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--- resident:va [2023/01/20 10:46] – taylor
+++ resident:va [2026/04/17 13:21] (current) – [Clinic] ariel
@@ Line 2: / Line 2: @@
 ==== VA Faculty ====
-[[resident:michael_gordon|Dr. Michael Gordon]]\\
-[[resident:david_mathes|Dr. David Mathes]]\\
+[[resident:david_mathes|Dr. David Mathes]]\\
+[[resident:david_mathes|Dr. Seth Tebockhorst]]\\
 ==== Generic Monthly Schedule ====
-Subject to change! Krysta and Melissa can update you on any changes, particularly with OR time. \\
+Subject to change! Melissa Munkwitz can update you on any changes, particularly with OR time. \\
-Hand fellow usually covers Weds hands cases--check weekly with fellow or Melissa. \\
+General Schedule
 ^ ^ Tuesday ^ Wednesday ^ Thursday ^
-|Week 1 - Dr. Mathes |Gordon 8 AM Plastic Clinic (door code is 3-2-4), PM Gordon Hand Clinic | AM Gordon Hand OR (Fellow covers), AM/PM Hand Clinic (located in E1: door code is 1-5-4)| Mathes Plastic OR - 7:45AM Start|
+|Dr. Mathes |AM/PM Tebockhorst +/- Mathes Plastics/Hand Clinic in E1 | Tebockhorst MPR | OR - 7:45AM Start|
-|Week 2 - Dr. Gordon| Mathes 8 AM Plastic Clinic, PM Gordon Hand Clinic | AM Gordon Hand OR (fellow), AM/PM Hand Clinic | Gordon Plastic OR - 7:45AM Start |
-|Week 3 - Dr. Mathes | Gordon 8 AM Plastic Clinic, PM Gordon Hand Clinic | AM Gordon Hand OR (fellow), AM/PM Hand Clinic | Mathes Plastic OR - 7:45AM Start|
-|Week 4 - Dr. Gordon | Mathes 8 AM Plastic Clinic, PM Gordon Hand Clinic | AM/PM Gordon Hand Clinic | Gordon Plastic OR - 7:45AM Start |
-|Week 5 - Dr. Mathes | Gordon 8 AM Plastic Clinic, PM Gordon Hand Clinic| AM Gordon Hand OR (fellow), AM/PM Hand Clinic | Mathes Plastic OR - 7:45AM Start |
 ==== VA Templates ====
@@ Line 24: / Line 20: @@
 ^ Phone Numbers ^ Role ^ ^
-| Vocera | Calling system, return pages | 303 299 8020 |
+| Vocera | 15239 | 720-857-5239 |
-| IT | 14681 | 855 637 4357|
+| IT | 14681 | 8556734357 |
-| Krysta Bearish | Plastics PA | 720-737-4532 (office 720-857-5817) |
+| ED | 16298 |
 | DJ | Plastics RN | 303 803 5199 |
-| Mary | Plastics Scheduler | 720-857-2710 |
+| Zeina Omisola | Plastics RN Coordinator | 720-989-5327 |
 | Jenn Hutton | SCI Wound Care RN | 720 469 8217 |
-| Melissa Munkwitz | Ortho Hand PA | 414 587 8491 |
+| 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:  720-723-7997 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.)\\
+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 (will loan, but may lock you up if you lose it) or Amazon. Make sure MAC compatible if user\\
+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/B0177O5XNA?psc=1&ref=ppx_yo2ov_dt_b_product_details (MAC friendly)\\
+https://www.amazon.com/dp/B002N3MM6W?psc=1&ref=ppx_yo2ov_dt_b_product_details (MAC friendly)\\
-https://www.amazon.com/Reader-Saicoo-Military-Compatible-Windows/dp/B071NT53M7 (for USB-C users)\\
+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 \\
@@ Line 61: / Line 64: @@
 ==== General Information & Onboarding ====
-Welcome to the VA. The senior resident has good autonomy at this location and you are expected to run the service. Krysta Bearish is the PA who helps coordinate for Breast Surgery as well. She works Tuesday through Friday and is present at clinic and available if needed for the operating room. There are no longer interns covering plastic surgery at the VA day or night. Mary is the plastics scheduler but easy to go through Krysta for most things. 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.\\
+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\\
@@ Line 68: / Line 71: @@
     *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 Selena both of your TMS certificates to add to your file.\\
+    *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 |}}\\
@@ Line 76: / Line 79: @@
     *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\\
-    *Selena must send you Without Compensation (WOC) Packet and you must sign it via DocuSign\\
+    *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)\\
@@ Line 99: / Line 102: @@
 |Men's Locker #59 | 8008 |
 |Woman's Locker #90 | ? |
+====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.
+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 ====
-Plastics 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 VSE 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. You and Krysta select your own rooms and camp out there throughout clinic. 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\\
-Hand clinic:
-st floor, building E. Code 154 enter. On Tuesdays it is you, Dr. Gordon and Melissa the PA. You will each have a room and will call patients similar to plastics clinic. On Wednesdays, you will sit in the main 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. Wednesday mornings are you, Melissa, and the attending. In the afternoon, the ortho residents should be joining after their didactics.\\
 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)\\
-Make sure if scheduling patient for follow-up via RTC in orders, you select the correct follow-up clinic\\
-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.\\
-For pre-ops, patients need: an H&P ("Surgical Preop-Op 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-op labs: Women <50 need HCG (under pre/post procedure orders-pre-labs-urine pregnancy), BINAX (under labs- POC), 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.\\
+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).\\
-==== PACS ====
+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.\\
-PACS is IMPAX here. Click the icon on the desktop and search by using the last #4 of patient's SSN ("*1234")
+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. \\
-==== Clinic Notes ====
+==== IMAGING ====
+PACS is IMAGING PACS (XERO Viewer) here.
-Make sure you always set up an encounter by right clicking note, select edit encounter and select yourself as a primary provider. Also select billing level of complexity, whether condition is service related, and a diagnosis for 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.  When you sign the notes - you are the "Primary" signer. Once you sign, right click and add co-signers. Add relevant attending and Krysta Bearish.\\
+Access by opening CPRS:
+. Tools
+. Imaging Apps
+. IMAGING PACS
+. Type in patient's last initial and *#### (last 4 of SSN)
-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.
-Residents wear blue scrubs at the VA. There is a scrub card that can be obtained from the administrator's office and Krysta can help you obtain that. In a bind, you can sign out a pair of scrubs from the office as well.
+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.
 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
-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. Krysta typically handles all of this when she sees the patient pre-operatively. I recommend letting Krysta do the pre-ops while you see new patients and post-ops. 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 also go into VistA under "tools" "more" and "operating room schedule" from here you can select the date and see the schedule
+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.\\
+Ordering Tumescent: Go to surgery main menu, order tumescent\\
 ==== Admitting Patients ====
-Under orders, "Write Delayed Orders"
+Under orders, "Write Delayed Orders"\\
-"Admit to Plastic Surgery", relay orders immediately
+"Admit to Plastic Surgery", relay orders immediately\\
-Surgery Main Menu - can use general surgery
+Click inpatient orders for all the below orders, and start by going through all the "REQUIRED Admission Orders"\\
-Go through each tab
+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 Notes-discharge instructions)\\
+  - 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\\
-  - Pain medication\\
+  - 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)\\
+  - Discharge summary (under D/C Summ tab, click new summary, DISCHARGE SUMMARY)\\
-(Clicking discharge menu under orders will walk you through this)\\
 Prior to discharge OUTPATIENTS, select:\\
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 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 ====
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 .	To access dictation system:\\
         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.\\
 .	Enter your USER ID, followed by the # key. \\
@@ Line 223: / Line 252: @@
 .  REWIND AND PLAY\\
+DRAGON SUPPORT:
+\\18006541187
+\\18008337776
@@ Line 229: / Line 261: @@
 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
-  * 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
+  * Whoever you are in clinic or OR that day is who I tend to staff the patient with.
   * Our criteria is that their co-morbidities are relatively well-controlled, osteo has been addressed, and their albumin is 3 or above.
   * Intraoperatively, Dr. Mathes typically does V-Y advancements, and Dr. Gordon does rotational flaps.
   * 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. 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.
+  * 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
@@ Line 240: / Line 273: @@
 ==== 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)
+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.\\