Outstepping Your Colleagues

Liz Harrell is determined to outstep her rival who bears the same first name Lizzie Gutierrez. Since Irwin Army Community Hospital launched an internal Performance Triad challenge in October that happened only once.

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Staff from the OB/GYN clinic at Irwin Army Community Hospital can sometimes be seen taking walks around the hospital during lunch. As part of the Performance Triad challenge, they each strive to reach 10,000 steps per day.

“I ran three miles in the morning and walked up a hill during lunch. It felt good to beat Lizzie,” Harrell said. “And that’s probably the only way I can outstep her.”

Both Harrell and Gutierrez are staff nurses in the OB/GYN Clinic at Irwin Army Community Hospital. Their friendly competition grew into a movement within the clinic’s staff who wanted in on the excitement. By November the count had grown to 13 participants.

Although it was occasioned by an inner hospital program, what made the rivalry possible was the distribution of a wearable activity tracker. The device tracks the wearer’s activity, exercise, nutrition (when the wearer manually inputs the data) and sleep. Users can sync or upload their stats to an online site to let friends see how well they are doing at a given time.

“Our goal throughout this challenge has been to encourage our hospital staff to learn more about the Performance Triad and experience the positive effects from it,” said Lt. Col. Amanda Forristal, Deputy Commander for Surgical Services. “As medical personnel we often advise patients to be active, eat healthy and get more sleep. What better way is there to educate patients than by exemplifying?”

The Performance Triad is an Army Medicine campaign designed to improve readiness and resilience among Soldiers. But program has spread to civilian staff and families who value health and optimal performance. It focuses on three core principles: sleep, activity and nutrition. A hospital committee designated the months of October, November and December respectively for each core event. Depending on the month, classes were provided to educate staff on the intricacies of sleep, activity or nutrition.

Anecdotal evidence suggests that the program had a slow start in gaining traction among staff but became more popular by mid November, said Forristal.

“More people started asking questions about the events we had listed. They asked if we would offer makeup classes on sleep or if more wearable activity trackers would be available,” she said.

Based on the popularity of the program the committee launched a second edition starting in February. New events for each month have been such as drinking the right amount of water for seven days, eating a meal that one would typically skip, or maintaining consistent sleep and wake times.

This second edition will give clinicians like Harrell and Gutierrez another opportunity to compete for the greatest number of steps.

Harrell was already active before the hospital launched the Performance Triad initiative.

But using a wearable device helped quantify her activity throughout the day. Syncing her steps online gave it a social component. An app allows Harrell and others to view each other steps, feeding a healthy competitiveness among staff with similar responsibilities in the same work environment.

It takes about 10,000 steps for the average person to log about five miles. At that point the device tingles to congratulate the wearer.

“It sounds like a lot but you can cover that distance in the course of an average day without even trying, especially if you have stairs like here in the hospital,” Gutierrez said. “Or a long hallway to walk up and down. Every little bit helps.”

Sometimes Gutierrez and Harrell corral the clinic staff during lunch to walk with them around the hospital building. It has the effect of getting those extra steps needed to reach one’s daily goal.

But in Gutierrez and Harrell’s world, getting from point A to point B has turned into a competition for who can lengthen the distance.

Harrell said it isn’t easy keeping up with Gutierrez who tends to achieve 7k steps before 9 a.m. But that’s a good thing.

“She keeps me on my toes,” Harrell said.


January is Cervical Cancer Awareness Month

Kaya Sparks receives her first dose of the human papillomavirus vaccine. Young adults and children 9-26 years old can protect themselves from HPV related cancers with the HPV vaccine.

No woman should die of cervical cancer according to the Centers for Disease Control and Prevention. Cervical cancer, which is caused by the human papillomavirus or HPV, remains the most preventable cancer in women who have regular screening tests to include yearly well woman exams and Pap tests, said Ramona Derousseau, IACH Well Woman Clinic nurse practitioner.

The Pap test looks for precancers, which are cell changes on the cervix that might become cancerous if not treated. Women should get Pap tests regularly starting at age 21. Routine screening is recommended every three years for women 21-65 years who have a normal Pap test with a negative HPV test according to the CDC. Women who are 30 years and older with an unclear Pap test are also tested for HPV.

Women of all ages should also have yearly well woman exams for their reproductive health care needs, Derousseau said.

“I recommend all women have yearly well woman exams because a Pap test doesn’t tell us if the ovaries are normal size or if there are any changes to the uterus,” she said.

The well woman exam includes a breast and pelvic examination, a Pap test if needed, a review of labs and medications, a review of family history and testing for sexually transmitted diseases.

If a Pap test comes back abnormal or if a woman is diagnosed positive for HPV, it does not mean cervical cancer is present, according to the CDC. HPV can cause normal cells on the cervix to turn abnormal. Over many years, abnormal cells can turn into cancer if they are not found or treated.

“I tell women it only takes one encounter to get HPV and once you are exposed it stays in your body. Your body takes up to two years or more to suppress the virus. We monitor it to make sure it stays suppressed,” Derousseau said.

Young adults and youth may also protect themselves from HPV related cancers with the HPV vaccine.

The CDC recommends youth begin all three doses of the HPV vaccine at age 11 or 12, the vaccine is most effective when all does are received before a person has their first sexual encounter.

Youth and young adults up to age 26 are encouraged to get vaccinated.

TRICARE coverage of the HPV vaccine starts at age 9 through 26. For more information on the HPV vaccine, contact your medical team through Secure Messaging Services at https://app.relayhealth.com/.

To schedule a well woman exam or Pap test, visit http://www.tricareonline.com, or call the appointment line at 785-239-DOCS (3627).


The Joint Commission Re-Accredits IACH

Irwin Army Community Hospital received its long-awaited Gold Seal of Approval in December.

The accreditation document is awarded by The Joint Commission for demonstrating continuous compliance with performance standaGoldSeal_4colorrds. It reflects a hospital’s commitment to providing safe and effective patient care.

“We are delighted to have earned our three-year hospital accreditation from The Joint Commission,” said COL Risa Ware, IACH Commander. “The IACH team underwent a rigorous on-site survey to re-accredit the hospital. The achievement demonstrates the high quality and commitment of all our providers and staff.”

The Joint Commission evaluates and accredits more than 20,500 health care organizations and programs in the United States. It has accredited hospitals for more than 60 years. The Joint Commission’s hospital standards are developed in consultation with health care experts and providers, measurement experts, and patients. The standards are informed by scientific literature and expert consensus to help hospitals measure, assess and improve performance.

A team of five Joint Commission expert surveyors evaluated IACH for compliance with hospital standards related to several areas, including provision of care, emergency management, environment of care and facilities, infection prevention and control, leadership, patient safety, and medication management.

“Joint Commission accreditation provides hospitals with the processes needed to improve in a variety of areas from the enhancement of staff education to the improvement of daily business operations,” said Mark G. Pelletier, Chief Operating Officer, Division of Accreditation and Certification Operations, The Joint Commission. “In addition, our accreditation helps hospitals enhance their risk management and risk reduction strategies. We commend Irwin Army Community Hospital for its efforts to become a quality improvement organization.”

TRICARE Pharmacy Copays Change February 1

2016-Copays-ChangesOn Feb 1, 2016, most copays for prescription drugs at Home Delivery and retail network pharmacies will increase slightly.

Military pharmacies and TRICARE Pharmacy Home Delivery will remain the lowest cost pharmacy option for TRICARE beneficiaries when some TRICARE pharmacy copays change in 2016.

The 2016 National Defense Authorization Act requires TRICARE to change its prescription copays. All drugs at military pharmacies, and generic drugs through Home Delivery, are still available at no cost to beneficiaries. Copays for brand name drugs through Home Delivery increase from $16 to $20, for up to a 90-day supply. At retail pharmacies, generic drug copays go from $8 to $10, and brand name drug copays go from $20 to $24 dollars, for up to a 30-day supply. Copays for non-formulary drugs and for drugs at non-network pharmacies will also change.

Beneficiaries can save up to $208 in 2016 for each brand name prescription drug they switch from retail pharmacy to Home Delivery. Home Delivery offers safe and convenient delivery of your prescription drugs right to your mailbox.

To see the new TRICARE pharmacy copays, learn more about the TRICARE Pharmacy benefit, or move your prescription to Home Delivery, visit www.tricare.mil/pharmacy.

Hooking Youth on Cotton Candy Nicotine

Pvt. Hunter Chubb had already quit smoking. Basic Combat Training left him no choice.

The marketings efforts of the electronic cigarette industry are catching the attention of a new generation of consumers: youth. Pvt. Hunter Chubb, a former vaper, believes that’s on purpose.
The marketing efforts of the electronic cigarette industry are catching the attention of a new generation of consumers: youth. Pvt. Hunter Chubb, a former vaper, believes that’s on purpose.

“That was a good thing,” said the preventive medicine specialist with the Fort Riley Public Health Department. “I came to appreciate my new found freedom.”

Weeks after completing boot camp his freedom was cut short. A friend introduced him to the electronic cigarette. It wasn’t the first time he’d seen the device. But there was something different.

“It looked really cool,” said Chubb, “similar to owning a flip phone and seeing a smartphone for the first time. You just really want it.”

An array of juices, or flavored nicotine, also made vaping an appealing recreation.

“’Vaping’ and ‘juices’ are terms the industry uses to distinguish the activity from smoking or tobacco consumption,” said Wayne Darsow, Fort Riley Public Health Nurse Practitioner.

Chubb said his initial interest in the electronic device was more about the technology and social lures.

“I didn’t have a desire for nicotine so I started with the lightest level available,” he said.

He began vaping at 6 mg/mL of chocolate flavored nicotine, which is considered entry-level strength. A week later he increased it to 12. A month later to 18.

“I wanted to keep feeling the effect from when I first started,” Chubb said.

Darsow said Chubb’s description is typical of a smoker who gradually develops a nicotine tolerance. To maintain the euphoric effect, smokers increase the number of cigarettes they smoke to intensify the levels of nicotine. With electronic devices, vapers increase the nicotine strength level in the juice.

“After a while I started smoking cigarettes because vaping wasn’t enough,” Chubb said.

He was back to where he was before he joined the Army.


Electronic nicotine devices, or e-cigarettes, are marketed as healthy alternatives to smoking, Darsow said.

Advertisements for e-cigarettes report they are free from chemicals that cause cancer and other respiratory diseases.

“E-cigarette ads are also attracting a younger population,” Darsow said. “YouTube commercials for e-cigarettes show attractive people promoting the latest features. Their message is that vaping is glamorous, independent, and high tech. And this appeals to youth.”

Darsow said he doubts that vape juice flavors like cotton candy and chocolate are targeted to adults.

“It’s no accident that e-cigarette use among youth is increasing,” Darsow said. “It’s very easy for students to vape in schools without teachers suspecting a thing. Vaping leaves no smell behind.”

Data from the Center for Disease Control indicates that e-cigarette use among middle and high school students tripled from 2013 to 2014.

The upward trend among youth usage is a serious public health problem, Darsow said.

“We don’t want our kids experimenting with vaping. Nicotine exposure at an early age permanently alters neuro-receptors in the brain that then manifest into an addiction,” said Darsow.

Currently e-cigarettes are not officially deemed tobacco products by the federal government. That means there is little regulation on the marketing of e-cigarettes, Darsow said.

In November, the Kansas City metro area adopted ordinances raising the legal age to purchase cigarettes, e-cigarettes, and related products to 21. But in spite of these local and regional movements to curb sales among youth, e-cigarettes are not subject to the same marketing restrictions as traditional cigarettes.

“E-cigarettes are the perfect machine luring a new generation of young people to lifelong nicotine dependence. We as a community must be vigiliant to protect our youth through education while policies and regulations catch up,” Darsow said.


“I wholeheartedly believe that vaping is more addictive than cigarettes,” Chubb said.

In October 2015, Chubb learned about the Fort Riley Tobacco Cessation Support Program and enrolled. The news of becoming a father gave him the motivation to quit – again.

“This time I’m quitting for good,” he said. “But if I relapse it won’t be because of the latest features on an electronic device. I know better now. ”