PROVIDER FOCUS
JULY 2014
Lymphedema Clinic at JSCC
The Lymphedema Therapists at the John Stoddard Cancer Center are Breast Cancer Exercise Specialists and nationally certified Lymphedema Therapists. The Lymphedema Therapists are professional PTs and OTs who have gone through extensive training and are qualified to assess, treat and implement an individualized rehabilitative treatment program based on the cancer patient’s functional impairments. The therapists are trained in post-operative breast cancer rehabilitation which includes the Pink Ribbon ProgramTM. Therapists will perform an evaluation to establish a treatment plan that incorporates a progressive exercise program with manual therapy techniques as well as lymphedema risk reduction and survivorship strategies. This may include:
- Soft tissue mobilization
- Range of Motion/ Strengthening/Postural exercises
- Conditioning guidelines/preparation for Live Well Program
- Axillary Web/Cording Release
- Scar Management
- Kinesiotape
- Compression Garment recommendations
- Lymphedema Education and Risk Reduction
- Comprehensive Lymphedema Treatment Program (CLT) as indicated
- Monitor and assess rehab and recovery during chemotherapy, radiation, and reconstruction.
The Breast Cancer Rehabilitation Program at the Lymphedema Clinic is part of the complete line of services provided by the John Stoddard Cancer Center’s Nationally Accredited Breast Cancer Program.
A physician’s referral is required for this service. Registration and insurance authorization for treatments will precede scheduled appointments. Patient readiness is usually 2 weeks after surgery once drains are removed. Patients are usually evaluated within a week of receiving the referral. To schedule an appointment or for further information about Breast Cancer Rehab contact the Lymphedema Clinic at 515-241-6839.
ILH Implants First S-ICD
Iowa Lutheran Hospital is among one of the first hospitals in Iowa to implant the only commercially available subcutaneous implantable defibrillator (S-ICD) for the treatment of patients at risk for sudden cardiac arrest (SCA).
Most episodes of sudden cardiac arrest are caused by the rapid and/or chaotic activity of the heart known as ventricular tachycardia or ventricular fibrillation. Recent estimates show that approximately 850,000 people in the United States are at risk of SCA and indicated for an ICD device, but remain unprotected.
“We are always looking to enhance our technology here and this is a great opportunity,” said Dr. Prasad Palakurthy, cardiologist at UnityPoint Clinic. “We are excited to be the first hospital in Iowa to be using this system and to offer this level of care to our patients.”
The S-ICD System is designed to provide the same protection from SCA as traditional transvenous implantable cardioverter defibrillators (ICDs). However, the entirety of the S-ICD System sits just below the skin without the need for thin, insulated wires – known as leads – to be placed into the heart itself. This leaves the heart and blood vessels untouched, providing a new exciting solution for both physicians and patients.
The S-ICD System has two main components: (1) the pulse generator, which powers the system, monitors heart activity, and delivers a shock if needed, and (2) the electrode, which enables the device to sense the cardiac rhythm and serves as a pathway for shock delivery when necessary. Both components are implanted just under the skin—the generator at the side of the chest, and the electrode beside the breastbone. Implantation with the S-ICD System is straightforward and can be done using only anatomical landmarks which removes the need for fluoroscopy.
The S-ICD System, from Boston Scientific, is intended to provide defibrillation therapy for the treatment of life-threatening ventricular tachyarrhythmias in patients who do not have symptomatic bradycardia, incessant ventricular tachycardia, or spontaneous, frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing.
Medical Education Research
Multiple resident physicians and faculty members were recently able to disseminate their medical education research conducted at UnityPoint Health – Des Moines at the national and international level. The project by Veach et al. received a first place award at its respective conference.
Dorner DB, Smith HL, Letendre PV, Claytor AR, Wortman WE. Impact of a resident quality council on annual quality improvement survey data. 2014 Integrating Quality Meeting: Improving Value through Clinical Transformation, Education and Science (Association of American Medical Colleges [AAMC]), Rosemont, IL, June 12-13, 2014.
Veach L, Gibbons J, Smith HL, Craig SR. An infection Prevention Education Program Targeting Resident Physicians. Association for Hospital Medical Education (AHME), Charleston, SC, May 14-16, 2014.
Smith HL, Letendre PV, Claytor AR, Wortman WE, Dorner DB, Rodemyer MP. Impact of a resident quality council on annual quality improvement survey data. Association for Hospital Medical Education (AHME), Charleston, SC, May 14-16, 2014.
Cheyne KL, Smith HL, Schifsky KD, Pettit EC. Examination of pediatricians on diagnosis, treatment, and resources for common mental health disorders in a rural state. 2014 Pediatric Academic Societies'/Asian Society for Pediatric Research (PAS/ASPR) Joint Meeting, Vancouver, Canada, May 3-6, 2014.
Infection Prevention
INFECTION PREVENTION NEWS: MEASLES (RUBEOLA) 2014
DID YOU KNOW?
The U.S. has reported its highest number of measles cases since 1994
· 539 cases reported in 20 states
· 17 outbreaks representing 88% of reported cases this year
· Nearly all associated with international travel by unvaccinated persons
o Subsequent transmission among clusters of unvaccinated persons
At least 18 countries implicated as source
· Most common Philippines and India
WHY THE CONCERN?
· Measles is a highly contagious viral disease
· Spread from person to person through the air; approximately 9 out of 10 susceptible persons with close contact will develop measles (virus can remain infectious on surfaces and in the air for up to two hours after an infected person leaves the area)
· Risk of serious morbidity or mortality is significant
o 30% of reported cases experience one or more complications
o Fatality as high as 1-2 deaths/1000 cases
WHAT CAN YOU DO?
Keep a high index of suspicion for measles in patients with fever and rash!!!!
· If symptoms of measles (cough, coryza, conjunctivitis)
o Ask about travel abroad/contact with travelers and vaccination status
· Institute empiric infection control precautions
o AIRBORNE ISOLATION
o If in a clinic setting, use single patient room with door closed
o In exposed UNVACCINATED individuals, measles vaccine may prevent or modify disease if given within 72 hours of exposure (www.cdc.gov/measles/)
Report suspected cases to the Iowa Department of Public Health promptly!
For more information please visit www.cdc.gov/measles/
Clinical Informatics Update
Order Set changes:
Recently, there have been questions raised that some physicians do not have to accept order set changes. There can be some variables when order set changes are made:
· Only providers with user order set versions saved will get a pop-up/warning indicating a change has been made. If they don’t have a user version, they will not get a pop-up/warning.
· If the provider with a user version does not have preferences saved in a section where changes have been made, i.e. antibiotic orders, then these changes will automatically update even in their user version.
If you get a pop-up warning that your user order set has changed, you will need to accept the changes:
1. Enter your InBasket within Epic
2. Click the section title called Order Set/Preference List Notifications.
3. When that screen opens, there will be a list on the left of all order sets that contain changes.
4. Click the order set name once to see the changes on the right. The changes will be in red.
5. If the changes are appropriate, click at the top of the left column.
6. If you click , it will open your user order set so you can make appropriate changes.
7. Click save or accept.
Consult Order Reminder:
Consult orders are for consults only. Consult orders do not print requisitions in Lab or Radiology, so procedures may be missed during off-hours. Please enter orders for required tests instead of writing comments within a consult order.
Medication Reconciliation (Med Rec) from ER:
When reconciling Home Medications upon admission, choose “Don’t Order” for any home medications that are being held during the patient’s stay. This will allow the medication to stay as a choice upon discharge. This process helps a primary physician see medications and doses to reorder if the admitting provider did not want to order the medication when admitting a patient.
Problem list:
The problem list is a critical part of electronic documentation and serves as a communication tool between all care providers. Paramount to understanding the uses of the problem list are certain key expectations.
1. Each patient’s Problem List should provide a readily available, succinct, and accurate depiction of health issues that require further assessment, additional treatment, or continued monitoring.
2. Each patient’s Problem List should serve as a vital source of information and communication for and among various caregivers, helping to ensure safety and quality and improve efficiencies.
3. Each patient’s Problem List should be updated with sufficient frequency to ensure its accuracy and maximize its utility as an important source of relevant information.
4. A universal understanding of the problem list is very important as it is critical to all EHR users. All providers are responsible for the problem list and should understand what is to be included in the problem list, the medical/surgical history, and how to reconcile the problem list at every encounter.
Future communications will include specific work flows and scenarios to further clarify functionality, both within EPIC and existing problem lists in legacy applications, as you prepare them for transition.
To prevent home medications from being omitted upon discharge that were stopped when a patient is admitted. Follow this procedure.
Reconcile Home Medications, Choose Don’t order, to allow the medication to stay as a choice upon discharge.
Shows acetaminophen as not ordered.
Discharging physician is able to see all home medications to reconcile at discharge.
This process helps a primary physician see medications and doses to reorder a home medication if the admitting provider did not want to order the medication when admitting a patient unfamiliar to them.
UnityPoint Health Named “Most Wired”
UnityPoint Health was recognized for the third year in a row as one of the nation's "Most Wired Health Systems" by Hospitals & Health Networks magazine. UnityPoint Health received the honor for its adoption of technology designed to improve and coordinate patient care.
The Most Wired survey measures the adoption, implementation and use of information technology in U.S. hospitals and health systems across four focus areas: Infrastructure, Business and Administrative Management, Clinical Quality and Safety, and Clinical Integration. The survey also covers the evolution of new models and payment from the IT perspective.
Among some of the key findings this year:
o Sixty-seven percent of Most Wired hospitals share critical patient information electronically with specialists and other care providers, which reduces the likelihood of medical errors.
o Thirty-seven percent of Most Wired hospitals aggregate data from patient encounters to create a community health record.
o Seventy-one percent of Most Wired hospitals manage care transitions compared with fifty-seven percent of all responding organizations.
o Forty-three percent of Most Wired organizations integrate clinical and claims data so that they are accessible, searchable and reportable across the care community.
o Sixty-nine percent of Most Wired hospitals use tools for retrospective analysis of clinical and administrative data to identify areas for improving the quality of care and reducing the cost of care delivered.
o Thirty-five percent of Most Wired Hospitals use social media to deliver care management messages and forty percent provide mobile application for secure messaging with patients.
“We are using technology to proactively manage the health of our patient populations, such as a patient portal deployed across the organization, different population health tools and applications, and electronic medical records – all to coordinate care so that our patients can be engaged as active participants in their wellness journey between multiple care settings,” said Joy Grosser, UnityPoint Health Chief Information Officer.
Save the Date
Save the date – Tuesday, July 29 for Moderate Sedation from 6 p.m. to 7:30 p.m. in the Dorner Seminar Room.
We invite you to participate in these free CME programs which are structured to provide instruction in the administration / management of moderate sedation. The programs are intended to increase physicians’ awareness of and capabilities for administration of moderate sedation. Upon completion of the program, the participants should be able to:
· Describe assessment of the patient prior to, during and after administration.
· Review the pharmacological principles of Opioids, Benzodiazepines, and barbiturates.
· Recognize inadequate ventilation in the sedated patient and immediate treatment.
· Demonstrate airway management; understand diagnosis and treat pre-arrest complications.
If interested in attending the CME event, please call (515) 241-6266 / (515) 241-8595 or e-mail to register.
Quality in Action
Link to July edition of Quality in Action:
http://intranet/mlbnet50530/documents/Quality%20in%20Action%202014/14.10.pdf
In Stitches