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--- resident:va [2021/01/08 09:19] – jonathan
+++ resident:va [2026/04/17 13:21] (current) – [Clinic] ariel
@@ Line 1: / Line 1: @@
-=====VA day-to-day=====
+===== Veteran's Affairs =====
+==== VA Faculty ====
-**VA Faculty**\\
-[[resident:michael_gordon|Dr. Michael Gordon]]\\
 [[resident:david_mathes|Dr. David Mathes]]\\
+[[resident:david_mathes|Dr. Seth Tebockhorst]]\\
+==== Generic Monthly Schedule ====
+Subject to change! Melissa Munkwitz can update you on any changes, particularly with OR time. \\
+General Schedule
+^ ^ Tuesday ^ Wednesday ^ Thursday ^
+|Dr. Mathes |AM/PM Tebockhorst +/- Mathes Plastics/Hand Clinic in E1 | Tebockhorst MPR | OR - 7:45AM Start|
+==== VA Templates ====
+Here is the page for the [[Resident:VA_Templates|VA Templates]]. Currently only the generic operative report template is here. In the future, it would be nice to have the common plastic surgery discharge instructions here as well. The VA templates for notes need to be updates.
+==== 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:  720-857-5239 or 1-5239 (in-house), then say the name of the person you want to call (example: Pre-op charge nurse, K3 [room number] nurse/provider/resident, wound care, OR 1 nurse, radiology, outpatient pharmacy, etc.)\\
+==== 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!)
+{{:resident:screenshot_2025-12-19_at_3.31.31 pm.png|}}
+{{:resident:screenshot_2025-12-19_at_3.31.04 pm.png|}}
+==== 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://www.amazon.com/dp/B002N3MM6W?psc=1&ref=ppx_yo2ov_dt_b_product_details (MAC friendly)\\
+https://www.amazon.com/Identiv-SCR3310v2-0-Smart-Card-Reader/dp/B07VVSY96H/ref=sr_1_6?keywords=IDENTIV&qid=1699290763&sr=8-6&th=1 (for USB-C users)\\
+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://raportal.vpn.va.gov/.  \\
+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://citrixaccess.va.gov/vpn/index_citrix_splash.html. \\
+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't show your name at top and says some generic VA thing, click More choices in lower left and select your name\\
+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.\\
+    *{{ :resident:va_fingerprint_request_form.pdf |}}\\
+    *{{ :resident:va_local_policies_acknowledgement.pdf |}}\\
+*VA Fingerprints\\
+    *Fingerprints must be completed at a VAMC facility. Don't bother doing them at an outside facility, there are always issues\\
+    *Recommended: Email VHAECHAcademicAffiliations@va.gov or Kayla.Lewis3@va.gov to schedule an appointment at the Aurora VA for fingerprints. the resident will need to bring 2 forms of ID - see PIV Acceptable Forms of ID. See RMR map for office location and directions for where to park for this visit.\\
+*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\\
-Important numbers:\\
+When signing up make sure you have the following things:\\
-Krysta: 720-737-4532 (office 720-857-5817)\\
+  * Access Code
-VA Prefixes: 720-857-xxxx or 720-723-xxxx. \\
+  * Verify Code
-Vocera:  720-723-7997 or 1-7997 (in-house), then say the name of the person you want to call (example: Pre-op charge nurse, K3 [room number] nurse, OR 1 nurse, radiology, outpatient pharmacy, etc.)\\
+  * PIN
-Jenn Hutton, wound care nurse in the SCI: 720-469-8217\\
+  * 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
-==== General Information ====
+^ ^ Code ^
+|Locker room code | 1-4-5 Enter |
+|Men's Locker #59 | 8008 |
+|Woman's Locker #90 | ? |
-We usually have an intern, but they've been trying to skimp on us lately. If this becomes an issue, let Dr. Mathes know, because the service really is starting to get busier.  We also have a PA, Krysta Bearish, who is awesome, but she is also part of the Breast service. She can see ED consults and patients, and helps out in the OR.  DJ is the scheduler but easy to go through Krysta for most things. She works Tuesday - Friday.
+====Expired Badges====
+    * OH NO I HAVEN'T SCANNED MY BADGE >90 days SO NOW IT'S EXPIRED\\
+    * 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/service. \\
+    * NON-EMERGENT: Email VHAECHfacilityaccessrequest@va.gov to request badge re-activation in advance of your rotation.
+    * If you are already on campus when you realize this, use intercom button at entrance of staff garage marked "POLICE" and you will be granted entrance after answering few questions. You must then visit Facility Access Section in A2-104 during normal business hours for re-activation. REQUIRED: WOC letter with non-digital signature (can get from HR on 1st floor in A building\\
+==== 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 - Tuesday AM 8-11:30. We are in Maroon Peak clinic. 3rd floor specialties clinic in Building E, in rooms 224 - 228. 3-2-4 “enter” is the code to the door to get back into the clinic from the waiting room. They're using this VetLink program now to show when patients arrive. Once the vital signs are taken, you call for the patient yourself and bring them to your room. You can edit the memo to say you are seeing the patient by adding your name/initials or adding “done” in the memo if the patient has been seen so everyone else is on the same page. The attendings have been using the 3rd room (room 228) from the main door as his office. Since we only have 3 assigned rooms, Krysta will often use one of the Thoracic rooms if an intern is helping in the clinic. Krysta will typically see the pre-ops, and the fellow/resident will see the new patients, and the intern will see everyone else. Obviously, if things fall behind, you see anyone. I also encourage you to at least peek in on your post-ops, as you are afforded quite a bit of independence in the OR and it’s a good way to learn from your mistakes. Because of COVID, we are disinfecting the rooms ourselves between patients).
+Hand clinic and Plastics Clinic:
+st floor, building E. Code 251 enter. On Tuesdays it is you, Mathes, Dr. Tebockhorst and Melissa the PA or some combination of those people. Everyone sits in the "Care Team Center" E1-223. You will sit in the main team room and the nurse will room patients and write on the schedule when people arrive and when she roomed them; you will write initials next to one you see. These clinics are more organized. So you should only have to look at 1 schedule. Melissa will print out list of all patients for clinic and leave in team room. Make sure if scheduling patient for follow-up via RTC in orders, you select the correct follow-up clinic. Ask Melissa\\
-If you have a case to schedule, the patient should be provided a business card with the contact information for the office (Krysta has those available).  Sometimes we can offer them an OR date same day, but most of the time she will call them later in the week to get them onto the schedule.
+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 are electronic:  under “Tools” -> iMed Consents -> Plastic Reconstructive Surgery -> Consents Basics -> then select appropriate consent and follow prompts).
+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" and create new template. When filling out notes, you can drag these to empty note page and will copy over. \\
+When you click "new note" it will pop up with progress note title:\\
+Plastics: PLASTIC SURGERY RESIDENT/FELLOW CLINIC NOTE\\
+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"--select yes.\\
+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 "SURGICAL PRE-OP H&P" as progress note title), pre-op labs (under pre-procedure labs), signed consents (consents are electronic:  under “Tools” -> iMed Consents -> Plastic Reconstructive Surgery -> Consents Basics -> then select appropriate consent and follow prompts).\\
-==== Clinic Notes ====
+For pre-op labs: Women <55 need HCG (under pre/post procedure orders-pre-labs-urine pregnancy), pre-procedure (NPO/IV/Iodine/CHG/Hair), and CBC/coags if indicated. I recommend placing/confirming these orders in clinic or the night before cases or you will be woken up to a page at 6am.\\
+If ordering studies/labs that require follow-up or change management - please make sure to add to "tasks to follow up on" spreadsheet in Excel. Melissa and next resident will then be able to follow-up after you change rotation. \\
+==== IMAGING ====
+PACS is IMAGING PACS (XERO Viewer) here.
+Access by opening CPRS:
+. Tools
+. Imaging Apps
+. IMAGING PACS
+. Type in patient's last initial and *#### (last 4 of SSN)
-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).  When you sign the notes - add the attending and Krysta as co-signers. Also order clinic follow up appoints (RTC - specialty clinic - plastics).\\
-If you are seeing a NEW patient consult:  “Plastic Resident/Fellow Consult Note”\\
-If you are seeing a patient for follow-up, post-op:  “Plastic Resident/Fellow Clinic Note”\\
-If you are seeing a pre-op: “Surgical pre-op H&P” then follow the prompts and check all the boxes\\
 ==== 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 "late." Start time is supposed to be 07:45 AM. The operating room is on the 3rd floor of the D building. There are locker rooms in the back of the resident call room.
-Thursdays, first case at 0800, typically in OR1. 3rd floor of building D. You have a locker: male locker is in the back corner, women’s is #90. (Tell Krysta if it gets taken away). The code to get into the locker rooms and the break room is 145 enter. Scrub cards can be obtained from the administrator down the hall from the computer room (ask Krysta).
+Residents wear blue scrubs at the VA. There is a scrub card that can be obtained from the administrator's. Go to office next to resident workroom to ask for one. In a bind, you can sign out a pair of scrubs from the office as well.
-Prior to procedure patients need orders, a pre-op H&P and a consent. Krysta typically handles all of this in her pre-op visit the tuesday before.  If you had an intern for clinic they are typically also with you on your OR day.
+To check the OR status, go to Sharepoint and search for "VA ECHCS Perioperative Services". Link is https://dvagov.sharepoint.com/sites/ECHOR/IP%20DAILY%20CALENDAR/Forms/AllItems.aspx?viewpath=%2Fsites%2FECHOR%2FIP%20DAILY%20CALENDAR%2FForms%2FAllItems%2Easpx
-If you admit patients, they usually go to the 3rd floor of building K.
+You can also go into VistA under "tools" "more" and "operating room schedule" from here you can select the date and see the schedule
-All patients require a brief op note prior to dc.
+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.\\
-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).
+Ordering Tumescent: Go to surgery main menu, order tumescent\\
-==== Dictations ====
+==== Admitting Patients ====
-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 ID.
+Under orders, "Write Delayed Orders"\\
+"Admit to Plastic Surgery", relay orders immediately\\
+Click inpatient orders for all the below orders, and start by going through all the "REQUIRED Admission Orders"\\
+Next in same menu, click "Nursing" for orders on drains, neuro checks, ice or heat packs \\
+Select NURSING free text (0) for free text wound care instructions\\
+Click "Inpatient Meds" under pharmacy for all analgesics, antiemetics, antibiotics, etc\\
+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&O's found in a different application called clinicomp.\\
+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 >Transfer to Outpatient. Will generate meds in Orders tab that you need to sign)
+  - 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, select:\\
+   - Pre/post procedure order sets\\
+   - Post\\
+   - Outpatient discharge orders 1,2,3\\
+For narcotic prescribing, email vhaechepcshelp@va.gov to get your pharmacy ID\\
+\\
+Can sign a bunch of orders at once by clicking File > Refresh Patient Information.\\
+==== Dictations/Op Reports ====
+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
+Dictation Instructions\\
-.	To access dictation system:
+.	To access dictation system:\\
-        From within the facility, dial x15075
+        From within the facility, dial x15075\\
-        From outside the facility, dial 800-394-3845
+When the call is answered, you will be greeted with a voice prompt which gives you instructions.\\
-When the call is answered, you will be greeted with a voice prompt which gives you instructions.
+.	Enter your USER ID, followed by the # key. \\
-.	Enter your USER ID, followed by the # key.
+.	When prompted, key in the patient’s full 9-digit SS number, followed by the # key.\\
-.	When prompted, key in the patient’s full 9-digit SS number, followed by the # key.
+.	When prompted, key in Work Type, followed by # key.\\
-.	When prompted, key in Work Type, followed by # key.
-WORK TYPE	REPORT TYPE
+WORK TYPE	REPORT TYPE\\
 	DISCHARGE SUMMARY
 	OPERATIVE REPORT
@@ Line 64: / Line 220: @@
 	PROGRESS NOTE
-At the sound of the tone, please begin your dictation.
+At the sound of the tone, please begin your dictation.  \\
-*** THE FOLLOWING MUST BE DICTATED DURING THE BEGINNING OF DICTATION***
+*** THE FOLLOWING MUST BE DICTATED DURING THE BEGINNING OF DICTATION***\\
-•	IDENTIFY PATIENT NAME (SPELL THE LAST NAME AND FIRST NAME).
+•	IDENTIFY PATIENT NAME (SPELL THE LAST NAME AND FIRST NAME). \\
-•	ENTER FULL SOCIAL SECURITY NUMBER
+•	ENTER FULL SOCIAL SECURITY NUMBER \\
-•	CLINIC SPECIALTY TITLE (i.e., ORTHOPEDIC, NEUROLOGY, PRIMARY CARE, ETC.)
+•	CLINIC SPECIALTY TITLE (i.e., ORTHOPEDIC, NEUROLOGY, PRIMARY CARE, ETC.)\\
-•	DATE OF SCHEDULED APPOINTMENT
+•	DATE OF SCHEDULED APPOINTMENT \\
-•	NAME OF CO-SIGNATURE (ATTENDING) IF APPROPRIATE.
+•	NAME OF CO-SIGNATURE (ATTENDING) IF APPROPRIATE. \\
-.	If you wish to dictate multiple reports, press ‘8’ to end one and begin another.
+.	If you wish to dictate multiple reports, press ‘8’ to end one and begin another.\\
-.	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.
+.	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.\\
-.	To disconnect, simply hang up.
+.	To disconnect, simply hang up.\\
-DICTATION KEYPAD FUNCTIONS
+DICTATION KEYPAD FUNCTIONS\\
-PRESS
+	To pause dictation. \\
-	To pause dictation.
+	To resume dictating after pausing.\\
-	To resume dictating after pausing.
+	Rewind – rewinds approximately 3 seconds.  Press ‘2’ to resume dictating.\\
-	Rewind – rewinds approximately 3 seconds.  Press ‘2’ to resume dictating.
+	To end current report & begin another\\
-	To end current report & begin another
+##  To get job number of report just dictated before hanging up\\
-##  To get job number of report just dictated before hanging up
+To disconnect, simply hang up.\\
-To disconnect, simply hang up.
-‘LISTEN’ ACCESS
+‘LISTEN’ ACCESS\\
-.	DIAL  800-394-3845
+.	DIAL  800-394-3845\\
-.   Press 333, followed by the # key.
+.   Press 333, followed by the # key.\\
-.   Enter the patient’s full 9-digit SSN or Report number, followed by the # key.
+.   Enter the patient’s full 9-digit SSN or Report number, followed by the # key.\\
-.   The latest dictation or selected report will begin to play.
+.   The latest dictation or selected report will begin to play.\\
-‘LISTEN’ KEY FUNCTIONS
+‘LISTEN’ KEY FUNCTIONS\\
-.  PLAY				4.  WILL GO TO END OF REPORT
+.  PLAY\\				4.  WILL GO TO END OF REPORT\\
-.  PAUSE				6.  NEW SEARCH
+.  PAUSE\\				6.  NEW SEARCH\\
-.  REWIND AND PLAY
+.  REWIND AND PLAY\\
+DRAGON SUPPORT:
+\\18006541187
+\\18008337776
 ==== SCI ====
-SCI - This is the inpatient spinal cord unit (first floor of H).
+SCI - This is the inpatient spinal cord unit (first floor of H). This unit is run by PMNR doctors and wound care.
-  * First Tuesday of every month there is a multidisciplinary meeting at 715 with us and PMNR
+  * There are no longer MDC meetings
-  * Krysta typically gets first call. Whoever you are in clinic or OR that day is who I tend to staff the patient with.
+  * See Plastic Surgery TEAMS spreadsheet for pending SCI consults. You keep this up to date
-  *  Our criteria is that their co-morbidities are relatively well-controlled, osteo has been addressed, and their albumin is 3 or above.
+  * Whoever you are in clinic or OR that day is who I tend to staff the patient with.
-  *  Intraoperatively, Dr. Mathes typically does V-Y advancements, and Dr. Gordon does rotational flaps.
+  * Our criteria is that their co-morbidities are relatively well-controlled, osteo has been addressed, and their albumin is 3 or above.
-  * Postoperatively, Dr. Mathes typically likes to keep the patients on antibiotics until the bone biopsies result. Dr. Gordon likes to keep dressings on for as long as possible (2 weeks) and sutures in for 4 weeks. Drains stay in until nothing consistently draining. Once sutures are out can start on movement protocol (led by PMNR).
+  * Intraoperatively, Dr. Mathes typically does V-Y advancements, and Dr. Gordon does rotational flaps.
-  * Patients are typically seen every tuesday after clinic. Will see with krysta. Have her or the charge nurse call for wound care nurse (Jen) to help you turn and go over what they have been doing for wound care. Unless ongoing concern for a wound, we typically stop following a week or two into their motion protocol.
+  * Postoperatively, Dr. Mathes typically likes to keep the patients on antibiotics until the bone biopsies result. Dr. Gordon likes to keep dressings on for as long as possible (2 weeks) and sutures in for 4 weeks. Drains stay in until nothing consistently draining. Once sutures are out, can start on movement protocol (led by PMNR).
+  * Patients are typically seen every Tuesday after clinic. Have her or the charge nurse call for wound care nurse (Jen) to help you turn and go over what they have been doing for wound care. Unless ongoing concern for a wound, we typically stop following a week or two into their motion protocol.
+  * Criteria:
+      * Co-morbidities are relatively well-controlled, osteo has been addressed
+      * Albumin is 3 or above
-==== 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://militarycac.com/|Military CAC]]. There is a section for buying a card reader and installing the required certificates.\\
 ==== Templates for Notes ====
@@ Line 118: / Line 282: @@
 See Aline's guide here: {{ :resident:plastics_va_.docx |}}
-==== Common Discharge Instructions ====
+Ryan's VA Templates here: {{{{ :resident:va_hand_templates.docx |}} & {{ :resident:va_prs_templates.docx |}}
-=== Dr. Mathes Tissue Expander ===
-Dr. Mathes Post-Operative Instructions\\
-Breast Tissue Expanders\\
-\\
-Dressing:  \\
-  - You have a soft surgical bra in place.  You may change the gauze or pads inside the bra as needed if they become damp or soiled.
-  - 48 hours after surgery, you may remove the surgical bra and dressings, and shower.  Leave Steri-strips in-place, and pat them dry after showering.  Do not submerge in water (tub bath/pool/hot tub) for 4 weeks after surgery.
-  - You may wear the surgical bra as needed for comfort, or you may go bra-less.
-  - If needed, apply antibiotic creme to any blistered areas, twice a day.
-  - NO ICE to the breasts.
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-Drains:\\
-  - You will be sent home from the hospital with drains in place.  Empty the drains as instructed twice a day, and record the amount emptied each time, for each drain.
-  - Bring the record with you to your post-op appointment, as this will determine if the drains may be removed.  Drains are removed when draining <30cc/day.
-  - Make sure the bulbs are collapsed on suction after you empty them.
-  - You may shower with your drains, but be careful not to accidentally pull them out.  Do not take a tub bath until after your drains are removed and the drain sites are  healed.
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-Pain:\\
--  You will have some pain and discomfort from your surgery.
--  Take the pain medication that you have been prescribed.
--  If you have extreme pain not relieved by the pain medicine, or if you have swelling,
-   fever, redness or drainage from your wound, call immediately.
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-Activity: \\
--  You should begin walking as much as possible immediately after surgery.
--  Refrain from lifting greater than 10 pounds, and strenuous activity/exercise, for 4
-   weeks after surgery.
--  Do NOT sleep on reconstructed breasts—sleep on back, only.
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-Post-operative appointment:\\
--10 days after your surgery day.  If you don’t already have your post-op appointment scheduled, please call the number below to schedule with Dr. Mathes:\\
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-The Plastic Surgery clinic, 6th Floor	\\
-      	Anschutz Outpatient Pavilion 	\\
--848-0800		\\
-Date _________________     Time _________________\\
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-Prescriptions given:\\
-Pain Medicine:\\
-Antibiotics:\\
-Anti-nausea medicine:\\
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-If you have further questions, please call Dr. Mathes, at The Plastic Surgery Clinic at 720-848-0800.  If you require immediate attention after business hours, call the hospital at 720-848-0000 and ask to page the plastic surgery service.