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--- resident:va [2023/09/11 09:18] – [Dictations/Op Reports] haley.d
+++ 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! Melissa Munkwitz can update you on any changes, particularly with OR time. \\
+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, 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, 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, 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, AM/PM Hand Clinic | Mathes Plastic OR - 7:45AM Start |
 ==== VA Templates ====
@@ Line 23: / Line 20: @@
 ^ Phone Numbers ^ Role ^ ^
-| Vocera | Calling system, return pages | 303 299 8020 |
+| Vocera | 15239 | 720-857-5239 |
 | IT | 14681 | 8556734357 |
 | ED | 16298 |
 | DJ | Plastics RN | 303 803 5199 |
-| Zeina Omisola | Plastics Scheduler | 720-989-5327 |
+| 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 |
@@ Line 33: / Line 30: @@
 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 81: / Line 84: @@
     *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.\\
-* 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. \\
 *Trial & error\\
     *Prior to starting VA rotation or taking call, recommend trying badge both for computer & door access during business hours\\
@@ Line 102: / 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 ====
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 ==== 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. The attendings have been using the 3rd room (room 228) from the main door as his office. You (and medical student, if there) 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. Disinfect 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\\
-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 IMAGING PAC (IMPAX) here. Click the icon on the desktop and search by using the last #4 of patient's SSN ("*1234").
-You can also access by opening CPRS:
+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
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 . Type in patient's last initial and *#### (last 4 of SSN)
-==== Clinic Notes ====
-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.\\
-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.
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 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.\\
@@ Line 162: / Line 181: @@
 (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)\\
@@ Line 175: / Line 195: @@
 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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 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 with.
   * Our criteria is that their co-morbidities are relatively well-controlled, osteo has been addressed, and their albumin is 3 or above.
@@ Line 250: / 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.\\