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--- resident:va [2024/02/29 10:05] – [Surgery] haley.d
+++ resident:va [2026/08/20 12:00] (current) – 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 ====
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 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 (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/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)\\
@@ Line 103: / Line 106: @@
     * 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. \\
+    * 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. There are multiple clinic schedules on CPRS as listed below. We will see patients from each schedule on Tuesday mornings. You have to look at each one individually, yes it's annoying but RN should print out list for you each week with all 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. They have their own rooms. 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\\
 Clinic names on CPRS: \\
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 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. \\
-==== PACS ====
+==== IMAGING ====
-PACS is IMAGING PAC (IMPAX) here. Click the icon on the desktop and search by using the last #4 of patient's SSN ("*1234").
+PACS is IMAGING PACS (XERO Viewer) here.
-You can also access by opening CPRS:
+Access by opening CPRS:
 . Tools
 . Imaging Apps
@@ Line 159: / Line 161: @@
 Ordering Tumescent: Go to surgery main menu, order tumescent\\
-==== Admitting Patients ====
+==== Outpatient Surgery and Inpatient Tasks  ====
-Under orders, "Write Delayed Orders"\\
+All the things you need are in the tabs at the bottom of the screen \\
-"Admit to Plastic Surgery", relay orders immediately\\
+Right click with the mouse to sign orders/notes/etc. \\
-Click inpatient orders for all the below orders, and start by going through all the "REQUIRED Admission Orders"\\
+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. \\
-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.\\
-==== Discharging Patients ====
-Admitted patients will go to the Building K - 3rd floor.\\
-Prior to discharge INPATIENTS, the patients will need:\\
+Outpatient Surgery Discharge. \\
-(Clicking discharge menu under orders will walk you through this)\\
+. Go to Notes, click New Note, Brief op note\\
-  - Discharge order\\
+	- Fill in the form \\
-  - Discharge Instructions (under new Notes- PROVIDER DISCHARGE INSTRUCTIONS)\\
+	- Sign after it populates as a note\\
-  - Pharmacy Consult\\
+. Go to Orders tab \\
-  - place a nurse free text order for drain teaching if applicable\\
+	- Click “ Pre/Post Procedure Order Sets”\\
-  - Pain medication\\
+	- Click “POST PROCEDURE ORDERS (click here)”\\
-  - Operative Note must be dictated the same day\\
+	- Under “outpatient discharge orders” there is a 1,2 and 3 click thru each one and fill in what you need 	\\
-  - Discharge summary (under D/C Summ tab, click new summary, DISCHARGE SUMMARY)\\
+	- easiest to have some generic dc instructions in you email or something that you can just copy and paste in there \\
+. 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 \\
+. 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. \\
+. Complete brief op note, can do op note too if you want, or do it later. \\
+. Go to “Orders” tab \\
+	- Open “Surgery Main Menu”\\
+	- Under surgical speciality menus there is “General Surgery Menu” click that \\
+	- <<Click Here>> General Sx Admission Order Set, let that go through all its things. \\
+	- Can also just click all the orders you want here in the “general surgery menu”\\
+	- don’t forget no ice or heat to breast, surgical bra or binder, drain care can write those as nurse free text orders. \\
+. 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”\\
+. 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\\
+\\{{ :resident:va_inpatient_orders.jpg?nolink&400 |}}
+\\
+I have an APP check this before I leave \\
+\\
+How to discharge at the VA \\
+. 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) \\
+. 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 \\
+. 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…”, click that\\	- Under “Home Oxygen” there is a “New Home O2 Order” click that to get a home O2 order and get O2 delivered to bed \\
+	- In your dc order (under step 4) you can write in the “special instructions”, “do not dc until home O2 delivered.” \\
+. 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, yay 	\\
+	- “Click here to order Discharge Order”\\
+. 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 \\
+. 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 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\\
 ==== Dictations/Op Reports ====