1. New Experiences in the CF Clinic Why Do We Do What We Do? Darci Pfeil APNP

2. Some of the New Experiences Wearing masks to/from clinic room More frequent visits Greater focus on weight/BMI Adding more caloric supplements More frequent vitamin D levels Adjusting Vitamin D doses

3. Some of the New Experiences Holding vitamins the day of labs Independent clinic visits starting at age 14 Turning 18, authorization for verbal communication More opportunities to participate in studies

4. Wearing Masks Our CF Center Infection Control Guidelines recommend all patients with CF mask when they come to clinic. This protects our patients from coming into contact with other bacteria

5. More Frequent Visits Based on several studies and recommendations from the NACFC year after year. More frequent follow up results in better health outcomes New flow sheet that recommends when to return to clinic. Based on weight and respiratory symptoms

6. Greater Focus on Weight/BMI CF Foundation set of goal of 50%tile for BMI and Weight for Length More and more studies show the impact of weight on lung function Recently even more studies are focusing on early nutrition (age birth-4) and its impact later in life

7. Adding More Caloric Supplements Using high calorie infant formulas Supplementing breast milk Using more oral supplements Recommending more high calorie foods

8. More Frequent Vitamin D Levels CF Foundation recommends a level>30 Cholecalciferol is the supplement of choice. If level is <30 we will increase dose of cholecalciferol. We will recheck level in 3 months

9. Adjusting Vitamin D Doses Goal is to have Vitamin D level >30 If level is <30, cholecalciferol dose will be increased. Vitamin D level will be rechecked.

10. Holding Vitamins the Day of Labs New recommendation from our CF Center is to hold CF specific vitamin and cholecalciferol the day of lab draw You may receive a reminder phone call the day before clinic appointment This will allow for more accurate vitamin levels

11. Independent Clinic Visits starting at age 14 As part of the transition program to adult care, we ask to see you alone for the first half of the visit. This begins to build trust and confidence between you, your parents and the CF team as you begin to take a more active role in your care

12. Authorization for Verbal Communication When Turning 18 By law, at 18 years of age, we need your permission to communicate with your parents. A release needs to be signed and on file in our system Signing a form in clinic allows us to communicate verbally with parents in clinic or via phone calls

13. More Opportunities to Participate in Studies As more and more medications are being developed, this means more studies are designed to test the medications. You may be asked to participate in more studies. This sometimes means more frequent visits and recording information into a diary.

14. If any questions or concerns ever arise during a clinic visit, never hesitate to ask Why do you do what you do? Thank you!!