Heart At Work: Coram Nurses nurture their patient to good health

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It was the peak of COVID-19 and their patient suffered from pancreatitis. When she recovered, she was so grateful for the expert round-the-clock care provided by Coram nurses: Nancy Marlett, Mallory Young and Lucy Runnels, she made a very special video to let them know. 

Nancy, Mallory and Lucy, thank you for nurturing your patient back to health through your medical expertise and dedication. You exemplify the very best in the profession.

Heart At Work recognizes CVS Health heroes across the country who bring their hearts to work, helping people on their path to better health. Read their stories, watch their videos and celebrate our CVS Health Heart At Work heroes along with us!

Three Coram® nurses, from left to right: Nancy Marlett, Mallory Young, and Lucy Runnels.
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Adventures abroad with parenteral nutrition

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In honor of Home Parenteral Nutrition Awareness Week, October 12-16, 2020, Coram patient Katie Marschilok shares how she won’t let total parenteral nutrition limit her bucket list travels.

Home Parenteral Nutrition (HPN) Awareness Week, which takes place this year on October 12-16,  was established to spread the word that people can survive and live a full life on home parenteral nutrition. Katie Marschilok, of Troy, New York, exemplifies this. Despite beginning HPN with Coram in 2019, Katie is active and busy, defying assumptions of what life with HPN looks like. In fact, she is steadily making progress on her bucket list travels with her husband during retirement. 
 
"I feel determined to do the things he dreamed of, I don’t want to hold him back," Katie explains. Together, they have visited the Great Wall of China, Yellowstone National Park, Mount Rushmore, and the pyramids of Egypt.

Katie standing in front of Mount Rushmore with her husband.

In 2015, Katie began experiencing intestinal issues leading to pain, anemia, GI and bowel distress, and weight loss. After several attempts at treatment, she went on total parenteral nutrition, known as TPN, and finally began to feel better.
 
In TPN, all feeding is given directly into a vein, bypassing the gastrointestinal tract. Katie receives 14 hours of nutrition per day, most of it overnight. Brenna Kowalczyk, a Coram nurse, helps with weekly dressing changes, and registered dietitian Tara McGovern collaborates with Katie's gastroenterologist to assess her nutrition and labs.
 
During her first interaction with a Coram nurse at her hospital bedside in February 2019, Katie inadvertently issued a challenge. "I said, 'Oh, by the way, we have an Egyptian river cruise booked in three months. How can we make that happen?'"
 
Katie's Coram team accepted the challenge. Tara, Brenna and patient advocate Michael Medwar worked to adjust her nutrition formulations to travel halfway across the world without refrigeration — a delicate process involving trial and error — gathered and packed over 160 pounds of supplies, and planned for travel-related contingencies. 

"Michael was instrumental in helping me feel like I could do it. Same goes for the local branch, including Tara and others who do formulations,." Katie recalls. 
 
The trip went off without a hitch. 

Katie standing with her husband by a sign that reads, "Old Faithful Geyser"
Katie and her husband also visited Yellowstone National Park with the help of her Coram team to make sure she gets the nutrition she needs while traveling.

"It all worked out, and because it did work out, we felt comfortable booking a Machu Picchu and Galapagos trip for next summer. We've also done lots of smaller trips, Coram helps with anything that involves a flight,." Katie explains. 
 
Despite ongoing challenges, Katie remains positive and humble about the hurdles she's overcome. "You need to have a level of interest in your own self-care, a desire to be independent, and attention to detail. Anyone motivated and willing to wash their hands a lot can do it!"

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A new homecoming for health care

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Pain management, antibiotics for an infection, hydration and nutrition support — these are just a few examples of why a person might require infusion therapy. 

For patients like Brittany Detrick, 27, a paralyzed gastrointestinal tract requires her to use a feeding tube along with a port in her chest to receive IV antibiotics and hydration, making infusions just another part of her daily routine. 

“I'm hooked up to a pump all the time,” she says. “I have IVs and tube feedings in a backpack that I wear, and it’s kind of my normal life.” 

Now, in response to the pandemic, Coram, CVS Health’s infusion care business, is expanding its mission to care for more infusion patients like Brittany at home – all while helping hospitals prioritize and maintain bed capacity for those infected with COVID-19.

Coram heeded the call for help early on. “As coronavirus struck, we were hearing from our hospital partners that they were concerned about freeing up hospital beds so that they could care for the many patients who would contract COVID-19,” says Tricia Lacavich, RN BSN, Coram Vice President and General Manager. We asked, ‘How can we help?’”

The approach they took is threefold, Lacavich says: First, get patients out of the hospital and home safely. Second, prevent future patients from being admitted to the hospital unnecessarily. Third, she says, make sure that outpatients who receive long-term infusions in the hospital get those treatments at home. 

Much of this is what Coram normally does, but COVID-19 created a new layer of urgency to get and keep patients out of the hospital in a safe and timely way, Lacavich says. That meant more home visits from nurses and increased support for virtual visits through telehealth.

Today, Coram is scaling its mission nationwide, starting in markets with high rates of COVID-19 cases. Its model of home-based health care may become more common even after the pandemic, as more people learn what can be managed at home. 

Brittany credits Coram's care for keeping her out of the hospital even when she contracted COVID-19 herself – experiencing mild symptoms and recovering at home, instead. That was crucial, because of her compromised immune system. 

“When someone like me goes into the hospital, there’s not just fear of catching COVID, but fear of catching everything else there, too,” she says. “Being able to stay home is always the best thing I can possibly do.”

Tricia Lacavich
When Coronavirus happened, Tricia Lacavich, Coram Vice President and General Manager asked, “How can we help?”
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During Nurses Month, we salute the vital work that nurses do every day

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This year, on the 200th anniversary of Florence Nightingale’s birth, National Nurses Month is celebrating the dedication of nurses in every interaction, every setting, every era, every day. Throughout May, CVS Health is also recognizing the thousands of nurses who work across our enterprise in this time of extraordinary challenge.

In honor of Nurses Month and in recognition of the vital work of nursing, CVS Health is making a $40,000 donation to Direct Relief to deliver protective gear and critical care medications to as many health care workers as possible.

Today, many nurses are found on the frontlines of the COVID-19 pandemic. Others are contributing their expertise, experience and compassion behind the scenes. This includes some 10,000 nurses, nurse practitioners, LVNs and LPNs working for Aetna, MinuteClinic, CVS Caremark and Omnicare. All have been doing amazing work since COVID-19 began, including volunteering to oversee rapid testing in various areas or embracing new ways to treat patients during social distancing.

Sheryl Burke, Aetna Senior Vice President of Cross-Enterprise Strategic Innovation, recently praised nurses by saying, “You care for our customers and members like your own family through teaching, advocacy, listening and action. Your efforts have been nothing short of extraordinary and are well-deserving of our sincere gratitude.”

To learn more about the extraordinary work being done by our CVS Health nursing professionals, take a look at our Friday Pulse video recognizing Nurses Month. And please join us in celebrating nurses!

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

A practitioner consults a female adult patient with a child via video call during a telemedicine visit.
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Coram nurses rise to the challenge during COVID-19 pandemic

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A global pandemic cannot stop Coram nurses from doing what they do best: providing critical patient care in the home or at one of our ambulatory infusion suites, helping patients avoid and prevent hospital stays, giving them the autonomy to administer their own medications, and providing emotional support. Infusion nurses not only provide important nursing care, they support, educate and reassure patients and caregivers who may be scared, anxious, and overwhelmed — something increasingly common during the COVID-19 pandemic.

This National Nurses Month, we're proud to feature a few of our over 1,000 Coram nurses here.

Jeannie Collazo-Torres

Jeanette (Jeannie) Collazo-Torres

Jeanette (Jeannie) Collazo-Torres understands what it takes to support patients with complex conditions requiring IV-therapy — a former Coram nurse, she now works for CVS Specialty focusing on pulmonary arterial hypertension, and is also supporting the Coram team during the COVID-19 pandemic. Though she is familiar with administering and educating patients about complex therapies (called ‘teaches’), Jeannie notes that new safety guidelines, personal protective equipment (PPE), and social distancing have made patient care more complicated. "We wear the full equipment: N95 masks, gowns, gloves, and goggles," Jeannie explains. "We talk with the patients, but we can't be close to them and it can be harder to provide emotional support."

Jeannie recently met with a COVID-19 patient who had been discharged from the hospital. She could see that both the patient and family members were scared. "It can be intense and scary for patients and families, but I try to come in and set everyone's minds at ease. As a nurse I have to sense what is needed." Sometimes that's a sense of humor, she explains, and sometimes it's someone to talk to or pray with.

Martha Silverspring

Martha Silverspring

A nurse for over 35 years, Martha Silverspring has been working in IV home care since 1992. She enjoys home care nursing because every day is different, and she loves people and the relationships she has built over the years. "In IV home care nursing, you work toward a common goal, and nothing breaks down barriers like working together towards a common goal."

Her home visits may look a little different during the COVID-19 pandemic, but Martha credits Coram and CVS Health for helping her continue doing her job while staying safe. "I keep hearing about shortages of PPE elsewhere, but we've had access to what we needed from the beginning."

Chris Keller

Chris Keller

Nurse manager Chris Keller loves the challenge he describes as "air traffic control" — coordinating arrival of a delivered medication from the branch to the patient, ensuring a nurse trained in administering the specific medication can be at the patient's home after delivery, etc. "It's a lot of logistics and juggling, but I have a fantastic team of support that helps get it all done."

Chris and his team were recently put to the test when a cruise ship with several COVID-19 patients onboard arrived in his hometown of San Diego. Coram was asked to help hospital patients who needed to be discharged quickly to make room for the quarantined passengers, and Chris and his team jumped right in. "Everyone stepped up. I'm fortunate to oversee an excellent team of nurses who said 'let's do it.' We got PPE equipment delivered to our branch, packaged it up, mailed to our nurses’ homes by the next day."

Jeannie, Martha and Chris are just a few of the dedicated Coram nurses providing exceptional care and support during this unprecedented time. We thank all of our Coram nurses for their courage and commitment to helping patients get and stay well.

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CVS Health works with Piedmont Healthcare to help create hospital bed capacity in Georgia

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Coram, the infusion care business of CVS Health, expands strategy to help transition eligible IV-therapy patients from hospitals to in-home nursing in Georgia during the pandemic

WOONSOCKET, R.I. — CVS Health (NYSE: CVS) is working with Piedmont Healthcare in Georgia to support their solutions for increasing hospital bed capacity. This expands a recently launched strategy of Coram, the company’s infusion care business, to help transition eligible IV-therapy patients to home-based nursing care in response to COVID-19. Specifically, Coram has enhanced its clinical monitoring, virtual support and oversight through telehealth to complement existing personalized in-home support, coordination and administration of medications and supplies. In states like Georgia, ensuring the ability of hospital and health systems to handle potential surges of COVID-19 patients has become a critical factor in assessing stay-at-home orders and reopening local economies.https://gov.georgia.gov/press-releases/2020-04-20/gov-kemp-updates-georgians-covid-19

“Coram can deliver a clinically appropriate in-home care setting, which can be the safest place for patients recovering from a range of illnesses during this time by helping to minimize their risk of contracting COVID-19,” said Sree Chaguturu, M.D., Chief Medical Officer of CVS Caremark and CVS Specialty. “Our Coram model allows us to deploy clinical teams where the need is greatest, and we are shifting resources to support Piedmont Healthcare as a critical part of their solution to build and maintain hospital bed capacity for treating the critically ill impacted by the virus.”

Coram is working with Piedmont Healthcare to identify and begin transitioning stable patients to home-based nursing care. Patients with a range of conditions that may require infusion therapy, including hydration and nutritional support, anti-infectives and/or specialty medications for chronic condition management, will be considered. Once home, Coram’s specialized nurses will provide and coordinate a range of care, including daily visits and monitoring, medication administration, IV catheter line care, lab draws and educational support via telehealth. Coram is scaling this approach nationwide in other markets with high rates of COVID-19 cases, and working with home health agencies to enable care for patients with high acuity needs that may require additional clinical oversight and monitoring.

“During these extraordinary and unprecedented times, we remain focused on serving Georgians’ health care needs and have implemented a number of strategies that enable continuity of care for our patients and communities,” Robert Miller, M.D., Medical Director of Wound Care and Hyperbarics, Chair of the Board Piedmont Atlanta Hospital. “Together, with companies like CVS Health, we can employ innovative solutions that create the additional care capacity we need to help Georgians get through this.”

More information on the steps that CVS Health is taking to address the COVID-19 pandemic is available at the company’s frequently updated COVID-19 resource center.

About CVS Health 

CVS Health employees are united around a common goal of becoming the most consumer-centric health company in the world. We're evolving based on changing consumer needs and meeting people where they are, whether that's in the community at one of our nearly 10,000 local touchpoints, in the home, or in the palm of their hand. Our newest offerings – from HealthHUB® locations that are redefining what a pharmacy can be, to innovative programs that help manage chronic conditions – are designed to create a higher-quality, simpler and more affordable experience. Learn more about how we're transforming health at https://www.cvshealth.com.

Media contact

Christina Beckerman
CVS Health
401-479-6570
christina.beckerman@cvshealth.com

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Home care dietitians improve tube feeding patient outcomes

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Coram’s research highlights the critical role home care dietitians play in decreasing tube feeding intolerance and improving nutrition outcomes

Home-based health care continues to gain traction as an option for people living with a variety of chronic conditions. In fact, home infusion care can be a safe and cost-effective treatment alternative when compared to the same care provided in an in-patient or hospital setting. Coram CVS Specialty Infusion Services (Coram) is leading the way in home infusion care and parenteral (intravenous) and enteral (tube feeding) nutrition with a team of skilled home care Registered Dietitians, who can address nutrition intolerance, assess adequacy of hydration in feeding regimens, and address associated patient questions.

To advance the knowledge of health care practitioners and improve care for patients, Coram is actively involved in home nutrition care research. This research includes evaluating the impact of transitioning nutrition care from the hospital to the home and the benefits of home-based parenteral and enteral nutrition in certain populations.

Coram dietitians Nicki Bray, MS, RD, LDN; Sarah Allen MS, RD, LDN; and Caitlin Wendecker, RD, CNSC, recently conducted research to evaluate the efficacy of home care dietitian recommendations in addressing reported enteral nutrition intolerances, and the critical role home care dietitians play in creating interventions to improve nutrition outcomes. They shared their findings in their abstract, Home Care Dietitian Intervention Effectiveness to Reported Intolerance.

When patients are sent home from the hospital with little additional support and potentially poor tolerance to tube feedings, their outlook and compliance with their home tube feeding regimen may be impacted. Identifying and effectively addressing intolerance will increase a patient’s compliance and improve nutrition outcomes.

Coram conducted a retrospective review of adult patient records that reported intolerance within 48 hours of start of care. This retrospective review supported the important role of home care dietitians in evaluating and managing tube feeding intolerance, with dietitian interventions effective for 72% of patients by day 30 and 91% of patients by day 60. Without appropriate intervention by a dietitian, patients may be at risk for poor nutrition outcomes such as gastrointestinal distress, malnutrition, weight loss or underfeeding.

Home enteral nutrition patients are also at increased risk for dehydration due to inadequate fluid administration, and Coram dietitians explored this in an additional abstract, Adequacy of Flushing Orders in Home Enteral Nutrition Patients, by Katrina Sesler, MS, RD, CNSC; Rebecca Caldwell, MS, RD, LDN; and Laura Kashtan, RD, which reviewed patients’ water flushing orders at discharge from facility to home care. From a retrospective chart review of adult patients, Coram dietitians noted that discharge flush orders are missing or are inadequate for a considerable number of home enteral nutrition patients. Individualized recommendations and early patient contact by a dietitian may be important to prevent dehydration in these patients.

Early intervention by home care dietitians can help patients address tube feeding intolerance, assess hydration levels, improve therapy compliance and address patient questions and concerns. This support can help improve patient outcomes, potentially preventing hospital readmission at a time when hospital resources are stretched due to the increasing rate of COVID-19 admissions. Measures to help patients remain home and avoid hospital readmission are always valuable, but today they are critical.

A practitioner, using a tablet computer, assists a patient with tube feeding therapy.
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Coram Nurses Help Teen Bike across the Country

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A photo of a teenager at the airport with luggage.
Andrew leaving Boston for his cross-country bike trip.
A photo of a teenager with a nurse, administering an IV infusion.
Coram nurse Melissa Rupert infuses Andrew in Oklahoma City during his trip.

Coram, a CVS specialty business, provides high-quality infusion and tube-feeding care to patients where they live, work and travel. So when 17-year-old Andrew had an opportunity to go on a six-week cycling, cross-country adventure this past summer, his parents knew the Coram nursing team could help.

Andrew has Gaucher disease and receives enzyme replacement home infusions every 2 to 3 weeks. His trip would leave from Massachusetts in June and not return until early August, so he would require infusions along the route. His parents and medical team mapped out the trip and planned for infusions in Oklahoma City and Santa Monica, CA.

Coram nurses worked with Andrew’s primary care team at Boston’s Children’s Hospital to secure connections in the other states who would be willing to help. He needed an in-state physician to write the nursing orders, and a Coram nurse to meet him at a hotel for the infusion. The Coram Oklahoma City and Los Angeles branches ensured Andrew received the specialized care he needed.

Gaucher disease is a rare genetic enzyme deficiency disorder that affects 10,000 to 20,000 Americans, and can largely be controlled with enzyme replacement. Patients experience anemia, low platelet counts, severely enlarged liver and spleen, and bone disease.

Coram’s Vast Nurse Network

“The benefit of working with Coram is that we have more than 38 years of experience providing infusion services to patients,” said Julie Scaramuzzi, Nurse Manager, Infusion. “We meet patients where they are, and Coram has 73 ambulatory infusion suites across the country. Our team helps patients prepare the paperwork to bring liquids through airport security, and secure a nurse and location for the treatment,” she said. Coram has more than 2,000 clinicians who provide care to nearly 200,000 patients annually for a range of complex conditions including immune deficiencies, neurological disorders, digestive diseases and serious infections.

Andrew’s mom, Heidi, connected with Coram to pick up the medication near her home, and with the paperwork in order, boarded planes to Oklahoma and California. She met Andrew and the nurses in the hotels, and Andrew successfully received his treatments on the road. He was able to stay with his biking group for the entire trip.

Julie said “Andrew proves that patients who home-infuse are no longer home-bound. Our team works with many patients who travel for business or even just to see family for the holidays. Our network of nurses is vast and we are able to meet patients where they are, when they need their treatment.”

The Accordant Team Approach for Gaucher Patients

In addition to care from Coram clinicians and nurses, Accordant offers support for members with rare conditions, such as Gaucher disease, through targeted interventions designed to meet each patient’s unique needs.

“The specialized care team is composed of registered nurses, pharmacists, social workers, and a medical director – all backed by a medical advisory board,” Ahmed F. Hassan, Vice President and General Manager, Accordant. “These skilled practitioners set mutually agreed-upon health goals with the patient, discuss symptom management, explain proper use of medications, and even deal with resource issues such as lack of transportation to doctors’ appointments or cost of care.”

The more than 30 physicians on Accordant’s medical advisory board are available to the Accordant team to discuss complex situations and offer insights into care approaches that the nurse may use in supporting the patient. And, all of the team’s care is grounded in the latest evidence-based medicine and clinical guidelines.

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter

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Improving the Infusion Therapy Experience with Coram

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As health care costs continue to rise, payers, providers and patients are looking for new ways to help improve quality of patient care and their experience while lowering overall costs. One promising area is in home infusion care.

In fact, published research has shown that the home infusion services, like those provided by Coram CVS Specialty Services, can be safe and beneficial for those patients requiring infused therapies and in some cases can be a lower cost alternative to receiving the same services in a hospital or inpatient setting. In addition, the research has also shown that patients overwhelmingly prefer receiving their infusion therapies at home.

Read more about the benefits and value of home infusion care from Tricia Lacavich, Vice President for CVS Specialty Coram Infusion Services, in her recent article in Fierce Healthcare.

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Coram Pediatric Backpacks Help School-Age Patients Stay Active

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Coram, a CVS specialty business, provides high-quality infusion and tube-feeding care to patients where they live, work and travel. For younger patients, that list now includes where they play.

As part of enhancing the consumer experience, Coram pediatric patients who receive home parenteral (intravenous) nutrition (HPN) and enteral (tube-feeding) nutrition can carry their pump and nutrition in a backpack that’s sized just for them.

A photo showing Coram’s “Pediatric Pump Pals” enteral backpacks.
Coram Pediatric Pump Pals enteral backpacks.

Coram Pediatric Pump Pals backpacks enable children and teens to carry their portable pump and nutrition while they participate in normal activities while infusing.

About 1,200 pediatric patients use the parenteral backpacks, while nearly 1,600 utilize the enteral packs for school and other activities.

“The entire system fits nicely into these small backpacks for little ones,” said Karen Hamilton, Director of Clinical Nutrition for CVS Health. “They can be worn by the patient or hung nearby throughout the infusion.” As with all home infusion therapies, the intent is for the patient to be as mobile as possible.

“Our backpacks give young patients the freedom to leave the house and live their lives,” said Hamilton. “Gone are the days of being homebound and having to miss out on activities, birthday parties and other events. The backpacks are designed to be fun and not look medical.”

A photo displaying Coram’s “Pediatric Pump Pals” parenteral backpacks.
Coram Pediatric Pump Pals parenteral backpacks.

Providing quality infusion care at home and on the go

Coram CVS Specialty Infusion Services delivers high-quality infusion therapy services in home-based and outpatient settings to more than 183,000 patients per year. Services are provided at more than 90 locations nationwide, as well as through the largest home infusion network in the country.

Coram’s home-based care includes nutrition, delivered either intravenously when the digestive tract is not functional and necessary for patients to maintain adequate nutrition, as well as through tube-feeding. Patients may receive parenteral or enteral nutrition for weeks or months until their issues resolve, or may even need care for their lifetime.

The Coram Pediatric Pump Pals backpacks connect to a portable infusion pump that has been pre-programmed by the Coram pharmacy team to deliver the nutrition over a specified amount of time with each pump customized to the unique patient’s needs.

“I remember the days with the challenges when we had pediatric patients and no backpacks. Then we progressed to an initial mini- adult pack for these little patients,” said Wanda Rogers, Director of Pharmacy Infusion. “This is a wonderful advancement to have these young patients ambulate with color and fit into the typical daily activities.”

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