nonsense. Instead, she takes her time explaining just how specialized the practice of pediatric medicine has become, and why pediatrics “frankly deserves its own unit.”

“Medically speaking a child is not just a small adult and treatment options can be entirely different for kids than adults,” she said. “Children, for example, respond differently to chemotherapy. The way the liver reacts to medication is different.

“And there’s the fact that the patient is a changing person. What are we going to do that might change the growth and development of an infant or child?”

The pediatric team members are always mindful that they are treating a future adult, said  Richards, who specializes in premature and sick newborns.

The new facilities allow TMC staff to address what Richards calls “the psychosocial needs of growing beings.”

“In young children, play is so important,” she said. “So our specialists work with medical play, which helps explain what it means to have a tube in your stomach. The new facilities give us more room for this sort of thing.”

Because child siblings face their own kind of stress, including fears that they might get really sick, too, TMC for Children makes sure that there are games to play, movies to watch and books to read. The playground, naturally, is state-of-the-art.

“There’s a library with a big reading tree, and the tree is a big hit,” said Bourn. “TMC for Children is a happy place for the families. It’s clean, it’s fun.”

All of the 44 patient rooms are private, and that’s no small thing, she added.

“Health care is a very personal matter and you don’t want people to hear all about your diagnoses and treatments through a curtain and then know that they can tell whoever they want.”

Bourn said she got involved in TMC’s fundraising because her family is passionate about community health care. “It was a no-brainer,” she said.

“Michael Duran recruited me to help lead this effort specifically because all three of our children were born at TMC. Our first we had difficulty with because he was premature.”

The successful campaign was a team effort from the outset, Bourn said.

“Duran’s leadership and his crew at the foundation are just stellar, and we have our volunteer leadership committee as well. It’s not like there were just one or two people. It took a village.”

And Southern Arizonans stepped up to the plate in a big way, said Duran.

“We have been so impressed and humbled by the community’s response,” he said. “We received donations large and small from a really diverse cross-section of the community.”

The TMC family came through, as well.

“The commitment of the TMC staff was just phenomenal,” said Bourn. “You had nurses, anesthesiologists, doctors and other staff holding fundraisers of their own. It illustrates how much these folks who work with children wanted to have something new, that was state of the art, that would serve not only the needs of families and children, but also the needs of the staff.”

But the fund-raising drive is not done yet. If you’d like to help put the last block in the Block by Block campaign, make a donation at TMC Foundation.

M. Scot Skinner, an Arizona native, is an award-winning reporter with more than 25 years of experience in daily journalism. After a long career at the Arizona Daily Star, he is now working for Tucson Medical Center as a freelance writer. He can be reached at mscotskinner@gmail.com.


Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461