resident:va
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| resident:va [2020/09/01 21:12] – jonathan | resident:va [2026/04/17 13:21] (current) – [Clinic] ariel | ||
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| - | =====VA day-to-day===== | + | ===== Veteran' |
| + | |||
| + | ==== VA Faculty | ||
| - | **VA Faculty**\\ | ||
| - | [[resident: | ||
| [[resident: | [[resident: | ||
| + | [[resident: | ||
| + | ==== Generic Monthly Schedule ==== | ||
| - | Important numbers:\\ | + | Subject to change! Melissa Munkwitz can update |
| - | Krysta: 720-737-4532 (office 720-857-5817)\\ | + | |
| - | VA Prefixes: 720-857-xxxx or 720-723-xxxx. \\ | + | |
| - | Vocera: | + | |
| - | Jenn Hutton, wound care nurse in the SCI: 720-469-8217\\ | + | |
| - | ==== General | + | General |
| + | ^ ^ Tuesday ^ Wednesday ^ Thursday ^ | ||
| + | |Dr. Mathes |AM/PM Tebockhorst +/- Mathes Plastics/ | ||
| - | We usually have an intern, but they' | + | ==== VA Templates ==== |
| + | Here is the page for the [[Resident: | ||
| + | |||
| + | ==== VA Phone Numbers ==== | ||
| + | |||
| + | ^ Phone Numbers ^ Role ^ ^ | ||
| + | | Vocera | 15239 | 720-857-5239 | | ||
| + | | IT | 14681 | 8556734357 | | ||
| + | | ED | 16298 | | ||
| + | | DJ | Plastics RN | 303 803 5199 | | ||
| + | | Zeina Omisola | Plastics RN Coordinator | 720-989-5327 | | ||
| + | | Jenn Hutton | SCI Wound Care RN | 720 469 8217 | | ||
| + | | Melissa Munkwitz | Hand/PRS PA | 414 587 8491 | | ||
| + | | IT Help Desk| 855 673 4357 | | ||
| + | |||
| + | VA Prefixes: 720-857-xxxx or 720-723-xxxx. Use this last number to call back pages. ie. 1-2345, call 720 723 2345 skipping the 1.\\ | ||
| + | Vocera: | ||
| + | |||
| + | ==== VA APP'S ==== | ||
| + | The VA now has APP's that help manage inpatient needs and consults. There are sometimes gaps in coverage. If you admit a patient, please sign out to them so that they know the plan in case they get called (this limits phone calls to you!) | ||
| + | |||
| + | {{: | ||
| + | {{: | ||
| + | |||
| + | ==== VA Remote Access ==== | ||
| + | |||
| + | Get Card reader either from VA IT (as of June 2024 they don't write down your info and don't care about getting it back) or Amazon. Make sure MAC compatible if user\\ | ||
| + | https:// | ||
| + | https:// | ||
| + | |||
| + | Make sure you have received Welcome Letter in email giving remote access. IF you have not, email Ashley.Herrera@va.gov \\ | ||
| + | |||
| + | Download Citrix (must download this VA specific one) Steps below: \\ | ||
| + | https:// | ||
| + | Click First Time downloads --takes awhile \\ | ||
| + | Restart Computer \\ | ||
| + | Same website, log-in with Smart Card option\\ | ||
| + | |||
| + | Make sure card reader driver is downloaded at this point\\ | ||
| + | |||
| + | Login to Remote VA (Bookmark this site)\\ | ||
| + | https:// | ||
| + | Open Desktop West, general or ECH-CPRS (again 1st time takes forever)\\ | ||
| + | Make sure PIV reader plugged in, should pop up screen that asks you to select Smart Card for PIV Login, click picture of PIV\\ | ||
| + | If next screen doesn' | ||
| + | Enter Pin # and you're in\\ | ||
| + | |||
| + | |||
| + | ==== General Information & Onboarding ==== | ||
| + | |||
| + | Welcome to the VA. The senior resident has good autonomy at this location and you are expected to run the service. We no longer have a PA or interns on service (including night coverage). For cases at the VA, it is VERY important to make sure you have everything ordered beforehand. They won't have anything like Integra or implants on consignment.\\ | ||
| + | |||
| + | Signing up for the VA can be a huge hassle. Please start the process as early as possible. You will need the following processes to get started with onboarding\\ | ||
| + | |||
| + | *TMS Training (open the VA User Job Aid Form and review instructions before starting the training) – keep a copy of your TMS Certificates\\ | ||
| + | *Complete VHA Mandatory Training for Trainees-Refresher (if done before), VHA Mandatory Training for Trainees (if not done)\\ | ||
| + | *If you need help with your TMS Account when you log in please contact 1(855) 673-4357 or email VHAECHTMSHelpDesk@va.gov\\ | ||
| + | *Please email PRS Program Coordinator both of your TMS certificates to add to your file.\\ | ||
| + | *Review VA Policies and then sign the VA Local Policies Acknowledgement Form and return it to Selena.\\ | ||
| + | *{{ : | ||
| + | *{{ : | ||
| + | *VA Fingerprints\\ | ||
| + | *Fingerprints must be completed at a VAMC facility. Don't bother doing them at an outside facility, there are always issues\\ | ||
| + | *Recommended: | ||
| + | *VA WOC Letter\\ | ||
| + | *Program coordinator must send you Without Compensation (WOC) Packet and you must sign it via DocuSign\\ | ||
| + | *If completed and held up at this stage Please reach out to VHAECHSurgeryPSA@va.gov .Michael T. Kilmer is the director who signs the letters\\ | ||
| + | *VA Badging (after completion of fingerprints)\\ | ||
| + | *You need to be sponsored for a badge, email Ashley.Herrera@va.gov this takes few days -a week. I’d check back in with her after a week and email her again to get scheduled to obtain a badge.\\ | ||
| + | * When you present for your badge, I recommend earlier in day, not lunch hour in order to get both building and computer access as these are 2 separate people and the computer people leave at 3.\\ | ||
| + | *Trial & error\\ | ||
| + | *Prior to starting VA rotation or taking call, recommend trying badge both for computer & door access during business hours\\ | ||
| + | *Set up Remove access as below \\ | ||
| + | *Must sign into remote access every 30 days to prevent expiring\\ | ||
| + | |||
| + | |||
| + | When signing up make sure you have the following things:\\ | ||
| + | * Access Code | ||
| + | * Verify Code | ||
| + | * PIN | ||
| + | * Signature Code | ||
| + | * Dictation Code (45 followed by the last 4 of your social. ie. 45XXXX) | ||
| + | * Microsoft Teams access (add Plastic Surgery team and inpatient list): From VA home page, click Sharepoint, then Apps in upper left hand corner | ||
| + | |||
| + | ^ ^ Code ^ | ||
| + | |Locker room code | 1-4-5 Enter | | ||
| + | |Men's Locker #59 | 8008 | | ||
| + | |Woman' | ||
| + | |||
| + | ====Expired Badges==== | ||
| + | * OH NO I HAVEN' | ||
| + | * EMERGENT: Call Police Dispatch 720-723-5800 and request reactivation for emergent purposes. This gets recorded in Facility Access Section for follow-up and verification with the supervisor/ | ||
| + | * NON-EMERGENT: | ||
| + | * If you are already on campus when you realize this, use intercom button at entrance of staff garage marked " | ||
| + | |||
| + | ==== Meals ==== | ||
| + | We get weekly meal vouchers here redeemable at the canteen, coffee shop, or canteen store. Every Mon/Tues, get them from Ashley Herrera at the front desk next to the resident office. She will ask you how many days you are "on call" to determine how much money you get - tell her 5 days for each week. | ||
| ==== Clinic ==== | ==== Clinic ==== | ||
| - | Clinic | + | Hand clinic and Plastics |
| + | 1st floor, building | ||
| - | If you have a case to schedule, the patient should be provided a business card with the contact information for the office | + | Clinic names on CPRS: \\ |
| + | Plastics: Rmr Surg Plastc (MD MPR, MD Oper, MD/PA, MD/PA postop, Md/PA preop, MD/Res Eval) (VVC is video)\\ | ||
| + | Hand: Rmr Surg Hand (MD, MPR, OPer, Md/PA urgent, Pa post, pa screen)\\ | ||
| - | For pre-ops, patients need: an H&P, pre-op labs (under pre-procedure labs), signed consents (consents | + | Note Formats on CPRS:\\ |
| + | I recommend you creating templates for new patients vs. post-ops etc. Go to templates in lower left corner of CPRS, right click "My templates" | ||
| + | When you click "new note" it will pop up with progress note title:\\ | ||
| + | Plastics: PLASTIC SURGERY RESIDENT/ | ||
| + | Hand: Type in Hand --> will pop up options, select HAND RESIDENT CLINIC NOTE\\ | ||
| + | Sign notes by right clicking and selecting "sign note now" | ||
| + | It will show a prompt saying "are you the primary for this encounter" | ||
| + | You have to select encounter type, complexity, add Dr. Gordon, and diagnosis for encounter, then sign\\ | ||
| + | For pre-ops patients, patients need: an H&P (select " | ||
| - | ==== Clinic Notes ==== | + | For pre-op labs: Women <55 need HCG (under pre/post procedure orders-pre-labs-urine pregnancy), pre-procedure (NPO/ |
| + | |||
| + | If ordering studies/ | ||
| + | |||
| + | ==== IMAGING | ||
| + | PACS is IMAGING PACS (XERO Viewer) here. | ||
| + | |||
| + | Access by opening CPRS: | ||
| + | 1. Tools | ||
| + | 2. Imaging Apps | ||
| + | 3. IMAGING PACS | ||
| + | 4. Type in patient' | ||
| - | Make sure you always set up an encounter, a primary provider, and a diagnosis (The first 2 tabs when you set up the encounter). Then write the note - there are specific plastic surgery headings to select. You can create your own template or use a pre-populated one. Before I made my own templates, I often used the Urology clinic note template). | ||
| - | If you are seeing a NEW patient consult: | ||
| - | If you are seeing a patient for follow-up, post-op: | ||
| - | If you are seeing a pre-op: “Surgical pre-op H&P” then follow the prompts and check all the boxes\\ | ||
| ==== Surgery ==== | ==== Surgery ==== | ||
| + | Find surgery schedule by selecting clinic schedule RMR SURG PLASTC MD OPER. All Gordon hand cases are now under this schedule as well\\ | ||
| + | \\ | ||
| + | \\ | ||
| + | The plastic surgery operating room day is Thursday. The first case is supposed to roll into the room before 08:00 AM to not be deemed " | ||
| - | On Thursdays. Usually in OR 1. 3rd floor of building D. You have a locker, I don’t know what the male locker is, but the women’s is #90. Please be aware that they have a tendency | + | Residents wear blue scrubs at the VA. There is a scrub card that can be obtained from the administrator' |
| - | If you want to put in pre-surg orders so you don't get paged at 5:30 am on Thursdays, you put them in under the RMR OR Plastics MD visit encounter. Have one of the interns show you how to do it. (Note: Krysta has been taking care of this for us as she mostly sees the preops in clinic) | + | To check the OR status, go to Sharepoint and search for "VA ECHCS Perioperative Services" |
| - | If you admit patients, they usually | + | You can also go into VistA under " |
| - | ==== Dictations ==== | + | Prior to procedure, patients need orders, a pre-op H&P (by attending) and a consent. You do not need to write note on day of surgery. It's good practice to double check the charts beforehand to make sure that was all done. You should mark every patient. Dr. Mathes likes you to text him all patient names/last 4 of SSN at the beginning of each OR day so that he can write all his notes in the AM.\\ |
| - | The attendings expect us to dictate all of the operative reports. Attached below are the dictation instructions. Your dictation code is 45 followed by your pharmacy | + | Ordering Tumescent: Go to surgery main menu, order tumescent\\ |
| + | |||
| + | ==== Admitting Patients ==== | ||
| + | |||
| + | Under orders, "Write Delayed Orders" | ||
| + | "Admit to Plastic Surgery", | ||
| + | Click inpatient orders for all the below orders, and start by going through all the " | ||
| + | Next in same menu, click " | ||
| + | Select NURSING free text (0) for free text wound care instructions\\ | ||
| + | Click " | ||
| + | Labs can be found under own menu listed on left of CPRS\\ | ||
| + | Restarting home meds: click on meds tab at bottom of CPRS--> Select all outpatient meds you wish to restart --> open action menu at top left of CPRS--> select transfer to inpatient.\\ | ||
| + | Vitals and I& | ||
| + | Pre-op attending H&P counts as admission H&P, but you need to write a Life-Sustaining Treatment note to be able to order their code status and admit them. Click New Note and type in Life to find note template. \\ | ||
| + | Can sign a bunch of orders at once by clicking File > Refresh Patient Information.\\ | ||
| + | |||
| + | ==== Discharging Patients ==== | ||
| + | Admitted patients will go to the Building K - 3rd floor.\\ | ||
| + | |||
| + | Prior to discharge INPATIENTS, the patients will need:\\ | ||
| + | (Clicking discharge menu under orders will walk you through this)\\ | ||
| + | - Discharge order\\ | ||
| + | - Discharge Instructions (under new Notes- PROVIDER DISCHARGE INSTRUCTIONS)\\ | ||
| + | - Med rec (Meds tab, under Inpatient Meds. Click on med you want to prescribe and click Action > | ||
| + | - Pharmacy Consult\\ | ||
| + | - place a nurse free text order for drain teaching if applicable\\ | ||
| + | - Operative Note must be dictated the same day\\ | ||
| + | - Discharge summary (under D/C Summ tab, click new summary, DISCHARGE SUMMARY)\\ | ||
| + | |||
| + | |||
| + | Prior to discharge OUTPATIENTS, | ||
| + | - Pre/post procedure order sets\\ | ||
| + | - Post\\ | ||
| + | - Outpatient discharge orders 1,2,3\\ | ||
| + | |||
| + | For narcotic prescribing, | ||
| + | \\ | ||
| + | Can sign a bunch of orders at once by clicking File > Refresh Patient Information.\\ | ||
| + | |||
| + | ==== Dictations/ | ||
| + | |||
| + | You can either dictate (see below) or type your operative notes. However if you type, make sure it goes into the right encounter (it is often easier to simply dictate). If typing, select surgery tab in CPRS. Select surgical date, and then select operative report for associated attending. If it was an intra-op consult, this may not exist and you will be forced to dictate. Next right click blank document to edit report. And copy and paste op note here from word document(you only get once chance with 0 edits). Right click again and hit sign. You will get a warning memo that you can't view report. This means it has gone to attending for their attestation.\\ | ||
| + | |||
| + | The attendings expect us to dictate all of the operative reports. Attached below are the dictation instructions. Your dictation code is 45 followed by your last 4 of your SSN. To get dictation number, go to academic office next door or email richard.wagner6@va.gov. I recommend doing this sooner even if you plan on writing your op notes just in case.\\ | ||
| + | |||
| + | DENVER VAMC | ||
| + | Dictation Instructions\\ | ||
| + | |||
| + | 1. To access dictation system:\\ | ||
| + | From within the facility, dial x15075\\ | ||
| + | When the call is answered, you will be greeted with a voice prompt which gives you instructions.\\ | ||
| + | 2. Enter your USER ID, followed by the # key. \\ | ||
| + | 3. When prompted, key in the patient’s full 9-digit SS number, followed by the # key.\\ | ||
| + | 4. When prompted, key in Work Type, followed by # key.\\ | ||
| + | |||
| + | WORK TYPE REPORT TYPE\\ | ||
| + | 1 DISCHARGE SUMMARY | ||
| + | 2 OPERATIVE REPORT | ||
| + | 3 CONSULT & PROCEDURE | ||
| + | 8 PROGRESS NOTE | ||
| + | |||
| + | At the sound of the tone, please begin your dictation. | ||
| + | |||
| + | *** THE FOLLOWING MUST BE DICTATED DURING THE BEGINNING OF DICTATION***\\ | ||
| + | • IDENTIFY PATIENT NAME (SPELL THE LAST NAME AND FIRST NAME). \\ | ||
| + | • ENTER FULL SOCIAL SECURITY NUMBER \\ | ||
| + | • CLINIC SPECIALTY TITLE (i.e., ORTHOPEDIC, NEUROLOGY, PRIMARY CARE, ETC.)\\ | ||
| + | • DATE OF SCHEDULED APPOINTMENT \\ | ||
| + | • NAME OF CO-SIGNATURE (ATTENDING) IF APPROPRIATE. \\ | ||
| + | |||
| + | 3. If you wish to dictate multiple reports, press ‘8’ to end one and begin another.\\ | ||
| + | 4. To obtain a job number for the report you just dictated, press ## before hanging up. KEEP THIS NUMBER UNTIL THE DICTATION IS AVAILABLE FOR ELECTRONIC SIGNATURE.\\ | ||
| + | 5. To disconnect, simply hang up.\\ | ||
| + | |||
| + | DICTATION KEYPAD FUNCTIONS\\ | ||
| + | 1 To pause dictation. \\ | ||
| + | 2 To resume dictating after pausing.\\ | ||
| + | 3 Rewind – rewinds approximately 3 seconds. | ||
| + | 8 To end current report & begin another\\ | ||
| + | ## To get job number of report just dictated before hanging up\\ | ||
| + | To disconnect, simply hang up.\\ | ||
| + | |||
| + | ‘LISTEN’ ACCESS\\ | ||
| + | 1. DIAL | ||
| + | 2. Press 333, followed by the # key.\\ | ||
| + | 3. Enter the patient’s full 9-digit SSN or Report number, followed by the # key.\\ | ||
| + | 4. The latest dictation or selected report will begin to play.\\ | ||
| + | |||
| + | ‘LISTEN’ KEY FUNCTIONS\\ | ||
| + | 1. PLAY\\ 4. | ||
| + | 2. PAUSE\\ 6. | ||
| + | 3. | ||
| + | |||
| + | DRAGON SUPPORT: | ||
| + | \\18006541187 | ||
| + | \\18008337776 | ||
| - | {{: | ||
| ==== SCI ==== | ==== SCI ==== | ||
| - | SCI - this place is going to make our service busier each month. It is located one the first floor of building | + | SCI - This is the inpatient spinal cord unit (first floor of H). This unit is run by PMNR doctors and wound care. |
| + | * There are no longer MDC meetings | ||
| + | * See Plastic Surgery TEAMS spreadsheet for pending SCI consults. You keep this up to date | ||
| + | * Whoever you are in clinic or OR that day is who I tend to staff the patient | ||
| + | * Our criteria is that their co-morbidities are relatively well-controlled, | ||
| + | * Intraoperatively, | ||
| + | * Postoperatively, | ||
| + | * Patients are typically | ||
| + | * Criteria: | ||
| + | * Co-morbidities are relatively well-controlled, osteo has been addressed | ||
| + | * Albumin | ||
| - | ==== Card Reader and Logging on From Home ==== | + | ==== End of rotation Tasks ==== |
| + | Set up a Surrogate: In CPRS - under “Tools” —> select “Options” —> select Surrogates —> select “Add Surrogate” put in name of next resident coming onto rotation and select start date as your last Friday on rotation (just make sure you clear your inbox your last day of rotation)\\ | ||
| + | |||
| + | Make sure TEAMS spreadsheets for SCI consults & Tasks to follow up are updated.\\ | ||
| - | Instructions for installing a card reader can be found at [[https:// | ||
| ==== Templates for Notes ==== | ==== Templates for Notes ==== | ||
| See Aline' | See Aline' | ||
| + | |||
| + | Ryan's VA Templates here: {{{{ : | ||
| + | |||
| + | |||
resident/va.1599009151.txt.gz · Last modified: 2020/09/01 21:12 by jonathan
