Becker's Hospital Review

31 WOMEN'S LEADERSHIP 31 CEO / STRATEGY Rhode Island hospital CEO removed after no-confidence vote By Ayla Ellison T he interim CEO of Eleanor Slater Hospital, a state-run psychiatric hospital in Cran- ston, R.I., has been removed after a no-confidence vote by nurses and amid an in- vestigation into the facility by the state's attorney general, The Providence Journal reported April 13. Jennifer White is no longer interim CEO of the hospital, a spokesperson for the state's De- partment of Behavioral Healthcare, Developmental Disabilities and Hospitals confirmed to the Journal. She had served as interim CEO since June 2020. Though Ms. White is no lon- ger leading the hospital, she is still the CFO "assigned" to the agency that runs the facility, according to the report. e move comes aer Ms. White and three other top executives at Eleanor Slater Hospital re- ceived a no-confidence vote from members of the local unit of United Nurses and Allied Profes- sionals. e vote also applied to the hospital's chief of medical services, CMO and chief nursing officer. At the time of the vote, two state lawmakers were calling for the "immediate dismissal" of An- drew Stone, MD, the hospital's chief of medical services. State Sen. Jessica de la Cruz and state Rep. David Place claim several physicians have resigned from the hospital rather than comply with Dr. Stone's directives. Rhode Island Attorney General Peter Neronha's office also launched an investigation into prob- lems at the hospital. "We're very concerned about patient care," Mr. Neronha told WPRI. As of April, his office was still gathering information about the hospital's operations and said it planned to share informa- tion with the public in the future, according to the report. n • In patients undergoing hemorrhoidectomy, a total of 266 mg (20 mL ) of EXPAREL was diluted with 10 mL of saline, for a total of 30 mL, divided into six 5 mL aliquots, injected by visualizing the anal sphincter as a clock face and slowly infiltrating one aliquot to each of the even numbers to produce a field block. Local Analgesia via Infiltration Dosing in Pediatric Patients The recommended dose of EXPAREL for single-dose infiltration in pediatric patients, aged 6 to less than 17 years, is 4 mg/kg (up to a maximum of 266 mg), and is based upon two studies of pediatric patients undergoing either spine surgery or cardiac surgery. Regional Analgesia via Interscalene Brachial Plexus Nerve Block Dosing in Adults The recommended dose of EXPAREL for interscalene brachial plexus nerve block in adults is 133 mg (10 mL), and is based upon one study of patients undergoing either total shoulder arthroplasty or rotator cuff repair. Compatibility Considerations Admixing EXPAREL with drugs other than bupivacaine HCl prior to administration is not recommended. • Non-bupivacaine based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. • Bupivacaine HCl administered together with EXPAREL may impact the pharmacokinetic and/or physicochemical properties of EXPAREL, and this effect is concentration dependent. Therefore, bupivacaine HCl and EXPAREL may be administered simultaneously in the same syringe, and bupivacaine HCl may be injected immediately before EXPAREL as long as the ratio of the milligram dose of bupivacaine HCl solution to EXPAREL does not exceed 1:2. The toxic effects of these drugs are additive and their administration should be used with caution including monitoring for neurologic and cardiovascular effects related to local anesthetic systemic toxicity. • When a topical antiseptic such as povidone iodine (e.g., Betadine ® ) is applied, the site should be allowed to dry before EXPAREL is administered into the surgical site. EXPAREL should not be allowed to come into contact with antiseptics such as povidone iodine in solution. Studies conducted with EXPAREL demonstrated that the most common implantable materials (polypropylene, PTFE, silicone, stainless steel, and titanium) are not affected by the presence of EXPAREL any more than they are by saline. None of the materials studied had an adverse effect on EXPAREL. Non-Interchangeability with Other Formulations of Bupivacaine Different formulations of bupivacaine are not bioequivalent even if the milligram dosage is the same. Therefore, it is not possible to convert dosing from any other formulations of bupivacaine to EXPAREL and vice versa. Liposomal encapsulation or incorporation in a lipid complex can substantially affect a drug's functional properties relative to those of the unencapsulated or nonlipid-associated drug. In addition, different liposomal or lipid-complexed products with a common active ingredient may vary from one another in the chemical composition and physical form of the lipid component. Such differences may affect functional properties of these drug products. Do not substitute. CLINICAL PHARMACOLOGY Pharmacokinetics Administration of EXPAREL results in significant systemic plasma levels of bupivacaine which can persist for 96 hours after local infiltration and 120 hours after interscalene brachial plexus nerve block. In general, peripheral nerve blocks have shown systemic plasma levels of bupivacaine for extended duration when compared to local infiltration. Systemic plasma levels of bupivacaine following administration of EXPAREL are not correlated with local efficacy. PATIENT COUNSELING Inform patients that use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly. Advise patients or caregivers to seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue. Pacira Pharmaceuticals, Inc. San Diego, CA 92121 USA Patent Numbers: 6,132,766 5,891,467 5,766,627 8,182,835 Trademark of Pacira Pharmaceuticals, Inc. For additional information call 1-855-RX-EXPAREL (1-855-793-9727) Rx only March 2021 EXPAREL_Brief Summary Peds sNDA 210126_r1.indd 2 EXPAREL_Brief Summary Peds sNDA 210126_r1.indd 2 3/24/21 07:44 3/24/21 07:44 What hospital leaders can learn from 175,000 patient comments By Hannah Mitchell T here are only a few different themes that characterize a positive patient ex- perience, yet there are various missteps that can cause patient dissatisfac- tion, according to an April 2 study cited by Harvard Business Review. The study was conducted by Press Ganey, a healthcare organization known for its patient satisfaction surveys. Press Ganey analyzed 175,334 patient com- ments collected through surveys at surgical units in a major teaching hospital between November 2018 and March 2020. Positive comments were similar, with the most common positive comment among happy patients being a sense of courtesy and respect. Negative comments varied, with the most common sources of unhappiness being long wait times, noise complaints and chaos with the discharge process. The data suggest hospitals will need to be vigilant in tracking the source of unhappiness in their patients. To find sources of unhappiness in patients, the authors suggest using a mix of structured and more open-ended questions. For example, hospitals may ask patients to rate its cleanliness on a scale of one to five. Adding a com- ment section can allow hospitals to pinpoint specific issues like soiled bed lin- ens or gowns. n

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