PROVIDER FOCUS

MAY 2014

IQ4 Update

Patient Care Facilitator

Patient Care Facilitator notes in EPIC will now be identified easily by having the service type “Care Facilitator” listed by their name. An example of what this might look like is attached.

Given the number of Patient Care Facilitators we now have in our organization, this makes it easier for all on the care team to find and read notes put in by PCFs.

Trauma ICD-9 and E-codes

When entering a problem into a patient’s problem list and it had to do with a traumatic reason, please choose the appropriate ICD9 or E-code. For example there are multiple ICD9 codes for subdural hematomas. The first choice on the list “Subdural Hematoma - 432.1” is non trauma related, but Traumatic Subdural hematoma – 852.2 or those in the 850 range, are all trauma related. If you use the abbreviation SAH for subarachnoid hemorrhage it will only pull up the code 430 and not the codes within the 852 range. General rule of thumb, if it was related to a traumatic event, the code used should be between 800 and 955.

E codes or mechanism of injury can also be used if you have not identified the injuries yet or no injuries are identified (i.e. MVC, fall, or GSW)

Also, you must make them hospital problems if that is what you are treating during the hospital stay.

Why is this important? UnityPoint health Des Moines must report all trauma patients that are seen/ treated at our hospitals to the state and national programs. In order to find the patients, we run reports as it is impossible to look through the chart of every patient that enters our doors. For the report to run correctly and to most accurately reflect our patients’ care, we need to identify that their injuries were a result of a traumatic event.

Medication changes

There are multiple medications that have been changed recently. If you receive a pop up notification that an order set or a personal favorite order has changed, please take a moment to update your user order sets or favorites to reflect these changes. That will ensure you do not continue to receive those notifications. TIP: The ERX number is a quick way for you to look up the medications.

The following medications were recently changed:

Medication / New ERX / Old ERX
Novolog (Insulin aspart) pen / 128779 / 28534
Lantus (Insulin glargine) pen / 128781 / 28282
Novolog 70/30 (Insulin aspart/prot) pen / 128789 / 33666
Levemir (Insulin detemir) pen / 128787 / 70261
Famotidine 20mg/2ml inj vial / 128799 / 10009
Dexamethasone 4mg/ml 5ml vial / 128803 / 2332
Hydrocortisone 100mg inj vial / 128795 / 3743

Medical Student Notes

Medical students should be completing their notes with the note type of “Medical Student”. They should not be doing notes under any other type (i.e. progress note, H&P). Medical student notes cannot be used for any portion of the required physician documentation. Medical students should never request a co-signature for their notes.

UnityPoint Epic Image Link

Lightweight image viewer can be used to display radiology studies throughout UnityPoint. ECRV (Enterprise Clinical Reference Viewer) is a zero footprint browser that allows users to view radiology images quickly and easily.

ECRV is available for all types of devices:

• iPad/iPhone

• Android

• Windows

• Mac

With ECRV as our default web browser, studies launched from EPIC will be displayed regardless from what type of device is being used. ECRV is also available via a direct link from inside or outside the UnityPoint network by visiting

BCH Pediatric Blog

General pediatrician Dr. Nathan Boonstra has launched a new blog, PedsGeekMD, to share parenting tips with followers on how to keep children safe and healthy. Having learned about the role of social media in pediatrics, he is determined to share important health information through the blog on the Blank Children’s website.

Dr. Boonstra’s posts will cover medicine, kids, safety and nutrition topics as well his passion for immunizations. He will also incorporate his personality, including his interests of video games, Star Wars and Star Trek.

Since many parents and patients are on social media, Dr. Boonstra believes doctors and hospitals also should be on social media to inform and advocate as a trustworthy voice. He is looking forward to sharing and communicating with parents, patients and colleagues as this blog moves forward

Visit the blog at pedsgeekmd.org and follow Dr. Boonstra on Facebook and Twitter.

Opioid Webinar

Achieving Safe Use of ER/LA Opioids While Improving Patient Care Webinar. This educational activity is supported by an independent educational grant from ER/LA Opioid Analgesic REMS Program Companies (RPC) to the Association for Hospital Medical Education (AHME). This activity is intended to be fully compliant with the ER/LA Opioid Analgesic REMS education requirements issued by the US Food & Drug Administration (FDA). Please note that this program also satisfies the Iowa physician licensure

requirement for two hours of chronic pain management education (IA Administrative Code Chapter 11.4).

To register for this webinar please go to the following link, link can also be found on the UnityPoint Health – Des Moines intranet, Physicians tab,Continuing Medical Education. Please note: the link to this webinar has been extended through December 31, 2014.

For any additional questions/concerns, please contact the Medical Education Administration office at (515) 241-6266. Thank you.

Quality in Action

Click here to read the latest edition

ILH 3 Years VAP Free

Ventilator-associated pneumonia (VAP) in critically ill patients increases their risk of mortality. Hospital mortality of ventilated patients who develop VAP is 46 percent compared to 32 percent for ventilated patients who do not develop VAP. It also prolongs time spent on the ventilator, increases length of ICU stay, as well as length of hospital stay after discharge from the ICU. Strikingly, VAP adds an estimated $40,000 to a typical hospital admission.

VAP is the leading cause of death amongst hospital-acquired infections, exceeding the rate of death due to central line infections, severe sepsis and respiratory tract infections in the non-intubated patient. The most concerning aspect of VAP is the high associated mortality.

Reducing mortality due to ventilator-associated pneumonia requires an organized process that guarantees early recognition of pneumonia and consistent application of the best evidence-based practices.

UnityPoint Health-Des Moines piloted its first official “VAP protocol” in 2009. Prior, in 2005, the first steps to decrease VAP were planned through a VAP committee of respiratory therapists and nurses from quality, infection control and front line critical care staff. The Ventilation Bundle was introduced; it consists of these key components:

  • Elevation of the Head of the Bed
  • Daily “Sedation Vacations” and Assessment of Readiness to Extubate
  • Peptic Ulcer Disease Prophylaxis
  • Daily Oral Care with Chlorhexidine

After much observation and data collection our first VAP prevention order set was introduced at the end of 2010. Two new strategies were added: Vest therapy or manual percussion every four hours and chlorhexidine oral rinse would be used for teeth brushing twice a day, in addition to our routine oral care every four hours.

Our mobility initiative started in 2012, called I-C-U Go. Early mobility is important for all patients and that hold true for the ventilated population as well. Mobility for this population could be as little as rolling from side to side, sitting on the side of the bed, or even ambulating ventilated patients. Mobility decreases debilitation, improves outcomes and can decrease days spent on the ventilator and less days on the ventilator means less chance of a VAP!

As we move forward in 2014 and strive toward a fourth year VAP- free, we continue to look at ways to improve our care at the bedside. Education for all critical care nurses will be beginning to teach strategies we can implement to improve the way we provide sedation for this vulnerable population. Daily interruptions to sedation will allow us to evaluate the patient’s readiness to breathe on their own and allow us to minimize the amount of sedation used. Sedation is important but its use does not come without risks. Delirium can occur, especially with the use of benzodiazepines. Delirium puts patients at high risk for injury and can even make other components of our VAP efforts nearly impossible to accomplish.

Partners with Nursing Award

During the Nurses Week Conference, the Professional Growth Committee nominated ten physicians for the Partners with Nursing Award. Congratulations to the winner, Dr. Sheryl Sahr!

Nominees

Erik Bedia, MD

Greg Berry, DO

Holly Bzedga, MD

Lucas Groben, DO

Greg Hicklin, MD

Teresa Lamasters, MD

Naga Meka, MD

Stacey Neu, MD

Sheryl Sahr, MD

Wendy Woods-Swafford, MD, MPH

From nominator Cheryl Lillegraven:

“Dr. Sahr attends the ICU Go Mobility Meetings every other month as the physician liaison. She contributes ideas and feedback at the meetings and is always present and sensitive to how initiatives affect nursing. Dr. Sahr has been very collaborative with the geriatric CNSs regarding implementation of the principles of geriatric care into the trauma protocols. She believes that nurses have a huge impact on how older adults will respond to care in the hospital and the importance of preventing iatrogenesis. She has said many times that nurses are key players for good patient outcomes and she strives to help us be better at what we do as nurses. She is sensitive to the hard work of nursing and always asks for nurses to be at the table when talking about care of trauma patients and when there is discussion about new initiatives.

Dr. Sahr is always willing to teach nurses whether it is at the bedside or through discussion about research and current evidence. When she is not on trauma call, she is here continually working on how to make trauma care better and how nursing fits into the process. She doesn’t dictate nursing practice rather she solicits nursing input and values what we have to say. I have heard her visit with patients/families and she has a very good way of presenting difficult information. She is very respectful of the nursing profession and she makes you feel very valued. Doesn’t matter what level of nursing you are practicing; either a new nurse at the bedside or in an advanced practice role….she collaborates at all levels and is a joy to work with. “

In Stitches