From: Angie Schroeder Sent: Thursday, August 30, 2012 3:57 PM
To: Moore, Rose Ann; Beal, Ramona MSubject: Protocol/Order Set for Aquapheresis
Good Afternoon Rose Ann and Ramona, Attached please find the Protocol/Order Set for Aquapheresis that we discussed today. Please let me know if you have any questions. Thank you for your time today. I’m very excited to get this program off and running. Angie Schroeder, Director of Operations, Liberty Dialysis, 214-277-3507 (cell)
From: Moore, Rose Ann Sent: Friday, August 31, 2012 1:39 PM
To: Guy, Kathy; Westcott, NancettaCc: Beal, Ramona M; Grijalva, Yvette; Beaty, Holly; Decker, Gail; McCord, Kate Subject: FW: Protocol/Order Set for Aquapheresis
FYI on this DRAFT of this new order set (see PDF for more info)
Yvette pls identify the Liberty vs 5th floor nurses responsibilities
Kathy fyi on the PICC
Nancetta, fyi and we will be the only Centura facility doing this new procedure so nothing to standardize r/t Order Set, what other questions come up for you? Ramona is taking on the issue of building a new Ultrafiltration Intervention in MT and if we cannot get approved maybe we go to documentation on paper
Gail/Holly- if we have to go to paper what does that mean r/t charging
From: Grijalva, Yvette Sent: Friday, August 31, 2012 3:40 PM To: Moore, Rose Ann
After close examination – I do not think there is anything there we cannot do if the patient has a CDELC placed. I am assuming (while waiting to hear conformation from Angie) that we will be taught how to set up the machine. We already do heparin drips/boluses, the rest is monitoring, adjusting, labs, and weights. I left a message asking for clarification, so if I am wrong I will update you.
From: Beaty, Holly Sent: Wednesday, September 05, 2012 1:37 PM
To: Beal, Ramona M; Decker, Gail; Moore, Rose AnnSubject: Aquadex
Hi ladies, In answer to my question to Liberty, it appears that the Gambro GamCath is the catheter that Aquadex prefers to use with the Aquadex due to the construction (steel coil to prevent the catheter from collapsing). Dr. Flaxenburg mentioned this brand specifically during the meeting. Per below, the cost is $130.00 with the introducer and $80.00 for just the catheter. Have we spoken with our PICC team to see if they can actually do this insertion? I have reviewed the CDM and the charge for the insertion by PICC team of this catheter would need to be added (not a big deal), I cannot remember if anyone reached out to them to see if this is something they felt they could do. If not, the patient would end up in interventional rad. for the placement. Let me know and I’ll be happy to reach out if it has not already been done. Happy Wednesday all! Holly
From: Richard J Fatzinger Sent: Wednesday, September 05, 2012 10:39 AM
To: Angie SchroederSubject: Re: Fwd: Aquadex for Penrose-St. Francis
Hi Angie, The catheter that is utilized by the Aquadex that is placed by the PICC Team is actually not a dialysis catheter. It is called their "CDELC" (Coiled Dual-Lumen Extended Length Catheter). It is a 6-7Fr Midline catheter that has a steel coil running through it to prevent the catheter from collapsing on itself as blood is withdrawn from the patients. The product is manufactured by Gambro UF Solutions and is item 1664 or item 1665 if the hospital also wants the introducer. It costs $80 for just the catheter and $130 for the catheter plus introducer. Rich Fatzinger, Senior Director of Market Development, UFComplete Heart Failure and Fluid Management Program, Fresenius Medical Care North America
From:Date: September 5, 2012 9:05:28 AM PDT
To: Subject:Aquadex for Penrose-St. Francis
Hi Angie, I have a question on the Aquadex, but I don’t know if you are the right person to ask or not: during our meeting, Dr. Flaxenburg mentioned the Gambro catheters that could, potentially, be placed by our PICC nurses…is there a specific brand of dialysis catheter that only works with the Aquadex FlexFlow (like GamCath by Gambro) or would any brand of dialysis catheter work with the machine?
Thanks so much! Holly Beaty RN, BSN, BSBA, Clinical Nurse Auditor
From: Beal, Ramona M [mailto: Sent: Friday, September 07, 2012 4:24 PM
To: Angie Schroeder Cc: Moore, Rose Ann; Grijalva, Yvette; Force, Mike; Schlang, Alison; Westcott, Nancetta Hi Angie, My question was about the “UF complete Prescription Card” referred to in the order set on page 3, #1 and #3. We need to know exactly what this encompasses to build this order set.
Thank you, Ramona Beal, Clinical Informatics
From: Angie Schroeder [mailto:
Sent: Monday, September 10, 2012 1:41 PMTo: Beal, Ramona M
Cc: Moore, Rose Ann; Grijalva, Yvette; Force, Mike; Schlang, Alison; Westcott, Nancetta
The prescription card will provide the physicians with recommendations on UF Rate prescription and titration based on clinical studies and firsthand experience. The card is just a guide. The ultimate decision that will be entered as an order is up to the prescribing physician.
From: Beal, Ramona M Sent: Friday, September 07, 2012 9:01 AMTo: Force, Mike (Pharmacy)
Cc: Moore, Rose AnnSubject: New Project at PH
Mike, Could you please review this order set for a new procedure we are going to be doing at PH only(at this time). I have also attached the research article Rose Ann distributed at the meeting, just to give you an idea of what we are doing. I was tasked with the Meditech documentation piece, Liberty Dialysis along with Dr, Flaxenburg came up with the attached order set. Since there are medications involved I realized Pharmacy needed to be consulted. Upon further review of the order set(page 3, #1,#3) it talks about a “UF Complete Prescription Card” I am not sure what that is so I am contacting the rep today. I will let you know what I find out. Please feel free to contact me with questions.
From: Angie Schroeder [mailto: Sent: Friday, September 07, 2012
To: Beal, Ramona M
Hi Ramona, The only involvement the pharmacy may have is the following:
1. Patients will be anticoagulated with heparin or argatroban. Typically hospitals follow their most aggressive heparin protocol or they adopt one similar to what is on the order set.
2. All diuretics should be discontinued during the UF treatment.
3. If patients received contrast, it is typically recommended to wait 72 hours before initiating UF.
Please let me know if you need further information.
From: Beal, Ramona M Sent: Friday, September 14, 2012 10:06 AM
To: Moore, Rose Ann; Grijalva, YvetteCc: Beaty, Holly; Guy, Kathy
All, Just wanted to send you all an update:I have met with the Jeanie Fox from the PICC team, so we are on the same page with the catheter documentation for charges. She did ask who picks up the cost for the catheter supply and about an in-service from the supplier. Could someone please address that piece?I also met with Nancetta and gave her Mike’s input from Pharmacy for the medication piece so she is working on the order set. Next, Yvette and I can meet an to look at the nursing charting pieces in Meditech. Yvette let me know when you are available to do this. Thanks, Ramona
From: Beaty, Holly Sent: Tuesday, December 18, 2012 7:49 AM
To: Decker, Gail; Moore, Rose AnnSubject: Aquapherisis tracking code
Good morning! Just wanted to advise that the Aquapherisis tracking code is now set up and available only in BA/R:
PH / 6212 / 5TH FLOOR / 9000871 / VT00238 / TRACK AQUAPHERESISThanks! Holly Holly Beaty RN, BSN, BSBA, Clinical Nurse Auditor, Penrose-St. Francis
From: Moore, Rose Ann Sent: Tuesday, December 18, 2012 5:04 PM
To: Beaty, Holly; Decker, GailCc: Mueller, Linda M
Subject: RE: Aquapherisis tracking code
So as we begin to pull all the pieces together to begin education, what would the nurses be responsible for r/t to the tracking code???
From: Beaty, Holly Sent: Wednesday, December 19, 2012
To: Moore, Rose Ann; Decker, GailCc: Mueller, Linda M
Subject: RE: Aquapherisis tracking code
Good morning! Well, first the nurses will not be able to see the tracking code as it is not visible to them. The way that Gail and I approached this when we spoke about a tracking code was when we are invoiced by Liberty, the tracking code could be added at that time as the account would need to be reviewed to make sure the patient actually received the services Liberty is billing us for. So, to answer your question, I’d say documentation in PCS (notes, IV site care record) would be the clue that would be needed to add the tracking code on my side. The nurse is going to need to document the amount of fluid removed anyway and since we are not going to build an intervention right off the bat for this service, the documentation would need to go somewhere. I am open to suggestions on where it should go, though, as I do not have access to PCS to check out other possibilities so maybe there is someplace better than freehanded ‘NOTES’? Thoughts? Thanks! Holly
From: Moore, Rose AnnSent: Friday, December 28, 2012
To: Beaty, Holly; Decker, GailCc: Mueller, Linda M; Hollenback, Robert
Subject: RE: Aquapherisis tracking code
I met with Ramona about this and we have several significant CPOE implications with the order set/workflow/communications within Meditech. Too much to discuss on email, more to come.