GEM Service
THIS IS INFORMATION YOU WILL NEED!
Didactics/Meetings
7:45 a.m. M,T,W,F VA Geriatrics office-building 4. Southwest corner of Clermont St
and Hale Pkwy. 2nd floor conference room, (usually T, F)
SVH Classroom (usually M,W)
7:30 a.m. Thurs Geriatric Grand Rounds AOP 7th floor (1st & 3rd Thurs)
Geriatrics Journal Club VA Auditorium (2nd Thurs)
Except June, July, August
11:00 a.m. Tues Interdisciplinary GEM meeting VA NHCU conference room
Case Presentation Check schedule for your date
20-30 minute discussion of patient/geriatric issue
Please make a handout, no powerpoint necessary!
Rounds
Usually Mondays, Wednesdays, and Thursdays at SVH, Tuesdays and Fridays at the VA. Schedule is flexible depending on where the consults are and where the most patients are, so location of rounds may not always adhere to the printed schedule. The team will decide at the end of rounds where to meet the next day. We try to coordinate locations with your morning lectures and minimize driving back and forth, but some days we may need to round at both sites.
Notes/Sign-Out
*Progress notes should be written on your patients about twice a week. They do not need to be extensive. Please do leave a thorough note when you go off of service for the benefit of the oncoming team.
*Sign-out at the VA NHCU is through the CAIRO Hand-off system.
*Sign-out at the SVH is the GEM.doc list on the computer desktop.
Consult Pager: 266-1180
*Each resident will carry the consult pager for one week (including weekend) while on service. In addition to responding to consults, you are responsible for covering all GEM patients on the nights and weekends you are on call.
*We try to see consults same day and staff the following whenever possible. Sometimes due to scheduling we cannot see the consult until the next day. Generally tell the team we will see the patient today or tomorrow.
*Weekend rounds vary by attending. If you are not going to be rounding, please call both the VA NHCU and CO SVH on Saturday and Sunday to check in on any patient issues. If you get called with a new consult on the weekends take down the patient information and let the team know we will see the patient on Monday. You do not need to see new consults on the weekends.
*Night/weekend calls are of 2 basic varieties: easy questions (i.e. clarify an order, report a lab value, pt wants Tylenol, etc.; harder questions (i.e. patient looks sick). Part of the learning on this rotation is how to handle these more difficult questions from home without being able to see the patient. You DO NOT go in to see the patient at night. If you think the patient is sick, and cannot wait until the next morning to be seen, send them to the ER. If you are not sure what to do or have any questions, call your fellow (if you have one), or your attending for back-up.
*The VA NHCU is not supposed to call after 10:00 pm; if you get called by them after that, please let your fellow/attending know.
VA CLC (Community Living Center)
Building 38 far northeast corner of hospital
Charge nurse: 303-399-8020 x 4468
GEM patients in purple on the board
Consults: use NHCU/GEM Rehab consult report template from the consult tab.
NHCU cannot take patients with trachs, sitters, heparin drips, IV narcotics.
Admissions to the VA Community Living Center (nursing home):
· Check with charge nurse for bed availability and timing of admissions
· Enter delayed admission orders, preferably day before, but at least by morning of transfer.
· Admit to: NHCU short stay (14-90 days) always;
· Specialty: GEM nursing home care.
· Make sure to enter NHCU PT and NHCU OT consults through Geriatrics/Nursing Home menu
· Complete NHCU MD/NP Admission template on patient transfer
Progress notes: use GEM MD Progress note
Discharges: Complete Discharge Note template. Dictate discharge summary of patient's nursing home course within 48 hrs.
CO State Vets Home at Fitzsimmons
1919 Quentin Street, Aurora, Southeast corner of Montview St and Peoria. Main doors down the main hallway to the "Classroom."
Park in front or in employee lot. A placard is provided to put in your window so they know who you are.
Contact Info:
Heritage Left (Main Skilled Unit): 720-857-6448
See note card for access codes
GEM patients will be on Heritage Left wing (1st floor)
RN station is generally for RNs (try to meet/write notes at other pods)
Charts are in the chart room near the RN station.
Medication Administration Records are on the Med carts
Vitals, weights, intake/output are in separate charts in cupboards above RN station
Orders: Flag by leaving order sheet sticking up out of the chart and leave at top of chart (if orders need to be done promptly, communicate to an RN in person)
All medication orders need to have an indication written on the order
Admissions: do written H&P on standard form provided. Orders will come from the hospital discharging patient; we just need to approve them and make any changes we feel are needed.
Discharge issues
Summaries:
UCH Patients: please type a brief note into the UCH system on clinical workstation. Need to do this on-site at the University. Access patient record and when you view notes you will see a box “new” at bottom of notes viewer screen. Click to get a clean template for your note. Top left of screen asks for a note type – you can use “discharge summary report”. Keep notes very brief, mostly to summarize events/course at nursing home, d/c meds, and f/u plans. No need to repeat H&P (though certainly can comment on any such items if you think will help f/u care).
VAMC Patients: Dictate VA discharge. x7300. Site ID 2000. ID number (VA pharmacy #). Discharge summary =1. If the patient is coming from SVH, enter note into VA computer as above.
Non-UCH/VA Patients: Communication from nursing home (NH) to PCPs is generally not good and no system is set up to communicate notes from NH to PCP. If you have an occasional patient whose f/u will be outside and you feel PCP needs certain info, would call or fax to PCP to pass along necessary info.
Discharge Meds:
Facility (SVH) gives patient supplies that they have, can be anywhere from a few days to 3-4 weeks supply. In general, you will not need to write rx’es for pts at d/c, but occasionally may be asked to do so to cover patient until they can get to PCP. VA meds need to come from pharmacy.