VCU Internal Medicine Training Program
Clinic Tip of the Week
9/8/09
MCV:
Check out this cool trend...
When labs show up in your message center for endorsement, click on the trend button next to the value - a separate screen will pop up with the last several values so you can quickly and conveniently view the trend.
** Don't forget to enroll your patients in the H1N1 vaccine study - we need a full list of participants well in advance of the arrival of the vaccines!
VA:
Utilize you local pharmacist...
Each clinic has a designated pharmacist. Send your patients to this knowledgeable practitioner when you prescribe new meds or when your patient needs a little extra medication education. They can even help your patients set up and maintain their pill boxes. The pharmacist's office is usually just around the corner from yours...
9/1/09
MCV:
There will be a big push this year to fill out the PMH/Problem List and Procedure History. To save time and make this easy, you can create a favorite list of diagnoses and procedures. It's very similar to making a favorite list for labs/tests. Once you find a problem and want to add it to your list, click the "add to favorite" button in the bottom L hand corner of that screen. Next time you want to use that diagnosis, click on the favorite folder at the bottom of the screen.
VA:
We now have psychologists located in the clinics to help improve the care we provide. They are available the majority of time and can see most patients within 15 to 30 minutes. They can help with anxiety, depression, schizophrenia, and PTSD. All you have to do is call over and talk to them. Your attendings will have the numbers.
Reminders:
- H1N1 Vaccine Study is still enrolling patients in ACC Clinic - Get your patients in!
- Clinic Task Force meeting Thursday at noon - Be there or be square!
8/18/09
ACC:
Just when you thought ACC Clinic wasn't on the cutting edge...
The ACC Clinic will be participating in a national clinical study for an H1N1 flu vaccine. The best part: there is virtually no work for the residents. All you need to do is be aware that it is going on and to alert your attending if you have a patient that is eligible.
Here are the eligibility criteria:
- Inclusion: > 65 years old, able to consent, good health as deemed by you.
- Exclusion: Cancer (except localized skin cancer or cancer in remission > 10 yrs), CAD, CVA/TIA ever
** If you think you have a patient that qualifies, let your attending know when you are presenting. The patient will have to meet with the attending, a study coordinator, and have 8 blood draws. They will be compensated with $300 for participating. The trial will be starting at the end of the month, so keep an eye open for eligible patients!
VA:
You might not be participating in any cutting edge clinical trials right now, but you still have some good stuff going on...
Use your Clinical Reminders to stay on top of cancer screening, Diabetes maintenance, Alcohol and tobacco counseling, and much, much more! (It's not only helpful... it's also required!)
These Clinical Reminders show up on your Cover Sheet, but they can also be found in the bottom left-hand corner when you are writing your clinic note. When you get to the end of your note, click on Reminders, and you will be prompted to address the reminders that are due at that time. Once you fill out the template, it will be automatically documented in your note.
8/10/09
ACC:
With the conversion to metric, the BMI calculator has been turned on! Now all patients that have a height and weight will have a BMI automatically calculated. This can be viewed in the Vital Signs tab. It can also be imported into your notes (under vital signs and measurements).
Another quick tip: When pulling in Vital Signs, there is no reason to pull 3 different versions of someone's height and weight. Just pick kg and cm, and you're done - after all, we're now exclusively metric!
VA:
Click here for the instructions and paperwork required to get CPRS access from home. Not only would this be a huge time-saver, but it would also allow you to prep for clinic the night before in the comfort of your own home.
8/3/09
Just a couple of tips to make life a little easier...
For ACC:
Make sure that your clinic notes are being placed in the correct folder. Over the last several weeks there have been a number of clinic notes placed in inpatient or consult folders. When you create a new Power Note, make sure that the Type of note is General Internal Medicine Established Visit Note. This way, your notes will be easy to locate once they're finished.
For VA:
Learn to set up your favorite note types, so that it is easy to find your lab letter, clinic note, and phone message. Information for this is located on ERIC > Housestaff Resources > Administrative Resources > CPRS resources.
7/29/09
Tip of the Week: take responsibility for your patient's chart and keep the problem list or PMH section up to date.
In the ACC clinic, in hopes to get rid of the paper chart we need to move all the information from the paper chart into CERNER. Best times to do this are during clinic if you have a no show, after clinic, and when you are doing POD work. As of now, the clinic leadership has not set a deadline for when this has to be done, but there will likely be one. The sooner we start doing this the better off we will be.
In the VA clinic, you will notice that the longer the patient has been in the VA system the more and more "problems" get accumulated and often duplicated on their problem list. These are your patients - take pride in them. Whenever you have a free second either before clinic, during clinic if there is a no show, or when you are doing lab follow up - take a look at the problem list. You can inactive old problems that are no longer relevant and/or cancel duplicated problems.
The other nice thing about doing this task is that it will help you get to know your patients better and you may uncover a problem that had been previously overlooked .
7/21/09
Tip of the Week: hand out business cards to your patients. Besides making you feel like a real primary care doctor, they have a lot of useful information on them.
There are business cards in all exam rooms, on the center table in the conference room (ACC), or in your preceptor's office (VA). They have the clinic phone number and fax number on them. It helps the patients know who their new PCP is and it gives them the clinic fax number so they can get outside records sent over.
7/13/09
Tip of the Week: check out the new pseudo-health maintenance section in CERNER.
CERNER does not have a true health maintenance section, so last year's Clinic Task Force got together and helped create one. This section of CERNER will have most of the relevant health maintenance information (ie. height/weight, blood work, imagining, and procedures).
To get there: Results > Specialty View > Primary Care Specialty View
It contains: vital signs (BP, ht, wt), labs (BUN/Cr, LFTs, PSA, TSH, PAP, etc), imagining (mammo), and procedure (c-scope, EGD, and stress tests). It does not contain DEXA or any other tests that do not show up in CERNER. This view should really help speed up clinics and make it easier to follow up on when labs/tests are due.
7/6/09
Tip of the Week: get to know your personal triage nurse
There is a system that is being employeed in the ACC clinic involving the triage nurses and we think this will really help make things easier for us. We will be matching up one triage nurse with each class, and they will follow you through your whole residency. This will hopefully allow the pt's to develop a repore with the triage nurse and allow us to develop a repore with them.
Also PLEASE return pages from the triage nurses as soon as possible. Mostly these have to deal with medication, abnormal tests, clarification of an order, or clarification of when you want a patient to return. This normally takes 1-2 minutes and will save you, the nurse, and the patient a huge headache. There has been a trend of ignoring these pages that needs to be changed.
As of July 1st:
- R1's will have Rabiyah as their triage nurse
- R2's will have Lakeisha as their triage nurse
- R3's will have Peggy as their triage nurse
Clinic Tip of the Week Compiled by Erin Alesi
