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 Recent changes to Epic documentation: retained packing
Because of recent instances of retained packing after a surgical or other procedure, there have been changes made to the documentation standard in Epic. Of primary interest to the OBGYNs, but also to urologists and general surgeons, these screen shots display changes to the flowsheets, the vaginal packing order, and finally the revised OBGYNBRIEFOPNOTE which adds categories for lines and drains, as well as vaginal packing.
Retained items generally fall into two root-cause categories: communication and documentation failures or end of procedure count failures. These electronic tools are aimed at clear communication of the existence of vaginal packing, the type and amount of packing left in place, and finally who will remove the packing and by when.
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Insulin sliding scale orders
Insulin sliding scale orders for discharge have not included the quantity of insulin to give in the AVS because Epic caps the number of characters in the order. This has been a significant problem, especially for care facilities receiving our patients. A reformatted insulin sliding scale (and correction bolus) order for discharge has been created to address this issue.
The problem is that the new order cannot be e-prescribed; a printed prescription must be generated and signed if the patient needs a prescription fillable at a pharmacy. This change will go live on Dec. 2.
If you have any questions or concerns, please contact Matt Tanner in Pharmacy at 4-2048.
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Sepsis affinity team update
Sepsis Core Measures started Oct. 1, 2015. It is required to have physician documentation of specific focused exam elements for septic shock prior to the end of the six hour septic shock window to meet the CMS requirement. A smartphrase has been created to include all the specific focused exam elements for your ease in documentation, named ".6HRSEPTICSHOCKSUMMARY." Watch MyEpic/Radar for a tip sheet with more information.
If you have any questions, please contact Steven Marvel, MD, or Claire O'Brien, MD.
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Test of change for inpatients with diabetes
The Diabetes Affinity Group will be conducting a glycemic management team test of change (TOC) starting Dec. 7, 2015. The purpose of this is to test a diabetes clinical pathway and verify that patients with diabetes, when followed by an advance practice nurse and a certified diabetes educator, will have reduced readmission rates, and a decrease in length of stay. Patients (n=30) for this TOC will be chosen at random with the only criteria being an A1C >6.5 percent or a random CBG of >250 mg/dL.
What you need to know?
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Baby Friendly Health Initiative training needed
Salem Hospital is seeking the Baby Friendly designation. In 1991, the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) established the Baby Friendly Health Initiative (BFHI). The BFHI is a global program to encourage and recognize hospitals and birthing centers that offer an optimal level of care for breastfeeding. Several professional organizations and the Healthy People 2020 objectives encourage a sound program of information and support necessary to promote the successful establishment and maintenance of breastfeeding. Three of the several professional organizations supporting BFHI are the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians.
The BFHI core components are the Ten Steps to Successful Breastfeeding. The one that is significantly impacting providers is step two: "Train all health care staff in the skills necessary to implement this (breastfeeding) policy." This step has multiple components for all staff, and requires all physicians, midwives, physician assistants and advanced practice registered nurses with privileges for labor, delivery, maternity, and nursery/newborn care to have a minimum of three hours of breastfeeding management education pertinent to their role.
In order to move to the next phase of the process, we need at least 80 percent of those providers to complete the training. We are currently at 46 percent completion, with family practice physicians as the largest group that has not completed the training. One hundred four providers still need the training. This training is available to all providers via HealthStream.
Healthstream can be accessed on the Salem Health Intranet home page. Please do your training today and help us reach our goal of 80 percent participation.
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Physician recruitment needs assessment
Every two years since 2002, Salem Hospital has conducted a survey of physicians in our service area to support the development of physician resources. Federal regulations require the demonstration of need before using hospital funds to bring private practice physicians to the community. As a result of these studies, Salem Hospital has helped recruit more than 128 physicians to private physician practices in Salem and Dallas.
AmeriMed, a firm specializing in this type of confidential study, gathered data from physician offices in Marion and Polk counties related to the number of full-time equivalent physicians now practicing and the access available to patients covered by Medicare, The Oregon Health Plan, commercial insurance and indigent care. In addition, a series of one-on-one interviews were conducted with a variety of leaders and content experts to provide the qualitative insights of physicians on the challenges they, and their patients experience in accessing care.
Recent studies indicate physicians are leaving medicine at an earlier age and therefore communities should consider succession-planning activities for physicians age 55 or older. Twenty-nine percent of the physicians on the Salem Hospital medical staff are age 55 or older. Areas needing attention include:
- Primary care
- Hospital based - emergency medicine and hospitalist
- Various medical specialties including neurology, OB-GYN, pain, psychiatry and others
- Surgical specialty
If you have any questions, please contact Barbara Amato, HR Director, supporting Salem Health Medical Group.
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Improving IV antibiotics on AVS
Making IV antibiotics appear on the AVS has been (at a minimum) a painful process, largely because of the huge number of options available in Epic, most of which do not seem to be the right choice. This will improve as of Dec. 2.
Typing the name of an IV antibiotic will bring up an entry in the tab marked "preference list" which will populate the AVS without having to wade through a dozen or more different options. This entry does NOT include all of the necessary elements to order the antibiotics for SHWIC or Cascade Infusion, etc., so please do not assume that this will change those processes, and prescriptions cannot be created for any of these orders.
This change will go live on Dec. 2.
If you have any questions or concerns, please contact Matt Tanner in Pharmacy at 4-2048.
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Documentation tips: Linking substance abuse to disease process
ICD-10 focuses more attention on the effects that tobacco, alcohol and drugs have on a patient's health. It is important to link this impact to the patient's disease process in your documentation.
It is not enough to simply state the two conditions separately. ICD-10 has codes that link substance abuse to its affects. You might document CAD likely accelerated by 40 pack year history of cigarette smoking. Since it is difficult to know for sure there is a link, you may use words such as 'likely, suspected, or probably,' and the codes can still be assigned.
ICD-10 codes also provide for greater specificity concerning substances. For example, one should also document the type of tobacco that is/was being used (cigarettes, chewing tobacco, etc.) to get the most accurate code. If there is drug abuse, what specific drug is being used? This is useful not only for coding, but for the hospital record as well.
Cirrhosis or cardiomyopathy due to alcohol abuse are other examples of linking the substance to the disease process. The linkage will actually generate a completely different code than if the substance and the disease condition were listed separately.
Documentation KUDOS!
Dr. Guzman: Thanks for great H&Ps per CDS Karen Gray who states: "Dr. Guzman covers everything so well in his H&P." We know this makes coding so much easier and answers the 'present on admission' question before it has to be queried!
Dr. Jeff Davis: CDS Coleen Elser states: "I was very impressed that he read the queries and did the research needed to answer them in his progress notes." Thanks Dr. Davis!
For more information, contact Claire O'Brien, MD. (formerly Norton), Medical Director, Continuum of Care.
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Update from VTE prevention team
The VTE prevention team has taken input from key members of the medical staff and are actively working on solutions which will both ensure patient safety through best practice and satisfy provider's needs for efficient workflow. Changes in BPAs and possible adjustments to order sets are being evaluated. Continued education and communication will be seen over the next few weeks. Section chiefs will be informed as work progresses.
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MEDICAL STAFF UPDATES
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WELCOME
Brenda A. Chandler, PA-C - Orthopedics
Hope Orthopedics of Oregon
| Medical education: |
Western University of Health Sciences
Pomona, California
Aug. 2011 to July 2013
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| Residency: Orthopedic surgery |
Arrowhead Regional Medical Center
Colton, California
Sept. 2013 to Oct. 2014
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Board certification:
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National Commission on Certification of Physician Assistants
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Michael S. Farris, MD - Psychiatry
Salem Health - Psychiatry Unit
| Medical education: |
University of Arkansas for Medical Sciences
Little Rock, Arkansas
July 2009 to May 2013
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Internship:
Psychiatry |
Oregon Health & Science University
Portland, Oregon
June 2013 to June 2014
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Residency:
Psychiatry |
Oregon Health & Science University School of Medicine
Portland, Oregon
June 2014 to June 2017
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Olivia A. Galvez, MD - Family Medicine
Willamette Family Medical Center
| Medical education: |
University of Washington Medical Center
Seattle, Washington
August 2000 to June 2004
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Residency:
Family practice |
Family Medicine Residency of Idaho
Boise, Idaho
June 2004 to June 2007 |
Board certification:
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American Board of Family Medicine
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Mohammed F. Layas, MD - Internal Medicine
Salem Health - Adult Medicine Hospitalist
| Medical education: |
Garyounis University
Benghazi, Libya
Sept. 1996 to Oct. 2003
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Residency:
Internal medicine |
State University of New York at Buffalo School of Medicine
Buffalo, New York
June 2007 to June 2010 |
Fellowship:
Nephrology |
Virginia Commonwealth University
Richmond, Virginia
July 2013 to June 2015
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Board certification:
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American Board of Internal Medicine
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Meenakshi A. Narasimhamurthy, MD - Nephrology
Kidney Care Physicians, LLC
| Medical education: |
Madurai Medical College
Madruai, India
July 1996 to May 2002
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Residency:
Internal medicine |
John H Stroger Hospital of Cook County
Chicago, Illinois
Aug. 2005 to Aug. 2008 |
Fellowship:
Nephrology |
The Rhode Island Hospital, Brown University
Providence, Rhode Island
July 2012 to June 2014
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Board certification:
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Internal Medicine
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Jeffrey H. Shuhaiber, MD - Cardiothoracic Surgery
WHP Cardiothoracic Surgery Clinic
| Medical education: |
King's College School of Medicine London, United Kingdom
July 1992 to July 1998
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| Internship: |
King's College Hospital
London, United Kingdom |
| Residency: |
Loyola University of Chicago, Stritch School of Medicine
Chicago, Illinois
July 2004 to June 2006
University of Illinois College of Medicine
Chicago, Illinois
June 2000 to June 2004
Mayo Graduate School of Medical Education
June 1999 to June 2000
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| Fellowship: |
Royal Brompton and Harefield Hospital
London, United Kingdom
Aug. 2007 to July 2008
University of Cambridge
Cambridge, United Kingdom
June 2006 to Aug. 2007 |
Board certification:
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American Board of Thoracic Surgery
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NEWS
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John Hannig featured in ACCME interview
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| John Hannig, MD, discusses CME development |
The Accreditation Council for Continuing Medical Education featured Salem Health's own John Hannig, MD, in a recent interview. Hear Dr. Hannig discuss empowering teams, building leadership and improving patient outcomes in this video.
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COMING EVENTS
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Preparing for "The big one"
What will happen when a big earthquake hits our region? Are we ready to deal with the needs of the community in such a crisis? Attend "When the Shaking Stops: The 336-Hour Challenge" on Wednesday, Dec. 9, from 12 to 1:30 p.m. at the Salem Convention Center to learn more about improving your ability as a small or large business to recover from a major disaster.
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