How to Survive Clinic at the VA - matheny



How to Survive Clinic at the VA

June 2009

How Does Clinic Flow?

• The nurses will check in your patients, check vitals, and place the packet in your door.

• Go out to the waiting room and call the patient back to your room.

• Order tests yourself in CPRS.

• To schedule follow up visits: On the “Orders” page click on “TVH Return to Clinic Orders” then Click on “Nashville PCC RTC Orders” and fill in the appointment fields. .

• For urgent imaging orders today, call the department involved: MRI extension 68185, CT extension 67615 or Nuclear Medicine/Ultrasound extension 67550.

• Finish your note and encounter form before the day is over.

• Be sure to follow up on all tests that you ordered during the clinic visit and let the patients know about the results (phone call or letter).

• Consider looking up your patients the day before clinic so you have a plan in place

• Interns have 4 slots per clinic day. Juniors/Seniors have 6 slots per clinic day.

Alerts:

• Check alerts in CPRS as often as possible. Calls from patients will be recorded here.

• Do not sign off on your alert until you have returned the phone call to the patient and documented what you have done.

• The goal is for all alerts and patient phone calls to be answered and dealt with within 24 hours of the initial patient call.

• Document whatever action you take – including calling and NOT reaching patient – by making an addendum on every telephone care alert.

Useful Phone Extensions:

Police: 911

Code Blue or STAT: 911

Emergency Department: 66892

Admissions/Care Coordinator: 66086

Outpatient Pharmacy: 68196

Firm A Fax Number: 615-873-8056

Medical Service Fax Number: 615-873-7743

Telephone Care (for patients): 225-3700 (internal extension 23700)

Centralized scheduling: 225-3600 (internal extension 23600)

VA Address (for all those forms…)

1310 24th Avenue South

Nashville TN 37212

How Does the Computer Work?

View Radiology Images, EKG's

• Open "VISTA Imaging Display" under the "Tools" menu

Outside records:

• Records from outside non-VA facilities are scanned into the medical record. There will be a little blue icon next to the note. To view open "VISTA Imaging Display" under the "Tools" menu.

• Records from other VA sites – If the "Remote Data" button is highlighted (top right menu bar), select "VistaWeb" which is also on the menu bar.

How to look up your clinic schedule:

• When you open CPRS and see your alerts, at the top left put a check mark in the “Clinic” option. In the drop down box type “Na-pcc-res/your last name”. In the next drop down box select “Choose date range” and pick the date you are in clinic. When you hit enter the list of clinic patients should appear to the right.

Vacation: Selecting a surrogate:

• Ask one of your fellow residents to cover your alerts while you are on vacation – you can make your covering resident your “surrogate” (all alerts go to your covering resident)

• How to designate your “surrogate” in CPRS

o Go to “Tools.” Go to “Options.” Go to “Notifications.” Go to “Surrogate settings.”

o Pick a resident surrogate from the drop down menu (make sure the person knows you are picking them!). Pick the date range for which they are to receive your messages. Press “ok”

Computer Problems

• Call computer specialist Kim Leonard first at extension 67667.

• If there is no resolution, call the help desk at 26500.

Things you might need to do in Clinic:

Vaccinations:

• Place the patient’s face sheet with the vaccine request in the nurses’ door and ask the patient to wait in the waiting room until called.

• Nurses will automatically offer flu shots, pneumovax and tetanus to patients. Please talk to your attending about how to order a zoster vaccine before ordering this one.

• Document the order to give the vaccine as a free text order in CPRS.

Patient Education:

• EXIT Nurse – Check with Emily in firm A at extension 66834 to see if she has time that day and enter a consult for "patient teaching". She may have to schedule a time if she is busy.

o Great for medication instruction – insulin administration, formoterol or MDI use.

o Important to send patients when you refer them for diagnostic tests that require a prep – colon, IVP, etc – for prep sheets, instructions – patients have a tendency to take the prep when it arrives in the mail, rather than waiting for the procedure

• Can also order a nutrition consult or diabetic education consult to be done at a later time.

Admitting

• Complete the “Admission-Admission Form (PC)” note in CPRS in detail and include your pager number. Then call admissions at extension 66086. If the patient is critically ill or unstable, send to the emergency department (66892) as patients can wait in admissions for many hours.

• The admissions office will give you a team assignment and resident name and pager number (Be sure to ask if they don't provide) – call the resident and let them know about the patient before the patient leaves clinic.

Forms Patients want you to fill out

• All forms for completion should be submitted to Release of Information on the first floor for tracking. Once completed, the form goes back to Release of Information and then their staff will send it to the patient. If a patient happens to give you a form directly, you may complete it and then give it to Release of Information.

• We do not complete functional assessment forms. We are not qualified to do Department of Transportation (DOT) physicals for truck drivers. Check with your attending for questions about this.

Scheduling Follow-up:

• On the “Order” tab, click "TVH Return to Clinic Orders” then select “Nashville PCC RTC Orders" feature.

• If the F/U appt is >90 days in the future, the patient will receive a card in the mail and have to call to schedule the appointment. If the F/U appt is ................
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