resident:va
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| resident:va [2023/09/29 11:10] – [Clinic] haley.d | resident:va [2026/08/20 12:00] (current) – ariel | ||
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| ==== VA Faculty ==== | ==== VA Faculty ==== | ||
| - | [[resident: | ||
| - | [[resident: | ||
| + | [[resident: | ||
| + | [[resident: | ||
| ==== Generic Monthly Schedule ==== | ==== Generic Monthly Schedule ==== | ||
| Subject to change! Melissa Munkwitz 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. \\ | ||
| + | General Schedule | ||
| ^ ^ Tuesday ^ Wednesday ^ Thursday ^ | ^ ^ Tuesday ^ Wednesday ^ Thursday ^ | ||
| - | |Week 1 - Dr. Mathes |Gordon 8 AM Plastic Clinic (door code is 3-2-4), | + | |Dr. Mathes |AM/PM Tebockhorst +/- Mathes |
| - | |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 | + | |
| - | |Week 5 - Dr. Mathes | Gordon 8 AM Plastic Clinic, PM Gordon Hand Clinic| AM Gordon Hand OR, AM/PM Hand Clinic | Mathes Plastic | + | |
| ==== VA Templates ==== | ==== VA Templates ==== | ||
| Line 23: | Line 20: | ||
| ^ Phone Numbers ^ Role ^ ^ | ^ Phone Numbers ^ Role ^ ^ | ||
| - | | Vocera | Calling system, return pages | 303 299 8020 | | + | | Vocera | 15239 | 720-857-5239 |
| | IT | 14681 | 8556734357 | | | IT | 14681 | 8556734357 | | ||
| | ED | 16298 | | | ED | 16298 | | ||
| 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.\\ | 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: | + | 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 ==== | ==== 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 |
| - | https:// | + | https:// |
| - | https:// | + | https:// |
| Make sure you have received Welcome Letter in email giving remote access. IF you have not, email Ashley.Herrera@va.gov \\ | Make sure you have received Welcome Letter in email giving remote access. IF you have not, email Ashley.Herrera@va.gov \\ | ||
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| *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.\\ | *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.\\ | * 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' | ||
| - | * 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: | ||
| *Trial & error\\ | *Trial & error\\ | ||
| *Prior to starting VA rotation or taking call, recommend trying badge both for computer & door access during business hours\\ | *Prior to starting VA rotation or taking call, recommend trying badge both for computer & door access during business hours\\ | ||
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| |Men's Locker #59 | 8008 | | |Men's Locker #59 | 8008 | | ||
| |Woman' | |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 ==== | ==== Meals ==== | ||
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| ==== Clinic ==== | ==== Clinic ==== | ||
| - | Plastics Clinic | + | Hand clinic and Plastics Clinic: |
| - | + | 1st floor, building E. Code 251 enter. On Tuesdays it is you, Mathes, Dr. Tebockhorst | |
| - | Hand clinic: | + | |
| - | 1st floor, building E. Code 154 enter. On Tuesdays it is you, Dr. Gordon | + | |
| Clinic names on CPRS: \\ | Clinic names on CPRS: \\ | ||
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| For pre-op labs: Women <55 need HCG (under pre/post procedure orders-pre-labs-urine pregnancy), pre-procedure (NPO/ | For pre-op labs: Women <55 need HCG (under pre/post procedure orders-pre-labs-urine pregnancy), pre-procedure (NPO/ | ||
| - | ==== PACS ==== | + | If ordering studies/ |
| - | PACS is IMAGING PAC (IMPAX) here. Click the icon on the desktop and search by using the last #4 of patient' | + | |
| - | You can also access | + | ==== IMAGING ==== |
| + | PACS is IMAGING PACS (XERO Viewer) here. | ||
| + | |||
| + | Access | ||
| 1. Tools | 1. Tools | ||
| 2. Imaging Apps | 2. Imaging Apps | ||
| Line 138: | Line 144: | ||
| 4. Type in patient' | 4. Type in patient' | ||
| - | ==== 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 " | ||
| - | |||
| - | 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 " | 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 " | ||
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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.\\ | 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.\\ | ||
| - | ==== Admitting Patients ==== | + | Ordering Tumescent: Go to surgery main menu, order tumescent\\ |
| - | Under orders, | + | ==== Outpatient Surgery and Inpatient Tasks ==== |
| - | " | + | |
| - | Surgery Main Menu - can use general surgery | + | All the things you need are in the tabs at the bottom of the screen \\ |
| - | Go through each tab | + | Right click with the mouse to sign orders/notes/etc. \\ |
| - | ==== Discharging Patients ==== | + | I pre wrote all my instructions and op not in an email to myself to make copy and pasting easier, you’ll see why below. \\ |
| - | Admitted patients will go to the Building K - 3rd floor.\\ | + | |
| + | |||
| + | Outpatient Surgery Discharge. \\ | ||
| + | 1. Go to Notes, click New Note, Brief op note\\ | ||
| + | - Fill in the form \\ | ||
| + | - Sign after it populates as a note\\ | ||
| + | 2. Go to Orders | ||
| + | - Click “ Pre/Post Procedure Order Sets”\\ | ||
| + | - Click “POST PROCEDURE ORDERS (click here)”\\ | ||
| + | - Under “outpatient discharge orders” there is a 1,2 and 3 click thru each one and fill in what you need \\ | ||
| + | - easiest | ||
| + | 3. Outpatient meds I could never order, so I would ask Melissa or ask for a surgery APP to help me \\ | ||
| + | - Melissa is there tues - thurs and can help you \\ | ||
| + | - Tebock does his own meds or can for you \\ | ||
| + | 4. Op note \\ | ||
| + | - Go to “Surgery” tab \\ | ||
| + | - Find the surgery date and name you just did in the left hand column \\ | ||
| + | - Open that *date*, OPERATION REPORT\\ | ||
| + | - Right click to edit, and then you can type your op report in there. \\ | ||
| + | - once you SIGN it you cannot edit, it disappears so make sure you are happy. Some people write the notes on their own comp or in word then copy and paste, then sign. \\ | ||
| + | - I never got the phone call dictation to work, this works just as well. \\ | ||
| + | \\ | ||
| + | Admitting at the VA \\ | ||
| + | HIGHLY recommend doing this in the resident bowl so a surgical APP can help you. \\ | ||
| + | 1. Complete brief op note, can do op note too if you want, or do it later. \\ | ||
| + | 2. Go to “Orders” tab \\ | ||
| + | - Open “Surgery Main Menu”\\ | ||
| + | - Under surgical speciality menus there is “General Surgery Menu” click that \\ | ||
| + | - << | ||
| + | - Can also just click all the orders you want here in the “general surgery | ||
| + | - don’t forget no ice or heat to breast, surgical bra or binder, drain care can write those as nurse free text orders. \\ | ||
| + | 3. Restarting Home Meds: In the Meds tab \\ | ||
| + | - under “Outpatient Meds” you can hold Shift and highlight all meds you want to be continued. \\ | ||
| + | - At the top of the CPRS screen there is “Action” click this and in the drop down menu select “transfer to inpatient”\\ | ||
| + | 4. You must complete a “Life-sustaining Treatment” note, you’ll need their family contact phone number before hand!!!\\ | ||
| + | - Go to Notes tab, select New Note, Search “Life sustaining “\\ | ||
| + | - fill in the form\\ | ||
| + | - sign after it populates as a note\\ | ||
| + | \\{{ : | ||
| + | \\ | ||
| + | I have an APP check this before I leave \\ | ||
| + | \\ | ||
| + | How to discharge at the VA \\ | ||
| + | 1. Check meds on the “Meds” tab and make sure outpatient meds are what you want, if needed order whatever post op meds you want (Residents usually can’t order meds so you have to ask a PA to order them for you - like Melissa or one of the surgery APPs) \\ | ||
| + | 2. Go to Notes and “New Note” and chose the “Provider discharge instructions” \\ | ||
| + | - fill out the form, easy if you have some instructions already written you can copy and paste, if not just free hand it \\ | ||
| + | - sign after it populates in a note \\ | ||
| + | 3. Home oxygen, if needed \\ | ||
| + | - Click Consults tab \\ | ||
| + | - click “New Consult” from the left hand column \\ | ||
| + | - On the far right column in that pop up window it says “PULMONARY…”, | ||
| + | - In your dc order (under step 4) you can write in the “special instructions”, | ||
| + | 4. Go to orders \\ | ||
| + | - in the left column click, Discharge pathway, follow the instructions in order\\ | ||
| + | - Pharmacy Discharge Consult, fill the pre filled form, you’ve already checked the outpatient meds, sweet \\ | ||
| + | - you’ve already done the provider dc instructions, | ||
| + | - “Click here to order Discharge Order”\\ | ||
| + | 5. Go to D/C summary and click “new summary”\\ | ||
| + | - chose any template that says “dc summary” or some version of that, it doesn’t matter which\\ | ||
| + | - fill out the form\\ | ||
| + | - sign when complete \\ | ||
| + | 6. Do the PDMP Query \\ | ||
| + | - top right hand corner just clinic and follow steps and sign \\ | ||
| + | \\ | ||
| + | If your unsure surgical APPs are very nice and helpful I would have them check my work before I left \\ | ||
| + | All BLUE orders need to be signed, you can hold shift and select them all and sign at once \\ | ||
| - | 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)\\ | ||
| - | - Pharmacy Consult\\ | ||
| - | - Pain medication\\ | ||
| - | - Operative Note must be dictated the same day\\ | ||
| - | - Discharge summary (under D/C Summ tab)\\ | ||
| - | Prior to discharge OUTPATIENTS, | ||
| - | - Pre/post procedure order sets\\ | ||
| - | - Post\\ | ||
| - | - Outpatient discharge orders 1,2,3\\ | ||
| - | For narcotic prescribing, | ||
| ==== Dictations/ | ==== Dictations/ | ||
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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. | 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 | * 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. | * 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, | * Our criteria is that their co-morbidities are relatively well-controlled, | ||
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| ==== End of rotation Tasks ==== | ==== 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.\\ | ||
resident/va.1696000243.txt.gz · Last modified: 2023/09/29 11:10 by haley.d