Paragon Scheduled Downtime

Paragon will be down from 9:00pm Tuesday 08/19/14 through 6:00am Wednesday 08/20/14

Purpose: Perform Paragon code upgrade from 12.0.980 to 12.0985 to apply fixes and enhancements including but not limited to;

  • Correcting the error received when medical records merges accounts
  • Correcting the issue of order requisitions not printing for future orders
  • Corrections and enhancements for Meaningful Use
  • New enhancement to be able to hide caregiver name from discharge instructions
  • Improved performance on Webstation for Physicians Action List

HPF will be available for medical record access.

For urgent medical record requests, please contact Medical Records at: 815-334-3111

Paragon CPOE Issues Reporting Procedure

In an effort to improve CPOE medication order selection as well as reduce the risk of medication events, confusion and frustration with medication order entry through Paragon CPOE; clinicians are requested to report issues or concerns immediately to the Department of Pharmacy services. The mechanism for reporting problematic CPOE medication orders to pharmacy is an e-mail to #fdbissue@centegra.com. Please provide appropriate detail including issues with drug name, dosage form, dose and dose mode, route, frequency, duration, schedule or other order entry problems encountered.

Paragon CPOE medication orders are categorized into one of two groups: OV or RX.
OV is Orderview which is populated with medication order selections from a third party called First Data Bank (FDB). RX is Centegra specific order sets built by Centegra pharmacists. RX orders will be reviewed and corrected locally through Centegra’s orders revision processes. OV orders will be reported to McKesson and FDB for appropriate follow-up. The Department of Pharmacy services will maintain a running log of reported issues for the purpose of communicating status and resolution follow-up.

To report a CPOE issue regarding medications please email #fdbissue@centegra.com.

For a printable copy of this memo, please click here.

Finding Visit ID’s for Pre-Registered Patients

Finding Visit ID’s for patients that are pre-registered for a procedure, study, or surgery can be done in 2 quick steps.

While inside your census (My Patients or Group & My Patients) switch the Bed Filter and the Pt. Type to ALL and click search.

Preop1

Click Picture To Enlarge

Your census list will be expanded to show “Pre-Reg” patients. Pre-Reg patients are patients that have been pre-registered for imaging studies, procedures, or surgery. The Visit ID will show up in the same place as the admit patients.

Preop2

Click Picture To Enlarge

Please remember to use the Visit ID when dictating.

For questions or concerns, please contact Michael Millare or Prapti Desai at (815)759-4330.

Bylaws vote at September 3rd 2014 Combined Medical Staff Meeting

An amendment to the current bylaws at both campuses will be proposed at the upcoming September 3rd 2014 combined medical staff meeting. This is subject to the approval of 2/3rds of the active medical staff present at the meeting from each campus.

Background

The current bylaws requires that a COBRA- EMTALA medical screening examination in the ED is performed by a physician or a physician assistant. Now that nurse practitioners are employed in the ED we require a change to this language to accommodate this group of practitioners as well. The change would be to allow this medical screening to be performed by a physician or physician extender.


McHenry proposal

bold added/ italics removed

Article III: MEMBERSHIP
Section 3.6 Basic Responsibilities of Staff Membership

g. COBRA-EMTALA-Medical Screening Examinations
All patients presenting to the hospital for emergency care must have a medical screening examination performed by a privileged Physician or Allied Health Professional to determine whether that patient has an emergency medical condition as defined by law and regulation. administrative policy. That examination will be performed by a privileged physician (M.D. or D.O.) or supervised physician assistant member of the Medical Staff.


Woodstock proposal

bold added/ italics removed

Article XIV – RULES AND REGULATIONS OF THE MEDICAL STAFF

F. COBRA-EMTALA-Medical Screening Examinations
All patients presenting to the hospital for emergency care must have a medical screening examination performed by a privileged Physician or AHP to determine whether that patient has an emergency medical condition as defined by law and regulation. administrative policy. A physician (M.D., D.O.) member of the medical staff will perform that examination.


Conclusion

Please support our ED by passing this amendment at the upcoming medical staff meeting.

Contact Donna Dermont (Woodstock) 815–334–3141 or Sue Henn (McHenry) 815–759–4293 for more information.

Anemia Clinic

The Centegra Health System Anemia Clinic was established in February 2013. The purpose of the Anemia Clinic is to screen patients with a hemoglobin level between 10.1 and 13 prior to having hip or knee surgery, with the objective being to help decrease the need for post-operative blood transfusions. Patients may be treated with injectable iron, epoetin or a combination of both products.

For any questions regarding the Anemia Clinic, please contact
Alan Mader
at (815)759-4407.

Routine Printing Discontinued

Effective immediately, routine printing of the following transcribed documents will be discontinued:

  • H&P’s
  • Consults
  • Progress Notes
  • Operative Reports
  • PFT
  • ECG
  • EMG
  • Sleep Study
  • Stress Test
  • Cardiac Cath
  • EEG
  • TEE

In lieu of printing the above documents, please refer to HPF. For questions regarding accessing HPF and viewing documents, please contact Michael Millare or Prapti Desai at (815)759-4330.

For a printable copy of this memo click here.

Outpatient Treatment of Deep Vein Thrombosis

At the June 26th 2014 Pharmacy and Therapeutics Committee meeting, discussion ensued with the Cardiologist and Hematologist members of the committee regarding the treatment of Deep Vein Thrombosis (DVT) on an outpatient basis. This concept is not new, and is reviewed in the 2012 CHEST Antithrombotic Therapy and Prevention of Thrombosis 9th ed. Guidelines, UpToDate and other references. The issue is that we occasionally find patients who have no other reason to be hospitalized except that they are waiting for their INR to become therapeutic. As referenced, options for outpatient treatment include bridging with Low Molecular Weight Heparin (LMWH) until the INR becomes therapeutic. Additionally, section 5.5 of the Chest 2012 guidelines recommends early discharge over standard discharge for patients with low risk PE whose home circumstances are adequate after five inpatient days.

There are four criteria that may be used to help identify patients who are NOT candidates for outpatient treatment:

  • Presence of massive DVT (eg, iliofemoral DVT)
  • Presence of symptomatic pulmonary embolism
  • High risk of bleeding with anticoagulant therapy
  • Presence of comorbid conditions or other factors that warrant in-hospital care

While initial treatment is recommended at home over hospital, this recommendation is conditional on the adequacy of home circumstances. Our intent is to evaluate a pathway at the September Pharmacy and Therapeutics Committee meeting that will aid physicians in the decision process. If your patient does not meet the criteria to remain in the hospital, we urge you to consider outpatient bridging therapy with LMWH and utilizing the Anticoagulation Clinic at Centegra.